On August 25, 49-year-old Dana Majhi, a tribal man from Melghar village in Kalahandi district of Odisha who works as a daily wage labourer, carried his dead wife on his shoulders for nearly 12 kilometers accompanied by his weeping daughter after he failed to get a mortuary van from the district headquarter hospital in Bhawanipatna. The sight, captured in videos and photographs by reporters, seems to have shaken the collective conscience of India.

Just two days after this incident, videos of another horrifying incident emerged from Balasore district in which a hospital worker breaks the bones a dead body with his foot to make it compact. He then helps another man put broken body into a large plastic bag and the two sling it on a bamboo stick. The body belonged to Salamani Barik, a 76-year-old widow who died in train accident. The man carrying her body is her son.

On September 1, photographs were circlated of tribal woman Sunita Bhatriya of Singari panchayat in of Rayagada district of Odisha delivering a baby inside a Tata Magic while on her way to the hospital. The much advertised 102 and 108 ambulance services could not reach to her in time.

Television screen grab of a woman delivering her baby in a car.
Television screen grab of a woman delivering her baby in a car.

These haunting pictures made news all over India. But none of this is uncommon in Odisha.

In 2010, Santosini Sisa, resident of Phulpadar village in Odisha's Koraput district, was 40 years old and eight months pregnant and suddenly developed health complications. She needed immediate medical attention but getting to a health facility was easier said than done. The primary health centre closest to Phulpadar is in Padua village, about 10 kilometres away. Traversing this distance may seem simple enough by city standards, but for Santosini it would be like an obstacle race. First she would need to cross the Patali River, which could be in spate after the rains. To get her across the river, her husband had to tie her to a pole and carry her through the water.

Santosini then had to walk another three kilometres to reach Goluru village, where she would waited to catch one of the few private vehicles running to Padua, a distance of about four kilometres. Luckily, both Santosini and her child survived.

Eight months pregnant Santosini being carried across a river. Photo: Sarada Lahangir.
Eight months pregnant Santosini being carried across a river. Photo: Sarada Lahangir.

A few years ago a couple from the remote Malkangiri district carried the body of their 14-year-old son back home from a hospital because there was no serviceable ambulance. “My son had severe fever and loose motion,” said a crying Jana Kadraka, the boy's father. “The local health centre is at Badpada, about 12 kilometers from our village and there was no transport to take him to the health centre. So we had to walk miles, carrying my sick son on a bamboo cot but it was too late and by the time we reached my son was declared dead.”

Jana Kadraka and his wife carrying their dead son. Photo: Sarada Lahangir.
Jana Kadraka and his wife carrying their dead son. Photo: Sarada Lahangir.

These incidents do not surprise journalists in Odisha any more. Anyone who has reported from the more distant parts of the state must have come across these tragic scenes.

What is disturbing is that after 70 years of independence and the implementation of numerous social and health welfare programmes by both the state and the central governments, Dana Majhi still did not have access to a mortuary van or ambulance to transport his wife body. This clearly shows the failure of several government schemes and programmes meant for the welfare of poor people and highlights the health service issues that have never been addressed in Odisha.

According to the norms fixed by the National Rural Health Mission, there should be one subsidiary health centre for a population of 5,000, a primary health centre for a population of 30,000, and a community health centre for a population of 1.20 lakh in non-tribal areas.

In tribal dominated areas, there should be a subsidiary health centre for a population of 3,000, a primary health centre for a population of 20,000 and a community health centre for a population of 80,000, according to the general and social audit report of 2014 by the Comptroller Auditor General.

Going by the 2011 census report, Odisha should have 11,967 health centres. However, at present, there are only 8,291 health centres in the state, which include 377 community health centres, 1,226 primary health centres and 6,688 subsidiary health centres. The are 31% fewer health facilities than the requirement, the report said.

Odisha needs 10,594 doctors in the state as per the stipulated norms under Indian Public Health Standards. However, there are only 3,435 doctors, which is only one-third of the required number of doctors and much less than the 5,077 posts of doctors approved by the state government. The Odisha Government has been trying to recruit doctors through an ad hoc basis, offering salaries of Rs 40,000 and a location-based incentives of Rs 20,000 per month so that they opt to stay. But it has not worked.

The state has 9, 000 posts for health workers out of 20,000 lying vacant.

Photo: Sarada Lahangir.
Photo: Sarada Lahangir.

Let’s take a closer look at just one district - Kalahandi. There are 16 community health centre and 42 primary health centres. Out of the sanctioned 212 doctor posts for the peripheral healthcare centres only just about 129 are filled.

“The hospital started by the administration under [public private partnership] mode at Nakrundi, Melghara’s gram panchayat headquarters, is yet to have permanent doctor, ” said Dillip Das, chief functionary of Antoday, a Bhawanipatna based NGO. “A pharmacist visits the hospital occasionally – two or three days a week, and runs the show ultimately.”

Food insecurity, poverty and hunger are defining features of places like Melaghar, Kangualmali, Keuamali, and Kutrumali in the Thuamul Rampur block in the district. People in this high-rainfall belt are prone to gastrointestinal diseases, malaria, cholera ad diarrhoea. Tuberculosis maternal and infant health issues are common. Health services are not easily available for people in distant villages that haven't even been connected by the village road scheme, the Pradhan Mantri Gram Sadak Yojana.

In Odisha, it is obvious that because of state apathy, poor men like Dana Majhi will continue to carry their dead on their shoulders and pregnant women will continue to risk their lives trying to have a safe delivery.