December 24, 2006 : Onge and IMNCI after the Tsunami
by Gaurav Garg
** incorporates updated ICO inputs received Thursday November 8
DUGONG CREEK, Little Andaman: Rajni, a six-months pregnant woman from the Andamans’ dwindling Onge tribe, lies nervously on the floor of her wooden hut as health worker Shanti Teresa Lakra runs her hands over her stomach, checking the position of her unborn baby.
Later in another home in this old government-built settlement for tribespeople on the remote island’s Dugong Creek, new mother Gitai holds her baby up to Lakra to check for diarrhoea.
Home-based antenatal and neonatal care is relatively new to the Onge, one of four Stone Age ‘Negrito’ tribes on India’s remote Andaman and Nicobar islands. With less than 100 Onge people left, keeping their babies and new mothers alive – against India’s high infant mortality rate of 58 per 1,000 live births and maternal mortality rate of 407 per 100,000 live births – takes on new meaning.
Lakra is one of the community health workers who’ve been trained by UNICEF since the tsunami to deliver frontline antenatal and neonatal care across these far-flung Indian Ocean islands, where many people like the Onge live in remote and inaccessible areas, and home visits are often the only way to deliver health care.
Strewn in an 800-kilometre long arc, close to the coasts of Thailand and Indonesia and 90 kilometres from the epicentre of the earthquake that triggered the tsunami, the Andaman and Nicobar islands bore the full force of the waves’ fury.
At least 3,500 of the islands’ 400,000 people died, entire coastal towns were swept away, 9,700 homes were destroyed, 46,000 people were left homeless, and over a quarter of health facilities were damaged. Half of the islands’ health workers were taken by the ocean.
In response UNICEF made neonatal health the priority of its intervention in Andaman and Nicobars, through its Integrated Management of Neonatal Childhood Illnesses strategy.
“IMNCI was at the forefront of our intervention in the Andaman and Nicobars,” said Dr Marzio Babille, UNICEF India’s Chief of Health.
Under IMNCI’s multi-pronged approach, community health workers are trained in delivering antenatal and neonatal care in the home, good hygiene behaviours are promoted, and the health system is strengthened through medical provisions and facilities.
“IMNCI takes a wholistic view of mother and child health,” said Dr Babille. “We decided to train every community and volunteer health worker. We urged the government to invest funds in rebuilding places for children who need medical attention, like babies with very low birth weight and newborns who are septic.”
“There were so few workers and doctors left on the islands. If sick children are left unattended, they die.”
In 2003, neonatal deaths in India accounted for nearly two-thirds of all infant deaths. Under IMNCI, mothers are encouraged to breastfeed exclusively for six months.
“The bulk of neonatal deaths occur in the first week, close to 50 percent,” said Dr Babille. “Seventeen to 19 percent of infant deaths can be prevented by exclusive breastfeeding for six months.”
UNICEF didn’t have an office in Andaman and Nicobar when the tsunami hit, but it was the first aid agency to reach the islands in the aftermath.
IMNCI equips village-based workers and auxiliary nurses and midwives with skills to assess and classify sick infants and children below five, provide the first-level of treatment when doctors are not available, and refer the child to the nearest healthcare facility as soon as it shows signs of danger. IMNCI was launched on Car Nicobar, the worst-affected of the islands, in June 2005.
“Just by introducing proper breast-feeding practices and insisting on micronutrients – malnutrition rates are dropping,” said UNICEF Program Coordinator for Andaman and Nicobar, Subhash Misra.
Child malnutrition across the islands declined from 48.5 percent in 2005 to 33.6 percent in 2006, aided by UNICEF’s restoration of basic equipment and services to 621 weighing centres and increased support for early child development workers.
UNICEF has built two Sick and Newborn Care Units in the capital Port Blair and on Car Nicobar island. The first unit, in Port Blair, has already saved 300 newborns: at least 60 percent would likely not have survived in the pre-tsunami era, when no specialized facility for premature and sick babies existed.
Lakra, who has been running the Dugong Creek Public Health Centre for five years, now spends much of her time on home visits to women like Rajni and Gitai. She is equipped to administer neonatal care in their homes, and detect and refer cases of diarrhoea, acute respiratory infections, malnutrition, anaemia and malaria – the five top killers of children under 5.
Malnutrition among the Onge is a rising concern. Traditionally they hunt wild boar and ocean turtles with crude spears. But swathes of stagnant water left by the tsunami have made boar hunting dangerous.
“The men are not hunting too much these days. Micronutrient levels are quite low,” says Lakra, as she hands Rajni a strip of iron and folic acid tablets.
Palm trees bearing coconuts, another of the Onge staples, were ravaged and left in saline pools, their coconuts rotting.
The Onge and the three other ethnic ‘Negrito’ tribes of Sentinelese, Jawaras and Shompen survived the tsunami without a single loss of life. While settler and migrant populations lost thousands along the coast, the Negrito tribes fled to high ground as soon as the earthquake hit, avoiding the killer tidal waves that followed.
“Some of us were by the ocean hunting when the ground started shaking,” explains Toto, a 58 year old Onge tribesman, with a mixture of gestures and broken Hindi.
“We rushed home, gathered our things, and ran to the hills.”
The Onge flight to high ground is attributed by anthropologists to ancestral understanding of ocean patterns. The Negrito tribes are believed to have migrated from Africa up to 60 or 70,000 years ago. The rest of the population are settlers from eastern India and Mongoloid tribes who migrated from the Malay peninsula some 600 years back.
Having survived the tidal waves, the welfare of the traditional hunter-gatherer tribes like the Onge is now challenged by the long-term aftershocks: reduced hunting prospects, a growing reliance on handouts, and a reluctance to return to their traditional housing.
The gender ratio among the Onge is out of balance, fuelling extinction fears. Of the 94 Onge in existence as of July 2006, 53 are men and 41 are women. Of the under-five population, 12 are boys and six are girls.
Misra is optimistic that UNICEF’s long-term commitment will pay off for all the islanders.
“It’s often noted that UNICEF was the first humanitarian agency to come to the Andaman and Nicobars after the tsunami,” he remarks.
“But, while there are others who joined in the efforts, UNICEF continues to sustain its interventions.”