The health epidemic plaguing Thar

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 immunisation 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 immunisation, 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.