Wednesday, January 25, 2017

The nowhere people of Sewage Basti

Along a narrow strip of land between the sewage treatment plant and a canal of the Sabarmati river on the outskirts of Ahmedabad, Google earth shows some shadows for about 2 kilometres. If you get to this place on foot, you find it is actually sand dunes, with about a thousand migrants living there for 9 months in the year. They are tribals from Dahod district in Gujarat and from Jhabua district in Madhya Pradesh and working as construction workers on daily wages. This settlement is called Sewage basti.
Sewage basti, ringed in red, on the sand strip between the sewage treatment plant and the canal. Sabarmati river seen in bottom half where the froth of water foam from the plant enters.         
When a small group of us visited the settlement at 10 am on a chilly morning last week, several people are returning, walking along the sand dunes after having failed to find work that day. A metro line is coming up on the other side of the canal, and some find work there; others have to go further to a naka, or crossroads and auction the only asset they own: their physical strength. They are adults, teenagers, youth in their twenties, younger children, babies in arms. They sit on the dunes, warming themselves in the sun. 

We meet a group of people in what passes for a street on the sand. This community from Jhabua lives here for nine months in the year, and gets no services. No one visits them here, so our visit generates interest. They are faceless citizens of India here: no services reach them, and not even the police visit to demand their hafta as they do in so many other places. The women get no care during pregnancy: when they are 8 months pregnant they stop working and go back to their village in Madhya Pradesh to deliver their babies. Depending on how long they remain there, their babies may receive two doses of vaccines, or more, or less. The women themselves are unimmunized. The children are all illiterate, having never been to school. Some among the youth have studied up to Standard 5 before they began this life as migrants. With no official identity here, they cannot apply for any benefits at all. During the three months they return home, there is no work for them, they say - perhaps some work as agricultural labourers if they are lucky.

On the days they get work, everyone leaves for the worksite - the older children look after the younger ones, and those a little older help in construction work. 
Some of the Sewage basti migrants from Jhabua who could not get work that day. Behind the group is a house under construction.

Their homes are flimsy, made of branches of the babool that grows there, bent semicircular and embedded in the sand, covered with sheets of polythene. If sufficient polythene cannot be obtained, a thin blanket is used as a substitute.
Homes at the Sewage basti, made of tree branches, thorny twigs, polythene bags and sheets, and sometimes a blanket.


View of Sewage basti from the road. The crane in the background is where work is going on for the metro rail line.
Sewage basti is a community of nowhere people, literally living in a world of their own, and invisible to anyone else. 








Wednesday, December 21, 2016

Weekend at Karangabahla.

I spent last weekend at the CHF run hostel at Karangabahla in Jashpur district in Chhattisgarh. I was visiting it after a gap of over two years, and there were several visible changes. This hostel is run by nuns of the Convent of the Holy Family (originally from Kerala), seven kilometres outside Pathalgaon on the Jashpur road.My husband Ravi and I had gone primarily to visit Priti and Muskaan, who have been there nearly five years now.

Priti and Muskaan with their father Dev Kumar in January 2011
 For those unfamiliar with the two girls, I wrote first about them in late 2010 here and here. The story of their finally reaching Karangabahla in early 2011 is herehere, here and here. The first picture of them in their new school uniform is here, and this is the second picture I have, taken in 2013.

Karangabahla is a small village with perhaps 50 households, and the hostel is set off the road. The convent has a garden around it where vegetables are grown when water is available - these are used in the kitchen for the boarders.

The hostel that housed 42 girls three years ago has expanded to 78 boarders now, stretching the Sisters' resources for space, as well as funds for feeding and housing them.  The nuns, being sensitive to the needs of underprivileged families in the community found it hard to refuse admission to girls who have been orphaned and whose guardians say they are unable to care for them; for younger siblings of older girls already in the hostel; for very poor families who are unable to pay the boarding and lodging costs fully or partially each year. Now they cannot take in any more - depending on the number of senior girls who finish and leave the hostel, they will be able to take in that many girls only. 

In order to accommodate the additional student strength, the nuns have been allotted funds by their house to build an extension over the study room and kitchen which will have two rooms, and a toilet complex. Construction is under way, and funds will need to be found for furniture. An enclosed covered space has already been made for the girls to sleep in during the summer and to hang out their clothes. A portion of this has been enclosed fully to store blankets and mattresses in the summer months.


Thanks to generous contributions from friends and well-wishers, the boarders all have mattresses and blankets for use in winter; a new set of kitchen utensils; a small solar panel that provides solar lighting when they do their homework at night (The entire area, like large parts of rural India, has extensive power-cuts and even if the power does not fail, the voltage is often too low to read by); a generator to pump up water when the power fails or the voltage is poor; and a new toilet block. The studies of seventy of the girls are supported by others - fifty-nine from grants, and eleven from individual donations. None of the girls know who is supporting their studies and boarding, nor are the donors allowed direct, individual interaction with the student they support. Personally I think this is an excellent policy that the nuns follow.

The nuns lead simple lives, five of them live in the convent which is an extension of the hostel. They are careful to see that benefits to the hostel are not utilized by them. This small community has five nuns - one in charge of the hostel, two at the school, one for the dispensary and one in charge. The sisters who teach, as well as Sr Chaitanya (the oldest, and one who is now in charge of the hostel) supervise the homework of the children each evening. The older ones (Standards 6, 7, 8) study mostly on their own, but the younger ones need more supervision and help.

The school within the same compound is run by Diocesan priests and has upto 800 children - a mix of Yadav and Oraon children attend classes Kg to standard 8. After the 8th standard, the girls from the hostel will have to move to one of several hostels in larger towns around.

Priti and Muskaan have settled in well - probably the first time in their lives they have felt secure and been certain where their next meal is coming from. Their father calls every week from Bombay (at least, that is where we think he is). Their mother used to call them too, before she died (according to their father Dev Kumar) of a snake bite two years ago. However, they long to see their father, who has never once visited them in the five years they have been here. They watch with envy when other girls are visited by their parents, or their birthdays are celebrated with the family visiting and often bringing a small cake. No one comes to visit them, nor do they have any place to go to during the holidays. (They are from a place called Akaltara in Janjgir-Champa district of Chhattisgarh. Attempts to contact family there when the girls first joined here were met with a firm refusal to take the responsibility for two girls).

During the holidays, five other girls stay behind with Priti and Muskaan - one girl from Madhya Pradesh who is the fifth girl in the family and whom her family has virtually abandoned here; and four other girls who are orphans and whose guardians express their inability to take care of them during the holidays. They eat along with the Sisters at these times.

Muskaan and Priti outside their hostel, December 2016.


For the older girls, the dormitory is also their study.
Younger girls complete their homework in the study room.
Parents pay for the hostel and the school, though some are able to make only partial payments. Funds for food supplies are allotted partially by their order, some are donated by a few merchants in Pathalgaon, and donations (in cash or kind) are gratefully accepted.  There are four new boarders for whom financial support is sought.

The hostel is a place humming with activity when the children are back from school, and in the early mornings. They have three meals a day, have a set schedule that includes prayer, supervised study time (morning and evening), time set aside for working in the vegetable garden, for play, and for washing and bathing. Occasional picnics are organized by the Sisters to a nearby place.The children seem happy there, and in good health, and all are at the top of their class in studies.

The hostel kitchen serves lunch to 80 additional day students, both boys and girls, who are too poor to bring their own lunch. Almost of all them arrive hungry to school, sometimes after a walk of 8 or 9 kilometres.

video 
Action song by the younger girls. 


On receiving their writing kit
Construction of extension wing under way.

Enclosed covered verandah for sleeping and for drying clothes.

The hostel students along with the Sisters, on the terrace of the hostel, December 2016.
The nuns welcome any kind of support to the hostel, financial or in kind - a small gift of money this winter got them all thick sweaters; the gift of a writing kit (pencil case, erase, sharpener, pencil and a box of crayons) had the students delighted. The hostel needs funds for various things - ongoing need of purchasing food supplies (the grant from their parent institution is never quite enough) and scholarship support for four more girls (needs to be ongoing for the duration of their studies in school), and benches and chairs for the study room for the senior girls in the hostel, among other things. Over the next two years, the sisters are looking at installing a solar water heating system for the hostel and convent (at present the children bathe in cold water, even in the cold of winter), as well as solar cookers for the hostel kitchen. Establishing a small library of appropriate reading material in English and Hindi is also needed. Costs are still to be worked out. 

At Christmas time each year, the Sisters organize a party in the hostel for all the children with a special treat. Last year it was scarves for the girls. This year they will get a tiny jar of Vaseline each for their chapped lips. Whatever the nuns can afford to spare from their budget that year determines the gift. 
Playing with balloons during the Christmas party, 2015.
At the end of a year that had little to cheer about, the visit to Karangabahla raised our spirits immeasurably. It is an ongoing tale of hope, of giving poor families the opportunity of a safe space to educate their girls; of empowering these girls and young women for a better future. In this tiny corner of Chhattisgarh, the nuns are quietly doing a remarkable job.

Friday, September 23, 2016

East and West - a slice of Odisha in Gujarat

Surat is a bustling, prosperous city, known for its diamond cutting and polishing industry, as well as for the largest production of man-made fibre in India. It has one of the largest wholesale textile markets in the country, and has thousands of powerloom units for production of cotton and synthetic textiles.
Surat the textile city, by night.

Last Sunday, I was given a glimpse into a part of what makes this city the capital of India's textile industry.


Raju's Dance Academy in Meena Nagar
Meena Nagar is one the areas where powerloom mills abound. Its busy streets and narrow lanes are all bustling with activity - with no women to be seen. This is one of the hubs of migrant workers from Odisha - an estimated 700,000 of them in the textile sector alone.

Raju (name changed), who shows us around, wears jeans and a full-sleeved T-shirt. He is thin and wiry, with bright eyes and a cheerful smile. He is also from Odisha, and proudly points out his shop on the first floor of a larger building. This is the Realy Dance Academy which he runs and says is doing well. (It teaches hip-hop, Bollywood, Canterbury, Kathak, Break, Step-up, Fri Style, Sambalpuri, Classical, Pop and Bebop). He moved to this after he saved up some money working on the looms. He was fortunate not to have family members needing support and is one of the very few who could move out of working on the looms at a young age. He is most probably a second generation migrant in his family - many migrants have brought their families here and settled down, creating a mini Odisha, complete with Oriya schools and cinema theatres showing Oriya films.

We first go to see the "mess" where the loom workers live - one is through a narrow dark , damp corridor, up three flights of crumbling, sometimes slippery, narrow stairs with no railing to hold on to. At each landing is a smelly toilet overflowing with water (and perhaps worse), which sometimes drips onto the landing below. The smell is overpowering and nauseating.

On the third floor we enter the kitchen where enormous quantities of rice and daal are being cooked. I see no signs of any vegetables other than potatoes and onions. The mess in charge is here, who manages the kitchen as well as the facilities for the migrants - water and electricity and the rent. The building is rented by him from the owner. He charges Rs. 2200 per month from each man for stay, and for the meals. The floor above the kitchen is where the workers live - over a hundred of them in a room barely 100x40 feet in dimensions. There are no windows to this room. Clothes lines criss-cross across the room, sagging beneath the weight of wet and dry clothes. Along the wall are tin trunks and rexine bags holding the belongings of the men who live there. Several are fast asleep, but about a dozen gather around us to talk. They have just completed a 12 hour shift in the looms, and have had a bath. They will now eat and sleep for most of their shift off. For entertainment they watch movies loaded onto their cellphones in nearby shops for a small fee.

They are all from Ganjam district in south Odisha, and are surprised and pleased to know that I know the language, and that I have lived in Ganjam for four  years.They range from 18 to about 45 and have worked here from five to twenty five years and more. They say the work is tough - 12 hour shifts with no days off; no sick leave or leave to go home to Odisha. They go at their own cost once or twice a year, not earning when they are away. Each month they send some money home through small shops that facilitate money transfer through banks. These shops charge a steep Rs. 25 per Rs. 1000 that they need to send home, but it is convenient for the workers to hand over money to these entrepreneurs. The banks are reluctant to keep transacting small amounts of cash each month from the worker to their account in Odisha. Besides, most are asleep during banking hours.Still, the pay here is better than what they would earn at home. A novice is paid around Rs. 8000.00 per month after he has spent some months learning the job (when he is not paid at all, but usually a senior family  member who is already working on the looms looks after him). More experienced workers earn upwards of Rs. 15000.00 per month. I listen in silence, wondering how we as a country can be utterly indifferent to how workers in our factories work and live and eat and earn.

There are many such messes in this part of the city.

Raju next takes me to see some of the looms. We go into the next street, into a series of three and four storeyed buildings which are crumbling and have not seen a coat of paint in years. The path in between the buildings is littered with knots of synthetic fibres that have been discarded after the weaving process is done. There is a steady clack-clack-clack sound emanating from the buildings, which only gets louder as we draw closer. Visiting one of the powerlooms takes a fair amount of negotiation with the supervisor who checks with the owner that he has been informed of our visit. Finally we are allowed in.

The noise inside is deafening and throbs through you, as well as through the floors and walls of the building. The building seems to be vibrating too, and I wonder whether it will collapse on our heads - it seems decrepit enough. On the floor are a row of powerlooms, each with a red light glowing as the machine works and the shuttle races back and forth across the loom between the frames. When the thread breaks, the light goes off and `the machine stops. The worker then has to restore the thread and start the machine again. Each worker monitors twelve looms. We can barely hear ourselves speak as the noise of the looms drowns out all sound - indeed, all thought as well.
Thread being wound onto the spindles for weaving.
The floor above has rows of machines which wind the thread from large reels onto the spindles that will then be used in the looms.

I tried to discreetly record a few seconds of the sound inside the loom - a bad recording with my low-end cellphone, trying to keep my clothes from getting caught in the machinery. To get an idea of what it is like, play this sound clip on the maximum volume your device will allow. The sound is much, much louder than this.

video

Twenty minutes inside the powerloom shed and we came out with our ears ringing and a temporary deafness. What does it do to people standing there for twelve hours every day, day after day, week after week, month after month without a break? Noise induced hearing loss for sure; stress due to the long hours and the high level or noise (Powerlooms typically generate 90-100 db of noise, whereas city traffic noise level is about 85db, and ordinary speech is 55 db). Every 10 db increase means a doubling in loudness. At the noise levels in powerlooms, and working for twelve hours at a stretch, hearing loss is guaranteed. Additionally, noise induced stress as well as inability to concentrate are well known.

All the powerloom sheds have officially less than ten employees, thus keeping them out of the purview of the Factories Act where certain rights and privileges of the worker are guaranteed by law. Most of these workers are in the informal sector, vulnerable to exploitation by the employer.

Power looms like these are also now struggling to keep up with the competition provided by more efficient water jet looms and newer designs of looms. Hence the lack of investment in upkeep (apart from the minimum to keep the machines running), and the reduction in the workforce (where earlier one worker tended to four machines, now each worker looks after twelve looms), in an effort to cut costs.

I left Raju at his Academy after visiting three powerloom sheds and two messes, marveling the hope and joy in youngsters who have enrolled in his dance academy, even living in this environment of displacement across the country for hard work, poor living conditions, and even poorer wages. I feel angry and depressed too.

Driving back to the hotel, the glittery buildings and the flyovers of Surat are not so impressive any more.







Sunday, May 1, 2016

Uttarakhand diary

Forest fires between Ramgarh Malla and Bhimtal
Smoke rises from fires near
Sitla

The mountains are on fire. Literally. I was in Nainital district for a week, and smoke haze lay thick in the air. Driving up from baking hot Kathgodam last Saturday afternoon, the driver Dinesh tells me the Gaula river running past the town has been dry for some weeks now, and each year there is less and less water in it. Our destination is a village called Khansyu in Okhalkanda block in Nainital district. The normal route is past Bhimtal, but Dinesh seeks an alternative, longer route as the Bhimtal road is blocked, and there are many fires along the Bhimtal road.


I try to ease my nausea induced by the numerous hair-pin bends by lying down in the rear seat of the taxi, but it not helped by the acrid smell of wood smoke. In some places the smoke smells of pine. We drive past tree trunks charred and still burning.

The dry river bed of Gaula river near Khansyu
Khansyu is in a valley in Okhalkanda block. The Gaula river flows at the base of the valley, and is completely dry. This is the river that supplies water to Kathgodam. Nain Singh, the local co-ordinator of the project I am visiting, tells me that in the six years that he has been here, this is the first time it has run dry.

The place is beautiful, layers and layers of mountains all around. That evening, though, I see a fire creeping up the hill opposite. I cannot see other fires, but I know they are there. The next morning, the valley is full of a smoke haze.


A fire creeps up the hill near Khansyu
Smoke haze in the valley at dawn.
The reason for the fires are discussed locally - was it the locals who tried to burn the grass? Was it the dry winter with no rain at all? Is it the pine forests that help to spread this fire far and wide? Some blame the pine (an import by the British) for it all, saying it depletes ground water, does not allow other trees to grow, and that it is highly flammable.

There is a terrible water shortage in Khansyu and the villages around, and indeed all over Nainital district. Water is guarded jealously, and having your water tank emptied in the night is not unusual. During the week I was there, water was supplied twice.




Driving back to Kathgodam on Friday, we cross large tracks of mountainside that have already burnt out - blackened tree trunks (some still smoking), an eerie silence with no bird calls, no crickets chirping, and an overall bleakness. Would the earth look like this after a nuclear holocaust, I wonder - such total desolation?

Closer to Bhimtaal we see and hear fires again, and just a few kilometers before Kathgodam I spot large areas of mountainside that have been sheared clear of trees and dirt. Landslides during the monsoons last year, Dinesh tells me. They stand out as ugly white streaks many metres wide, against the brown and green of the mountainside, ending in a pile of boulders at the bottom of the valley.

The mountains are achingly beautiful, but how long can we preserve them that way?

5 pm: Just received the sad news that Nain Singh's landlord died on Saturday, trying to save people of his village when the fire threatened to engulf their homes. He sustained 80% burns and was taken to the hospital in Haldwani, but could not be saved.




Thursday, April 7, 2016

Where do we go from here?

Bicky, 9 and his sister Vaishali, 6, are children of a gardener who works for our landlady downstairs, as well as for several other house owners in this relatively better off part of Bhopal. They are both first generation learners, their parents having moved to the city to give their children a better education than they could get in their village. You can see them last year, elated with their new uniforms and ready for the new school. (They moved schools to one in the neighbourhood, when their parents moved to live in this area).

Vaishali and Bicky, 2015
Bicky is in Standard 3, and is in a Hindi medium private school. He is not able to read simple words in Hindi, nor construct a sentence. His English textbooks have been selected by the school, and have words far beyond his comprehension, telling stories that he cannot relate to. While he struggles to spell "table" and "door", his English textbook talks of the "quest" of a prince in search of the "most beautiful princess in the world" and of the beautiful girl who knocks on his palace door on a night of "torrential" rain. 
Bicky can neither spell or understand what all this is about. Yet his workbook is complete, and correctly done. 
How is this, I ask him. 
The teacher writes the answers on the blackboard, and we copy them down, he says. Then she marks them as correct. 
His parents send him to a tuition teacher each afternoon, paying the same amount as the the school fee each month. 

Vaishali is in Standard 1, and her parents put her in the English medium section of her brother's school, hoping she will have an advantage over others studying in the Hindi section. She has a problem recognizing alphabets and numbers, though her English workbooks, too, are full of words copied from the blackboard and marked as correct answers. However, her maths skills are passable, and she can do two digit addition (don't ask her to recognise and name the numbers, though). She is in a class full of upper middle class children in this neighbourhood, and is not getting the extra attention she needs to learn. 
She, too, attends the same tuition classes her brother does, and neither seems to benefit from the tuition one bit. 

When they come upstairs to study, I keep trying to make sure they learn their basics, while they are under pressure to prepare for the test the next day. I am aghast at the quality of teaching going on in their schools, and how they and their parents are being cheated. If they cannot be provided a proper primary education, where do they go? Who regulates the quality of teaching in all the small neighbourhood "private" schools that spring up like mushrooms everywhere? 

Don't we owe our next generation anything? Can we honestly look these children in the eye and say we have given them a fair chance?

Tuesday, December 29, 2015

An inspiring man

I find that my blogs related to health services in rural India have mostly told negative stories, of services not provided, of indifferent or hostile care providers,of difficulties in access and availability of basic services. I have met many cynical or jaded or dishonest health care providers, be it ANMs or doctors, ready to misuse the system, or just be indifferent and do the bare minimum possible. There are any number of excuses - some valid, some not - as to why they are not doing what they are supposed to be doing. There have been a few very good ones of course, and the effect is immediately apparent - a motivated team, or a community that is immunized or gets the services it should. And these people keep the system going.

Dr N Saxena, Civil Surgeon, Rajgarh
Last week I visited Rajgarh district in Madhya Pradesh. It borders Rajasthan and the district headquarters town of Rajgarh is dry and the landscape more akin to desert areas - in complete contrast to the southern part of the district that is forested. My colleague and I visited the district headquarters hospital which is housed in an ancient building. We met the Civil Surgeon Dr Niranjan Saxena who is in charge of the running of the hospital. In the hour we spent talking to him about facilities provided at the hospital, and constraints faced, I watched him process several files. These were of patients who needed more care than the hospital could provide - facilities that were often available only in private facilities, at a cost the patient could not afford. He was instructing his assistant about which scheme could be utilized for which patient, and what amount. For instance, there was one child who had come with headaches, who turned out to have a benign brain tumour. The family could not afford the treatment, and Dr Saxena recommended a grant of Rs. 1 lakh from the State Illness Assistance Fund.

He informed us that he uses this fund, as well as the Chief Minister's Scheme for health assistance, in addition to the Deendayal programme for financial assistance in health care. He is a surgeon by profession, and carries out all kinds of surgeries - general and orthopedic surgeries (including amputations where necessary); obstetric and gynaecological surgery when the obstetrician is on leave; and cancer surgery. They see about 20 cases of oral cancer each month, and 1-2 cases of breast cancer. Post-operative cancer patients are then referred for radiation or chemotherapy to higher centres that have these facilities. Day care for chemotherapy is provided at this hospital, once the regime has been prescribed by a higher centre.

Not many women with cancer of the uterine cervix are seen, he said, probably because too many women have their uterus removed at an early age. A sad commentary of our times.

Dr Saxena was full of energy and enthusiasm, and informed us he retires at the end of the year, when he turns 65. One would not think it, to look at him. An inspiring man and one that the health system could utilize for some more years to come.

Friday, April 3, 2015

'Acche Din' in Salumber block

Palash amidst the all-pervading brown
Salumber block of Udaipur disrtrict in Rajasthan is a study in brown. Brown hills, bare trees, brown rocks absorbing and radiating heat in the harsh sun - hardly a welcoming place at this time of the year. Bright orange Palash flowers defiantly add a splash of colour amidst all this drabness. The only greenery is are a few thorny shrubs on the roadside or the occasional palm. I have seen these same hills in the monsoon - lush green, streams flowing, fields green with crops, so I know this brown is just a passing phase. Still I put on my dark glasses for the drive from Salumber to the clinic at Ghated, half an hour away.
The road to Ghated

The Ghated clinic opened four months ago, and is staffed round the clock by three nurses, while a doctor visits once a week. Today I accompany the regular doctor to the clinic. Amidst a range of patients who attend, I meet and talk to Bhanwarlal who is 32, and suffering from tuberculosis. 

The oldest of five children, he migrated to Ahmedabad as a teenager, working at polishing granite for nearly a decade before he fell ill and developed tuberculosis of the lymph glands and of the skin nine years ago. He tried treatment with various doctors, but did not find relief. As he got weaker, he started taking on lighter work to fund his treatment but now for the past five years he has been unable to work and has come back home. Last  year he had some months of anti-TB drugs too.

Bhanwarlal at the Ghated clinic
What stands out about Bhanwar are his eyes -large and distressed, they seem to look at you with hope that he can still be healed and get well. His eyes stand out because the rest of his face, like his body, is extremely wasted. At a 170 cm, he weighs a mere 41.9 kg, which gives him a body mass index (BMI) of 14.5. A normally nourished adult has a BMI of at least 18.5.

The scars and wounds are disfiguring and Bhanwar comes to the clinic wrapped in a shawl in spite of the heat. He has been started on Anti-TB drugs but the chances that he has multi-drug resistant TB (MDR-TB) are high.

Two younger brothers are also in Ahmedabad as migrant workers  - one polishes stones; the other works as a headloader at construction sites. The youngest brother is in college, and the family hopes he will get a better paying job than a labourer does. The youngest child, a 12 year old sister, also has swellings in the lymph glands of the neck now.
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The deforested Aravalli hills: one the way to Bedawal
The next day I travel to Bedawal, to another clinic. The road to Bedawal winds through more hills, now bare and revealing half-hearted efforts at reforestation. However, these cannot hide the fact that the Aravallis have been devastated over the years through unregulated cutting of trees, and, in some places, mining for granite and marble.


Rajudi, 40, Devliya village

40 year old Rajudi of Devliya village awaits me at the clinic, with cough and breathlessness. Her husband died of TB and she herself was treated six years ago with some drugs (unsure whether correct dose or duration). She too, like Bhanwar at Ghated, is wasted, weighing only 33.2kg at a height of 153 cm (BMI 14.2). She is severely anaemic and on examination I find evidence to suggest that part of her right lung has probably collapsed. It is difficult for me to make out whether her breathlessness is due to her anaemia or her collapsed lung. Her children too, like her husband, are migrant workers in Ahmedabad.


Phuski
Phuski, 65, comes in with nausea and giddiness. She says she is not hungry. She too is severely anaemic, with a hemoglobin of 5gm%. I ask her who she lives with, what she ate the previous day. She tells me she lives alone, and ate one roti the day before. When I ask her why did not eat more, she looks away and mumbles that she is not hungry. I ask about her old age pension: she gets Rs. 500 per month, she tells me, and uses it to buy spices, some jewellery....I wonder what she is hoarding jewellery for. Again, I am not sure whether her giddiness is due to the anaemia or her hunger. I can see she is starving - weighing only 33 kg at a height of 153 cm, her BMI is below normal. She insists she is OK except for her giddiness.
The senior health worker tells me her oldest son takes away her pension each month as soon as she gets it, and the neighbours feed her, depending on what they can spare each day.



This is the context in which the AMRIT clinics function.