By Ali Nawaz Rahimoo
The Tharparkar desert in Sindh boasts an area of 22,000 square kilometres and is host to a population of over 1.6 million inhabitants, most of which reside in 2,880 villages which fall under seven talukas or tehsils, namely Mithi, Diplo, Chachro, Islamkot, Nangarparkar, Dahli and
Kaloi. The expanse is divided into 64
union councils. District Tharparkar was separated from district Mirpurkhas in
the year 1990 and Mithi was designated as the region’s headquarters. Despite
the demarcation, the infrastructure in Thar remains abysmal. Not only does Thar
battle yearly droughts and famine, it also struggles with a high infant
morality rate, with over 700 children dying till November this year.
Malnutrition has been deemed the primary cause of the high number of infant
deaths. The plot thickens when you add to it the fact that malnutrition is a
common problem in the area, affecting both the adults and the children. Many
women who give birth are malnourished themselves and are unable to breastfeed,
which is essential for building an infant’s immunity and health. It is
therefore important to understand the cause behind malnutrition. The people of
Tharparkar are dependent on agriculture and livestock. The region’s staple
crops are jowar or sorghum and bajra or millet because both are robust plants
that can survive the harsh conditions of the area. Apart from these two crops,
they also grow mung beans, bulgur, wheat and chili. Even though the crops can
tolerate extreme weather, they do need some water to survive and Tharparkar is
the only agricultural area of Sindh that does not have a fresh water source,
leaving it at the mercy of the rain for irrigation. The year that the area does
not receive rain, the crops are affected, resulting in the scarcity of food.
Such is the fear of an imminent drought that people store a year’s worth of
sorgham or millet and then continue to eat it throughout the year. In a study
conducted in 2014, it was discovered that only 17% of Tharis enjoy food
security for six months whereas only 1% of the population experiences food
security the whole year round. Owing to poverty and the lack of infrastructure,
transporting fruits and vegetables to the area is not feasible and are not a
part of a Tharis diet. This essentially deprives the people of Thar of vitamins
and minerals that many of us consume, leaving at least 80 per cent of women
with anemia. Anemia leads to a lower red blood count and deprives a mother of
the iron needed to aid the baby in the second and third trimester, which
affects the new born child and his or her weight at birth. The average weight
of a new born in Pakistan is two to three and a half kilos while the average
birth weight in Thar is less than one and a half kilogram. This exponentially
increases the infant mortality rate because such children are unlikely to
survive in the harsh Thar environment. Moreover, as mentioned above, Tharparkar
suffers from a fresh water shortage. Women fetch water for their families on
foot, every day from a communal source situated several miles away. Constantly
lifting and carrying heavy water pots over long distances results in many
health problems, particularly among pregnant women. Mostly, these communal
sources are wells which contain water that is brackish and not fit to drink. In
fact, nearly 80 per cent of groundwater found in the area is unfit for human
consumption. However, with no alternative, the people of Thar are forced to
drink water that has dangerous levels of fluoride, as high as 32mg/l. It is worth mentioning here that the World Health Organisation
(WHO) guideline value for fluoride in drinking water is 1.5mg/l. A high
fluoride intake causes dental mottling and skeletal calcification or fluorosis,
osteosclerosis, thyroid and kidney problems. It also leads to irreversible
chronic bone and joint deformations. Then there is the issue of child marriages
and teenage pregnancies, which directly contributes to the poor health of both,
the mother and child. The concept of
family planning is alien to those living in big cities, so it is not surprising
that not many pay heed to the idea in Thar either. Childbirth centres and
general health facilities are practically non-existent in Tharparkar. Several
doctors have been appointed on paper, but very few are actually seen performing
their duties. There are a total of 84 community midwifes working in the
district, which means that for every 34 villages, there is only one midwife. Additionally,
there is only one notable civil hospital in the entire region which is located
in Mithi. As a result, villagers have to travel anywhere between two to four
hours in order to avail basic health facilities. To add salt to the wounds, the
hospital at Mithi is quite dilapidated as well. Therefore, for serious issues,
villagers are forced to travel all the way to Sukkur which incurs considerable
travel costs and trauma for the patient involved. Such travel expenses eat away
a major chunk of the average Thari monthly income which is less than Rs 5,000. Another
reason for the high infant mortality rate is the close proximity of people and
livestock. The current livestock population of Tharparkar district is
approximately above six million. Livestock, fully or partially, contributes to
the finances of almost every household in the district. Simply put, these
animals are prized assets and so, they are kept close to the owner’s dwellings.
Consequently, diseases spread from animals to humans very quickly. Malnourished
infants have reduced immunity as it is, making infectious diseases transmitted
by animals deadly. Thus, the immediate opening of immunization centres for
animals and veterinary doctors is needed. To conclude, I would like to propose
certain remedial measures which may help alleviate this horrific crisis. It is
the need of the hour to provide clean, drinking water to the people of
Tharparkar and perhaps installing desalination plants along with solar powered
water pumps and mounting tube wells would be a better alternate for the people.
A children’s hospital with functional wards must be opened in every taluka or
tehsil. Female medical officers should be installed at basic health centres.
The current contingent of 1,091 lady health workers must be dispatched to
villages so they can raise awareness about reproductive health. Parents must be
educated regarding pediatric nutrition and childcare. Furthermore, specialist
female doctors, particularly pediatricians, gynecologists, and physicians must
sent to the region. Programmes of immunization, antenatal care, and child care
should be introduced. Public sector dispensaries and maternity clinics should
be set up to provide easier access to the needy. Due to the lack of carpeted
roads, a four-wheel drive ambulance service should also be initiated so
navigating the dirt tracks is easier. The government must also take strict action
against those who violate the Sindh Child Marriage Restraint Act of 2013 in
order to reduce the percentage of young mothers. In summation, even though it
seems like the issues plaguing Thar have no end, if the provincial government
takes appropriate remedial measures, the crisis can be alleviated within a few
years.
The Health Epidemic Plaguing Thar
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