Citizen Matters had published an article on the death of Meghala, a girl aged six and weighing 12 kg, at D J Halli. This article throws light on the extent of malnutrition in Karnataka and how various recommendations to combat the same were ignored by the government, resulting in a death that could have otherwise been prevented.

Meghala’s death and the subsequent reaction in the media and political corridors is reminiscent of the furore after the death of five-year-old Anjaneya from Raichur in late 2011. Anjaneya was diagnosed as being severely malnourished in 2010 and yet, thanks in no small part to an indifferent system, died, ironically after his image became a symbol of malnourishment in Raichur district of the state.

An aptly titled report  “Child Malnutrition in Karnataka” by Advocate Clifton D’Rozario, Advisor to the Commissioners of the Supreme Court, released in Dec 2011, lays bare the woeful state of child nutrition in the state. According to the report, 44% of children under age five are too short for their age, indicating that they have been undernourished for some time, 18% of children are too thin for their height, likely to be caused by inadequate recent food intake or a recent illness, and 38% are underweight, which takes into account both chronic and acute under-nutrition.

Clifton’s report was dedicated to Anjaneya, in the hope that his death will not be in vain and will spur the state government to double its efforts and make malnutrition a thing of past. Two years have passed since his death, and one year since the publication of this report. Yet, Meghala has slipped through the very same cracks that claimed Anjaneya.

Until every child and lactating mother is provided with nutritious food, the problem of malnutrition among poor will remain unaddressed. Pic: Shree D N

Lessons and recommendations go unheeded

Clifton’s report talks in detail about various problems with the current approach of the state government. towards tackling malnutrition, highlighting gaps in the functioning of various Integrated Child Development Services (ICDS). However, it also suggested several key changes and improvements, which if heeded, could have very well kept Meghala alive.

As per the report, only 17-18% of children received health check-ups and growth monitoring services at Anganwadis. It was also found that children aged between 6 months and 3 years were weighed only if they came to the Anganwadi. The report also mentions that the individual monitoring mechanisms being followed in Tamil Nadu and Maharashtra were “feasible and particularly important to prevent extreme undernutrition and prolonged illness.”

Unfortunately there was virtually no monitoring of Meghala’s progress (or the lack of it) and health condition. The near-daily visits by Anganwadi officials and staff to Murugamma’s house started only after Meghala’s death.

The disparity between Anganwadi records and the reality can be gauged from a sample survey conducted by a few rights activists in February 2012, in the Janibai compound area within D J Halli. The local Anganwadi listed a total of five children as being malnourished, but the survey revealed that there were 19 children severely malnourished and three children moderately malnourished (below the age of 10).

However, the Anganwadis, being understaffed, underpaid and under-represented in most target populations, can only do so much. Infrastructural problems dog many Anganwadis in the state, with some being run in dilapidated buildings. Repeated requests by Anganwadi staff to upgrade the facilities going abegging. According to the Comprehensive Master Action Plan Report on the “Prevention of Malnutrition of Children in the State of Karnataka” submitted by the Core Committee headed by Justice N K Patil to the High Court, almost half of the Anganwadis in Karnataka out of total 63377 Anganwadis do not have a kitchen. The report also indicates that 68% of them do not have electricity while 8% of them (5121 to be precise) do not even have a weighing scale for children.

‘Unhygienic living conditions are to blame for the infection’

So said Minister of Woman and Child Development,Umashree, with reference to the pneumonia that killed Meghala. The small tin shed where Meghala lived, was right next to an enormous mound of garbage dump even bigger than their house. Sewage and refuse could be seen flowing right next to her house. Of course, if you visited them today, you wouldn’t see it. As soon as the local officials saw a few newspaper articles and some unsavoury TV coverage, they stepped in and cleared the garbage mound – of course, after Meghala died.

This article on LiveMint, citing Clarissa Brocklehurst, former Unicef director for water, sanitation and hygiene and Dr.Gagandeep Kang of Vellore’s Christian Medical College Hospital, argues that extra food and dietary supplements will not help combat malnutrition as long clean water and sanitation are not available, as pathogens in the intestinal tract impede proper absorption of food.

Meanwhile, the Core Committee’s report reveals that 58% of the Anganwadis do not have a toilet, while 45% of them do not even have a water filter to ensure clean drinking water.

Nutrition and medical facilities denied

While the Anganwadis are critical in identifying malnourished children, monitoring their progress and providing nutritious mid-day meals, it is the ICDS and Public Distribution Systems (PDS) which ensure the continued availability of nutrition through subsidised food grains. According to Clifton’s report, these schemes. for which the BPL card is requires, were converted into ‘legal entitlements’ by the Supreme Court through an interim order on 28 Nov 2001.

However, Murugamma had not received her BPL card despite repeated applications. Her application for disability pension was still pending. These would have ensured a regular availability of funds and subsidised rations – extremely crucial for a family of three being maintained by a blind mother without a job.

In a section labeled ‘Immediate Measures,’ Clifton’s report calls for children with severe malnutrition to be given immediate medical care and also be fed nutritious food including eggs, khichdi, milk and bananas in the medical center itself. Most importantly, it also recommends that families with severely malnourished kids be given Antyodhya Anna Yojana (AAY – a Central Govt. scheme) ration cards immediately, to ensure access to highly subsidized rations.

Murugamma did get her AAY ration card – a few days after her daughter’s death, and only after intense media scrutiny. However, her AAY is yet to get her family any rations from the local PDS shop, as the ‘local list’ has not yet been updated with her name.

Non-availability of a BPL card to Murugamma also ensured that Meghala would not be eligible for the Bal Sanjeevani Scheme, which provides free medical treatment (up to Rs. 35,000) for malnourished children suffering from acute diseases, aged 6 and under, in a select few hospitals. Unfortunately, medical support for Meghala was conspicuous only by its absence, with the Ambedkar Medical College turning them away even while she was fighting for her life on June 15, two days before her eventual death. The condition of the local PHC which catered to a population of over 1 lakh can best be gauged by a recent visit by a group of doctors, volunteers and activists which revealed that only 42 of 342 essential medicines were present, with no doctors.

The lack of an accessible, free medical center for medical emergencies (and also non-emergencies) was a hammer blow in the case of Meghala.

Nothing works like a sensational death

Almost every single legal entitlement or “benefit,” or even the promise of one that Murugamma’s family has received, has come their way after Meghala’s death – the AAY card, the promise of a BPL card and disability pension, and even regular visits by the Anganwadi staff.

These hasty attempts at either covering their backs or providing token social welfare benefits to the kin of the deceased, leave a lot to be desired. On one hand, all this unprecedented media and political attention on Murugamma’s family alone have left some of their neighbours nonplussed, many of whom suffer from similar social problems and harbor genuine grievances. Murugamma’s neighbours, who too have suffered the governmental apathy, have vented out their anger on the unfortunate Murugamma and Ruth, as they saw her getting all the attention when they too were on the same boat.

Even more critically though, there is the real risk of the state administration being completely oblivious to the real extent of childhood malnourishment if all the outrage is only going to result in a few posthumously delivered sops only to the affected family.

Many more ‘Meghalas’ waiting to happen

The name ‘Nawaz’ kept popping up in conversations with social workers familiar with the malnutrition scenario in D J Halli. Severely affected by cerebral palsy due to chronic malnutrition, seven-year-old Nawaz’s condition remains very serious. Yet there is precious little support from the various governmental sections. Both Nawaaz, and seven-year-old Ismail, another D J Halli resident, were identified as being severely malnourished, weighing just 12 kgs when surveyed last year.

Some surveys have indicated stark differences in the nourishment levels of children from families identifying themselves as APL and those identifying themselves as BPL, a clear indication that the ICDS benefits were not reaching those most needy.

Nawaaz and Ismail, along with many other severely malnourished children in the neighbourhood, and in this state, are in real danger of slipping away from the state’s porous social safety nets.

Will the government act now?

Government needs to do the following urgently.

• Ensuring children, pregnant and lactating women, and adolescent girls are given access to regular, nutritious food and rations, clean water and a sanitary environment

• Ensuring Anganwadis are adequately staffed, funded and are present in numbers proportionate to the population being served

• Ensuring the local PHCs are equipped to provide adequate initial treatment

• Making sure long-term medical treatment and health care monitoring of malnourished children is available and affordable

• Delivering on the promise of providing government entitlements such as BPL, AAY and disability benefits.

The battle against malnutrition won’t even begin until these gaping holes are fixed.