Treatment Seeking Behaviour of Tribal Population in South Kerala
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PRC Report Series 2019-3 2018-19:7 Treatment seeking behaviour of Tribal population in South Kerala Dr. Oommen P.Mathew Mr. Sachin K.V Population Research Centre Ministry of Health and Family Welfare Government of India University of Kerala Thiruvananthapuram 2019 Page 1 of 77 Foreword The total Scheduled Tribe population of Kerala is 4.84 lakh which is 1.45 percent of the total population. Tribal population is concentrated in three districts of Palakkad, Idukki and Wayanad. In most of the other districts it is scattered. Upliftment of the tribal population has been an important objective since independence of both the Central and State Governments which has had its effect. Yet the development plans focused on tribals has been failing for causes unknown. The concern has been more on the success of the programmes to improve the health of the tribal population. The scattered and remote location of the tribal hamlets is believed to be one of the important reasons. On this footing the authors attempt to assess the treatment seeking behavior of the tribal population by carefully selecting the tribal hamlets located in remote locations. So the study was carried out in three districts: Thiruvananthapuram, Pathanamthitta and Idukki. Edamalakkudy from Idukki, Sayippinkuzhy colony from Pathanamthitta, Podiyam, Anakal and Pattampara from Thiruvananthapauram. I appreciate the authors of the study Dr. Oommen P Mathew, Research Investigator and Mr. Sachin K.V, Field Investigator of the PRC in successfully completing the study. The findings will definitely be of great use to Planners and Policy makers in understanding the treatment seeking behavior of tribal population in South Kerala. Kariavattom Dr. P Mohanachandran Nair March 2019 Director-in charge Page 2 of 77 CONTENTS Foreword 2 Executive summary 4 Chapter 1 Introduction 7 Chapter 2 Tribals of Edamalakkudy 15 2.1 Background Characteristics of Edamalakkudy 15 2.2 Treatment seeking behavior 29 2.3 Suggestions to Improve health care system in Edamalakkudy 34 Chapter 3 Sayippinkuzhy Tribal Colony 38 3.1 Background Characteristics 38 3.2 Treatment seeking behavior 42 Chapter 4 Tribal colonies of Thiruvananthapuram 47 4.1 General information about Kani Tribe 47 4.2 Background Characteristics of Hamlets selected for study 48 4.3 General treatment seeking behaviour 52 4.4 Antenatal, Delivery and Immunization care services 54 Chapter 5 Summary and recommendations 62 References 77 Page 3 of 77 Executive Summary Kerala, the small southern state of India, is homeland for about 35 tribal communities. Most tribal people live in remote rural hamlets in hilly, forested or desert areas where illiteracy, adverse physical environments, malnutrition, inadequate access to potable water, and lack of personal hygiene and sanitation make them more vulnerable to disease. This study is intended to assess the functioning living condition of the tribal population residing in very interior and remote area of forest. It also envisages to examine the general treatment seeking behavior, antenatal, delivery and postnatal care services received by these tribal population. There are hamlets which are very interior of forests without road connectivity to that hamlets. This study is limited to three southern districts of Kerala: Thiruvananthapuram, Pathanamthitta and Idukki. Edamalakkudy from Idukki, Sayippinkuzhy colony from Pathanamthitta, Podiyam, Anakal and Pattampara from Thiruvananthapauram formed the study area. Edamalakudy is the only tribal panchayath of Kerala, it has around 28 hamlets with houses in the range 8 to 30 in each hamlets. It was observed during the visit that the physical condition of Valappura, where tribal women stay during menstruation, was of very poor condition in all hamlets. The very poor condition of Valappura is themain reason for staying away from Valappura and avoiding menstruation by unscientific use of contraceptive pills. Modernisation of Valappura is a very important aspect required for Edamalakkudy. One Ayurveda dispensary and one Homeo dispensary are functioning in Edamalakkudy, both started under NHM initiative. Functioning of both these dispensaries are not at all beneficial to the public because of absence of doctor most of days. There is one 4 wheeler Ambulance in Edamalakkudy, but not functioning due to several reasons for the last 1 year. Pregnant women attend the medical camps organised at Society Kudi and other kudies by the CHC Devikulam. Some of the pregnant women depend on Munnar GH for antenatal care services. Due to the irregularity in the conduct of medical camp, pregnant women from far away Kudis are seldom benefited by ANC checkups. The institutional deliveries increased in Edamalakkudi considerably, still delivery in Valapura is common. With the continuous Page 4 of 77 effort of two Health department staff nurses of Sub centre, women are aware of the importance of institutional deliveries and the importance of immunisation and are often ready to immunize when medical team arrives in Kudi. It was observed that the immunization programme at Edamalakkudy is not organized in a regular manner, there was no immunisation programme in Society Kudi or any other Kudi for a period of more than 4 months. Sayippinkuzhy tribal colony is situated in Goodrical forest range of Ranni forest division. Most of the families do not have any toilets, electricity is available for some houses, water is mainly from springs / ponds, the non availability of water during summer is the main problem of the sheds. The Medical Officer of Seethathode PHC visits the tribal colony on every Thursday, the doctor attends the sick patients and ANC women at their residence and also provides immunization to children during the camp. Very few pregnant women are utilizing GH Pathanamthitta for Antenatal checkups and antenatal ultra sound scanning. Reaching GH Pathanamthitta at night or odd time is very difficult because of getting vehicle on time, this is one reason for home deliveries and certain women like to deliver in forest rather than in hospital because of their belief. The selected tribal colonies from Thiruvananthapuram for the study are Podiyam, Pattampara and Anakal. Pattampara and Anakal are the most remote hamlets and no toilet facility is available to houses of these hamlets of Thiruvananthapuram district. Podiyam sub centre of Kuttichal PHC created for the purpose of providing primary health care , antenatal care services and child immunization to the beneficiaries of these tribal colonies, is not functioning in this area for the past several years. Usually people of these hamlets utilize PHC Kuttical on market days, Wednesdays and Saturdays because of comparatively low transportation cost. There is weekly medical camp planned at Podiyam, Pothode, Kunnatheri etc from PHC Kuttichal, but these medical camp is not functioning in regular manner. The visit of the medical team is not regular and no specific time period is followed by the medical team on the day of visit. Even though the education level of women is less, most of them are aware of importance of antenatal check up, institutional deliveries and child immunization. Transportation of pregnant women in emergencies is not at all possible due to the lack of travel facilities. Some of the home deliveries are because of problem to get vehicle on time and some Page 5 of 77 deliveries are carried out in Jeep on the way to hospital. Problem of not getting reimbursement for the travel expense from Tribal department is another major problem in the colonies. There are several reasons for the partial immunization such as lack of immunization camp at Anakal and Pattampara, the information about the date of immunization camp at Pothode or Kunnatheri is not conveyed to the beneficiaries in advance, there is no fixed periodic immunization camp in these area. Last minute transfer of pregnant women is very tedious and risky one in all the selected hamlets for the study. Maternity stay house is the solution to this problem. Pregnant women along with their bystanders will be able to stay in these maternity house well in advance , say one month before the expected delivery date and one or two weeks stay in these house after delivery. Free nutritious food supply to the inmates of these house also required. The maternity house is required in Adimali TH, GH Pathanamthitta and at TH Nedumangad. Page 6 of 77 Chapter I Introduction The tribals are integral part of Indian civilization and possess a very rich cultural heritage. India has the second largest concentration of tribal population after that of the African continent. The Indian tribes are the autochthonous people of the land who are believed to be the earliest settlers on the Indian Peninsula. In India, a tribal is known as Adivasi meaning original inhabitant. There are 450 tribal communities including subgroups among them in India. Tribes in India are not only numerous, but also differ widely in their habitat, level of development, modes of production, exposure to the wider world, traditional values, customs, beliefs, etc. According to the Census of India 2011, population of the scheduled tribe was about 10.45 crores. They constitute about 8.6 per cent of the population of the country, and almost 90 percent (89.97%) of them live in rural areas. The percentage of the scheduled tribe population varies from one state to another. Though nearly half of the country’s tribal population is concentrated in the three states of Chhattisgarh, Jharkhand and Orissa, a few states like Nagaland, Meghalaya and Arunachal Pradesh are predominantly inhabited by tribals. Article 342 of the Indian constitution defines ‘tribal folk’ as “People living in a particular place, who enter into marriage relationship among themselves, who have no specific skills in any work, traditionally or ethnically ruled by adivasi leaders, who speak any special language, have own beliefs, customs and tradition”. The criteria of geographical isolation, distinctive culture, primitive traits, shyness of contact with others and economic and social backwardness, are in general, considered relevant in the definition of tribes in India Kerala, the small southern state of India, is homeland for about 35 tribal communities.