Bamri Pahari with her son Deva at the immunization session site in Godda in the eastern Indian state of Jharkhand.
By Sugata Roy
JHARKHAND, 3 July 2011 - Beating the scorching sun on a summer afternoon, a heavily perspiring Bamri Pahari in her magenta saree has trudged a mile through the treacherous terrain to reach the immunization session site with her two-year-old son, Deva.
The child is suffering from high fever. On reaching the site, she goes up to the anganwari (village health worker) with a pressing request, “Didi, please collect the blood sample of my son, he is having fever. I suspect it is malaria.”
“I lost my elder son, Kayani Pahari, when he was 2 years old. I am now sure I lost him due to malaria,” recalls Bamri Pahari.
Malaria is highly endemic in the hilly tracts of Sunderpahari in Godda in the eastern Indian state of Jharkhand.
To combat the malaria menace in Sunderpahari, an area majorly inhabited by tribal group Pahariyas, UNICEF started its intervention in 2008, targeting children and mothers in 16,000 households across 208 villages.
The intervention, piggy-backed on the monthly immunization services in the villages is aimed at reaching the small hamlets dotted along the hilly terrain, at least once a month.
Along with the routine immunization services, the blood samples of children and mother suffering from fever are collected for timely detection of malaria and appropriate treatment. Besides, insecticide treated mosquito bed nets, also known as Long Lasting Insecticide (Impregnated) Nets, are distributed to pregnant women and mothers having children less than 3 years old.
“Pahariya mothers, like Bamri, now come forward to get their blood sample tested whenever their family members suffer from fever,” informs Pramila Tudu, an Anganwari worker, “They also use the insecticide mosquito bed nets at night.”
Reaching out to the Pahariyas settled on almost inaccessible hill-tops or slopes and influencing their health-seeking behaviour for the prevention of malaria and treatment was the biggest challenge.
“Earlier the Pahariyas resorted to black magic for the treatment of high fever. They did not come forward for blood testing. It was also difficult to distribute the bed nets for the Paharis thought that the bed nets were meant for catching fish and sleeping under the bed nets as such would lead to suffocation,” says Haradhan Saha, village health worker.
The task in hand was daunting. Awareness level was at a minimum and mothers had to be informed of the danger their children were facing. “Mothers were told that the children suffering from malaria, if left untreated may die within a day,” reports Haradhan.
“Mothers were oriented to suspect malaria, if a child had high fever and chills.”
“Family members of the pregnant women were also sensitized. Malaria can cause severe anaemia, miscarriage, premature birth or stillbirth,” adds Pramila Tudu.
The mobilization strategy encouraged children and pregnant women suspected to be suffering from malaria to come forward for blood testing and were immediately provided medication at the Anganwari centre.
Quick recovery from malaria established the Pahariya mothers’ faith in the health system, thus discarding their age old beliefs in black magic.
The village mothers were also informed about the mode of transfer of malaria and sleeping under an insecticide-treated mosquito bed net was the surest ways to prevent mosquito bites.
“We are now aware that the best way to prevent malaria is to use a mosquito bed net. We use them religiously at home. In the last one year my children have not suffered from high fever,” states Surji Pahari, one of the women who had come to the anganwari centre for routine immunization of her daughter.
“Pahariya mothers who have experienced the benefits now encourage other households in their villages to use bed nets and go for blood testing in the event of children or pregnant women having high fever and chills,” says Haradhan.
Today around 80 per cent of Pahariya households have medicated bed nets at home while 90 per cent of them have knowledge of prevention of malaria.
UNICEF has distributed over 5000 insecticide-treated bed nets in the last two years and it is hoped that the spread of awareness and use of bed nets will further help the Pahariya population to effectively combat the scourge of malaria.