Chapter - 6
Nutrition and Food Security of Jarawas
6.1. Food and nutrition are crucial issues for everybody. All have their own means and approach to meet this basic need within the broad social system evolved by every human society, primitive or modern. Each human group needs a certain level of nutrition and food requirement depending on physical activities and physiological status. The present study intends to make a assessment of food and nutritional status of Jarawas. The diet survey and nutritional assessment, body measurement and serum analysis have been made in this study to ascertain the nutritional status of Jarawas.
6.2. Present study is first of its kind to observe closely the food behaviour of the Jarawas and also to make, at least, a quasi-quantitative estimation of intake of various types of food and also food values (energy and other macro and micronutrients) in the food consumed. The study includes the nutritional status of Jarawas in terms of anthropometric indices, deficiency diseases and also the morbidity profile that relate to or undermine the nutritional status. Laboratory estimations for routine blood parameters and serological status give indirectly the health and nutritional status of Jarawas.
Anthropometry
6.3. Instead of age specific mean body weight and height the data were developed on age-wise mean body weight and height, because, age determination lacked accuracy and for that reason age group-wise derivation of result could be more acceptable. Tables 6.1 and 6.2 present data on age-wise mean body weight and height of Jarawa males and females respectively. The growth curves of the same data show a good growth pace.
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6.4. Anthropometric indicators, clinical signs and symptoms of nutritional deficiency diseases and related serum parameters are important and dependable parameters to assess the nutritional status of Jarawas. Except a low percent of pallor (13.5%) and glossites (1.5%) no other signs and symptoms of deficiency disease are prevalent among Jarawas which reflects their good nutritional intake and satisfactory health status. Anthropometric data and nutritional status of Jarawas corroborates with the Onges of Andaman Islands and other Asian Negritoes like Semang (Malaysia) and Aeta (Philippines).
Table 6.1: Age group-wise of mean body weight (kg) and height (cm) of males
Table: 6.3 a I.R Age group (years) Number Mean height (cm) Mean weight (kg) 0-1 6 53.3 5.25 1-3 4 72.25 9.0 4-6 18 110.3 16.7 7-9 13 112.1 18.5 10-12 15 127.7 25.4 13-18 15 139.3 33.4 19-24 17 153.0 46.05 25 and above 39 153.7 (SD 5.86) 46.5 (SD 5.4) SD= Standard Deviation.
Table 6.2: Age group-wise of mean body weight (kg) and height (cm) of females
Table 6.3 b I.R. Age group (years) Number Mean height Mean weight (kg) (cm) 0-1 7 56.85 4.9 1-3 3 87.5 8.5 4-6 14 101.07 15.07 7-9 10 112.4 19.25 10-12 21 125 26.5 13-18 19 140.3 37.5 19-24 12 141.8 41.3 25 and above 36 146.1 (SD6.2) 43.8(SD 5.6)
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6.5. The data (collected during third phase of survey) on Body-Mass Index (B.M.I) shows that the adult females were better of than the adult male (Table 6.3) in respect of chronic energy deficiency situation probably because energy expenditures of females were less than that of males. This is also evident from the fact that obesity was prevalent in females but not in males.
Table 6.3: Frequency and Percentage Distribution of Jarawas Adults above 18 years According to BMI
Table 6.4 I.R Nutritional Male Female Total (Male + Status from female) BMI Number Percent Number Percent Number Percent Obese 0 0 5 9.5 5 4.5 Normal & Low 46 79.4 42 79.2 88 79.3 Normal CED-I 8 13.8 6 11.3 14 12.6 CED-II 3 5.2 - - 3 2.7 CED-III 1 1.6 - - 1 0.9 Total 58 100 53 100 111 100 Note: Two males have lost weight since thus 2nd phase of the survey reducing obesity in male adult to nil.
6.6. In respect of weight for height most of the young children were above Mean – 2 S.D.; only a few children were Table 6.4: Nutritional Status of children less than 18 years by weight for height between height 55 to 137 cm for girls, 55 to 145 cm for boys Table 6.5 a T.R Total Number 333 Table 6.5: Nutritional Status of young children (6 month to 60 month) according to MUAC by WHO criteria Table 6.5 b I.R Total Number 17 0(0%) 1(5.9%) 16(94.1%) Food Intake 6.7. Table 6.6 summarizes different types of food consumed on the days of survey. It is found that common food in three areas were different in three seasons. However, in Northern division (Tanmad) area almost all varieties of food were available. Major food groups consumed by Jarawas as indicated in Table 6.7 are flesh food (pig meat, pig fat, turtle oil, egg, larva of the wood borer, molluscs and fish etc) 850 gm/ACU, honey 130 gm/ACU, roots and tubers 85 gm/ACU, banana and wild fruits 135 gm/ACU and processed food (alien food) 55 gm/ACU. Table 6.8 presents the data of edible percentage of various raw foods consumed by the Jarawas. These figures help calculation of nutrients of the food consumed. Table 6.6: Percentage distribution of families consuming various types of raw foods in three different. Table 6.6 I.R Tanmad Boiab Thidong Total Animal food 1st 2nd 3rd 1st 2nd 3rd 1st 2nd 3rd 1) Pork muscle 100 80 70 100 25 100 87.5 96.6 55.6 72.0 2) Port fat 100 80 70 100 25 83.3 85 75 44.4 80 3) Turtle egg 47.8 13.3 30 0 0 0 0 0 0 12 4) Turtle fat (or oil) 0 0 10 0 0 0 0 0 0 4 5) Small fish 56.5 6.7 40 86.7 87.5 20 0 0 11.1 20.0 6) Larva of wood 0 20 20 0 0 33.3 0 0 77.8 44 borer 7) Honey 95.5 80 60 80 100 50 0 91.6 77.8 80 8) Crab 0 0 10 46.7 0 16.7 0 8.3 0 8 9) Pig Liver 0 0 10 86.7 100 0 0 0 0 4 10) Molluscs 73.9 6.7 0 85.6 100 0 62.5 0 0 11) Prawn 34.8 6.7 0 6.7 0 0 0 0 0 334 Plant food a) Fruits 1) Omin 0 0 100 0 0 0 0 91.6 33.3 52 2) Aab (seed of 0 73.3 40 0 87.5 0 0 0 11.1 20 jackfruit) 3) Plantain green 100 86.7 50 100 75 0 75 100 33.3 32 4) Ripe banana 100 85 50 75 75 50 75 75 33.3 44 5) Tooya (Fruit) 0 0 10 0 0 0 0 0 44.4 20 6) Quanantho 0 0 10 0 0 0 0 0 11.1 8.0 7) Guava 0 0 20 0 0 0 0 0 0 0 8) Tokano 0 0 10 0 0 0 0 0 0 0 9) Gub 0 73.3 0 0 0 0 0 0 0 10) Betfal 0 0 0 0 0 0 0 0 0 11) Gin 13.3 0 0 0 50 0 0 75 0 b) Roots & Tubers 1) Chew 0 0 70 0 50 50 87.5 8.3 44.4 56 2) Wagh 30.4 6.7 0 0 0 0 0 50 c) Nut 2) Coconut 0 0 10 0 0 0 0 0 0 4 d) Processed food 1) Biscuit 0 0 0 0 0 66.7 50 75 33.3 28 2) Bread 0 0 0 0 0 16.7 0 0 44.4 20 3) Rice 0 0 0 0 0 0 0 0 33.3 12 Note (i): - Tanmad – Northern Division (Kadamtala area) Boiab - Southern Division (Tirur area) Thidong – Central Division (R. K. Nallah area) Note (ii): - Jarawa terms are used for some plant foods. Table: 6.7: Major food groups intake (gm/ACU/day) (Table – 16 of Revised Report) Food group Boaib Thidong Tanmad Average Flesh food: Pig meat 567 471 515 533 Pig fat and oil, turtle 170 140 154 155 oil Larva, Mollusc, Fish, 165 146 185 165 turtle egg Honey 115 125 150 130 Roots and tuber 78 60 120 85 Fruits Banana, Omin, Tuyia 125 137 150 135 Processed food Biscuit, Bread, Rice 26 96 44 55 335 Table 6.8: Edible Part Percentage of Raw Food Consumed by Jarawas Table 6.7 of I.R Name of the food Type Edible Part (in %) 1. Honey Animal 100 2. Honey comb Animal 60 3. Pig fat/ oil Animal 100 4. Pig meat Animal 100 5. Bethen Larva 100 6. Molus with shell Animal 20 7. Omin Fruit 100 8. Tooya Fruit 24 9. Banana (Green) Fruit 70 10. Banana (Ripe) Fruit 90 11. Honey (Pod) Animal 90 12. Chew Root/ Tuber 80 13. Turtle egg Animal 90 14. Aab (Jack fruit seed) Fruit 100 15. Tokano Fruit 20 16. Small fish Animal 100 17. Crab Animal 22 18. Guava Fruit 100 19. Turtle fat Animal 100 20. Monitor lizard Animal 70 6.8. A complete lack of leafy vegetables intake should have normally posed health problem among the Jarawas. Similarly milk and milk products are not consumed by Jarawas at all. In the usual concept of a balanced diet a lot of both green leafy vegetables and milk and milk products are recommended. Interestingly, Jarawas are maintaining their health and nutritional status without the consumption of green leafy vegetables and milk and milk products. Therefore it stands out that the various food items consumed by Jarawas constitute a balanced diet for them. The micronutrients, namely, vitamin C, carotene, vitamin K, folic acid, calcium, sodium, iron. Zinc etc of leafy vegetables and calcium and phosphorus and protein of milk and milk products are possibly compensated by various animal food and wild fruits consumed abundantly by Jarawas. 6.9. Tables 6.9, 6.10 and 6.11 present mean intakes of energy, protein, fat and some vitamins and minerals per/acu/day among Jarawas. 336 Table 6.9: Mean Intake of Energy, Protein and Fat per ACU among Jarawas Table 17 of Revised Report ITEM RDA MEAN INTAKE Boaib Thidong Tanmad All Energy (Kcal/day) 2425 2770 2421 2436 2542 Protein (gm/day) 60 79 45 54 55.8 Fat (gm/day) 54* 195 111 138 148 * This includes invisible fat * Corrected table. Table 6.10: Mean Intake of Calcium and Iron per ACU among Jarawas Table 6.9 of I.R Item RDA Mean Intake Boiab Thidong Tanmad All Calcium 400 208 119 306 217.8 (mg/day) Iron (mg/day) 28 11 16 9 12.0 Table 6.11: Mean Intake of B1, B2, Niacin and Vitamin C by Jarawas per ACU Table 6.10 of I.R Item RDA Mean Intake Boiab Thidong Tanmad All B1 (mg/day) 1.2 2.39 3.12 1.14 2.11 B2 (mg/day) 1.4 3.59 1.78 0.33 1.52 Niacin (mg/day) 16 75.93 42.88 17.33 38.83 Vitamin C 40 55.2 63.26 98.7 76.95 (mg/day) Energy intake 6.10. Adult Jarawas were assumed to be moderately active. In that respect when RDA (recommended dietary allowance) of energy as recommended by ICMR for Indians were applied, a significant percentage (approx. 10%) of the families had energy intake less than 50% of RDA. BMI data also show that 337 about 15% of the adults had chronic energy deficiency (CED). Energy intake was however satisfactory for 84% of the families and in some families (approx. 6 %) energy was much above RDA. This also corroborate with the obesity status from BMI. Table 6.12 presents data on dietary energy and protein intake versus height and weight of the young children between 4-9 years. It is found that the nutritional status by weight for height (NCHS Standard) of these children was satisfactory. Table 6.12: Dietary intake of individual children by way of observation through out the day (6 A.M to 6 P.M) with reference to nutritional status by Anthropometry Table 6.11 of I.R Sl.No Age Sex Energy Protein Height Weight Nutritional (years) (k cal) (gm) (cm) (kg) status by weight for height (NCHS Standard) 1 8 M 1684 112 112 17.5 > median –2SD 2 4 M 1573 84 96 12.5 > median –2SD 3 6 M 1180 21 101 14 > median –2SD 4 6 M 1511 70 106 14.5 > median –2SD 5 7 M 1801 31 104 17 > median –1SD 6 6 M 1563 54 98 15 > median –1SD 7 8 M 1868 18.4 110 19 > median 8 5 F 1046 39.6 110 16.5 > median –2SD 9 9 F 1684 112 115 19 > median –1SD 10 5 F 1573 84 98 15 > median 11 4 F 1484 79.5 97 14.5 > median 12 6 F 1570 93.7 111 16 > median –2SD 13 5 F 1342 56 96 13 > median –2SD 14 7 F 1541 88 106 16 > median –1SD 15 9 F 1743 52 124 23 > median 16 8 F 1876 84 113 20 > median 17 6 F 1899 95 104 19.5 > median +1SD Protein intake 6.11. Mean protein intake was in the range of 50- 80 gm/acu/day. Dietary protein was mainly from animal source and therefore had high biological value. Considering the short stature of Jarawas these levels of protein intake may be taken as satisfactory (Table 6.9). 338 Animal fat intake 6.12. The main providers of energy were the animal fat, honey and coconut. It was found that during the period of survey large percentage of families and all members in a family, except very young children who were breast-fed, consumed pig fat in considerable quantities. Turtle fat was also found to be consumed in Tanmad area. However the lipid profile was normal for most of the Jarawas (Table 6.9). Calcium intake 6.13. The calcium intake was variable according to seasons because of variation in consumption of food such as small fishes, crabs, molluscs and prawn etc. Seasonally low intake of calcium may however lead to osteoporosis. But as Jarawas consume a lot of animal food rich in vitamin D and phosphorus these would help better absorption of calcium and phosphorus and better bone mineralisation, even with somewhat low calcium intake (Table 6.10). Salt, Sugar, Oil, Spices and Condiments 6.14. No salt, sugar, oil, spices and condiments were used by Jarawas in their raw or cooked foods. Alien food having such of the above said ingredients, if consumed by them regularly, may change their food habit and may affect their health adversely as they are not be used to them physiologically. Deficiency Diseases 6.15. Except for pallor, an indicator of anaemia and glossitis (B-complex deficiency) in a few cases, no other deficiency signs and symptoms were detected (Tables 6.13 to 6.15), which indirectly indicate that Jarawas diet was adequate in most vitamins and minerals. 339 Table 6.13: Prevalence of Deficiency Diseases Table - 21 of Revised Report AREAS PALLOR GLOSSITIS N No. of Male Female No. of Male Female subjects subjects Boaib 81 6 1 5 1 0 1 Thidong 66 10 2 8 2 0 2 Tanmad 104 18 5 13 0 0 0 Total 251 34 (13.5) 8(3.1) 26(13.5) 3 0 3 (1.5) Figures in the brackets are percentage prevalence • Four pregnant women were • No other deficiency diseases were anemic. detectable • Those who had glossitis had also • Women are much more anemic anaemia than male. Table 6.14: Sex and area-wise distribution of anemia status (W.H.O criteria) Table: 13 of Revised Report Area/age Normal Anemic Group Boaib n Sex Male Female Total Male Female total 6m –6yrs 3 2 1 3(100) 0 0 0 6yrs-14yrs 18 5 5 10(55) 4 4 (22.5) 8(45) 15 and above 15 4 6 10(66) 0 5 (33) 5(34) Total 36 11(30) 12(33) 23(63) 4(11) 9(25) 13(37) Thidong 6m –6yrsz 3 1 2 3(100) 0 0 0 6yrs-14yrs 9 4 4 8(89) 0 1 1(11) 15 and above 31 13 8 21(68) 7 (22.5) 3 (9.6) 10(32) Total 43 18(42) 14(33) 32(75) 7(16)* 4(9) 11(25) Tanmad 6m –6yrsz 12 8 2 10(83) 0 2 (17) 2(17) 6yrs-14yrs 13 8 3 11(85) 0 2 (15) 2(15) 15 and above 34 12 13 25(74) 3 (8) 6 (18) 9(26) Total 59 28(48) 18(30) 46(78) 3(5) 10(17) 13(22) (Numbers in bracket are percentages) Remarks: Anemia prevalence is highest in Tirur area (37%) area as compared to R. K. Nallah area (22%) and Kadamtala area (25%). * Sex-wise distribution indicates that adult female are more anemic than male in Tirur & Kadamtala whereas R. K. Nallah area about 16% of adult male had more anemia prevalence compared to females, which may be due to their stay along roadside and increased consumption of alien food. 340 Table 6.15 Distribution of Jarawas by grades of anemia Table – 6.12 c of I.R Grade of 1st 2nd 3rd phase Average anemia phase phase Mild 43 (66) 14(42) 35(87.5) 31(66 Moderate 22(33) 18(54) 4(10) 15(32) Severe 0 1(4) 1(2.5) 1(2) Total 65(57) 33(27.5) 40(29) 47(100) Numbers in brackets are percentages. 6.16. No meal pattern, such as breakfast, lunch, evening meal and dinner, were observed by Jarawas. Young children were found to eat fruits at random. Jarawas were found to practice different cooking methods like boiling, roasting or baking. They were also found to cook the same item in different ways. Colostrum is fed to newborn babies. The infants below 6 months of age were mainly fed breast milk, but in addition plain water, slices of pig fat and honey were also given. Food Fads and Fallacies 6.17. Some foods like pig meat, honey and lizard were avoided and some food like honey was preferred by some Jarawa women during pregnancy or after delivery. It was also observed that at the time of fever they avoided pig meat/fat but consumed extract of pig meat, just as soup, which may be considered as a good practice. Domestic Food Storage Practices 6.18. Jarawas often store foods, which are collected in excess of consumption. They also store food for lean periods. One such food is omiin, which they consumed when more delicious foods are not available. They are found to store pig meat by smoking by hanging the pieces over fire. Pig fat was also found to be stored in bottles. Honey is another item stored in wooden pots. Seeds of jackfruit are stored for consumption during lean period. 341 Water Usage Pattern 6.19. Most families kept 10 to 15 liters of water in plastic pots. They also used wooden bucket for storing water in the past. Consumption of drinking water ranged form 200 to 500 ml per adult with average intake of 1.5 liter per day (range 1.5 to 2.5 liter /day/person). Streams were the main sources of water for drinking and cooking. Water was drunk by touching the mouth at the rim of the pot. Serum Parameters 6.20. Serum parameters (Tables 6.16 to 6.23) indicate that fat related parameters, namely, cholesterol, triglyceride, LDL (Low density lipo protein) and HDL (High density lipid) cholesterol were normal for most of the Jarawas. These parameters are related to fat intake. Increased fat intake increases cholesterol and triglyceride levels in serum thereby increasing the risk of coronary heart disease (CHD). Increase in the serum level of LDL is more risky for CHD. Whereas increase in HDL cholesterol is good against CHD. It appears from the present data that although the animal fat intake was high, these serum parameters remained within normal limits for most of the Jarawas, which signifies that Jarawas might have a better fat metabolizing capacity. Serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) were within normal limits for most of the Jarawas indicating that the organic function including liver were in good condition. Blood glucose levels from random blood samples were in the normal range for most indicating that Jarawas did not have diabetic problem. Table 6.16: Area and phase-wise distribution of Jarawas by Serum LDL Cholesterol level Table 9 of Revised Report Area 2nd phase 3rd phase N Normal High N Normal High Boaib 44 42(95) 2 36 34(94) 2 Thidong 33 30(91) 3 43 43(100) 0 Tanmad 43 42(98) 1 59 59(100) 0 Total 120 114(95) 6(5) 138 136(98.2) 2(1.8) Numbers in brackets are the percentage. Remarks: more than 95% of Jarawas are having normal serum LDL cholesterol level in three different locations 342 Table 6.17: Area and phase-wise distribution of Jarawas by Serum HDL Cholesterol level Table – 8 of Revised Report Area 2nd Phase 3rd Phase N Normal High N Normal High Boaib 44 41(93) 3 36 24(67) 12 Thidong 33 32(97) 1 43 21(49) 22 Tanmad 43 39(91) 4 59 41(69) 18 Total 120 112(93.3) 8(6.7) 138 86 (62.3) 52 (37.3) Numbers in brackets are the percentage. Remarks: More than 90% Jarawas are having normal HDL cholesterol level and 37% are having high HDL cholesterol level, which indicates low risk of low coronary heart disease (CHD) among Jarawas. Table 6.18: Distribution of Jarawas by Serum Cholesterol status Table – 6 of Revised Report IInd phase IIIrd phase Place N Low Normal High N Low Normal high Boaib 44 8 35(80) 1 36 5 29(81) 2 Thidong 33 1 30(91) 2 43 0 42(98) 1 Tanmad 43 8 34(79) 1 59 13 45(76) 1 Total 120 17(14.2) 99(82.5) 4(3.3) 138 18(13) 116(84) 4(3) Figures in the brackets are the percentage. Note: low= <130mg%, normal=130-220mg%, high>220mg% Remarks: more than 80% of Jarawas are having normal serum cholesterol level in all the three locations. Significant differences seen in R. K. Nallah area (along ATR) where as low serum cholesterol level found in few Jarawas of Tirur & Kadamtala areas. This may be due to more consumption of alien food (Processed food) by the Jarawa staying along the ATR for a long time. Table 6.19: Distribution of Jarawas by Serum Triglyceride level Table – 7 of revised report 2nd phase 3rd phase Area N Low Normal High N Low Normal High Boaib 44 0 43(98) 1 36 0 34(94) 2(6) Thidong 33 5 22(67) 6 43 0 40(93) 3(7) Tanmad 43 4 29(67) 10 59 0 57(96) 2(4) Total 120 9(7.5) 94(78.3) 17(14.2) 138 0 131(95) 7(5) Numbers in brackets are the percentage. Normal (60-150) mg/dl 343 Table 6.20: Age group and area-wise distribution of Jarawas by blood sugar status Table – 24 of revised report (in 3rd phase of survey) Grades Tirur n = 36 Jirkatang n = 43 Kadamtala n = 59 <10 11- >25 Total <10 11- >25 Total <10 11- >25 Total yrs 24 Yrs yrs 24 yrs yrs 24 yrs yrs yrs yrs Low 3 2 0 5 5 1 0 6 10 2 2 14 (14) (14) (24) Normal 14 6 11 31 2 22 13 37 9 16 20 45 (86) (86) (76) High 0 0 0 0 0 0 0 0 0 0 0 0 Numbers in bracket are the percentage. Note: low= <70mg%,normal =70-139mg%,high=>140mg% Remarks: most of the young and adult Jarawas 85% are having normal blood sugar level whereas, 15% of them are having low blood sugar level in all areas. Low blood sugar level (<70mg%) noticed in children of <10yrs age group indicates their low energy intake. But none of the Jarawas had high blood sugar level. Serum Protein, Ferritin, Iron, and Haemoglobin 6.21. Serum proteins levels being normal for most of the subjects indicated good protein nutrition and liver function. Serum ferritin, a compound for storage of usable iron in the body, increases with iron intake. This being normal for most of the Jarawas, the iron nutrition was good. However caution must be applied to interpret the serum ferritin data as it increases with inflammatory conditions. The data of serum iron and hemoglobin levels indicated good iron status of Jarawas. It is therefore apparent that the iron intake status as obtained from the diet survey is not a complete reflection of the dietary intake either because iron-values of Jarawa foods are not known and/or the diet taken outside the house or outside the hours of survey could not be taken into account, or iron content of Jarawas food has much higher bio-availability than that of cereal based average Indian diet for which RDA is 28 mg/acu/day (2). 344 Table 6.21: Distribution of Jarawas by Serum Protein status Table 6.20 of I.R Serum Protein 1st 2nd 3rd Average Percentage Level (gm./dl) Phase Phase Phase Low - < 6.5 11 (10) 42(35) 14(10) 22 18.4 Normal 6-6 – 8.4 51(48) 75(63) 106(77) 77 62.6 High 44(42) 3(2) 18(13) 21.6 19 > 8-4 Numbers in brackets are percentages Table 6.21 (a) : Distribution of Jarawas according to Serum-Protein level Table – 12 of Revised Report 2nd phase 3rd phase Place/S. N Normal Low High N Normal Low High Protein TIRUR 44 32 12 0 36 31 1 4 JIRKATANG 33 17 15 1 43 30 6 7 KADAMTALA 43 26 15 2 59 45 7 7 Total 120 75(62.5) 42(35) 3(2.5) 138 106(77) 14(10) 18(13) Numbers in bracket are percentage Remarks: Serum protein level found normal in 77% of Jarawas in monsoon season (3rd phase) as compared to 62% in dry season(2nd phase) which reflects minimum consumption pig meat during dry season. Note : Normal = 6.6 to 8.6 gm%, Low < 6.6 gm%, High > 8.6 gm% Table 6.22 Distribution of Jarawas by Serum Iron status Table – 11 of Revised Report 2nd phase 3rd phase Sex N Low Normal High N Low Normal High Male 62 16 45(37.5) 1 70 4 54 12 Female 58 1 55(45.8) 2 68 6 57 5 Total 120 17(14.1) 100(83.3) 3(2.5) 138 10(7) 111(80) 17(13) Numbers in brackets are the percentage. Normal: Male (60-160)µg/dl, female (37-145) µg/dl. Remarks: Low serum ferritin and iron level corroborates with the anemia prevalence in severe and moderate grades. More numbers female are having low serum ferritin and iron status. 345 Table 6.23 Distribution of Jarawas by Serum Ferritin level Table: 10 of revised report 2nd phase 3rd phase Sex N Low Normal High N Low Normal High Male 62 3 59(95) - 70 0 65(93) 5 Female 58 - 56(96) 2 68 5 63(93) 0 Total 120 3(2.5) 115 2 138 5 128 5 (95.8) (1.7) (4) (92) (4) Numbers in brackets are the percentage. Normal: Male (32-501) ng/ml, female (3.5-223.5) 6.22. Data of anthropometry and laboratory investigations supported by clinical examinations indicated that the nutritional status of the Jarawas was not less satisfactory than that of the non-Jarawas, which, in turn, indicated: • That food was not unbalanced to significant extent. • Food security was not a problem. 6.23. Processed foods like biscuit, bread are demanded by the young Jarawas while staying along the roadside. Except for such behavior of Jarawas no significant difference is found in the serum parameters among Jarawas of three territorial divisions. Low serum iron and ferritin concentration corroborates with the percentage prevalence of moderate and severe anaemia (3.5%) among Jarawas of different areas. 6.24. Hemoglobin estimation status shows anemia prevalence more in Tirur area (Boaib) (37%) in comparison to other two areas. Sex-wise distribution shows that higher percentage (16%) of male Jarawas are anemic than female (9%) in R. K. Nallah area (Thidong) which may be due to their stay along the roadside and increased consumption of processed food (alien food). Anemia prevalence was shown abnormal (57%) during 1st phase of Jarawa survey due to the method applied i.e. Shalis method. In addition to that increased prevalence of Hepato- splenomealy suspected due to Malaria may be another cause for high prevalence of anemia during 1st phase of survey (Tables 6.14 & 6.15). 6.25. All the serological parameters of Jarawas were found within normal range when compared with that of standard of general population. High level HDL cholesterol found in 346 Jarawas is a good indicator as increased HDL cholesterol level reduces the risk of coronary heart diseases, hypertension etc. (Table – 6.17) 6.26. Blood sugar random found normal in 85% of Jarawas. But none of the Jarawas had high serum glucose level. However low serum glucose level found in children (15%) below 10 years of age, which indicates their low energy intake (Table 6.24). Table: 6.24: Blood sugar level (Dry season) Grades Boaib n = 44 Thidang n = 33 Tanmad n = 43 <10 11- >25 Total <10 11- >25 Total <10 11- >25 Total yrs 24 Yrs yrs 24 yrs yrs 24 yrs yrs yrs yrs Low 3 0 0 3(7) 2 0 0 2(6) 6 2 2 10 (23) Normal 10 19 12 41 9 13 9 31 5 17 11 33 (93) (94) (77) High 0 0 0 0 0 0 0 0 0 0 0 0 Numbers in bracket are the percentage. Note: low= <70 mg %, normal = 70-139 mg %, high=> 140 mg % Remarks: most of the young and adult Jarawas (85 %) are having normal blood sugar level whereas, 15 % of them are having low blood sugar level in all areas. Low blood sugar level (<70 mg % noticed in children of <10 yrs age group indicates their low energy intake. But none of the Jarawas had high blood sugar level. 347 Chapter - 7 Health and Hygiene of Jarawas 7.1. Health is one of critical issues pertaining to Jarawas consequent to their recent change in behaviour involving interface with diverse people. It has been the medical emergency, in most cases, in the world when isolated communities came in contact with heterogeneous people and many of the small communities perished in the process. It is not an easy job to handle such emerging situation as it lacks, inter alia, consensus in methodology and approach to deal them. The entire modern medical knowledge and technology accumulated over centuries is put to delicate test of its application to such small isolated community like Jarawa whose present stage would be compared to that stage of human civilization which existed at least one thousand years ago. It involves the question of medical parameters, health indicators, diagnosis, treatment and drug regimen, supplanting or supplementing the traditional health regime that served the community till the other day. 7.2. In the present study, the practicing doctors conducted health survey among Jarawas. Health team included Homeopath and Ayurvedic physician also. Homeopathic medicines were tried during the survey. The study cover usual aspects like general observation, clinical observation and laboratory tests. However, the findings of this study are to be considered cautiously and carefully as they are to be viewed in a backdrop of - lack of case history of Jarawa community, language and communication barrier and dependency on verbal autopsy in attempting to reach certain conclusion by health team. In- depth medical research in diagnostic approach, Jarawa specific health and nutritional indices and drug regimen is desirable to consider a comprehensive and long-term policy and health programme for Jarawas. 348 General Examination 7.3. On general examination of 251 Jarawas it was found that three Jarawas had jaundice and three had signs of vitamins-B deficiency. Their pulse rate was found to be within the normal range (60-80/min.). However axillary temperature was found 20 F below normal (97.60 F) in most of the Jarawas except for thirteen Jarawas who had high temperature due to fever. Table 7.1 Distribution of Jarawas by morbidity status 7.11 of IR Morbidity 1st 2nd 3rd Average phase phase phase ARI/LRI 10 23 28 20 (9) Pallor 43 16 34 31(13.8) Skin 101 91 94 95(42.4) infection Malaria 3 2 3 3(1.3) Hepatitis 0 0 3 1(0.4) Viral Fever 16 4 13 11(4.9) Numbers in brackets are percentages Morbidity Status: 7.4. Out of all the Jarawas clinically examined 42.4% Jarawas had various types of skin diseases, mainly of fungal origin. 13.8% were found to be pale (anaemic) and 9% having Respiratory Tract Infection. 4.9% had viral fever, 1.3% had malaria and 0.4% had hepatitis. No other deficiency signs of vitamins and minerals were detected. 7.5. Mid Upper Arm Circumference (MUAC) of the 36 Jarawa children below 6 years of age were found to be within normal range and only two children of Tirur area (Boiab) were found to be below normal, which indicates under-nutrition. Whereas weight for age remains lower in Jarawas when compared to NCHS standards, this may be due to their short stature (genetic factor). 349 Table 7.2: Area-wise cause of death of Jarawas (mortality status) by verbal autopsy 7.12 of IR Cause of death Jarawa Habitat Boiab Thidong Tanmad Total Fever with cough 69 52 84 205 (62.7) Abdominal pain with 26 9 34 69 (21.1) vomiting Burn injury 0 0 1 1 Maternal death 1 0 4 5 (1.5) Animal bite 0 1 3 4 (1.2) Accidental injuries 0 2 3 5 (1.5) Pig meat chocking 0 0 1 1 Diarrhoea 0 1 7 8 (2.5) Encounter 1 4 2 7 (2.1) Still birth 0 0 1 1 Drowning 0 0 2 2 Lost in jungle 0 0 1 1 Blood vomiting 3 0 0 3 (1) Unknown 3 3 9 15 Total 103 72 152 327 Numbers in brackets are percentages 7.6. Mortality status in Jarawa population in three continuous generations viz. self, parents and children elicited by verbal autopsy (past history of death in the family for about 50 years) found that approximately 327 Jarawas died in the past many years 50 years. This number may be higher as the Jarawas could remember only this many mortality in three generation which could be corroborated and cross checked with other Jarawas for its genuinity. 7.7. Mortality due to fever and cough (Respiratory Tract Infection) was reported to be 62.7%, this fact is further strengthened by the findings of the epidemic of community acquired pneumonia of 1998 among Jarawas and also the Respiratory Tract complications of measles out break of 1999. The 350 clinical evaluation of Jarawas of three phases of this survey too showed large morbidity due to Respiratory Tract Infection. So it can be said that the Respiratory Tract Infection was a major killer disease among the Jarawas. 7.8. Mortality had resulted due to abdominal pain with vomiting was accounted for 21.1 % which could not be corroborated with any diseases. About 4% of the death was reported due to unknown reasons. 7.9. 2.5 % of reported mortality was due to diarrhoea, 2% mortality due to encounter with Police and poachers and 1.5% mortality each due to maternal death, accidental injuries and animal bites specially crocodile. Table 7.3: Area-wise and sex-wise mortality status 7.13 of IR Area nos New Infant Child Adult born M F M F M F M F Boiab 103 8 6 4 5 4 4 42 30 Thidong 72 1 1 2 9 7 0 29 23 Tanmad 152 1 10 9 8 18 19 45 42 Total 327 10 17 15 22 29 23 116 95 (3) (5.1) (4.5) (6.7) (8.8) (7) (35.4) (29) Numbers in brackets are the percentage. 7.10. Age and sex-wise mortality status of Jarawas elicited by verbal autopsy shows 19% mortality each in the new born and infant whereas 16% mortality in childhood and 65% mortality in adult and old age Jarawa population. In other words 35% mortality were found in the age group of newborn, infant and childhood i.e (0-12years age group). Whereas 65% death occurred in adult and old aged Jarawas. Among adults more male died as compared to females. 7.11. A small percentage of Jarawa population has lymphadenopathy in inguinal and cervical region. This may be due to bacterial and fungal infection of skin. A large number of Jarawas having skin infection at Tanmad area however in Boiab and Thidong relatively small number of Jarawas were infected. This 351 may be due to longer contact with non-Jarawas of Tanmad and use of old clothes got from non-Jarawas. 7.12. All the 251 Jarawas were examined for skin infection and found that 94(37%) Jarawas of three different areas have skin disease mainly of fungal origin. Few Jarawas had injuries and multiple healed scars on their body. Five Jarawas were having varying degrees of physical disabilities caused due to accident. Two females and one male Jarawa were found to have blindness of one eye due to accidental injury. None of the Jarawas had goiter/Iodine deficiency disorder (IDD) signs. Clinical Examination 7.13. Of all the Jarawas subjected to systemic clinical examination during the three phases of study, nothing abnormal could be detected in central nervous system, cardio- vascular system and genito-rurinary system. Clinical examination revealed that about 9 % of Jarawas had Respiratory Tract Infection resulting into fever, cough and coarse crepitation and occasionally rhonchi on auscultation. Table 7.4: Distribution of Jarawas by blood pressure (systolic) 7.14 of IR Blood Pressure 1st Phase 2nd Phase 3rd Phase Average % (mm of Hg) 90 and less 49 (38) 70(46) 48(27) 55 (37) 91 – 120 80(62) 82(54) 133(73) 98(63) 121 and above 0 0 0 0 Numbers in brackets are percentages 352 Table 7.5: Distribution of Jarawas by blood pressure (diastolic) 7.15 of IR Blood Pressure 1st Phase 2nd Phase 3rd Phase Average % (mm of Hg) 70 and less 79(61) 99(65) 104 (57) 94 (61) 70 – 90 50(39) 53(35) 77(44) 60 (39) 90 and above 0 0 0 0 Numbers in brackets are percentages 7.14. Altogether 181 Jarawas of different age and sex groups were subjected to blood pressure measurement and found that 42.6% had diastolic blood pressure between 70-90 mmHg and 57.4% had diastolic pressure less than 70 mmHg but none of the Jarawas having diastolic blood pressure more than 90 mmHg. Majority of the Jarawas had systolic blood pressure within 120 mmHg. As such no hypertension case was detected among Jarawas. 7.15. On an average the pulse rate of Jarawas varied between 60 and 70 / minute. Only one of the female Jarawa of Boiab had dental carries but none of the other had bad oral hygiene or bleeding gums. Only three Jarawas had glossitis due to vitamin. B-complex deficiency. None of the Jarawas had bitots spots, xeropthalmia and cataract. However three Jarawas were found to have blindness of one eye due to accidental injuries and only one Jarawa found to have dacryocystitis of left eye. Only two children had chronic suppurative otits media. (CSOM) with central perforation of tympanic membrane. Table 7.6: Distribution of Jarawas by Hepato-spleenomegali status 7.16 of IR Status 1st 2nd 3rd phase Average phase phase Hepatomegaly 55(29) 64(28) 76(30) 65(29) Spleenomegaly 71(38) 32(13.8) 42(16.7) 48(22.8) Numbers in brackets are percentages 7.16. Per abdominal examination of Jarawas revealed on an average 29% had mild to moderate palpable liver (hepatomegaly) and 22.8% had palpable spleen (spleenomegaly). 353 This hepato-spleenomegaly among Jarawas may be due to chronic infective disease like malaria etc. Hepato-spleenomegaly was found to be increased during the third phase of study in comparison to the second phase of study but splenomegaly is decreased in comparison to the first phase of study. 7.17. Per abdominal examination of Jarawas during all the phases showed the following: - One Jarawa woman had an appendicular lump. Other Jarawa woman had acute cholecystitis. One male Jarawa had abdominal interstitial hernia. All the above cases were referred for specialized treatment to G.B. Pant Hospital and they recovered. 7.18. Per vaginal examination of two Jarawa women of Tanmad area showed normal shape and size of uterus and normal adenaxae, however one had foul smelling vaginal discharge. Examination of male genitalia of adult Jarawas revealed that glans penis and under surface of prepuce was very much neat and clean as compared to the non-tribals. No congenital abnormalities were noticed among the Jarawas except for vitiligo of lips, which were found in the members of one Jarawa family at Tanmad. Laboratory Investigation 7.19. The 138 blood samples collected from the three different territories and were put for various laboratory investigations. Table 7.7: Distribution of Jarawas by blood groups 7.17 of IR Blood 1st Phase 2nd Phase 3rd Phase Average % groups (M + F) M F T M F T M F T ‘O’ 53 34 87 39 41 80 53 39 92 86 Positive (76) (67) (67) (70) ‘A’ 14 13 27 22 18 40 17 39 46 38 Positive (24) (33) (33) (30) Numbers in bracket are percentages 354 7.20. In ABO and Rh (D) blood group systems, 70% Jarawas were “O” Rh-positive and 30% were “A” Rh-positive. None of the Jarawas were found to be Rh-negative. Table 7.8 Distribution of Jarawas by anaemia status (WHO criteria) 7.18 of IR Age group WHO 1st phase 2nd 3rd phase Average Criteria n=114 phase n=138 ( Hbgm/dl) n=120 6 month- 6 year 11 3 2 2 2.3 (5) 6-14 years 12 20 19 14 17.6 (38.2) Adult male 13 20 4 11 11.6 (25) Adult female (NP) 12 20 6 7 11 (24.4) Adult female (P) 11 2 2 6 3.4 (7.4) Total 65 33 40 46 (57) (27.5) (29) (38) NP – Not Pregnant, P – Pregnant, Numbers in brackets are percentages. 7.21. A total of 138 blood samples were collected during the third phase of study, while 114 blood samples during first phase and 120 blood samples during second phase were collected for haemoglobin estimation (MS4 Cell Counter method). Considering WHO criteria for anaemia in different age groups, 38% Jarawas had anaemia. Of the all age groups, 6 to 14 years age group Jarawas were found to be most anaemic, as 38.2% of them were found to be anaemic. However all the six pregnant Jarawas also were found to be anaemic. But the children below six years of age were found to be less anaemic than that of all age groups. 355 Table 7.9: Distribution of Jarawas by grades of anaemia Table 7.19 I.R Grade of 1st phase 2nd phase 3rd phase Average anaemia* Mild 43 (66) 14 (42) 35 (87.5) 30 (66) Moderate 22 (33) 18 (54) 4 (10) 15 (32) Severe 0 1 (4) 1 (2.5) 1 (2) Total 65 (57) 33 (27.5) 40 (29) 46 Numbers in brackets are percentages. Haemoglobin estimation done by Haematology cell counter (MS4). Mild > 10gm/dl to normal level according to age, Moderate 7 gm/dl to <10gm/dl., Severe <7gm/dl. 7.22. According to WHO criteria, anaemia of Jarawas was graded as mild, moderate and severe. Out of the total anaemic Jarawas, 66% had mild anaemia (Hb > 10 gm%) and 32% had moderate anaemia (Hb 7 to 10 gm%) and only 2% had severe anaemia (Hb < 7 gm%). Table 7.10 Distribution of HBsAg positivity – phase and sex-wise 7.20 of IR Sex 1st 2nd 3rd phase Average phase phase Male 35 35 39 36(60) Female 20 24 28 24(40) Total 55 59 67 60(100) Numbers in brackets are percentages. 7.23. Out of the all the blood samples collected during the three phases of study and analyzed by ELISA method for HbsAg, 48.5% individuals were HbsAg (Australia surface antigen) positive. Out of the 67 HbsAg positive Jarawas 58.2% were males and 41.8% were females. 7.24. Of all the blood samples tested for anti- Hbs, 70% of them showed positivity which means 70% of the Jarawas had hepatitis B infection in their life time. But HbsAg positivity was only 48.5% which means rest of the population became negative for hepatitis B virus. On the whole 3/4th of the Jarawa population had the chance of getting hepatitis B infection in their lifetime. 356 Table 7.11 Prevalence of HbsAg positivity by area and age-wise Table 7.21 of I.R Area 1st 2nd 3rd Average phase phase phase Boiab 3 15 14 Thidong 15 16 22 60(48.5) Tanmad 37 28 31 Total 55 59 67 (48.2) (49.1) (48.5) Numbers in brackets are percentages 7.25. Even though 48.5% Jarawas were HBsAg positive on an average in all the three phases of study, the serum bilirubin of most of the Jarawas were within normal limits except for three whose serum bilirubin was high. Hence all the HBsAg positive Jarawas were found to be healthy carriers. Prevalence of HbsAg among the Jarawas of all the three habitats is endemic in nature and there was no major variation in the prevalence of HBsAg in all the three phases of study. Table 7.12: Age group-wise distribution of Jarawas by HBsAg positivity Table 7.22 of I.R Age group 1st 2nd 3rd Average phase phase phase 1-5 years 3 3 2 2.5 (4) 6-14 years 21 26 25 24(40) >15 years 31 30 40 33.5(56) Total 55 59 67 60(100) Numbers in brackets are percentages 7.26. Out of 67 HBsAg positive Jarawas found in third phase, 59% were in the age group of more than 15 years, 37% were in 6 to 15 years and 4% were in 1-5 year’s age group. Blood samples were mostly collected from young and adults only, as blood sample collection was not possible from infants and children below 5 years of age due to refusal by the parents. Serum 357 billirubin was found to be high (> 1 mg %) only in three Jarawas of Boiab area who were also HBsAg positive. 7.27. Of all the blood samples analysed for SGPT/SGOT (liver function test) showed 93.5% within normal limits and only 6.5% had high levels. This indicates normal liver function in 93.5% of Jarawas inspite of high prevalence of hepatitis B. None of the blood samples tested for VDRL, HCV and HIV were found reactive. Table 7.13: Blood Sugar status random- phase-wise 7.23 of IR Blood Sugar 1st 2nd Phase 3rd Phase Average % level (mg./dl) Phase 70 and less 51 (46) 21 (17.5) 25 (18) 32.5(27) 71-110 57 (51) 90 (75) 103 (75) 82.5(67) 111-140 2 (3) 9 (7.5) 10 (7) 7(6) >140 and above 0 0 0 Numbers in brackets are percentages. 7.28. Random blood sugar of all the blood samples collected were tested. None of Jarawas had diabetes mellitus, and more than 27 % of them had low blood sugar level (less than 70 mg %). Table 7.14 Serum Protein status- phase wise 7.24 of IR Serum Protein 1st 2nd Phase 3rd Phase Average Level (gm./dl) Phase % Low < 6.5 11 (10) 42(35) 14(10) 22 (18.4) Normal 6.6 – 51(48) 75(63) 106(77) 77(62.6) 8.4 High > 8-4 44(42) 3(2) 18(13) 21.6(19) Numbers in brackets are percentages. 358 7.29. Total serum protein of all the blood samples collected in all three phases revealed only 18% had low serum protein whereas 19% had higher values and rest within normal limits. Albumin and globulin ratio (2:1) was found to be within normal limits. Serum albumin level was found within normal in 86.2% whereas 13.8% had high levels. Table 7.15 Serum Cholesterol status-phase wise 7.25 of IR Serum 1st Phase 2nd 3rd Phase Average % Cholesterol Phase Level (mg./dl) Low < 130 25(22) 17(14) 18(13) 20 (16) Normal 131 – 220 69(63) 99(83) 116(84) 94 (77) High > 220 16(14) 4(3) 4(3) 8(7) Numbers in brackets are percentages. 7.30. Of all the blood samples collected during three phases and tested for serum cholesterol it revealed that 77% had normal values (131 -220 mg %), 7% had high values (> 220-mg %) and 16% had low values (< 130-mg %). Table 7.16: Serum Triglyceride status-phase wise 7.26 of IR Serum 1st 2nd 3rd Average Triglyceride Phase* Phase Phase % Level Low NIL 9(8) 0 9 (4) Normal NIL 94(78) 131(95) 113 (86.5) High NIL 17(14) 7(5) 5) *Estimation could not be done due to non-availability of kit. Numbers in brackets are percentages. 7.31. In 86.5% cases serum tri-glyceride level were within normal range whereas 9.5% had high values. Table 7.17: Serum HDL cholesterol status-phase wise 359 7.27 of IR Serum HDL 1st 2nd Phase 3rd Phase Average Cholesterol Phase* Level Low NIL 0 0 0 Normal NIL 112(93) 86(62) 99 (77.5) High NIL 8(7) 52(38) 30 (22.5) * Estimation could not be done due to non-availability of kit Numbers in brackets are percentages. 7.32. Serum HDL level of 77.5% Jarawas were found to be in normal range, however 22.5% had high values but none of the Jarawas had low values of serum HDL level. This indicates low risk of coronary artery diseases. Table 7.18: Serum LDL Cholesterol status-phase wise 7.28 of IR Serum LDL 1st 2nd 3rd Average Cholesterol Phase * Phase Phase Level Low NIL 0 0 0 Normal NIL 114(95) 136(98) 125 (96.5) High NIL 6(5) 2(2) 4 (3.5) * Estimation could not be done due to non availability of kit Numbers in brackets are percentages. 7.33. Similarly 96.5% of Jarawas had normal serum LDL level and only 3.5% had high levels. 7.34. The renal function of Jarawas were evaluated by estimating the serum creatinine level of all the blood samples collected in three phases and found all within normal limits. Hence all the Jarawas have normal kidney functions. 360 Table 7.19: Serum Ferritin status-phase wise 7.29 of IR Serum 1st Phase 2nd Phase 3rd Phase Average Ferritin Level * Low NIL 3 (2.5) 5 (3.5) 4 (3) Normal NIL 115(96) 128(93) 122 (94.5) High NIL 2(1.5) 5 (3.5) 3.5 (2.5) * Estimation could not be done due to non-availability of kit Numbers in brackets are percentages. 7.35. Serum Ferritine level was found to be normal in 94.5%. It was high in 3% and low in 2.5%. This indicates presence of sufficient iron stores in their body. Table 7.20 Serum iron status phase-wise 7.30 of IR Serum 1st Phase 2nd Phase 3rd Phase Average Iron * Level M F T M F T M F T M F T Low - - - 16 1 17 4 1 5 10 1 11 (14) (4) (9) Normal - - - 45 55 100 54 57 111 49 56 110 (83) (80) (81) High - - - 1 2 3 12 10 22 6.5 6 12.5 (3) (16) (10) * Estimation could not be done Numbers in brackets are percentages. 7.36. Serum iron was found to be normal in 81%, low in 9% and high in 10%. This indicates no deficiency of iron in their diet. 7.37. Routine blood examination of all the blood samples collected in three phases and tested for TLC and DLC revealed values within normal limits. Blood smear for malarial 361 parasites were found positive in eight samples in all the three phases of study. Out of eight malaria positives, six were Plasmodium felciparum and two were Plasmodium vivax infection. Blood platelet counts were normal in 98% of Jarawas except for 2% who were having low count. 7.38. Stool and urine could not be collected from the Jarawas as they are not willing to cooperate with health and nutrition team. However during the first phase few samples of urine and stools were collected from Thidong area with a great difficulty and analyzed to find nothing abnormal. 7.39. The contact of the Jarawas with the non- Jarawas has caused ill effects for them. The analysis of the morbidity data of the Jarawas since 1996 shows various outbreaks of communicable diseases like community acquired pneumonia (1998) measles (1999) and malaria (2000-2001) which were probably absent among the Jarawas before their increased interaction with outsiders i.e. non-Jarawas. 7.40. Although, the other skin infections were prevalent among the Jarawas as reported by earlier contact team doctors but the incidence seems to have increased due to the acceptance of dirty cloths from the non-Jarawas and exchange of the same among the Jarawas without proper washing. 7.41. The Jarawas were not consuming foreign food earlier, after coming in close contact with others they have started taking food containing salt and spices. Intake of such salt has resulted in increase of their blood pressure, particularly among those who frequently visited hospital, jetty and villages and consumed alien food regularly. 7.42. Morbidity and mortality due to aboriginal diseases: During the study period no morbidity or mortality observed due to the hepatitis B carrier state among Jarawas as they are found to be only healthy carrier and not suffering from the disease. However 3 Jarawas were found suffering from jaundice with altered liver function test during the third phase of survey, which they have completely recovered. Hepatitis B is the only aboriginal endemic disease found among the Jarawas like other primitive tribes and nicobarese of A & N Islands. 362 Table 7.21: Prevalence of Disease due to contact with general population 7.32 of IR Year Name of the Disease Male Female Total Death Com. Acquired 27 22 49 0 Pneumonia. Measles with its 45 50 95 0 complications Mumps 18 9 27 0 available per records 1998-2002 as Malaria 45 28 73 0 Homoeopathic System of Medicine 7.43. Homoeo means ‘similar’ and pathos means ‘suffering’ or disease. Homoeopathy is a system of medicine founded on definite law ‘Similia Similibus Curantur’ which means like cure like. i.e. treating disease by medicine producing similar symptoms to that of the disease. The therapeutic law is as follows “A weaker dynamic affection is permanently extinguished in the living organism by a stronger one, if the latter (while differing in kind) is very similar to the former in its manifestation. 7.44. Evaluation of symptoms: The patient gives a list of symptoms all of which are not equal in importance, so the physician has to learn to distinguish the symptoms which are most important and which must be covered by the remedy as against those, which may be conveniently ignored. Out of Kentian, Hahnemanian, Boerick, Boenning Hausen’s method and considering the limitations of the source of symptoms only Hahnemanian method is observed. i.e. general symptoms and common symptoms. 7.45. Posology: Only one single simple medicine was chosen for administration, in 30th centicimal scale in acute and 200-centicimal scale potency in chronic disease. 7.46. Case study: During the study altogether 204 Jarawas (male, female, old, adult, young, & new born) were examined and Homoeopathic case taking was done on the basis of the subjective symptom, objective symptom, clinical examination and pathological 363 investigation. The following different symptoms were noted in almost 48 individuals indicating Respiratory Tract Infection: Cough, constant with thick Tenacious discharges Cough dry, irritating at throat. Running nose, Watery discharge Excoriating. Thick yellow discharges from nose Cough cold with fever 7 babies with cough congested chest rattling & wheezing. 7.47. On the basis of symptoms similarities the following Homoeopathic medicine were given with very satisfactory result. The medicines are Aco, Bry, Antimtart, Kali Bich, Bell, RT, Ipecac, HS, Puls. 7.48. In seventy five individuals the following skin infection is noted (fungal/bacterial) Itching (Nadu Hata) at the groin, waist, around the arms, neck. In some cases itching is more at night and or all the time. On the basis of the above the following Homoeopathic medicines were given with satisfactory result: Bacilinum, Sulphur, Lyco, Graphites, Tellurium, Graphites ointment, and Sukucumchuk ointment. 7.49. In forty five individuals, it is clinically found that they have liver and spleen enlargement for which Lyco, Natsulph, Cheli, Ceanathus were given and got good result. • Four cases of loose motion were noted among the babies due to dentition or other cause for which Arsalb, Cham, Podo were given with total relief within few hours. • Five cases were noted with high fever, cold and body ache for which Bella, Gels were given with same day relief. • One girl of 15 year who had late menses was given Puls for two days on the third day it is found that the menses started. • A boy fell down from the Truck & had Trauma on the right side of the face with swelling and conjunctival hemorrhage with close eyes, Arnica and Cham was given internally and Calendula ointment was applied with total cure in 3 days time. 364 • Eight children and one Adult complaint of pain in abdomen for which Cina was given to all with total cure. • Four children have injury with infection having pus discharge for which HS, Calendula was given with good prognosis towards healing. • One Jarawa having Veruccal growth at hand & leg. Thuja 200, 3 doses for 3 morning given, on the fifth day it is observed that the Verucca fell down from hand and Elbow and the one at knee was hanging • Pathological investigation reveals that 48 % of the Jarawas were having Hepatitis B +ve and on the basis of the earlier report Lycopodium in higher potency were given to few of them. 7.50. Miasmetic Consideration: In Homoeopathy an infecting agent and cause of disease are called miasm, which are dynamic disease producing power, which pollute the human organism and became the producer of every possible disease condition. Miasm may be acute, chronic, that may be single, psora, Syphilis, Sycosis and complex. In case of Jarawas it is observed that the complex miasm of psora-sycosis is the cause of disease. 7.51. Genus epidemicus: The medicine which is indicated in majority of cases affected from an epidemic disease is called ‘Genus Epidemicus’ for quick prescription with less labour and for preventive purpose. Dr. Hahnemann adviced to use genus epidemicus in treating epidemic diseases. 7.52. The common diseases among the Jarawas are probably due to maintaining and exciting causes which may exist among them. Such diseases may take epidemic turn due to contact with aliens. Further new exciting and maintaining causes may emerge on account of change in the ecological and cultural environment of Jarawas again due to contact. Physical activities of Jarawas as hunters and gatherers are intense. But frequent gifts of food items, vehicle and boat rides may cause sedentarism among them resulting in new problems related to such mode of life. As such, eradication of exciting and maintaining causes is appropriate approach for healthy survival of Jarawas. 365 Efficacy of Ayurvedic System of Medicine 7.53. The only addiction seen in some Jarawas is tobacco. According to Ayurveda tobacco has vyavayi, laghu, ushna, theeksna, rooksha, vikashi, raptapitha kopana, Ojakshaya and pramatha properties. The Jarawas even put tobacco on their wounds. Table 7.22: Plants used by Jarawas for treatment are as under: S. Jarawa name Botonical Uses No. name/ Family 01 Orroh Myristica The leaves are chewed Andamanica and taken internally for cough and throat pain. Myristicacea The leaves are tied on the back after pig hunting to avoid backache. 02. Homaal Pseuduvaria The leaves are tied with Prainu Homikanada for headache and abdomen Anonacea pain. Homaal is used externally for cuts. 03. Aam Theal - Hot fomentations are (Bhooti pathi) done with the leaves for pain, fever, cough etc. 04. Tangopachat Orophea Leaves are kept on the katschallica chest for chest pain. 05. Homiyakanada The aromatic bark fibre is tied as an analgesic. 06. Teethakakalla - Leaves are tied around the neck for cough, throat pain. 07. Kwatho / Vatho - The bark fibre or outer covering is tied as on analgesic. The plant sap is taken orally for cough and chest pain. 366 08. Uyyah Amomum The leaves are tied for (Wild ginger / Aculeatum pain, fever, cough, chest wild haldi) Zingiberacea pain. 09. Thaad - Used for sitting on (wild arecanut) during menstrual periods and also for post partum bleeding. Use of Mineral Orgin item for treatment: S.No. Jarawa Name Scientific Uses name 1. Alam Red ochre Mixed with pig fat and used for snake and centipede bites, pain, skin diseases. 7.54. Efficacy of Ayurveda medication on Jarawas: After giving Ayurveda medicines to the Jarawas, the following results could be seen: - • Remarkable relief was seen in clinical jaundice, stomach pain etc. • Results were varying in respiratory tract infections and skin diseases • Cases of hepatosplenomegaly, anaemia, skin diseases etc.require prolonged treatment in Ayurveda. • Ayurveda medicines can be made into palatable forms and can be given to the Jarawas to get good results without any side effects. However, there are many practical limitations. Indigenous system of medicine 7.55. The Jarawas believe into two states of body; tomo (normal) and ulleda (sick). When a person feels incapable of performing his or her normal activities, the person considers himself/herself as afflicted with ulleda. They have a 367 symptom oriented treatment pattern. In this community there is no medicine man, often the knowledgeable elderly persons suggest the treatment. Apart from dietary restrictions, they use various herbal medicines. Name of some of the diseases and pathological conditions common among the Jarawas are given below: (i) Snake bite Topo enok jalo (ii) Scorpion bite Telong enok jalo (iii) Centipede bite Taita enok jalo (iv) Abdominal pain a) Upper abdomen Aapaya ulleda b) Lower abdomen Aniyeya ulleda (v) Fever Hullu (vi) Otitis media Anika ulleda (vii) Headache Animul ulleda (viii) Pain in neck Enengdu ulleda (ix) Pain in the hand Eniboy ulleda (x) Wrist pain Enang Jali ulleda (xi) Diarrhoea Enchubele 7.56. As curative medicine for the aforesaid diseases, they use a number of herbs and red ochre in different ways. In most of the cases they use extract of certain leaves, bark, stem and roots. Name of different plants, parts of which are used as curatives, and their use are discussed below: • Pahala: Its leaf is used to treat snake, scorpion or centipede bite. They heat the leaves keeping on fire (tuhu) and apply the same on the spot of bite. • En-taw: Extract of its tender leaf is used to stop vomiting. • Omeya-nada: When they suffer from headache or any kind of body pain, they tie the bark of the tree on the affected 368 part. Leaves of the tree, after making them hot on fire, are used to compress the affected part. • Orow: The extract of its leaves are used to stop bleeding from any kind of cut or injury. Mat for newborn baby is made with its leaf. • Wa cha heel: Bark and leaves of this plant are used in the same way and for same purpose the parts of omeya-nada are used. • Chik baag: Extract of its bark is applied on the body when somebody suffers from fever. Menstruating females sit on a platform made with stems of this tree placed parallel. • Homal: Extract of its leaves is repellent of bees. Bark of the plant is tied to body or limbs to get rid of pain. • E-hol: It is a kind of climber. Sap of the stem is used to cure pain in abdomen. • In-neta: It is a shrub. To treat a person suffering from fever, they heat the leaves and compress the entire body with that. Besides, it is also used as a curative of labour pain. 7.57. Though the Jarawas continue to practice their indigenous system of medicine, in many cases they are asking for medical assistance from the non-Jarawas. However, they have not asked for any assistance from the non-Jarawas for any obstetrics and gynaecological problem. They prefer to treat the newborns and their mothers with their indigenous system of medicine. During our entire field investigation altogether four childbirths took place; in all those cases they showed reluctance in accepting any kind of antenatal or neonatal treatment from outside. Hygiene 7.58. The Jarawas do not alter the natural surrounding of their habitation much, still they maintain hygienic condition in and around their camps. They always defecate away 369 from their hutment and use either twigs or leaves for cleaning their bottom. The females use soft twigs after urination. Defecation of infants is immediately collected in leaves and along with some dirt is thrown away at some distance from their huts. 7.59. They generally wash their face and mouth with water early in the morning. A few young boys were seen using brush and paste in recent times to clean their teeth. They pair their nail and hair with knife (toaad). After eating honey, they invariably take bath. As calorific value of honey is high (319 k/cal for 100 ml), it generates body heat almost instantly. Moreover, the stickiness of honey causes discomfort, unless washed off properly. 7.60. They do not have the habit of washing hands before eating. However, after eating fish, meat or any other item that smears the hands, they often wash them by ejecting water taken in mouth. It is a custom to smear the face and upper parts of the body with clay after eating pig. They believe, if clay is not applied the hunter will not get good hunt in future; the meat eater also will suffer from abdominal pain. In fact the clay helps to remove any fat sticking to face or mouth. 7.61. The Jarawas, try to keep their immediate surroundings clean. They never bring the intestinal parts of any games to the camp; immediately after shooting down a pig the hunter removes its intestine and throw it away at the spot of hunting, this also helps them to carry the pig from a long distance. Same practices have also been observed among the women folk while collecting mollusc and fish. 7.62. When the Jarawas camp at one place, they can not completely avoid discarding some organic material like fish bone, mollusc shell, skin and inner pith of jackfruit. However, each piece of pig bone is dropped in fire. After a few days the discarded material start decomposing; now it is time for the people to leave the camp and shift elsewhere. During this fallow period nature takes care of the place, by the time the campers come back to the same place, the process of natural decomposition is complete. 7.63. They wear the clothes either new one presented by the outsiders or those used and discarded or taken 370 away from others, but do not wash them and wear it continuously until it is torn off. They continue to keep it on even when it becomes wet or damp with the water and mud etc. and this ultimately causes skin diseases. They take dips in the stream at least once in a day. Children play in water frequently and this is also a cause for respiratory tract diseases and fever. 7.64. Most of the Jarawas cut their nails either with knife or arrow and even some with blades. Some of the Jarawas use pointed bamboo sticks as tooth pick to remove the residual food from their teeth. These are carried in their hair above the forehead. 7.65. The genitals of a few males were examined and the glans penis with their foreskin retracted. None of the examined was dirty nor had deposits of smegma even in those who had sexual relations the previous night. They clean their penis after intercourse and also during baths. 7.66. After urination, the males squeeze and shake their penis to extract the last drops of urine. The females wipe their genitals with twigs or leaves after urination. After defecation also the leaves or twigs are used to wipe and clean. 7.67. The dogs, newly found friends of Jarawas, are adding to their problems. The dogs also share their food, which in ordinary course Jarawas should have been taking, which also causes further depletion of their food reserve. Exchange of food while eating with dogs causes emerging diseases for Jarawa. 7.68. The hut roof is so sloppy and down touching the ground level which cause low illumination and ventilation preventing the smoke and unclear air going out, causing an exciting and maintaining cause for cough and cold. They lie so close to each other (body contact), which facilitate communicable disease and skin diseases to spread. During menstruation the lady lies on leaves and men are not allowed to stay with. 371