On 28 MAY, as the rest of Kerala was eagerly waiting for the monsoon rains, a distraught Veera Swami performed the last rites of his four-month- old son in Pagalayur village. It was the 28th infant death this year in the picturesque Attapadi hills populated by tribals in Palakkad district. In the past 16 months, the people here have buried 52 infants. As one newborn died after another, the 30,000 tribals thought it was some curse. They prayed and performed pujas to please their local deities. But the reality was far from anything supernatural. The killer was a familiar one: premature deliveries caused by malnutrition. In Vechapathy village, Pushpa is still reeling from the shock. On 1 February, she had delivered a premature baby at a hospital in Anayiritti. Two days later, both mother and baby were rushed to the Coimbatore Medical College, 57 km away in neighbouring Tamil Nadu, after the baby developed respiratory problems. The very next day, the baby breathed its last. “He was a premature baby and weighed just 800 grams. I should have taken care during my pregnancy,” laments Pushpa, a Class VI dropout. Her neighbour Jyotimani says Pushpa didn’t have access to nutritious food when she was pregnant. “She never had milk or eggs. All she ate was the cheap rice that is provided by the government,” says Jyotimani who works at a local anganwadi. “It’s poverty that killed her baby.” Pushpa’s husband Maruthachalam agrees. “We can’t afford to eat egg and milk every day,” he says. “We are very poor and I don’t get regular employment. I had to borrow money to take her to the hospital in Coimbatore. It may take another six months to repay the loan.” In the neighbouring Vellakulam village, March was the cruellest month as three couples lost their babies, including a pair of twins. One of the grieving mothers is Rangi Raman, 26, a sickle cell anaemia patient, who has lost three infants during childbirth in the past three years. “My first delivery was in 2011 and I lost the baby during childbirth,” she says. “In 2012, I delivered another baby at home but the baby died after just two hours. This time, I’d gone to the hospital for checkups and took medicine. I delivered a baby girl on 13 March at home. Once again, it was a premature delivery and she died.” She adds after a pause, “Without children, there is no joy in our life.” Her neighbour Vanchi lost her twins during delivery. Unlike Rangi, she had delivered the babies at the Palakkad district hospital on 19 March. Later, both the mother and the babies were referred to the Thrissur Medical College where the twins died on 25 March. “My wife delivered premature babies. Though the doctors tried their best to save them, we lost them after six days,” says her husband Vellinkiri. The couple is yet to overcome the shock and grief of losing their twins. The recent spate of infant deaths has dealt a blow to Kerala’s image, which has consistently topped various parameters in the country’s health index. According to the latest bulletin of the Sample Registration System, Kerala’s infant mortality rate (IMR) was 12 per 1,000 births, while the national IMR is 44 per 1,000 births. As Attapadi’s IMR climbed above the national average, politicians and officials rushed to the tribal region and announced a slew of schemes and emergency measures to tackle the situation. The health department has started screening pregnant women as well as children and providing medicines for sickle cell anaemia patients. The infant deaths are linked to absolute poverty prevalent in the tribal areas, says KA Ramu, a tribal activist. “In the past few years, the infant mortality rate in Attapadi has risen to an alarming level. But no action was taken by the district administration or the health department. Even the media never reported about the issue,” he says. The activist says he conducted a survey in 2012 and found that 776 deaths were reported from Attapadi in January 2011- June 2012. Almost 70 percent of the victims were tribals. Another significant find, he adds, was that 90 percent of the dead belonged to the 35-45 age group. “During the same period, only 519 births were reported from the region. A majority of the deaths were due to starvation,” he says. “I’m not a health expert. But why are only tribal children dying during delivery? Don’t you think that the government has a primary responsibility to save them?” Ramu claims that he was branded an extremist whenever he raised questions regarding allocation of funds for tribal welfare programmes. “If the government had initiated action and screened the pregnant women, we could have saved many lives. Now, officials are left to make lame excuses,” says Ramu. His resentment has some basis. In the past 10 years, both the state and the Central governments have pumped in more than Rs 800 crore for the development of Attapadi under various schemes. But that has not stopped newborn babies from dying due to starvation and malnutrition. Timely intervention has always eluded Attapadi during a crisis as a majority of the officials posted see their transfers to the area as a punishment. They want the crisis to deepen as it would bring in more money. However, there are a few dedicated officials in Attapadi who work with missionary zeal. Dr Prabhudas, the Deputy District Medical Officer, is one among them. He had chosen to come to Attapadi in 1990 when he completed his MBBS and worked in tribal hamlets for 15 years. “The situation here is grave as a majority of the women are malnourished,” says Dr Prabhudas, who is coordinating the health department’s efforts. “There are no easy solutions to tackle the infant deaths. We are trying our best to provide adequate healthcare to avoid further casualties.” According to him, the current health crisis is not a new phenomenon. “The health standards of the tribal population in the area have been falling for a long time,” says Dr Prabhudas. “Their food habits and lifestyle have changed. Earlier, they used to eat rich nutritious food cultivated in their farms. Now they eat substandard rice provided by ration shops for Rs 1 a kg.” “As a doctor, I feel sad as I could not do enough for the people I serve. Very few tribal women attend neonatal clinics and visit the hospital for delivery. Their personal hygiene is also poor,” he says. According to him, the abortion rate among tribal women is also on the rise. Official statistics reveal that 22 women underwent abortion in 2010-11; 27 cases were reported in 2011-12 and 44 cases were recorded in 2012-13. Eighteen more cases have been reported since April. “The statistics indicate the status of reproductive health among the tribal mothers. Malnutrition and poor hygiene are leading to the high rate of abortions,” he says. But these statistics don’t reveal the real picture as many women don’t attend hospitals. Health officials fear that a large number of abortions in the region go unreported. A recent survey by the departments of health and tribal welfare among the 23,597 tribals in the area showed that 496 adults, 70 pregnant women and 283 children under 12 were found to be anaemic. The survey revealed the failure of the government’s development initiatives and massive corruption in the welfare programmes. It found that 3,600 tribal couples are facing infertility problems. Diseases like sickle cell anaemia, tuberculosis and Thromboangiitis Obliterans (chronic or acute inflammation in blood vessels of the hands and feet) are also common. “We are on the verge of extinction and the only way out for us is to return to traditional farming,” says PK Murugan, a tribal in Attapadi. “We are facing a health crisis because our traditional food is no longer available. We used to eat 46 varieties of vegetables and millet, which is rich in iron content. Now we are left with only one choice: eating subsidised rice, which is not nutritious.” But most of the Attapadi tribals don’t have cultivable land as much of the region has been encroached upon by settlers and the land mafia in the past 30 years. Now, Attapadi has nearly 260 landless tribal families. According to PV Radhakrishnan, project director of the Integrated Tribal Development Programme in Attapadi, tribals used to own 16,151.14 acres earlier. “Our survey in 1977 revealed that 2,158 families lost 10,159.65 acres in the region,” he says. “Around 900 land dispute petitions are pending in various courts. Though we have passed strict laws banning the transfer of tribal landholdings to non-tribals, it’s not helping the tribals much on the ground.” The powerful land mafia and settlers were able to scuttle various moves to restore the tribal land to the original titleholders. Recently, 150 acres of tribal land was encroached upon in Vellakulam but the Revenue officials failed to take action against the encroachers. “Many resorts have come up in tribal areas. But no action was taken against the encroachers because they are backed by political parties,” says Radhakrishnan. The infant deaths have put the spotlight on the land issue and social activists are demanding that Attapadi should be declared an exclusive tribal zone. “We have exclusive national parks for tigers and elephants. So why not for tribals?” asks Rajendra Prasad, a social activist. If the government is sincere about tribal development, it should address the land issue and restore encroached land to the tribals, says Prasad. “It’s the only way to save them from extinction. Cheap rice and ragi are not going to save them. These things will enslave them forever.” Ironically, the infant deaths have ensured that more tribals are eligible for the cheap rice scheme. Earlier, 3,066 tribal families didn’t have access to the scheme because they held APL (Above Poverty Line) ration cards as they had colour TV sets, two acres of land and cell phones. Now, the state has issued BPL cards to all the tribals and they are entitled to cheap rice. Even as the din over the land debate grows, experts are warning of a major health crisis in the tribal region. A survey conducted in 50 tribal villages found that 99 percent of the children are suffering from malnutrition. “The health scenario in Attapadi needs critical analysis,” says Dr EK Satynajee, a leading paediatric surgeon based in Kochi. “Four percent of the children here suffer from sickle cell anaemia. Their immunity level is very low.” Dr Satynajee had conducted a survey last month to unravel the causes behind the large number of infant deaths. “If the present health situation prevails for some more time, more infant deaths will occur in Attapadi,” he warns.