How a health crisis is brewing in Assam

The state government has found that sanitation and health facilities in some tea plantations are abysmal and workers are susceptible to treatable ailments such as tuberculosis, anaemia, hypertension and leprosy.
Women workers pluck tea leaves at Doyang Tea Estate in Assam’s Golaghat district.(Sadiq Naqvi/HT Photo)
Women workers pluck tea leaves at Doyang Tea Estate in Assam’s Golaghat district.(Sadiq Naqvi/HT Photo)
Updated on Apr 02, 2018 09:22 AM IST
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Hindustan Times, Golaghat/Guwahati | BySadiq Naqvi

On the morning of February 26, Janki Rawtia woke up feeling uneasy. The 36-year-old had no history of any serious ailment and no reason to think death was near.

“I told her not to go to work,” Ratan Nayak, her husband, who also works at Doyang Tea Estate in Assam’s Golaghat district as a “faltu” (temporary worker) says, sitting on the courtyard of his two-room mud house in Tongi Line, a cluster of quarters for workers. Rawtia stayed back. “She watched TV, ate bhaat (rice), but when she was about to go to sleep in the evening, she started sweating profusely,” Nayak recalls.

The panicked husband ran to fetch an ambulance. The pharmacist at the tea garden’s hospital, a 10-minute walk, told Nayak that Rawtia’s blood pressure was low and referred her to the civil hospital in Golaghat town, a drive of about 30 minutes. The Doyang hospital has a pharmacist and a nurse. A doctor visits twice a week on Mondays and Fridays, when most workers are out in the plantations.

Rawtia died on her way to Golaghat. “She passed away even before we could get to the hospital,” Nayak says.

A few houses away across the road, Ajay Sobor is yet to come out of the shock of his mother Durgi Sobor’s sudden death on February 27. She would hang out with Rawtia on most days. On February 27, she had gone to Rawtia’s house after coming to know of her death.

“After she came back, she too complained of uneasiness,” recalls Ajay, another temporary worker at Doyang. Durgi, too, was referred to the civil hospital in Golaghat. “My mother passed away as we were entering the hospital.”

Between February 9 and March 16, Doyang saw 20 deaths, including that of a two-year-old girl. Six of them died on February 12 and February 13, seven people passed away between February 24 and February 27, leaving the 3,500 people in the plantation in a state of disbelief.

Ratan Nayak with his deceased wife’s photo. (Sadiq Naqvi/HT Photo)
Ratan Nayak with his deceased wife’s photo. (Sadiq Naqvi/HT Photo)

Nayak complains that the tea garden management did nothing to investigate the deaths. “There was no postmortem, no attempt to find out if there was any virus causing the deaths,” he says.

Rajat Das is the manager at Doyang, one of the six plantations owned by Grob Tea Company, run by the Rawalwasia group. It is the lone loss-making garden of the group, which claims to produce 4million kilograms of Assam tea a year.

“Nobody died at the estate hospital,” he says, pulling out a sheaf of papers.

Rajat had an explanation for the death of Sunaina Nayak, a two-and-a-half-year-old girl, who died mysteriously too. “She had a lot of worms. They came out of her nose and mouth,” he says.

“Others mostly died of drinking toxic liquor,” he says and brings out a report submitted by officials of the Integrated Disease Surveillance Programme who had visited the tea estate.

The report blames toxic alcohol and existing diseases such as tuberculosis and hypertension causing “damage to the organs” and leading to their death.

“They would mix battery chemicals and urea in the liquor,” Das says, pointing to vessels at an abandoned unit for brewing “chulai”, a highly intoxicating local alcohol. But he has yet to file a first information report against the owner of the “bhaati”, or illegal distillery.

Workers contest the management’s theories. Ratan Nayak is aghast at the chulai accusation. “Both of us (Nayak and his late wife) are followers of Sree Sree Thakur Anukulchandra (a Bengali spiritual guru). We do not eat meat or drink alcohol,” he says. “Janki wouldn’t have died if there was a doctor,” he says.

The Assam Plantation Labour Rules make it mandatory for tea gardens employing more than 500 workers to have a decently equipped hospital or have a lien on beds of a neighbouring hospital.

Yet, Doyang has none, despite a decent hospital building. “Most hospitals on the gardens run as referral points,” says Ghanshyam Bhahoi, president of the Assam Chah Mazdoor Sangh’s Golaghat chapter.

Data for the first quarter of 2017 with the labour commissioner’s office in Assam says only 343 of 800 tea gardens have a full-time medical practitioner, even when there are as many as 469 plantations with a permanent workforce of 500 or above.

The situation is worse on the smaller gardens. At Hatigarh Matikhula Tea Estate, workers complain that patients are ferried on handcarts to the garden’s clinic because there is no vehicle available. And if they are referred to the civil hospital in Golaghat, they are mostly forced to rent a vehicle, which could cost as much as their weekly wage.

“There are no tea gardens that are following the rules properly,” says Rimjim Gogoi, the labour inspector in Golaghat.

Asked about the deaths at Doyang, she says the district does not have a medical inspector for plantations to check facilities on tea gardens. Of the eight sanctioned posts for inspectors, six are vacant in Assam, leaving thousands of permanent and temporary tea garden workers at the mercy of the management. There is a shortfall of another 20 labour inspectors in the state. “We are neither trained nor equipped to keep a check,” says Gogoi, the lone labour inspector for 55 tea gardens in Golaghat subdivision in 2017.

She had an alibi when asked if she visited Doyang after the deaths. The district was functioning without an assistant labour commissioner. It is only recently that the assistant labour commissioner of neighbouring Nagaon has been given the charge. He is yet to distribute the 55 tea gardens among two inspectors.

Assam’s part-time labour commissioner Tapan Sarma, who also serves as the secretary at the personnel department, says the department needs to be reorganised and that a high-level committee had been formed to look into it. It is yet to submit its report.

The state government has found that sanitation and health facilities in some tea plantations are abysmal and workers are susceptible to treatable ailments such as tuberculosis, anaemia, hypertension and leprosy. The maternal mortality rate in Tinsukia, Dibrugarh, Sivasagar, Jorhat and Golaghat — the Upper Assam districts with a large concentration of tea plantations — was 404 deaths per 100,000 live births, according to the government-commissioned Annual Health Survey of 2012-13. The national rate is 167 deaths for 100,000 live births.

“There are as many as 50% tea gardens that have abysmal health facilities. And to make inroads into these areas we came up with mobile medical units (MMUs),” says Mukul Chandra Gogoi, the state’s health secretary. Over 80 MMUs visit 240 tea gardens five days every month.

“We cannot build hospitals, so this is a way to ensure hospital comes to them,” says AC Baisya, executive director of the National Health Mission in Assam. He, however, conceded that this is a stop-gap measure.

The National Health Mission has signed a memorandum of understanding (MoU) with 250 tea gardens under which the plantations are required to provide vehicles to serve as ambulance and pay ?7.5 lakh a year to take care of a part of the expenses of staff salaries and drugs at medical facilities of tea estates.

But 100 MoUs, including the one with Doyang, were terminated after these gardens failed to comply with the NHM requirements and withdrew their share of expenses.

“Only continuous, sustainable health delivery is the solution,” Baisya says. The latest government scheme of providing ?12,000 to pregnant tea garden workers will help in the long run, he says.

In another long-term solution, officials say the government plans to open primary health centres in tea gardens. The project will kick off with 15 Assam Tea Corporation Ltd gardens. But the success of failure of this project, too, would depend on the support from private tea gardens.

Why death comes early in tea gardens
Some of the findings of a National Health Mission (NHM) study on contributing factors to infant mortality rates and maternal mortality rates in tea gardens:
of the population practices open defecation
Only 30% of households have access to tap water
Only 61% of women are aware of family planning methods
Medical officers and other staff are not oriented towards national health programmes
The average weight at birth of a baby is 2.6 kg
of infants weigh 2.5kg or less at birth in India, which is classified as a low birth weight

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