The Maharashtra Arogya Mandal, Hadapsar, Pune, is a Non Governmental organization (NGO) established in June1960 by the late Dr Dadasaheb Gujar and his colleagues with the aim to provide better health care facilities to the poor and underprivileged classes of society. An Ayurvedic Medical College with a 250 bedded hospital with all faculties was started in the Hadapsar area of Pune city. In addition to this, several health projects catering to the needs of tribal people in rural areas were also developed and clinics established in such areas. The Sickle Cell Anemia Project is such a project that started in 1998 with a mandate to provide diagnosis, treatment, counseling and prevention.
In 1972, a team of Russian Anthropologists visited India with the aim to study genetic markers amongst tribal population groups from Maharashtra and selected the Pawara tribal groups from Shahada taluka of the Dhule district. This was a collaborative project between the Russian Anthropological Association, the Indian Statistical Institute Calcutta and the Genetic Department of the BJ Medical College Pune. Prof. S.L.Kate was selected as a member from the BJ Medical College and given the responsibility of studying different blood genetic markers. While screening the Pawara tribal community for blood markers, he came across with few heterozygous and one homozygous patient suffering from sickle cell anemia. This was a new and first finding from Uttar Maharashtra area. He presented his data to his mentor Prof G S Mutalik who suggested him to continue this project work. He continued with work on this project and screened few more tribal groups from different tribal areas along with non-tribal population groups from the state of Maharashtra.
In 1986, he analyzed collected data and found that the sickle cell disorder is a public health problem and most common amongst the scheduled castes (SC), scheduled tribes (ST), nomadic tribes (NT) and other backward classes (OBC) from the state of Maharashtra. He submitted these findings to the state health authorities, suggesting the need to establish a separate unit to study this problem in depth. The efforts went unsuccessful. Prof. Kate retired from the Govt. Medical College in 1993 and continued to work on this problem as an emeritus medical scientist of the Indian Council of Medical Research (ICMR). The ICMR was planning to establish a temporary sickle cell anemia diagnosis and counseling centre in tribal areas of Maharashtra in order to find out the acceptability of tribal people for marriage counseling program. Two centers were established, one at Dhadgaon Taluka of the Nandurbar district and the other at the Aheri Taluka of Gadchiroli District under the supervision of Dr S.L. Kate.
The health providers from that area have little or no knowledge about the disease and it was therefore necessary to establish a laboratory and to train the people. It took time to organize all these activities in the remote tribal areas and during this period 58 patients from the Dhadgaon Taluka and 48 patients from the Aheri Taluka were identified. Since this project was a time bound activity for two years only, it was very difficult to introduce counseling program and ICMR was unable to continue with this activity for several reasons and the identified patients were left without any treatment and counseling. On this background, Prof. Kate approached Dr Dadasaheb Gujar, Secretary of the Maharashtra Arogya Mandal, Hadapsar Pune, and explained to him the need of the tribal people.
Newly created Nandurbar district of the Maharashtra state was part of Dhule district. The separation of this part of Dhule district is on the basis that majority (66%) of the population from this part belongs to tribal population group & it should be possible to promote welfare schemes for tribal people on priority basis. The district is located on the extreme north part of the state on border line with neighboring states Gujarat & Madhya Pradesh. The district consists of six talukas as Nawapur, Nandurbar, Shahada, Taloda and Akkalkuwa & Dhadgaon. 75% of the population belongs to Scheduled tribes, Scheduled caste & other backwards communities. Out of this 66% of the population belongs to two major groups known as Bhilla and Pawara. Since these groups are isolated, scattered, living in geographically hilly areas, existing health facilities are inadequate and unable to co-up with their health needs. & hence remain backward in all aspect of life including health and education. They are poor and backward and hence under influence of superstitions, particularly towards health problems.
The health problems amongst S.T., S.C. & OBC population from these areas have been studied by Government & N.G.O. including Maharashtra Arogya Mandal Pune and to summaries these they are as follows-
As per recent information available Maharashtra State ranks second in population and area-wise third in the country. As per 2001 census the total population of the state likely to be 10 crores and this is about 10% of Indian population. The total tribal population of the state is 10% of the total and will be about (1 crore).
There are three mountain ranges in the state known as Sahyadri, Satpuda and Gondwan ranges. Majority of tribal population groups from the state of Maharashtra are inhabitants in these geographically difficult hilly ranges. There are in all 47 different tribal population groups, 17 are major tribal groups. Madia from Gadchiroli District, Kolam from Yeotmal District and Katkari from Raigad District are primitive tribal groups. Bhilla, Pawara from Satpuda.
These tribal groups differ from each other in various aspects. They differ in language they speak, in their cultural pattern and socio-economic categories. Inter tribal groups marriages not permitted. Majority of groups remain isolated, untouched by civilization. Hence these groups remain backward in all aspects of life including health and education.
Newly created Nandurbar district is separated from original Dhule district. It consists of six Talukas. 66% of the population of district belongs to two major tribal groups known as Bhilla and Pawara. These two groups differ from each other in language they speak, cultural pattern and socio economically. Generally inter group marriages are not permitted. These tribal groups are found either at the foot of hills of Satpuda ranges (Akkalkuwa Taloda and Shahada taluka) or in between third, fourth, fifth and sixth ranges. (Dhadgaon and part of Akkalkuwa Taluka). There is no proper communication with rest of the state because of geographically difficult hilly terrain and remain backward with poor quality of education and heath facilities.
Total population of Dhadgaon Taluka (As per 2011 census) - 1, 95,343
Estimated carrier individuals (Prevalence 22.5%) > 43,000
Estimated sufferer individuals (Prevalence 1.2%) > 1900
In last 10 years there is tremendous population growth in our country (On 11th May 2000, the total population of our country was one billion) On the basis of this with similar population growth the district population is likely to be about 13 lakhs and that of tribal population about 8 lakhs.
Health Problems of tribal population groups from Satpuda ranges (Nandurbar District) are as follows-
Unbalance dietary intake, coupled with poor availability and mal-absorption of micronutrients from routinely consumed cereal based diet. Milk and milk products are not consumed since this is taboo in their society. Net result is malnutrition, proteins, iron, iodine, vitamin-A and folic acid deficiencies are common.
Water borne and communicable diseases: Lack of hygiene and hence gastrointestinal disorders particularly dysentery and parasitic infections are very common, leading to marked morbidity and malnutrition. Several studies have indicated decrease in the level of rational, hemoglobin and circulating zinc in presence of acute or chronic infections. Anemia or infection appears to result from decrease in iron utilization for hemoglobin synthesis and also reduction in erythropoiesis. Malaria and tuberculosis is still remaining a major public health problem in this tribal area.
Genetic disorders: High prevalence of genetic disorders mostly confined to red blood cells. Genetically transmitted single gene disorders like sickle cell anemia, red cell enzyme defects and different forms of thalassemia are common amongst tribal population groups from Satpuda Ranges. All these defects found in the red blood cells that ultimately lead to early destruction of the cells. These factors complicate the health problem further and likely to develop refractory anemia.
Excess consumption of alcohol: The brewing of alcohol from Mahu (Madhuka indica) flower has been practiced traditionally. However due to scanty rain falls with less availability of flowers people are switching over the commercially available local liquor and is likely to be major threat.
Majority of the superstitions are towards food and related to health problem.
Very limited source of income. Agriculture (poor) is the only source of income. Poor and inadequate health facilities. Amongst the genetic disorder, sickle cell is very common in Nandurbar Dist.
The prevalence found to be very high amongst Scheduled Caste and Scheduled tribes groups form Nandurbar Dist. The groups are high risk groups since prevalence for sufferer is more than1% these high risk groups are found in geographically difficult hilly areas. Health facilities available at primary health centers, rural hospital and even civil hospital of the district is unable to provide even diagnostic facilities and hence proper treatment is difficult on this background Maharashtra Arogya Mandal have decided to work on this problem and selected difficult taluka of the district and established Sickle Cell Centre at Dhadgaon taluka.
This Taluka is located at the extreme North West side of the state, on the border line of Maharashtra with neighboring states Gujarat and Madhya Pradesh. Narmada River is borderline. Total geographical area is 32,106 hector. There are in all 163 villages (Revenue 99 + Forest 64). As per 1991 census total population is 96,912 and total tribal population is about 86.96% recent figures available in 2001 census the total population is about 1.4 lakhs and the tribal population is about 96%. Dhadgaon Taluka headquarter is located between the third and forth range of Satpuda ranges.
Majority of the villages are scattered and located in between 2nd, 3rd, 4th, 5th and 6th ranges of Satpuda ranges. There is one road for transport from Dhadgaon to Molagi. Villages situated towards the west side of the road have no proper approach and hence remain isolated. Bhilla and Pawara are two major tribal groups in this area. In all there are 11 Ashram schools run by Govt. and 4 by private institutions. One high school and college (art faculty) located at Dhadgaon, run by private institution. Toranmal is one of the tourist place in the Dhadgaon Taluka. There are about 7 Primary Health Centers and one rural hospital at Dhadgaon.
We follow Ayurvedic system and provide Ayurvedic medicine .We found one of the drug prepared by pharmacy of our institution is effective. There is improvement in anemic condition (Maintains blood hemoglobin level), intensity of crisis is decreased and duration and recurrence of the crisis is prolonged. On the basis of our experience we have developed a sickle cell medical kit which consists of a polyherbal medicine called SC3, Folic Acid, Soda mint and Painkillers like Paracetamol. This kit is distributed free of cost.
Patients and parents are happy with our medical and social treatment .Now we have 1316 patients diagnosed out of which more than 600 are under regular medical supervision. Reason for of irregular follow up is migration for labour in adjoining states and negligence towards this health problem. Every time our old patient brings new patient from his/her village. At present we organize our health camps once in two months and by finding out responses of the patients, planning to visit every month. We provide treatment free of cost. Our institution i.e. Maharashtra Arogya Mandal, Pune is voluntary heath organization has vast experience of working in tribal areas, expertise knowledge about genetic disorder (prevalent in tribal areas), a team of devoted medical and non –medical staff and finally confidence about the results. We are working in this taluka since 1996 and we have screened 25 villages for sickle cell disorder and other health problems. We found high prevalence for nutritional anemia and sickle cell anemia. We have mobile laboratory and facilities for blood investigations.