Hunger amidst the dunes?

Shahida Jaffrey Jamali offers a useful on-ground corrective to the portrayal of Thar as a region ravaged by famine

Hunger amidst the dunes?
“You were in qahat-sali (drought and famine) ridden Thar, where children are dying?!”

So asked my anxious PhD friend and neighbour in Islamabad, on learning from me that I just returned after an extensive visit to Thar.

Islamabad was cold and rainy. We had no gas. It snowed on the Margalla Hills after 10 years.

I narrated to her my experiences and travels to beautiful Thar:

On my plan to visit and extensively travel through various districts of Tharparkar and Umerkot during the month of January 2016, family and friends were anxious and worried - there is an epidemic (waba) in Thar; it is drought ridden, and faces extensive malnutrition and unfortunate infant mortality. Peacocks too have died in great numbers due to disease, I was told!

During my seven-day visit and stay in Thar and Umerkot, I visited numerous remote villages in the desert, from Mithi to the border at the Runn of Kutchh, meeting women, men and children, and representatives of Local Support Organisations - LSOs. I personally and directly had access to thousands of people in the course of my travel and visits, and saw their livestock, camels, donkeys, cows, goats, sheep and peacocks.

Mithi is a large town, the largest in Tharparkar. The population has grown as rural communities have moved into town, like any District headquarters.

Feeding ward at the Mithi hospital
Feeding ward at the Mithi hospital

The facilities we saw at Mithi were sterile, air-conditioned and well equipped

It is connected to other major cities of Sind with new, very wide metalled roads, similar in standard to the Lahore/Islamabad Motorway. Thus it is connected to Karachi, Jamshoro, Hyderabad, Mirpurkhas, Umerkot, Naukot, Chelhae, Thatta and Badin.

The district headquarters Mithi is linked with its taluka headquarters of Diplo, Nagarparkar and Chachro through excellent roads.

Previously when there were no metalled roads, the local KEKRA truck was the mode of transportation, along with hardy camels. Now long colourful buses, pickups and other vehicles ply the roads to and from the desert villages. The old camel and donkey carts, of course, also plod along these routes as they always have.

The Tharparkar Social Organisation has provided emergency medical care for 25 years now
The Tharparkar Social Organisation has provided emergency medical care for 25 years now

Mithi city and all other cities in Thar have vibrant and busy markets, loaded with fresh fruits and vegetables and other produce just like any other Pakistani towns. Business and local trade with neighbouring cities is flourishing.

Mounds of keenos, oranges; carts full of sweet bananas, sweet papayas, sweetest Larkana amrood (guava), fresh ripe cheekoos, fat bairs, apples from Balochistan and Iran; imported Chinese pears and grapes as well as local kiwifruit grown around Karachi.

So are all kinds of seasonal and extra-seasonal fresh vegetables, coming from all over the country, just like in any town. Markets are full of dry rations - there is no dearth of anything. Shakarkandi or sweet potato, is very popular and sold from carts.

We visited besides Mithi: Umerkot, Chelhar, Islamkot, Goori, Bhalv, Bhodesar, Nagarparkar and Kasbo right up up to the Indian border. We could see the Indian border fence lights at night.

During extensive field visits we met men women and children at their homes in remote desert villages and people’s representatives through Local Support Organisations - the LSO’s. We saw and accessed thousands of local people.

On our enquiries, about famine and unfortunate deaths of babies and children, we were informed that no such thing had happened in their areas.

On our enquiries about famine and infant deaths, we were informed no such thing had happened in their areas

Villagers have very large families, women bearing 10 to 12 children on average, but all seemed healthy and so did their livestock.

Since Thar is a desert, the income of people is dependent on livestock, agriculture - where there is water - and their skills in arts and crafts. Men often travel to larger cities to perform manual labour. All villagers can now easily go to hospitals due to the very good roads - the maximum time required to reach a hospital facility is about an hour.

Thardeep Rural Development Programme (TRDP) and other organisations have provided training to local ‘traditional birth attendants’ or midwives, who provide services to women at their homes, and when dealing with complicated cases, refer them to the nearest health facility or hospital.

Paediatric ward, Mithi - a prematurely born twin
Paediatric ward, Mithi - a prematurely born twin

Mamu Visan, the 'Edhi' of Mithi
Mamu Visan, the 'Edhi' of Mithi

During my last day in Mithi, we visited the Mithi District Headquarter Hospital.

We drove into the compound of the hospital at noon, when activities at the hospital were at their peak - it was not as crowded as the PIMS of Islamabad.

Our first stop was at a blood bank right at the entrance of the hospital compound, operated and managed by volunteers.

Mamu Visan, a Hindu, known as the local ‘Edhi’, runs a welfare organisation, the Tharparkar Social Organisation. This organisation  has provided free donated blood and plasma - and ambulance services - to the people of Mithi for the past 25 years.

The Sindh government has been accused of a callous attitude to the suffering of Tharparkar's famine victims
The Sindh government has been accused of a callous attitude to the suffering of Tharparkar's famine victims

The facilities we saw were sterile, air-conditioned and had numerous new and functional refrigerators - all purchased from donations - carrying stocks of screened and tested disease free blood  and plasma. The facility was connected to the world via the internet. Anyone who needed blood could search through the web. There were six volunteer staff on duty.

Mithi Government District Headquarter Hospital was very clean, and located in a very large compound. Numerous ambulances and staff were present. There was electric power with backup generators.

Families with children were sitting outside under trees, in the sun - as it was cold - and on the wooden benches of the hospital corridors. There was no litter or trash anywhere. There was neither any foul smell, or any kind of odour.

Food supplements for sick and weak babies at the Mithi hospital
Food supplements for sick and weak babies at the Mithi hospital

Patients and their attendants had lined up at the Reception for registration, and there was a bustling crowd at the medical centre, obtaining medicines.

We walked into the room of the Medical Superintendent (MS). The door was open. He was easily accessible.MS Dr. Iqbal Bhurgari and AMS Dr. Surtomal were in the room and welcomed us - we literally walked in without any prior appointment.

The MS seemed under immense stress and pressure. We discussed the prevailing situation of reports about malnutrition and unfortunate deaths of infants and children.

He handed to me a few pages of listing of children who had died on arrival at the hospital. They came from different parts of Thar. They were born weak and suffered from diarrhea and bronchitis and other diseases, and had been ill for several days. They were brought to the hospital when they were in a critical stage. Most of these children were being breastfed.

According to the three qualified pediatricians, the reasons for weak and sick babies include:

l    Girls are married right after reaching puberty and become pregnant right away; there is no birth spacing, which results in underweight and weak babies and affects the health of mothers.

l Women are responsible for all household chores, working even when pregnant. They work in the fields, tending livestock, fetching water from long distances, collecting and cutting wood for fuel. And of course, nutrition is severely lacking due to poverty.

l Families are often very large - each woman bears 10 to 12 children; there is not enough income, and then there is the lack of clean water and the extreme heat and cold of the desert.

All of these factors impact the health and lives of babies and mothers who are prone to various illnesses.

Sick babies and young children are not taken to nearest health care unit or hospital on time, which leads to fatalities.

Some villages have usable underground water and some have brackish water. The government has provided small desalination plants for some villages. There is a major desalination unit in Mithi City.

AMS Dr. Surtomal accompanied us to the Paediatric ward attended by three qualified paediatricians. Other doctors and nurses were on duty too. It was sterile and very well equipped with all essential machines and medical equipment. There were several baby cots and incubators. Several critical underweight and premature babies were receiving treatment.

One incubator housed one of a pair of premature twins, a baby as big as my hand. The other twin was discharged after it received treatment for a few days, and was healthy. This one was in an oxygen incubator and had a feeding tube inserted.

We also paid an impromptu visit to the Deputy Commissioner’s office; the compound was unusually quiet. The DC sahib was in his office and met us very graciously.

He too was under great stress, and was on the telephone most of the time. He provided us with an update of the prevailing situation.

The District Administration conducts consultations and meetings with all agencies working in Thar. Meetings are held daily in the mornings and evenings, to report, assess and share information and to take action where and when required.

My seven-day visit to Thar was extremely educative. I met and saw the beauty of Thar and its people. With Thar Coal and other projects, the future of Thar is very bright. Problems with malnutrition do need to be overcome, but I believe the future of Thar is a bright one, as long as its people are not sidelined.

A tale of neglect

Children affected by the famine in Tharparkar, 2014
Children affected by the famine in Tharparkar, 2014

In March 2014, it was reported that most areas of Sindh’s Tharparkar district faced a ‘famine-like’ situation and over 30 malnourished children were reported to have died. About 175,000 families were reported to have been affected and some of them were forced to leave their homes and move to areas with barrage access.

Reportedly, only nine of 166 dehs in the Tharparkar district are located in the command area of a barrage. Much of the rest of Tharparkar is un-irrigated desert, meaning that people must rely on meagre rainfall during seasons of drought. In 2014, the region received what was described as a mere “drizzle” of rain.

Media reports highlighted the lack of proper medical facilities in places such as Mithi. Poorly-staffed hospitals and the neglect of the district administration (as well as the PPP-led provincial government) were popularly blamed for the situation in Thar. Social media last year was inundated with the theme that senior members of the Sindh government enjoyed lavish dinners even as they were purportedly supposed to be addressing the severe famine in Thar.
“How can the government be responsible if someone dies far away in the sand dunes?”

During the current year, media reports state that as of January, 100 children had lost their lives due to malnutrition caused by the drought and resulting famine. This would suggest a recurring pattern to the problems faced by the people of Thar.

Official figures stated that there were 326 deaths in 2014 and 398 deaths in 2015. These figures refer, apparently, to infants. Other reports, emanating from various media sources and NGOs, give figures several times this number for fatalities among children.

The UN Office for the Coordination of Humanitarian Affairs, in a report, were of the view that limited access to health services and a severe drought has led to a ‘nutrition crisis’ in the region.

The PPP-led Sindh government, led by Mr. Qaim Ali Shah, acknowledges that there are problems, but complains that his administration is unfairly targeted for criticism.

Shah’s adviser Maula Bux Chandio was reported to have stated the following:

“The government is only responsible for deaths that take place in the hospital. How can the government be responsible if someone dies far away in the sand dunes?”