In the news: Cholera alert in Kerala, low breastfeeding rates across the world and more

A wrap of health news over the past week.

Cholera alert in Kerala

Kerala’s health department issued an alert against cholera last week after three cases of the bacterial disease were reported in the state, one of which resulted in death.

On July 24, an 18-year-old Biswajit Das, a migrant worker from West Bengal, died of severe dehydration after contracting cholera in Pathanamthitta district. The other two cases were confirmed in a labour camp in Kozhikode district. Three more suspected cholera cases have been identified, the Times of India reported.

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the Vibrio cholerae bacteria. If left untreated, it can rapidly plead to severe dehydration and death.

Dr L Saritha, Director of Health Services at the state health department told the Times of India that the state has reported more nearly three lakh diarrhoea cases this year, four of which resulted in death.

Kerala is also seeing an outbreak of other monsoon diseases such as dengue and H1N1 this year.

Couple forced to sell newborn to pay for delivery costs in Odisha

In Kendrapada district of Odisha, a couple was allegedly forced to sell their newborn daughter to foot the expenses of delivering the child at a private facility, the New Indian Express reported.

Girakar Moharana and his wife Gitaranjali Moharana, residents of a village in Odisha’s Kendrapada district, were expecting their third child and wanted to deliver her at a district hospital, the Press Trust of India reported.

According to the First Information Report lodged by the couple, they were allegedly advised by the village Accredited Social Health Activist or ASHA worker to go to a private hospital.

ASHA workers are community health activists selected from a village, under the National Rural Health Mission, to guide its residents through the public health system. Among other things, their work includes encouraging pregnant women to go for check ups and bring them to the hospital for delivery.

Gitanjali Moharana delivered a girl child in the private nursing home on August 3. The hospital then allegedly asked the couple to pay up Rs 7,500.

As Nirakar Moharana did not have the money, the ASHA worker and an employee of the nursing home allegedly suggested that they sell their baby to a childless couple and said the buyers would foot the bill on their behalf.

The couple then approached the police, who arrested four people including the ASHA worker and nursing home employee on Saturday.

One lakh children in India die of diseases preventable by breastfeeding

Nearly one lakh children die every year in India of diseases such as diarhoea and pnemnonia that can be prevented through breastfeeding, according to a report released by the United Nations. The report said that diseases and mortality associated with inadequate breastfeeding is estimated to drain the Indian economy by $14 billion.

The United Nations Children’s Fund and World Health Organisation, in collaboration with the Global Breastfeeding Collective – an initiative to increase global breastfeeding rates – released the Global Breastfeeding Scorecard at the start of the World Breastfeeding Week, observed from August 1 to August 7. The report evaluated 194 countries, including India.

India reported an exclusive breastfeeding rate of 55% for children below the age of six months.

The WHO recommends that mothers exclusively breastfeed their child (with no other food or drink) up to six months of age, followed by continued breastfeeding along with appropriate complementary food up till the turn two.

The report said that breastfeeding helps prevent diseases such as diarrhoea and pneumonia, which are the leading causes of child mortality.

Globally, investment in breastfeeding is far too low, the report observed. An annual investment of just $4.7 per newborn is required to achieve a 50% global rate of exclusive breastfeeding among children under six months by 2025, the report said.

In Tamil Nadu, a Siddha practitioner held for fatal abortion

A practitioner of Siddha, a traditional medicine system, was arrested near Kadambur town in Tamil Nadu on August 3 after a pregnant woman died allegedly after consuming medicines prescribed by her to abort the pregnancy, the Times of India reported.

Siddha is one of the five alternative medicines, including Ayurveda, Yoga, Unani and Homeopathy that is promoted by the government.

The accused, M Thailammal, based in Thondur village near Kadambur was arrested for murdering 35-year old K Selvi, who lived in the same village. After taking the medication allegedly given by Thailammal, she got sick and died under mysterious circumstances in May 2016.

After her death, the Kadambur police filed a case of unnatural death and sent her body to the government hospital in Sathyamangalam city in Erode district for a postmortem.

The results of the viscera test, usually done in cases of suspected poisoning, showed that Selvi had consumed some medicines at the time of her death, said the report. The police said Selvi’s husband told them that she had taken some Siddha medicines at the time to terminate her pregnancy.

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.