Attappady’s silent crisis

Valli, a frail 28-year-old woman from the Nallasinga tribal hamlet in Attappady, gently wipes her two-year-old daughter’s lips with the edge of her black cotton maxi. A quiet satisfaction settles on her face as she manages to feed her child some boiled rice. But the child remains restless, her hunger seemingly unsatiated. Valli smiles wryly, placing the toddler on the mud floor of her kitchen, and turns to speak with Priya, her friend and neighbour.

Priya is of the same age as Valli.

Life in the Nallasinga hamlet, nestled within the Attappady tribal taluk in Kerala’s Palakkad district, unfolds with a sense of routine. “The rice I cook in the morning serves for lunch and dinner as well, sometimes with a bit of green gram,” Valli says. She is one of the few in the community who manage to eat three meals a day.

“But we only cook once and eat it twice,” Priya interjects. Like her, most people in the hamlet survive on two meals a day. Many others across the 192 tribal hamlets spread over 735 sq km of rocky hills subsist on just a meal a day.

The eating habits of the tribespeople have undergone a drastic change in recent decades and they continue to be worrisome. Malnutrition is a bane of Attappady.

Both government and non-governmental agencies have run many programmes for the welfare of the 33,000 tribespeople of Attappady. According to the Integrated Tribal Development Project (ITDP), the tribal population in Attappady has plummeted to 44% from 90% of the total population in the taluk in 1951. As per the 2011 census, Attappady’s tribal population was 27,627.

Despite extensive official efforts to combat poverty and deprivation in Kerala’s Attappady region, malnutrition remains a critical issue.
| Photo Credit:
K.K. Mustafah

But the living conditions of the people have gone from bad to worse.  Nestled in the lap of the Western Ghats with 249 sq km of protected forests and the fertile catchment areas of the Bhavani river and its tributaries, the 192 tribal hamlets of Attappady are scattered, with some beyond easy access.

While sections of Irula and Muduga tribal communities live by daily labour, agriculture and cattle rearing, the more primitive tribal community of Kurumba living in the remote areas of Pudur panchayat are still dependent on minor forest produce and traditional farming.

The remoteness and inaccessibility of hamlets such as Upper Thudukki, Galasi, Kadukamanna, Kinattukara, Anavayi, Ooradam, Lower Poothayar and Upper Poothayar further alienate the people from the mainstream. In December 2022, the State government came under sharp criticism when a pregnant woman of Kadukamanna hamlet was carried in a litter for over three km through the forests to reach an ambulance. The incident prompted the National Women’s Commission to file a case.

Neonatal deaths due to malnutrition are a recurring phenomenon in Attappady. The latest death occurred on July 10 when 21-year-old Deepa, wife of Manikandan from Vellakulam hamlet, gave birth to a girl who weighed just 1.1 kg. She had sickle cell anaemia, and the child died from severe ventriculomegaly soon after birth.

Attappady has been under scanner since 2013, a year in which 47 tribal infants died of malnutrition. In the past 14 years, show ITDP data, 140 tribal infants have died in Attappady. Moreover, the region has witnessed about 300 abortions, 90 intrauterine deaths, and 21 stillbirths since 2012. On an average, 10 children die from malnutrition in Attappady every year.

“My child was born at Bethany Hospital in the Tamil Nadu side of Anaikatty. The baby weighed only 900 gm, and she could not be saved,” says Kumar about his third child. Kumar is a resident of the Palur hamlet.

Tribespeople say malnutrition is a relatively recent phenomenon and that their forefathers used to live in good health untouched by the influence of the outer world. “Our culture is gone. Our food habits have changed. We have been given food and other things by the government without considering our culture and tradition,” says Lakshmi Unnikrishnan, social worker from Nallasinga hamlet. 

A 45-year-old member of the Irula tribe, Lakshmi says that a drastic change in food habits in recent decades rendered her people malnourished and ailing. “We used to cultivate a wide variety of millets and spinach. We had some 60 types of spinach. Hardly a few are available now for consumption,” reasons Lakshmi. 

Rice has replaced millets as the staple food of the tribal families. The food shift was gradual. “In my childhood, we had both rice and millets. We started using rice in the 1960s and 70s, and by the 1990s, rice gained dominance,” says tribal leader K.A. Ramu.

As they turned to rice, they started missing the high nutrients found in millets. Realising this, the government tried to reintroduce millets, but the mission failed. “The biggest problem of our governments is that they introduce projects without learning or understanding our basic issues,” says Lakshmi. 

The community kitchen introduced to reach out to the tribal women and the elderly was a boon during the COVID-19 pandemic, but not any longer. It has not helped address the issue of malnourishment. Lakshmi says it made the tribals lazy, and resultantly, unhealthy. The kitchens have stopped functioning, though. 

“Addressing malnourishment by setting up community kitchens, nutrition rehabilitation centres, and millet village schemes have not had the desired effect,” says Rajendra Prasad, president of the Centre for Tribal Education Development Research, popularly known as Thampu, a non-governmental organisation working for the welfare of the tribespeople in Attappady.

Prasad and his team have trained dozens of tribal women in umbrella making, and their ‘Karthumbi’ umbrella brand was praised by Prime Minister Narendra Modi in his Mann Ki Baat in June this year.

Every time there is an infant death in Attappady, it captures news headlines. Four back-to-back infant deaths here during the pandemic forced the government to review its projects and introduce a comprehensive programme for all newly-wed tribal couples of Attappady block. The scheme envisioned the newly weds to undergo a thorough health screening, and accordingly would advise measures for a healthy pregnancy. A neonatal intensive care unit was set up at Attappady Tribal Taluk Specialty Hospital, Kottathara. 

While there have been fervent appeals for special packages for Attappady, why so many programmes launched since 2013 failed to have any positive impact has not been studied, rues Prasad. 

Following 47 infant deaths in 2013, the Central and State governments announced projects to the tune of ₹400 crore for Attappady. “Unfortunately, a third of the sum was never released,” he says. 

But there’s no dearth of welfare projects for Attappady’s tribal population. The ITDP is actively involved with its 145 promoters and three extension officers for the panchayats of Pudur, Sholayur, and Agali. Both the ITDP and the Agriculture department introduced separate millet projects. “We are doing our best for the tribespeople. Yet, something seems to be wrong somewhere,” says Sadik Ali, ITDP assistant project officer. 

Involving the tribespeople and engaging them in agriculture by giving their land back to them can be the best way out to save them from malnutrition, he thinks. 

Attappady used to be the tribespeople’s land until the 1940s. Settlers began to descend on these hills in the 1950s causing alienation of tribal land. “With the support of local officials, outsiders began to capture tribal land. Much of the fertile land on the banks of the Bhavani and Siruvani rivers is now in the hands of settlers,” says tribal leader K.A. Ramu. 

“Land is not something owned by an individual; it connects them to their ancestors, culture and rituals. For the tribespeople, their relationship with ancestral lands is an integral part of their identity. It symbolises the umbilical cord that connects them to the earth and their being,” says Prasad. 

Owing to generations of malnourishment, the generic health index of the tribal population of Attappady has gone down. “Their height, weight, life expectancy, and fertility rate have all gone down considerably,” says M.S. Padmanabhan, superintendent of the Attappady Tribal Taluk Specialty Hospital.

Although there has been no research to substantiate what caused the dip in their population, tribespeople testify that their ancestors were much stronger. “My father used to carry goods weighing 80 to 90 kg all alone. He was much healthier than the people of our generation. A change for the worse is perceptible among us,” says Ramu. 

Although the entire Attappady tribal taluk is a prohibited area, unregulated use of liquor adds to their woes. Before it was banned in 1995, there were about 140 arrack shops in Attappady. With prohibition came bootlegging. Liquor, both smuggled in and spuriously made, is available in plenty in the area now. Liquor has become the biggest menace for almost all hamlets there. 

Most babies born to tribal women in Attappady weigh less than 2 kg. “The small-for-date babies, underweight or underdeveloped, are a cause for concern. Their adults too are of low weight. Malnutrition is the main villain,” says Dr. Padmanabhan. 

The State government has introduced a close monitoring mechanism for pregnant women of Attappady. Health workers of Kudumbashree, Integrated Child Development Services, ITDP, and the Health department reach out to antenatal mothers five days a week. Yet, early intervention is increasingly becoming tougher for the health authorities because of the failure of tribal women in early antenatal registration.

“The first period should not be missed. As the first trimester registration is rare among the tribespeople, early intervention is not possible,” says Dr. Padmanabhan, adding that pregnancy induced hypertension is increasing among the tribespeople. 

Apart from nutritional anaemia, sickle cell anaemia too remains a major cause of worry. Life expectancy of sickle cell anaemic patients has gone down considerably. “It’s about 40 years now,” says Dr. Padmanabhan.

A survey held in 2013 had found 212 sickle cell anaemia patients in Attappady. Some of those patients may have died since. But what alarms observers is that nearly 20% of the tribal population can be suspected to be carriers of sickle cell anaemia. Out of the 80 samples collected at a medical camp held early this year, 18 tested positive for sickle cell anaemia. 

According to D. Dharmalashri, former Ottapalam Subcollector and nodal officer for Attappady, tribespeople have been finding it tough to shift back to millets from rice. Their tastes have changed, she argues. “Tribespeople are fond of watermelon, spinach, and drumstick. But their consumption has gone down largely. Alcoholism among them is leading to even pregnant women being beaten up,” says Dharmalashri. 

Pregnant women in remote hamlets such as Galasi, Upper Thuduki and Kadukamanna are forced to trek for hours through forests, hills, and across rivers to get a vehicle to the Kottathara hospital. “It may take even a full day to reach the hospital from certain hamlets such as Ooradam and Galasi,” says Prasad. 

Most schemes and interventions done to help the tribespeople have been made without taking the indigenous community into confidence. “Instances of the police accompanying health workers to the villages to ensure that pregnant women are taken to hospital for delivery have done little to build their trust in the health system and its intentions,” says Prasad. 

According to Lakshmi, winning the trust of the tribespeople and involving them in projects meant for them is a must if the government is sincere about its approach. “Schemes devised without knowing the real life and real problems of Attappady will naturally die,” she says.