insurgency: challenges in medical … october 2013... · 2016-03-25 · pran gopal saha*;...
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ISSN: 2278-4853 Vol. 2, Issue. 10, October 2013 AJMR
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P u b l i s h e d b y : TRANS A s i a n R e s e a r c h J o u r n a l s
AJMR:
A s i a n J o u r n a l o f
M u l t i d i m e n s i o n a l
R e s e a r c h
(A Do u b le B l ind Re fe r r e d & Re v ie we d I nte r na t io na l J o ur na l)
INSURGENCY: CHALLENGES IN MEDICAL SERVICES IN TRIPURA
Pran Gopal Saha*; Amlanbrata Chakraborty**
*Research Scholar,
Department of Management,
Monad University,
Uttar Pradesh, India.
**Research Scholar,
Department of Commerce,
Tripura University,
Tripura, India.
ABSTRACT
In facilitation of services three important elements apart from conventional four, are
people, process and physical evidence. These elements are known as marketing mix.
In case of facilitation of medical services the provider of service, that means the
personnel, must have security, so that he or she could possibly provide the service
without any fear. It is a regular trend, that in insurgency prone areas medical
personnel usually feel insecure and often become anticipated of being abducted or
killed by insurgents. Such was the situation in hilly areas of Tripura event few years
back. But since many extremists have surrendered and joined the mainstream life,
insurgency in hill Tripura is now under control. Despite such surrenders and return
to normal life, providing medical services is yet now a difficult task, as the fear of
insurgency has not gone fully from people’s mind. On the other hand new outfits
have been emerging and such is a factor of continued intimidation and it is
reflecting in the poor standard of medical services being provided in hill Tripura.
This article has tried to assess such challenges.
KEYWORDS: Insurgency, Medical Services, Marketing, Fear factor.
______________________________________________________________________________
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INTRODUCTION
Tripura is one of the small states in northeast India. It is sharing 856 Km international border
with Bangladesh on its three sides. The total area of the state is 10,491.69 sq. km. The state is
nearby other northeastern states including Assam and Mizoram. It connects with the rest of the
country by only national highway, which moves through Assam. Due to poor communication
network the state’s economy could not develop. Unemployment, poverty and backwardness are
problems among many others. However in case of other states in northeast the condition is
similar except Assam, which made considerable progress. Schemes of union government as well
as of the state are being implemented. There are schemes to ensure better medical services to
people. But despite enormous initiatives, taken by government, health services but these are not
reaching to people in remote rural areas . Social exclusion is not new in India ,but factors here
are different and these factors are insurgent activities, extortion, and murder. Ruling left front
government has made considerable progress in bringing extremist towards normal life ,but fear
factors are still now existent. Health services are not satisfactory in India and particularly in the
northeast region. A huge number of patients frequently move to other states for better medical
attendance. There are hospitals but there are shortages of beds and doctors. Where sophisticated
equipments have installed, there is shortage of technician. Rural health care units are facing
shortage of equipments as well as medical personnels. The problem is worst in hilly areas, where
doctors don’t want to work. The reason is insurgency in rural areas and particularly hilly areas ..
OBJECTIVES
The objectives of this study are:
1. To study the challenges in facilitation of medical services in hill Tripura.
2. To assess the present status of health infrastructure in Tripura.
INDIGENOUS POPULATION OF INDIA
According to Census 2001 84.3 million scheduled tribe people are in India. The population of
tribals belonging to scheduled tribe is different in different states and is different in union
territories. In North-East, there is considerably higher population of tribals than that of non
tribals. However the highest populations of tribals reside in Madhya Pradesh following
Maharashtra and Orissa. According to census 2001 there are 700 different tribal communities in
India.
As per first census records held in 1901 tribals constituted 52.89% of Tripura's total
population while non-tribals formed 47.11%. In the year of 1931 census the balance remained
relatively stable when Tripura's tribal population was 50.26% and non-tribal Bengali population
was 49.74%. Even in the year of 1941 tribal and non-tribal population was respectively 50.9%
and 49.91%. The major changes in the demographic balance of Tripura was seen in the year of
1951 census when tribal population was recorded at 36.85% and the trend continued till 1981
census when tribal population reached its lowest limit of only 28.44% and so on.
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TABLE 1
Source: Census of India 2001 available in http://destripura.nic.in/
According to Table 1 Total population of people belong to Schedule Caste in West
Tripura District is 160832 ,107755 in newly formed Sephijala District,158311 in Gomati
District, 127258 in South Tripura District ,103109 in North Tripura District, 166326 in Dhalai
District ,122444 in Khowai District,47391 in Unakoti District .
TABLE 2 STATISTICS OF HEALTH CENTERS IN TRIPURA
According to Table 2, there is a shortage of, 732 Health Sub Centers.130 Primary Health
Centers, 38 Community Health Centers.
The total requirement of Medical Officers in the state is 1,032 ( but the existing number
is more than the requirement) .On the other hand there is a significant shortage of Specialist,
Staff Nurse, Laboratory Technician , X Ray Technician ,Ophthalmic Assistant, Blood Bank
Technician, Female Multi Purpose Worker(MPW) as well as Male Multi Purpose Worker(MPW)
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and so on. It is important that Capital Agartala is situated in West Tripura District .This district is
considerably developed than other districts. So health care facility is developed than any other
town in Tripura.
TABLE 3 STATISTICAL PRESENTATION OF REQUIRED AND EXISTING
PERSONNEL
TABLE 4 STATISTICAL PRESENTATION OF NUMBERS OF HOSPITALS
(DISTRICT WISE)
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According to Table 4, there are 4 state hospitals in West Tripura District. But most
insurgency prone district, Dhalai District the number of State Hospitals and District Hospitals is
Zero. There is no Blood Bank and Blood Bank Centre in the same district. The nearby district of
Dhalai is North Tripura District. In North Tripura District there is no State Hospital. The Number
of District Hospital is one, Two Sub-Divisional Hospitals single Rural Hospital. It is mention
worthy that Reang Refugees (also known as Bru) is residing in 6 Camps after an ethnic clash in
Mamit District of Mizoram. The number of Reang Refugees is near about 40,000 and half of the
population is of Children. Refugees of these camps are exposed to various serious illnesses, but
they have to depend on Medical Camps. An insurgent group of Reangs was Bru National
Liberation Front (BNLF) and now it has been spitted into various other extremist outfits. These
insurgent groups are operative in North Tripura District as well as in Dhalai District.
TABLE 5 STATISTICAL PRESENTATION OF NUMBERS OF BEDS IN HOSPITAL
AND PHCS/RHS (DISTRICT WISE)
It is quite clear from Table 5, that the number of beds in hospitals and PHCs/RHs are not
sufficient as compared with the population of Tripura. According to Table 5, more number of
beds are available in West District of Tripura as all the State Hospitals are in the same district. In
North district a total no of 442 beds, south district 601 beds and Dhalai district 270 beds are
available. The above table also shows the number of beds in hospital and PHCs/RHs in 4
different districts.
TABLE 6 STATISTICAL PRESENTATION OF NUMBER OF PATIENTS IN BOTH
INDOOR AND OUTDOOR
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According to Table 6, a total no 19,73,858 patients has got the healthcare from different
hospitals and PHCs including both indoor and outdoor in 4 districts. Approximately 50 percent
patients have got the healthcare from West District of Tripura as all the state hospital located in
West Tripura. Because of the most insurgency prone district, Dhalai District the number of
patients also very less.
TABLE 7 PRESENT STATUS OF HEALTHCARE INFRASTRUCTURE IN TRIPURA
PRESENT SCENARIO OF HEALTHCARE
From Table 7 it is very easy to understand about the different imitativeness taken by NRHM and
Govt. of Tripura. So far 446 premises have been completed out of 570 which are very
significant. Another 99 premises is under contraction and it is expected to complete very soon. It
is also presumed that once all the contraction is over then there will be a new chapter of
Healthcare Infrastructure in Tripura.
HEALTH ISSUES OF INDIGENOUS PEOPLE
Malnutrition is an important problem in tribal communities in India. Apart from malnutrition
there are a lot of cases of infectious diseases.1 Malnutrition is prevalent in case of children as
well as adult in tribal population. Health problems are anemia, iodine deficiency, malaria and so
on. In tribal community smoking is an addiction in both tribal male and tribal female. Quite
naturally tuberculosis and lung cancer is much prevalent in tribal community. Though Indian
government initiated programmes to eradicate tuberculosis but remoteness of villages and
improper communication became an obstacle in process of success in this drive. Apart from this,
awareness among tribal communities is less and it is a matter of great concern.
Sexually Transplant Diseases (STD) is important other health problem in tribal
communities and it is due to lack of health consciousness and education. The contributing
1 K S Mohindra ,et.al “A systematic Review of population health intervention and scheduled tribes in India.2010
.Mohindra and Labonte BMC Public Health
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factors for ill health among tribal communities are poverty, illiteracy, improper lifestyle and so
on.
INSURGENCY IN TRIPURA
An insurgency is violent agitation against authority acknowledged by the state.2 the insurgency
in Tripura continues and disputes the existing social order of the society where the insurgent
groups tries the establish new social order by forming different types of groups like TNV
(Tripura National Volunteers) (1978), ATPLO (All Tripura Peoples Liberation Organisation)
(1980), NLFT (National Liberation Front of Tripura) (1989), ATTF (All Tripura Tiger Force)
(1990) and BNCT (Borok National Council of Tripura) (2000). These groups from time to time,
starting from 1978 intended killed innocent people, kidnapped, set fire to houses, intimidated
masses. These created psychological impact and such is still now felt
Government tried to find out solutions of problems, even success also came in 1988 when
TNV guerrillas surrendered. However other groups continued insurgent activities. Recently
another rebel leader, Nayanbashi Jamatia surrendered, but hill Tripura is yet to be free from
insurgency. With an aim of social inclusion various schemes, projects and programs were
launched but unable to get success because of fear of insurgency of those days. It is important
that nature of insurgency have gradually have been changing. Once terrorism was organized, but
after a series of surrenders terrorist activities have become sporadic. There are reasons of
concern as insurgents are working in many small groups, about those state intelligence have very
less information to share. Situation of this kind is hampering health care services.
TABLE-8 FATALITIES IN TERRORIST RELATED VIOLENCE IN TRIPURA
1992-2008
Source: Tripura: Ethnic Conflict, Militancy and Counter-insurgency By Subir Bhaumik . 2012
available in URL: http://www.mcrg.ac.in/PP52.pdf
2 http://en.wikipedia.org/wiki/Insurgency
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HEALTH SERVICES FOR TRIBALS OF TRIPURA
In Tripura seventy percent of population is of Bengalis and thirty percent represent tribal
population. Tripura is in northeastern India and it has 19 tribal communities. Reang, Tripuri,
Mog, Jamatia, Garu, Munda, Chakma, Mura-sing (sub Tribe of Noatia community) etc. are
among them . The second largest tribal community in Tripura is 'the Reang community'. Almost
all of them are residing in rural areas, mostly in remote hill regions with little or no basic civic
amenities like transport, roads, markets, health care, safe drinking water or sanitation. The
literacy rate of the Reangs is not noteworthy and their economic condition is also not sound .
Tribal communities are yet to improve their life standard and bring changes in aspects of income,
education, health and other prerequisites for better living. (See Table 1)
Providing medical services to tribal people was always a challenging task. The task
mainly was challenging due to insurgency problem in the state. There were much abduction for
ransom and many people lost life. Due to these factors for a considerable period of time basic
medical facilities could possibly not extended in hilly areas. Many medical staff were scared to
go into remote areas and to provide life saving drugs. Although present condition is much better
than that of the past. But how long the condition will be peaceful is a big question. If condition
becomes similar, what it was earlier, the inevitable impact will be on providing medical services
in hilly areas.
TABLE-9
Source : Census of India 2011 available in http://destripura.nic.in/
The areas, those where insurgency prone mainly come under Dhalai, north Tripura
District, Unokoti Dist and a part of Gomati District. According to census 2011,(as shown in
table-9 ) there is a considerable proposition of people belonging to Schedule tribes have been
residing in hilly areas. In hilly areas there are cases of many types of medical illness, requires
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medical personnel to visit frequently, but due to inappropriate condition many medical
personnel’s just come and go such areas. Such condition has made medical facilities quite
infrequent. So the challenge is how to ensure better but continuous services to these areas.
CONCLUSION
The most important requirement for socio economic development is peace in society. But for
long years due to insurgency the social life in hill Tripura is rather dissatisfactory. Many people
abducted, killed and terrorized. These violent activities forced development works halted for
long time. There have been need to continue services ,but nobody dares to go to remote areas in
fear of being abducted. It is likely that providing medical services to tribal people have become
challenging. It is true, that challenge is everywhere ,but threats to life seems to be serious. In
the meantime political changes made remarkable improvement of the situation and it is
continuing still now. But its effect to medical services is yet to be real.
REFERENCES
1. K S Mohindra ,et.al “A systematic Review of population health intervention and scheduled
tribes in India.2010 .Mohindra and Labonte BMC Public Health.
2.Tripura: Beyond the Insurgency-Politics Nexus Praveen Kumar.
URL http://www.satp.org/satporgtp/publication/faultlines/volume14/article6.htm accessed on
September 5, 2013
3. http://cdpsindia.org/tripura_insurgency.asp accessed on September 4, 2013
4. http://www.tripurainfo.com/info/ATripura/Militency1.htm accessed on September 4, 2013
5. http://destripura.nic.in/ accessed on September 2, 2013
6. http://tripuranrhm.gov.in/Infrastructure.htm accessed on September 5, 2013
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