A 23-year-old pregnant woman, Madavi Raju Bai, would have been alive with her baby now, after a safe delivery, if the local ‘Asha’ worker had clearly communicated with her about the delivery date and precautions that needed to be taken for a safe delivery.
A resident of Kunikasa-Kolamguda an interior village in Gadiguda mandal of Adilabad district, Raju Bai spoke Kolami. But the Asha worker, who could not speak her language, failed to communicate properly to her about the delivery date. As a result, the would-be mother could not be shifted to a hospital at an opportune time for the safe delivery, which led to her death.
“We failed to provide medical assistance to my wife because of miscommunication by the Asha worker. The sudden rain and the lack of road connectivity to our village have also created hardships in shifting my wife in time to the nearest Gadiguda primary healthcare centre,” said Raju Bai’s husband Madavi Jangu.
“If we knew the exact delivery date,” Jangu insisted, “my wife could have been alive now.”
Raju Bai started experiencing contractions on her way to RIMS, Adilabad on August 22, 2021, where she was declared dead.
The unfortunate death of the 23-year-old woman exposed the language barrier amongst the Adivasi and the non-Adivasi communities. It also highlighted the critical importance of clear communication in medical advice.
Apart from the language barrier between healthcare professionals and patients, the Adivasi patients complain of improper treatment. As a corollary to this, reports abound of Adivasi patients absconding from government hospitals.
Another pregnant woman Mesram Bheem Bai from Mothiramguda village of Utnoor mandal died due to delayed medical assistance on June 28. Kolam Adivasis are recognized as PVTG in Telangana. She could not be shifted to the nearest PHC for delivery because of abysmal road connectivity.
Often, the Adivasis are shy in nature and are not inclined to interact with others outside the community due to several historic and cultural reasons. Certain Adivasi communities largely consider ‘outsiders’ as a threat and do not believe them.
To this issue, activists working for the interests of the Adivasis say state and central governments must give special admissions for the Adivasis students to make them doctors and nurses.
Non-tribal Medical staff and doctors
The common thread that binds all unfortunate stories of delayed medical care is linguistic disconnect between the healthcare professionals and the patients.
As most medical staff are from the non-tribal communities, they fail to speak to patients in their mother tongue during the treatment. Lack of clarity in communication, most of the time, makes the Adivasis believe that doctors were not treating them properly.
Adivasi leader Pendore Pushparani of Indravelli mandal said women in general and poor Adivasi and Dalit women in particular are more prone to health problems due to various reasons, and the government should, therefore, focus more on their health.
Mother tongue plays a crucial role in medical treatment
As doctors cannot speak the Adivasi languages, the patients could not tell them their medical history.
After many such incidents occurred, officials have appointed a few educated Adivasi girls as ‘patients care helpers’ at Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad, to address the communication gap between the doctors and the patients. This measure has significantly improved the delivery of healthcare to Adivasis.
Similar efforts should be taken at government hospitals at Jainoor, Tiryani, Gadiguda, Narnoor, Boath, Kerameri, Sirpur (T) and Bejjur mandals where the tribal population is high.
A special ward was set up with the financial assistance of the ITDA for the Adivasi patients at RIMS in Adilabad. A ‘May I help Desk’ was also set up at RIMS for the benefit of the Adivasis.
Miscommunication affects medical treatment
Dr Naitham Sumalatha, who is an Adivasi and one of doctors at RIMS, Adilabad, said most of the time Adivasi patients give incomplete medical history which makes treating them tougher.
Because of trust deficit between the doctors and the patients, Sumalatha said many patients prefer leaving the hospital before they are treated for the ailment.
“One of the key reasons for this is the communication gap. If doctors speak in the mother tongue of the patient, the treatment of Adivasis could improve considerably,” she said.
There are so many reports about private hospitals misguiding the gullible Adivasis to shun government hospitals in favour of the ones run by the private entities. The treatment at the private hospitals pushes them into debt.
As some Adivasis still remain reluctant to accept modern healthcare and depend on traditional gods, rituals and herbal medicine, their health condition has deteriorated.
Some others prefer to go to local quacks who are popularly known as RMP (registered medical practitioners) for medical treatment though they are not alternative to trained doctors — because they speak with patients in their mother tongue, stay locally and available round the clock in emergencies. The mother tongue, therefore, played a key role in their success.
Need for more Adivasi doctors and other medical staff
Adilabad Additional DMHO (Agency) Dr Kudimetha Manohar said the mother tongue will play a crucial role in treating the Adivasi patients and state and central governments must recruit more Adivasi doctors and other medical staff.
He said the appointment of the Adivasi doctors and other staff should be included in the health policy of the state and central governments.
He said as many as 15 maternal deaths of women took place last year in the Adilabad district alone. But transition deaths, he said, have come down drastically in the recent past.
Manohar said they have identified nearly 200 high-risk habitations that were considered inaccessible in the erstwhile Adilabad district due to overflowing streams and rivulets and the lack of road connectivity following the heavy rains.
‘One transition death of an Adivasi pregnant woman from Kunikasa village took place,” said Manohar and added that the premature deliveries have also been posing a threat to the Adivasi pregnant women in some cases.
He said the revival of the ITDA ward at the RIMS is a must for the benefit of Adivasi patients. However, the number of maternal deaths and inaccessible habitations are higher than the official figures in the erstwhile Adilabad district.
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