On April 19, Zahida Begum, travelled 25 kilometres by motorbike to attend her sister’s wedding. That evening, she got diarrhoea and began to vomit, so came to the Mahbubnagar government hospital with her husband the next day.

Zahida Begum, 35, was a patient at the Mahbubnagar government hospital, where a special 24-bed ward for sunstroke cases was opened in April. It gets 10 to 15 cases of sunstroke daily.

As unusually high temperatures at the end of March continued into April, occasionally crossing 45 degrees Celsius, an unfortunate side effect has begun to emerge. April is traditionally wedding season and as people congregated to celebrate, they risked the sun – and their lives.

People tied to agricultural work usually have money in hand after harvests in January and February, enabling them to organise weddings in March and April. On one day in Mahbubnagar, this reporter heard four separate wedding processions in one village – just after noon. This is reflected in government hospitals as well.

For Sheshamma, 66, of Chelimilla village in Pebbair mandal, it was a festival. On April 6, she went to attend a festival in Penchikalpadu, 12 kilometres away. When she returned, her body was dehydrated, she had diarrhoea and was vomiting.

Her family took her first to a Venugopal Hospital, a private hospital near their village, but the staff there claimed not to have the facilities to treat her there. Sheshamma's relatives then took her to a series of government hospitals, first in their mandal (as talukas as known in Telangana), then the district headquarters of Mahbubnagar and finally to the state capital of Hyderabad, where she died on April 8. Four days later, her son-in-law went to sleep in the shade of a tree after being exposed to the sun. He too died of sunstroke.

Eager for action

The heat wave stretching in patches from Bihar to Kerala is a result of a shift in the western disturbances in North West India, said Brahma Yadav, a scientist at the India Meteorology Department. Ordinarily, as temperatures across peninsular India begin to rise in March, thunderstorms that form when interacting with the air pressure trough help to keep a check on them.

This year, the western disturbances are too far north, resulting in a lack of thunderstorms, and coupled with warm ocean temperatures because of the El Nino, there has been a steep rise in temperature. This heat wave might break by the first week of May.

An alarmed Telangana government has set into motion a Heatwave Action Plan. The heat wave, though anticipated, began an entire month before it was expected.

The government had already been bracing for this after a severe heat wave in May 2015 resulted in the deaths of 585 people in Telangana and 1,735 in Andhra Pradesh. In August, a group of bureaucrats in Telangana’s disaster management department began to draw up their plan for a new action plan to deal with heat waves. This plan, one of only a few state-wide heat action plans in the country, was circulated to all collectors by March 4.

“This year, unfortunately, the heat began early and in a series of waves,” said Vinod Ekbote, assistant commissioner of Telangana's disaster management department. “The season is usually May, but we had fortunately prepared plans in advance. Our aim is that the death toll should be less than last year. Ideally, it should come down to zero, but this will take time.”

Ekbote hopes that with feedback from its implementation this year and with consultation from outside experts, the department will be able to hone the plan further to ensure that it is effective.

Like any other natural disasters, deaths due to heat exposure are not entirely preventable. At best, a government can hope to minimise people’s risks, not eliminate them.

Among the ideas suggested in the plan that outlines the responsibility of various departments before, during and after a heat wave, are to identify people at risk, provide shade and water at public places, send out SMS alerts, provide buttermilk to bus drivers and minimise bus operations in the afternoon, shut down schools in the afternoon, and have medical units in major bus stations. Orders are sent out from the revenue department to others, including labour, health, transport, and education. These are reviewed weekly.

The district administration is making efforts to raise awareness, said Joint Collector Ram Kishan.

“We have 20 kala jaatas [performing groups] in Mahbubnagar and for the past 15 to 20 days, they have been going to raise awareness about conservation of water and on sunstrokes,” he said. “We can print information in newspapers and pamphlets, but most people will not read this, which is why we are pushing other methods.”

Unanimously, none of the people who had been affected by the heat, either in hospital, or the families of those who had died, had heard any warning about the severity of temperatures on the day they were exposed. Even if they had, it might not have made a difference. A significant number of people at risk are daily wage labourers who have no option but to work or to starve.

But there is a wide gap between the plan on paper and its implementation on the ground.

For instance, an official at the Mahbubnagar district collectorate said that the labour commissioner had ordered that construction work be halted in afternoon timings. In practice, there is no real way to enforce this. At 2 pm the same day in Mahbubnagar city, construction sites buzzed with activity.

“Some of us get small fevers, but we don’t go to the hospital,” said Eapally Govind, a daily wage labourer working to construct a five-storey building. “We are responsible for our own illness. The contractors just give us filter water to drink. But nobody here has had sunstroke yet.”

Although the afternoon sun blazed outside, the inside of the building where Govind was working was relatively cool. Govind travels 50 kilometres daily from his village to Mahbubnagar, where he waits for work at labour addas each morning. But far fewer labourers have been working this year, mainly because of the heat, he said.

“Those of us who are still working are poor and so we have to come,” he said. “If we do work now in the heat, we suffer, especially those of us outside. There is no daily work in the villages so we have to come here.”

No other choices

In response to the heat wave, the Telangana government has ordered no work for the National Rural Employment Guarantee Scheme to be done between 11 am and 4 pm.

This was not the case for Gudise Krishnaiah, who on April 10 had worked from 8 am to 2 pm at his National Rural Employment Guarantee Scheme job site, removing large stones from the land. That night, he too vomited and had diarrhoea and asked for water several times.

Since he was concerned about missing work and a day’s wage, he decided against going to the hospital the next day. He got ready by seven the next morning and as he stepped out of the house, collapsed and died immediately. He and Sheshamma are one of the few people the government has acknowledged to have died of sunstroke.

After his death, the local government shifted work timings to between 6 am and 10 am. Activists too are asking for the official state window to be expanded so that work ends by 10 am, and also to reduce the amount of work expected for each worker to earn

“We advise people not to work between 10 and 5,” said Rambabu Nayak, medical superintendent at the Mahbubnagar government hospital. “Most cases here are of mild sunstrokes, but there might be people who live far away from hospitals who might not get treatment fast enough.

Most of the people in the sunstroke ward at the government hospital could not afford private treatment. Even so, they had to purchase medicines with their own funds. One bag of saline and an injection can cost up to Rs 500 – more than twice an average daily wage for women in Mahbubnagar.

“I am missing out on wages, but sunstroke is also a problem I can’t ignore,” said Padmamma, 50, who had gone to a relative’s wedding two days ago and had been in the Mahbubnagar hospital for two days. “What else can I do?”

This is the concluding part of a two-story series on the Telangana heat waves. The first part can be read here.