Kandeha, Bundelkhand: Shivbali Singh, a resident of Kandeha in Bundelkhand, is not amused when he is told about the ‘World Pneumonia Day’ which was on November 12.
“Instead of celebrating these special days, the government needs to do a lot of ground-level work to understand how to eradicate the disease in areas such as ours which have high prevalence,” he told us.
Semiya Devi, a 30-year-old resident of the village in Mau block of Chitrakoot district in Uttar Pradesh, has suffered recurring episodes of pneumonia from a young age. As she spoke to us about the debilitating effects of the disease, her despair made her seem older than her years. “I experience severe cough and breathing issues and when this peaks at 4 in the morning, I am not able to sleep,” Devi said and added that the fever usually lasted for at least a month before subsiding with the help of medicines, only to return again later.
She does not know as to why her condition has not been fully and permanently treated. “Till now, we must have spent over Rs 80-90,000 on treatment and have gone for treatment to Allahabad, Karwi, and local nursing homes,” she said. “Despite the medicine, I don’t get relief, especially when my problems peak at 4 in the morning.”
Many people, both old and young, in Kandeha complain of suffering from pneumonia. There were reports of four children and six adults suffering from pneumonia on the day Khabar Lahariya visited the village. The number of those afflicted with the disease fluctuates throughout the year.
The village also defies many popular misconceptions about the disease: that it occurs more frequently during childhood, that it is a one-off occurrence and that it occurs more often in the winter. Kandeha has no pneumonia-free season. Its residents have received little or no support from the local government health centres, and are forced to spend money on medicines and consultations at private pharmacies and hospitals, over generations of recurrent illness.
Pneumonia is a leading cause of death and the leading infectious disease killer worldwide, responsible for an estimated 2.6 million deaths in 2017, according to the Global Burden of Disease (GBD). Most of these deaths (75%) are concentrated within two populations: 809,000 deaths were of children under five years and 1.1 million deaths were of adults aged over 70 years.
Since 2000, India has consistently had the highest number of pneumonia and diarrhoea deaths amongst children under five years of age and childhood pneumonia contributes to 17.1% of IMR. The incidence of adult pneumonia, though less documented in government records, is reported to have risen by more than 100% in India in the past three decades.
Sixty-year-old Kamaliya Devi, prostrate on a bench, is a testament to the severity of the disease among the aged. “I suffer from severe cough, cold, and difficulty in breathing, and also experience tightness and swelling of joints. Since I cannot visit the hospital frequently, I get medicines from the ‘store’ which cost a lot of money but are not very beneficial,” Devi said. She contracts the disease in any season, and can only speculate as to why it is recurring. “Sometimes it’s caused by drinking water from other places,“ she said.
Vinod Kumar Yadav, the chief medical officer of Chitrakoot district spoke to Khabar Lahariya at length about the training given to the village ANM (Auxiliary Nurse Midwife) and ASHA (Auxiliary Social Health Activist) workers for detecting cases of pneumonia. This training, however, was more to do with prevention than treatment – early-stage detection of the disease in new-borns, checking for the status of breath, temperature etc.
When asked about the prevalence of pneumonia in the district, he responded by saying “We see very few cases of pneumonia, and whenever any are detected, patients are sent to the hospital.” He didn’t have any specific information about Kandeha.
While the CMO stuck to the official line – that the government does keep an eye on pneumonia – he didn’t acknowledge any of the ground realities. On the ground, there is a serious lack of support at the local government health centres and hospitals for patients of pneumonia.
Keerti, a 22-year-old pneumonia patient and mother of a six-month-old child said, “I don’t go to government hospitals for treatment because there is no point”. Keerti’s mother-in-law spoke with prejudice about the young woman and said, “If we had known that she suffered from this condition, we would never have gotten her married into the family”.
Uttar Pradesh has had the second-highest number of reported deaths from pneumonia at 78,470 in the country, as of 2017. None of the villagers we spoke to had received hospitalisation, no matter how serious their cases were. The data also reflects this reality – more than half of the children with severe pneumonia in Uttar Pradesh and Bihar do not receive required medical care, according to a survey conducted by the Bill and Melinda Gates Foundation.
Pneumococcal Vaccine (PCV), which prevents the most common form of pneumonia in children, was introduced as late as 2017 and many children are still not receiving their full schedules.
In a world where diseases like tuberculosis and pneumonia are curable and no longer have to consign a patient to a death sentence, Khandeha in Bundelkhand is symbolic of the extent to which this region has to travel to keep up with the smart and digital nation. It is no wonder that Shivbali Singh was impatient and dismissive of World Pneumonia Day.
Khabar Lahariya is a rural, video-first digital news organisation with an all-women network of reporters in eight districts of Uttar Pradesh.