insurgency: challenges in medical … october 2013... · 2016-03-25 · pran gopal saha*;...

ISSN: 2278-4853 Vol. 2, Issue. 10, October 2013 AJMR

TRANS Asian Research Journals

http://www.tarj.in 22

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.

______________________________________________________________________________




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.




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)




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)




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




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




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




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




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

insurgency: challenges in medical … october 2013... · 2016-03-25 · pran gopal saha*;...

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