A three day community health diagnosis program was conducted in a tribal community, Madakunnu, Paniya tribes, in Wayanad district of Kerala by the Department of Public Health Dentistry, Amrita School of Dentistry, Kochi, as a part of its yearly outreach program called Amritasmitham from August 31st to September 2nd 2016.
The goal of this program was to get an insight into the health care needs of the Paniya tribes based on concerns expressed by them. Information was elicited through primary data availed from household surveys in the form of structured interviews, group discussions and analysis of health care providers, community leaders and community representatives’ perspectives and from secondary data (previous studies, newspaper reports and government publications). A total of 28 houses belonging to Madakunnu tribal colony were surveyed on 31st of August 2016 by a nine member team. Doctors of major healthcare facilities (Vivekananda Mission Hospital, Muttil and Amritakripa hospital, Kainatty) frequented by tribals were interviewed. A local leader working for tribal community was also interviewed. We found that on an average five persons lived together in a single room Kucha house. Majority of them were manual labourers working for daily wages in nearby agricultural lands drawing a remuneration of Rs 400 (for men) and Rs 250 (for women) per day. They usually worked for a maximum of 10 days per month. Literacy rates were found to be poor with most of the females educated up to 4th grade and males till 8th grade of schooling.
Fever and cough were the common health issues expressed by the community for which care was sought from nearby government PHC (Vazhavatta) and two charitable hospitals (Vivekananda Mission, Muttil and Amritakripa Hospital, Kainatty). From the health provider’s perspective, tuberculosis, under-nutrition and anaemia were frequent health issues affecting them. Prevalence of this health issue especially TB was related to their living conditions like poor housing, overcrowding, lack of potable water and inhalation of firewood fumes. Consumption of alcohol and use of tobacco had a major modifying factor for their biological and social health. We find that the foremost barriers in seeking health care was difficulty in reaching the health care facility during the need, due to rough terrain, unmotorable roads, lack of frequent public transport services and financial issues. Unanimously it was reported that commuting was difficult in the dark and during rainy seasons. Lack of electricity compounded the problem leading to a situation where sick and needy were left to suffer till next twilight to access health care. When enquired about general needs, two major concerns were raised.
The primary concern was regarding housing. Roofs built of hay and plastic sheets gave way during rainy seasons leading to perennial leaks and dampness leading to associated illnesses like fever and other infectious diseases. Our observations reconfirmed these issues and in addition we deduced that the problem of overcrowding in a single room house, cooking using firewood in the same room and lack of ventilation were aggravating factors for development and spread of infections. The other concern raised was regarding the lack of potable water. Majority of the households drew water from a man-made pit on the river bank. This pit was not covered and exposed to a variety of litter and debris affecting the quality of water. Boiling of water before consumption was practiced only during rainy seasons. These two concerns were the major factor contributing to the health issues presently faced by the community.
Community leaders and doctors opined that awareness levels regarding health and disease were generally poor.
Based on the views expressed by the community, first-hand experience of the investigators and expert opinion from public health professionals, a causal diagram was developed to identify causes, factors and possible solutions to the burning health problems of the community. The following recommendations were proposed:
Continued emphasis on education and initiation of sustainable health programs is highly recommended as a long term strategy. Over a period of time, this could translate into the creation of skilled labourers widening the scope of employment opportunities.
These recommendations, if implemented, could have a positive impact on the health and overall development of this marginalised community.