Anantho ( called as Antho) is a five year old boy from Podapoi village in Kerpai Panchayat. He was accidentally seen by our medical team during our visit to the villages. He was left to die in the village square as the village ‘guru’ had pronounced his imminent death as he was not to recover from fatal illness. We found him lying alone naked, covered by the filth of his vomitus and flies and chicken feeding on the vomitus. His parents had gone to hills to earn for the livelihood as they have to feed many mouths.
On examination, we found he had high fever and was moderately dehydrated from repeated vomiting. He was not able to retain anything taken orally. There was no icterus or palpable spleen and no signs of meningeal irritation. Malaria being the commonest disease here that takes away many lives, we decided to treat him for malaria. But unfortunately we had exhausted required medicines in our emergency kit. We were left with only Tab Chloroquin and Tab Paracetamol and some ORS packets. No RDT kits and antiemetic injections or I V fluids were left. With much reluctance, Ashish and myself gave him Tab chloroquin and Tab Paracetamol, powdered and packed into different doses in sequence along with some glucose powder from our kit, knowing well that he may not retain anything we give. We explained to a man nearby on how to administer the doses. We came back worried and sad that we were not able to save a life.
3 days later when we were in the base clinic at Kerpai, the Swasthya Sathi ( health worker) from Podapoi village had brought a group of sickly patients. We were anxious to know what happened to Antho, when did he die…… The Swasthya Sathi pointed to a little boy and said “this is Antho”. The boy was there, looking fresh with well combed long hair, dressed in a new school uniform and smiling. He had walked 12 km climbing over the hills and crossing rivers to reach the clinic. We could not believe that it was Antho and looked at him from every corner and asked him many questions and were finally convinced that he is Antho. He was afebrile and perfectly OK.
His RDT was done and it was Falciparum positive. (RDT remains positive for two weeks after successful treatment). We gave him Artesunate combination therapy even though he had responded to Chloroquin.
More than the medical and research questions that arise from this episode, the question we raise is – How many Anthos are dying in the remote tribal villages daily? Why should they die at such a tender age?
In the baseline survey we did in 2014 the Under-five Mortality Rate was found to be 322 per 1000 live births and Infant Mortality Rate was 152 per 1000 live births. Do the poor children not have a right to health and health care?
These precious humans lives that fall off in their tender age like the tender leaves of a tree (which is an abnormal phenomenon) loudly proclaim that there is something seriously wrong with our systems and our society. This stark inequity in healthcare in the society which the poor have accepted passively as their fate cannot be tolerated anymore. Our development paradigms and our medical education are called to question by this event which continue to happen in not small numbers in tribal belts.
-Dr Aquinas Edassery