Lifestyle diseases surge as J&K tribals choose healers over pills

Gujjar and Bakarwal communities have an aversion for modern medical practitioners due to the language barrier, wrong notions about allopathic treatment and religious beliefsSrinagar, Jammu and Kashmir: Nestled in the Zabarwan hills just 20 km from the city centre, Faqeer Gujri is the most sought-after offbeat destination for Srinagar residents in summer — be it to take a bath in fresh glacial waters or savour a moment of solitude.However, things are not so rosy for the Scheduled Tribe (ST) of Gujjars living in this idyllic place. Lifestyle diseases, including anaemia and thyroid, are prevalent here. Razia* (17) recently gave birth to her third child. Recalling how she had fainted during her second pregnancy and was taken to a dai (local midwife), she told 101Reporters, “Usually, the dai has a readymade solution to all pregnancy-related issues. She helps in home deliveries, too. However, even dai could not do much in my case and told us to report to the nearby local sub-centre.”At the centre, Razia was asked to do some tests, which showed that she had anaemia and thyroid disorder. “Despite visiting the doctor, I could not communicate my problem properly. We speak gojri/pahari only and I am illiterate. I could not make out what the doctor was telling. From what my husband told me, I know I have some kamzori (anaemia) and thiride (thyroid),” she said.Razia got free medicines from the sub-centre, but she did not take them fearing side effects. “I rely only on herbal pills and concoctions given by the faith healer. They have a cooling nature, with no side effects,” she claimed.Her sister-in-law Shamshad* (23) shared a similar story. She also had a fainting episode and stomach pain during her first pregnancy. “My husband took me to a faith healer, who gave me some water and a medicinal paste, which was applied on my abdomen,” she recalled. “As my condition did not improve, I was taken to the local sub-centre. However, the facility was closed since it was past the working hours [10 am to 4 pm]. The other government hospital is located far away. Travelling to that place itself will cost a lot. As we could not afford it, we went home and decided to wait till morning. But the pain intensified at night and I had a miscarriage,” she said.A labourer from the Gujjar tribe, Abdul Hamid* (55) from Gutroo village of Tral district in South Kashmir suffers from uncontrolled blood pressure (BP) and diabetes. “Two years ago, I suddenly lost weight and began to feel extreme thirst. I consulted at the nearby dispensary and was given free medicines, which I stopped taking within a few weeks. As my health deteriorated, I travelled to Srinagar, where I was diagnosed with long-standing diabetes and high BP,” Hamid said.Hamid’s wife suffers from gout and heart-related problems. “She complained of palpitation and searing joint pain. We consulted several faith healers assuming that she was haunted by spirits. However, when pain intensified, we went to the main hospital in the city around four years ago,” he said.Hamid earns Rs 12,000 per month. The eldest of his three daughters is married. “My income is already inadequate. On top of that, we have to visit the city hospital every two to three months. I spend Rs 3,000 per month on medicines alone,” he added.Another ST community, Bakarwal faces a similar fate. Five years ago, Nayeema Begum* (40) shunned nomadic life and started living in a concrete house in Thanna Mandi village in Jammu’s Rajouri. “The diseases are the same, but city people have access to proper health care facilities unlike us. I have thyroid issue. My father has high BP and heart block. Every month, we travel to Srinagar to get his checkup done and every visit costs around Rs 15,000 to 20,000. Sirf ghadi ka kiraya hi nahi balki daira bhi dhoondna padta hai [Besides travel fare, we have to spend money on accommodation],” Nayeema said.Data crunchingAs per 2011 Census, the total population of Scheduled Tribes in Jammu and Kashmir is 14.9 lakh, which is 11.9% of the total population of the union territory and 1.4% of the total tribal population in the country. Poonch, Rajouri, Anantnag, Udhampur, Kupwara, Doda and Srinagar districts have a high concentration of  Gujjars and Bakarwals.  Gujjars are primarily agriculturalists. They rear cattle to earn a living and work as labourers and drivers too. Their lifestyle has not changed much and only a small percentage has switched to urban life. Bakarwals, on the other hand, go on seasonal migrations on foot. They take livestock to the upper regions of the Kashmir Himalayas in summers and return to the plains when winter sets in.Two recent studies conducted by Soura-based Sher-i-Kashmir Institute of Medical Sciences among Gujjars and Bakarwals of Kashmir Valley found prevalence of thyroid disorders, hypertension, prediabetes and associated risk factors (Photos - Dr Tajali Sehar/SKIMS, 101Reporters)A 2020 study by Soura-based Sher-i-Kashmir Institute of Medical Sciences (SKIMS), the largest tertiary care hospital in Kashmir, estimated the prevalence of thyroid disorders, and evaluated urinary iodine concentration and thyroid autoantibody status among the Gujjars and Bakarwals of Kashmir Valley.A total of 763 people from Anantnag, Pulwama, Ganderbal, Kupwara and Srinagar districts participated in the study, which revealed that 33% of the tribals had some form of thyroid dysfunction, including 24.1% subclinical and 6.8% overt hypothyroidism. As much as 30% had urinary iodine concentration less than 100 micrograms, which pointed to iodine deficiency. Another SKIMS study undertaken in 2021 evaluated the prevalence of hypertension and associated risk factors by including 6,808 tribals (5,695 Gujjars and 1,113 Bakarwals) aged above 20 years. The overall prevalence of hypertension was 41.4% and pre-hypertension was 35%. Passive smoking, family history and obesity were significantly associated with the condition.Cause and effectDr Nazia Zahoor, a senior resident at Government Medical College, Srinagar, told 101Reporters that stereotypes impeded medical consultation among tribals. “They prefer home deliveries assisted by midwives. They think antenatal care would have a negative impact on their health. This mindset could be due to lack of awareness and socio-cultural and religious beliefs.”Dr Nazia, who has researched extensively on tribal community in Faqeer Gujri, elaborated that the community being patriarchal in nature remains stuck to its traditional norms. “Owing to poverty, illiteracy and language barrier, they prefer traditional healing over allopathic medicines.”Deficiency of micronutrients, including zinc, iron, folate and iodine, in pregnant women causes low birth weight of babies, which in turn increases the risk of anaemia and non-communicable diseases in them as they grow up.“Subsidised rice, maize and pulses form the staple diet of tribals. They also drink noon chai, which has high salt content. Surprisingly, they do not consume much chicken and red meat. Overall, their dietary habits are very poor,” she said.Dr Tajali Sahar, a co-author of the mentioned studies and Scientist-B, Department of Clinical Research at the SKIMS, told 101Reporters that lifestyle diseases were not linked with sedentary lifestyle alone. “New research has shown its connection with a variety of factors, including poor nutrition, malnutrition, smoking, tobacco consumption and junk food. While we can rule out junk food from their diet, we have tried to learn about the other factors,” she explained.She said no dependable data were available on the prevalence of hypertension among the general population. “But we can easily say that hypertension in tribals could be on a par with the general population as percentage of smokers — both active and passive — is high... They mostly live in poorly ventilated kutcha houses or dhokas and depend on firewood for cooking. This acts as a passive smoke among women and children at a very young age.”Dr Sahar said prediabetes was a cause of worry with its prevalence between 11 and 13%. If not properly cared, it would eventually lead to fully functional diabetes.While a small percentage of these tribals have switched to urban life, most are primarily agriculturalists and pastoralists. Researchers believe these lifestyle diseases were linked with a sedentary lifestyle alone but also other factors like poor nutrition, smoking, lack of testing, etc (Photo - Dr Salim Khan, 101Reporters)Action plansAlthough no specific data on the health status of tribals are available, the Jammu and Kashmir administration in 2021 rolled out a health plan to provide holistic healthcare facilities in tribal areas, and transit accommodation on various migratory routes.“Under this plan, the National Health Mission (NHM) was to facilitate mobile medical units, ambulance services, treatment in hospitals, training of tribal youth, besides helping them benefit from various schemes. Unfortunately, it had remained on paper,” a senior NHM official, wishing not to be named, told 101Reporters.On the other hand, the SKIMS Department of Endocrinology has devised an interventional plan to address the issues. “We selected Anantnag and Pulwama districts for the project, funded by the Department of Science and Technology. Preliminary studies have been done in both districts. According to the plan, if any person with hypertension comes to us, we will give free medicines through Accredited Social Health Activists (ASHAs). We will provide IDs to ASHAs to easily monitor a patient’s condition. The ASHAs will send back the data to us on a weekly basis," Dr Sahar said. The department has prepared treatment charts for each person who is diabetic, prediabetic or has hypertension in a given area. “We did not give any medication for prediabetes, but framed pamphlets and documentaries in their local languages so that they can easily understand about the problems and what it can lead to in future," she said.Speaking to 101Reporters, Dr Sheikh Mohammad Saleem, a public health expert working with the Ministry of Health and Family Welfare, Government of India, highlighted the need for continuous communication with the community to initiate a change in behaviour. A comprehensive tribal-sensitive healthcare system incorporating the social, cultural and linguistic issues is needed,” he said. * Name changed to protect privacy Edited by Rekha PulinnoliCover photo by Zahid Parwaz Chowdary 

An apple a day won’t keep doctors away from Kashmir orchardists

Pesticide overuse with scant regard for safety protocols and protective equipment results in a high number of cancer patients among orchard owners in South Kashmir      Srinagar, Jammu and Kashmir: He was affable and perfectly healthy. Hailing from South Kashmir’s Shopian district, Ghulam Mohammad Sofi* (65) could single-handedly manage the workload of 10 people in his apple orchard spread over two-and-a-half acres. He earned Rs 15 lakh annually until his world turned upside down one day.Two years ago, after returning from the orchard where he had sprayed pesticide, Sofi complained of searing abdominal pain. “The local doctor gave him some medicine. However, he continued to feel weak with pain affecting his legs and arms in the following months. Worried about the sudden change in his appetite and loss of energy, we got him examined at the District Hospital, Shopian,” his brother Ghulam Mohiddin* told 101Reporters.“After a few tests, they advised us to immediately shift him to the Regional Cancer Centre, Sher-i-Kashmir Institute of Medical Sciences (SKIMS). We got his disease confirmation there. He had stage 4 stomach cancer. Soon, he was put on chemotherapy but unfortunately, he passed away.” Another orchardist from Shopian district, Mukhtar Ahmad* (60) was quite happy after switching from paddy cultivation to apple farming on his eight kanals of land six years ago. The crop brought him around Rs 10 lakh yearly, but his happiness did not last long as he was diagnosed with stomach cancer last year. “We took him to Delhi, where he was operated upon. It was too late. He could not survive,” his wife Hameeda Bano* said mournfully.Both these cases are examples of how a swift conversion of agricultural lands into high-density orchards has resulted in the excessive and indiscriminate use of pesticides in Kashmir. Farmers spraying pesticides in Kashmir (Photos courtesy of Dr Alamgir Dar/101Reporters) In the 2021-22 financial year, nearly 4 lakh hectares of land were under cultivation in Jammu and Kashmir. Of that, 3.35 lakh hectares had fruits and 0.6 lakh hectares had vegetable production.Figures revealed that in 1974-75, the area under horticulture was 82,486 hectares. It increased to 2,19,039 hectares in 2001. In 2020, it stood at 3,30,956 hectares. The exponential growth of over 400% was triggered by the high economic benefits associated with the sector. The region is the main producer of apples and walnuts, with 77% of apples and 90% of walnuts produced in the country coming from the Kashmir Himalayas.“Farmers traditionally cultivated irrigation-intensive paddy, but the income was meagre. So when the government incentivised apple farming, the majority of them converted their lands into apple orchards. With the introduction of high-density apple crops of huge economic value, pesticide use also increased threefold in the last 12 years, especially in Shopian, Pulwama, Kulgam and Anantnag districts of South Kashmir,” Dr Alamgir Dar, pesticide analyst, Research Centre for Residue and Quality Analysis, Sher-e-Kashmir University of Agricultural Sciences & Technology (SKUAST)-Kashmir, told 101Reporters.  Farmers initially sprayed pesticides, mostly fungicides and insecticides, twice or thrice annually. But 10 to 12 sprays became a routine as pest attacks increased over time. In spring, Scabs affected tender apple leaves. San Jose Scale sucked sap from branches, leaves and fruits and affected the plant's overall vitality in May-June. Its presence could be easily discerned from the reddish blemishes found on the fruit. European Red Mite pests also fed on the leaves, thereby reducing the yield.About 10 to 12 sprays became a routine as pest attacks increased over time (Photos courtesy of Dr Alamgir Dar/101Reporters) Chlorpyrifos is used to kill several pests including insects and worms. Notably, on August 18, 2021, the US Environmental Protection Agency announced a ban on the insecticide that caused neurodevelopmental problems and impaired brain function in children. Both the US and Canada banned its indoor use in 2001, which was later implemented by several other countries. “Unfortunately, Chlorpyrifos continues to be in use in India. Since there is no alternative to it, the insecticide is always present in the list of approved sprays that the Department of Horticulture issues every year,” Dar said, adding that Mancozeb, Dithane, Captan, Carboxin and Synthetic Pyrethroids are also commonly used.  Temperature has a great influence on dissipation pattern and persistence of pesticide on a particular crop in a particular climate, and climatic conditions in Jammu and Kashmir are very different from the rest of the country. “Insecticides are repeatedly applied during the entire period of growth and development, and sometimes even at the fruiting and pre-harvesting stage. Ironically, overuse does not serve any purpose other than affecting the health adversely and making pests resistant to sprays,” Dar said.To make matters worse, farmers in the Valley do not adhere to the advisories and recommended dosages approved by SKUAST-Kashmir. For instance, ‘The Management Guide for Apple Orchards in Kashmir (2022)’ compiled by the university outlined the cultural and management practices to be adopted, the amount of insecticides, pesticides, acaricide and oils to be used per 100 litres of water, and the type of protective gear to be used. Though farmers clearly know about the side effects, they use sprays in different concentrations and proportions on every part of the tree in a desperate attempt to save the crop. “They neither adhere to safety protocols nor wear protective equipment. A stick is used to handle the pesticide mixture. The farmer wears just a mask, and uses no goggles, face shield or protective glasses,” Dar detailed.Dr Umar Muzzafer, a Young Scientist Fellow of the Department of Health Research working in Srinagar Government Medical College, told 101Reporters that the pesticide exposure happened mostly while preparing or mixing the spray solution and during clean-up of the spraying equipment.“Exposure can be through skin or inhalation. Skin exposure happens mainly through the face and hands if the farmer has not put on protective clothing. If proper care is not taken, farmers can routinely get exposed to pesticides at a much greater level than what the consumers of those fruits are exposed to,” he said.Farmers are aware of the side effects, but in desperate attempts to save the crop, they use sprays in different concentrations and proportions on every part of the tree (Photos courtesy of Dr Alamgir Dar/101Reporters) A study titled ‘Acute Health Effects of Pesticide Exposure among Farmers Directly Involved with Spraying: A Cross-Sectional Pilot Study from Kashmir Valley’ showed the association between exposure to organophosphorus pesticides and various health ailments. It revealed that “neurological complications” were most commonly reported.“The neurological symptoms included weakness (60.3%), dizziness (44.4%), headache (38.09%), fatigue (30.1%) and muscle pain (19.04%). This was followed by respiratory symptoms like cough (58.7%), cough with phlegm (41.2%) and breathlessness (12.6%), and eye-illness symptoms,” it said.A surgical oncologist (breast, colorectal and peritoneal surface cancers) at New City Hospital, Srinagar, Dr Shabnum Bashir said the adverse effects of long-term pesticide use included the development of cancers, brain and nervous system damage, and birth defects. Overall cancer cases in Kashmir have seen an alarming rise since the pandemic. Bashir said a SKIMS research study on the association of pesticides and brain cancer among the orchard farmers of Kashmir had revealed that all of them had high-grade tumours caused by pesticide exposure. “Mortality in pesticide exposed tumours was 12%,” the 2005-08 study said.However, the severity of the disease manifested only after several months or years of pesticide exposure. “Farmers should be educated through workshops and awareness campaigns about the larger consequences of pesticide overuse and the necessary precautions,” Bashir explained.Over 55 per cent of production costs in the fruit sector are being spent on the protection of crops, according to a government report accessed by this reporter. To limit the rampant use of pesticides, the J&K government launched a pilot project in December 2022 at a budget of Rs 27 crore, which listed interventions like cluster-based high-density model orchards, identification of disease-resistant crop varieties and bio-pesticides, and popularising advanced spraying technologies.  On the possible alternatives, environmental expert Dr Irfan Rashid said farmers should switch to bio-pesticides and biofertilizers. "Biopesticides are compounds that protect crops by killing pests using living bacteria, natural materials, or biomolecules while biofertilizers promote plant and tree growth by enriching the nutrient quality of the soil. “Aquatic weed Azolla, found in Dal Lake in Srinagar city, can act as a biofertiliser,” said Rashid, an assistant professor at the Department of Geoinformatics, University of Kashmir.“The Lakes and Waterways Development Authority can use the weed removed from the lake to make biofertilisers. It can be converted into a sustainable business model for the larger benefit,” Rashid added.Meanwhile, Dar said recommended dosage of pesticides was mandatory to keep the crop disease-free. “The concept of biopesticides, derived from animals, plants, bacteria and certain minerals, can also be explored. A research on this front in our university is yet to produce any tangible result,” he said.  Elsewhere, Senior Scientist at Plant Biotechnology and Agro Technology Division CSIR-Indian Institute of Integrative Medicine, Jammu, Dr Wajid Waheed is studying naturally-occurring plant-derived pesticides like terpenoids“Our lab at CSIR-IIIM, Jammu is using a molecular approach to understand how these compounds are made by these plants and transfer the molecular machinery to high-value crop or fruit plants, so as to create molecular biodefence factories in these high-value crop and fruit plants where these pathways will get activated once plants are attacked by pests,” Dr Wajid said.*Names have been changed to protect identities Cover Photo: Courtesy of Dr Alamgir Dar/101ReportersEdited by Rekha Pulinnoli

Birdwatching community raises alarm as bird count at Srinagar's Hokersar wetland dwindles

Water level dips after dredging work, hindering the movement of thousands of winter migratory birds, say birdwatchersSrinagar, Jammu & Kashmir: Every winter, Hokersar wetland near Srinagar in Jammu & Kashmir transforms into a paradise for birdwatchers. European goldfinch, common teal, northern pintail, garganey, mallard, common coots, greater white fronted goose, bramblings, jackdaw and various types of bunting species flock to the wetland, which, in 2005, was declared a Ramsar site — a wetland deemed of international importance.Known as the ‘Queen Wetland of Kashmir’, Hokersar — also called Hokera — attracts half a million winter birds every year as well as thousands of birdwatchers. Spread over 1,375 hectares, it plays host to winged guests from Siberia, Turkey, Central Asia and eastern Europe between October and April.However, the past two winters, city ornithophiles observed that the migratory birds have dwindled in numbers in Hokersar. They blamed it on the “ill-planned” dredging work in the area, which started in July 2020. It has severely damaged the land because dredged soil was dumped at the site during work to install a flood management system. Adding that the haphazard dredging had hindered the movement of thousands of migratory birds, birdwatchers have urged the administration to look into the issue.“The water levels have dipped, because of which the number of winged visitors we get in winter has declined,” said a senior member of Kashmir Birdwatch, a local club that boasts 11,000 members.According to the Annual Asian Water Bird Census, Kashmir recorded 807554 birds in 2020 while the number dropped to 648322 in 2021. The report reveals that two Ramsar sites (Hokersar and Wular) saw a substantial decrease in bird population in the recent years — Hokersar wetland witnessed a drop from 4.8  lakh (2020) to 65,000 in 2021, while at Wular Lake, the population of birds declined from 1.2 lakh to 707 birds in the same time period. The primary cause — extensive damage to the wetlandsDr Irfan Rashid, senior assistant professor at the Department of Geoinformatics, University of Kashmir, attributed the decrease in the population of birds in the wetlands to land-system changes, rapid urbanisation and increase in agricultural activities around these areas. “The breeding and nesting grounds are mostly marshy areas in these wetlands. The marshlands have undergone a substantial change due to continuous land filling and encroachments. The water spread and depth has also decreased in the wetlands over the years, thereby affecting the habitat of the birds,” he explained. Commenting on the census, he pointed out that the bird count was not arrived at correctly. “Such drastic decline from lakhs to mere thousands is not possible. They either conducted the survey through ill-trained personnel, or the samples were not taken properly. The use of advanced drone technology could have helped in arriving at the precise count, though I believe it was not put to use,” Dr Rashid said. Local birdwatcher and college student Reyan Sofi, who has spotted 204 species of birds in the Hokersar wetland so far, said the birdwatchers held a meeting with the wildlife officials and the divisional commissioner of Kashmir in August 2021. They demanded a scientific assessment of the wetland by experts to gauge the extent of the damage. They also demanded restoration of the natural paths of water and an increase in security guards to check encroachments. But their demands have not been met yet.Moreover, the count of birds in Hokersar decreased far more considerably when compared to the bird population in other wetlands in Pampore, Wular and Hygam.Bird watchers in Kashmir have deliberated over reasons for the decreasing bird count, one of them being destruction of their habitat (Photo sourced by Intesar Suhail)“Birders have repeatedly highlighted the deplorable state of the wetland. Their efforts prompted the government to take some measures in September last year,” said Sofi, who has been extensively documenting birds around Hokersar since 2015.The student further said that the dry areas around the wetlands had been filled and a flood channel originating from the Jhelum had been diverted to the wetland. “The solution, though temporary, has increased the water level in Hokersar. But they have also dug a 60-ft nullah in the middle of the wetland, which pumps out the water entering the wetland. This should be stopped immediately,” Sofi emphasised.Dr Rashid further stressed that the wetlands can be salvaged through effective policy-making and by conducting a proper scientific assessment of these ecologically fragile zones. A separate wetland policy should be framed, he added, by bringing experts from all concerned departments on board. Human interference the other culpritThe ibisbill (Ibidorhyncha struthersii), a wader that inhabits the broad, stony rivers of the Pamirs, Himalayas and the Tibetan Plateau, is fast dropping in numbers. The bird is usually spotted at several sites along the river Sindh, in Wayil, Wussan, Kijpora, Sonmarg, Neel Grath and Baltal.However, human interference in the form of mining (extraction of sand and boulders from the river), human presence (movement of local people, tourist activities and fishing) and grazing by livestock (sheep, cattle and goat along the riparian areas and islands in the river) has affected the birds, including the ibisbill, and their habitats.(Above) Ibisbill, a bird that camouflages easily with rocky streams and rivers, has been severely affected by human interference; (Below) Kashmir Flycatcher has been tagged as a 'vulnerable species' due to its declining population (Photos sourced by Intesar Suhail)“Our surveys tell us that there was hardly any breeding of ibisbill in the Sindh area last year,” said a member of Kashmir Birdwatch.Another researcher and birder Iqram ul Haq explained that since ibisbills prefer a particular kind of habitat — they are partial to high-altitude, boulder-strewn rivers — they are prone to local extinction if this threat continues.“Immediate action needs to be taken to save the bird as most of the areas inhabited by the ibisbill are not protected. Research organisations and NGOs need to highlight the plight of the birds and approach authorities like the departments of wildlife protection and mining to ensure that its breeding grounds are protected,” said Haq, adding that mining needs to be checked at the sites inhabited by the bird.Tahir Gazanfar, avid birder and wildlife biologist at the Wildlife Trust of India, said spring sees the arrival of the golden oriole (posh nool), swallow (Katij) and the paradise flycatcher (phamb-seer).“These migratory spring birds are in our folklore more than those residing here permanently, perhaps because they signal the end of the gloomy winter,” he said.A hotspot for birdwatchersIn the past three years, a large number of birders from across India have been flocking to Kashmir. Clubs like Kashmir Birdwatch have been creating awareness on the avifauna in the valley and also encouraging birding among youth.“By now, we know which birds can be spotted in which month. This documentation helps attract more birding tourists to Kashmir. It also generates jobs for locals,” said Intesar Suhail, co-founder of Kashmir Birdwatch and Wildlife Warden, Shopian.Kashmir Birdwatch is planning to put together a calendar for sure-shot findings this year. “We are aiming to achieve almost 100 percent sightings through the calendar and by drafting seasonal itineraries,” Suhail said.Jainy Maria, a Bengaluru-based birder who’s been visiting Kashmir since 2010, said birdwatching has picked up among locals in the past few years.“It sensitises people towards the environment, as well. It’s a great change,” said Maria, who has photographed more than 1,100 birds across the country.Moreover, according to Regional Wildlife Warden Kashmir Rashid Naqash, there’s been a remarkable increase of birders in this region in the last decade. “This interest in birding has raised awareness not only about the birds but their habits and habitats, as well. The best part is the contribution to science that comes with reporting on new species spotted. Birders across the country get excited to know about some unique birds, and they, too, get inclined to visit,” Naqash said.He noted that proper documentation was the first step to conservation. “Knowing birds means knowing their habits and habitats, their issues and challenges. These birders, even if they can’t act suo moto, can help spread information and can act as the citizen’s voice to bring change for good,” he emphasised. Edited by Shobha Kiran Surin  

In Kashmir, the pandemic brings menstrual health campaigns to a halt

Lack of resources and restrictions on mobility during the lockdown have disrupted ongoing civil society efforts aimed at promoting menstrual health.Srinagar: Today, the government health centre in Nandpora at Saidakadal locality Srinagar wears a deserted look. The only visitor, a stray dog that lies dozing in the compound, basking in the mild May sun. In the pre-pandemic times, however, the health centre was the hub of many a bustling activity. Awareness campaigns around the importance of menstrual health would be held every fortnight, refuting myths and misperceptions around mensuration. The World Menstrual Hygiene Day, which falls on May 28, would have especially been a lively affair. But in these pandemic times, like every other non-Covid healthcare intervention, menstrual health has taken a backseat. With every resource being diverted to the crisis at hand, a crushing blow has been dealt to menstrual awareness efforts in the valley.Dr Auqfeen Nisar (30), a resident doctor at Shri Maharaja Hari Singh (SMHS) Hospital, initiated a first-of-its-kind, crowd-funded campaign against menstrual taboo, `Panin Fikr’, when she was still a post-graduate student. She has been championing the cause since 2019, leading a six-member team comprising two nurses and four ASHA (Accredited Social Health Activist) workers. She conducted her campaign from the health centre in Nandpora where she was posted, catering to a community of around 4,000 women, of whom 200 are adolescent girls. She notes that the COVID-19 pandemic and the ensuing lockdown has unleashed a sanitary napkin crisis in the valley. “After the pandemic began, the donations stopped pouring in. Our funds have completely dried up and we are unable to provide sanitary napkins free of cost under the initiative to those who have registered with us. Moreover, door-to-door and mass awareness campaigns are not possible at this time, when social gatherings are disallowed,” Dr Nisar rued.She said it took them a lot of time to bring about behavioural changes in women regarding menstrual hygiene. “The free napkins were a great source of motivation for them. However, all our efforts will go to waste if things continue like this. They will resort to their old, unhygienic practices, if they haven’t done so already,” Dr Auqfeen said.She cites the example of a 35-year-old woman from Nandpora, who had attended several awareness programs, subsequently shifting from cloth to sanitary pads. However, when Auqfeen met her recently, she was saddened to hear that the woman had reverted back to using cloth. The pandemic had reduced her income, and so pads had become unaffordable.Dr Nisar (extreme right) and a few members of her team during the pre-pandemic days. (Picture courtesy: Hirra Azmat)Similarly, entrepreneur Aqib Peerzada (28), popularly knowns as `Padman of Kashmir’ for launching organic sanitary napkins, concurs that the pandemic has exacerbated women’s deprivation of menstrual hygiene products.“Before the crisis, we at Seha Health and Hygiene were engaged in distributing packs of sanitary napkins to teenage girls at affordable prices as well as free of cost to many others across the valley. Our mission was to create awareness about menstruation in addition to manufacturing affordable and organic sanitary napkins,” he said. However, the lockdown severely hampered their production and operations. Their manufacturing units were shut down, and the lack of manpower ensured that the production of sanitary pads came to a screeching halt. Peerzada himself came down with COVID-19 pneumonia and had to stay away from Seha during his month-long hospitalisation and recuperation. “Eventually stocks were exhausted in many places and women had to resort to unhealthy alternatives,” he said.However, despite the lockdown and threat of infection, Seha has managed to distribute many boxes of napkins, especially to women in quarantine. “I have faced many hurdles and difficulties during this time but still I personally delivered many boxes to needy girls during this crisis. I believe that it's our priority to not think about profits and targets but come forward and help people as much as we can,” he saidThe crisis is aggravated by the fact that the mobility of women is severely restricted during the lockdown. Irfana Zargar (30), the founder of 'Eva’s Safety Door’ campaign, illustrates this. As part of her campaign to raise awareness, she used to distribute sanitary napkin packs for free among the attendants of public toilets in Srinagar city so that the women coming there could use them. With the toilets now shut, the campaign has also gone for a toss.“The lockdown has resulted in restricted access and mobility, making it even more difficult for girls to manage their monthly cycle in a dignified healthy way,” she said. Meanwhile, Zargar who also works at the Srinagar Municipal Corporation, is deputed these days at the 24*7 district control room Srinagar that handles COVID-19 related complaints.Irfana Zargar with a hamper of menstrual hygiene products that are made available for women in public toilets. (Picture arranged by Irfana Zargar)“The work is so taxing that there is no time to devote to altering the campaign to meet the pandemic needs,” she said.Dr Nausheen Khan, a senior gynaecologist at Lal Ded, the lone maternity hospital in Srinagar, said the government must step up during this crisis.“The government must ensure that the sanitary pads are distributed to females in the community through Auxiliary Nurse-Midwives (ANMs) and ASHAs. Even if sanitary napkins are not available, they should educate them on how to make sanitary napkins at home. The napkins can be made from cotton cloth and changed frequently. They should be washed properly before using it again,” she said.Dr Khan pointed out that subsidised sanitary pads can also be made available for sale through the ration shops. "An inclusive and gender-sensitive response to COVID-19 must involve catering to the menstrual health and hygiene needs of women and girls especially from the most marginalised sections,” she said.

COVID-19: Kashmir's NGOs step in to deliver oxygen, food and support

During Ramzan in Srinagar, traditional charities channelled their efforts towards helping those battling the coronavirus.  Srinagar: The SOS arrived in the dead of the night – a frantic young woman sought the urgent help of volunteers at Social Reforms Organisation - Kashmir (SRO Kashmir), desperate for oxygen for her mother.“The phone rang at 3 am," a volunteer at SRO Kashmir recalls. "On the other end was this girl, weeping bitterly as she spoke of her Covid positive mother. Her oxygen saturation level had dropped considerably and she was gasping for breath. So an ambulance was sent immediately and oxygen support was delivered within an hour. The next morning, a family member dropped in to pick up an oxygen cylinder from us. He declared that her survival would have been impossible had we not intervened in time.” A few nights later another heart-breaking SOS call to the NGO revealed a family of four that had tested positive and three of them had already been hospitalized.“The fourth family member was a 65-year-old man who was left alone at home. He was positive but stable. Within a few days, however, his condition had deteriorated. Our team members immediately went to his aid after learning about his condition. We provided him with meals, medicines and also got him hospitalised the next day. The volunteers took care of him till he recovered. Today, he can't believe that he actually survived this darkest hour of his life,” the volunteer said.Many local NGOs like SRO-Kashmir have taken on the mantle of saviours in this second wave of COVID-19, catering to needs as diverse as supplying oxygen to adopting the role of caretakers.Mohammed Afaaq Sayeed, Project Director of Oxygen Kashmir at SRO Kashmir, said their volunteers have taken on this herculean task head-on, and work right from daybreak till midnight.“We have 15 volunteers on the ground who work from 5 am till late in the evening. Of them, three volunteers remain awake till Suhoor (the pre-dawn meal eaten before fasting in Ramzan). They cater to patients and SOS calls during the night. Then, there are 12 volunteers at the backend. They create the database, monitor inventory, and maintain the data on equipment with people and their details,” he said.A volunteer with Athrout which is running free 24/7 ambulance services. (Picture courtesy: Athrout)SRO Kashmir’s main focus is on oxygen. It provides oxygen concentrators, oxygen cylinders, non-invasive ventilation machines, and other equipment. Besides, it offers ambulance services, burial services, plasma donation services, and runs a food programme for those affected by the lockdown and loss of livelihood.“All this comes with a set of challenges. First, people don’t return the equipment easily. Second, we are unable to procure new equipment as there are no supplies. That said, we still try to cater to at least 70 per cent of the 80 calls on an average we receive every day,” Sayeed said.The NGO is planning to create a more robust and real-time system for tracking the availability of oxygen cylinders and concentrators with them in the coming days.  “We are on it, and it will soon be up and running so that attendants don’t have to suffer any inconvenience.”Srinagar-based charitable organisation Athrout is also doing stellar work on the ground with the aid of more than fifty volunteers. Athrout is running a free 24/7 ambulance service. “We have six ambulances fitted with oxygen and two are designated exclusively for Covid positive patients. We have also hired ambulance drivers who can drive during the night time,” an official with Athrout said. In order to proactively respond to the crisis, Athrout, in collaboration with the district administration, has created a 100-bed oxygen facility at Haj House. "Besides, we are also offering free PPE kits, hand sanitisers, masks, and pulse oximeters to the family members of those in home-quarantine and the attendants of those Covid positive patients admitted in hospitals,” they said.Relief being handed out by NGOs range from food materials to household goods and safety equipment. (Picture courtesy: Athrout)Help Poor Voluntary Trust, another local NGO, is chipping in with ambulances and first-of-its-kind hearse services to transport the dead with dignity, with vehicles that can carry up to three bodies at a time.  Ali Muhammad Lone, who is the incharge of hospitals for the NGO, said that more than 100 volunteers are working with them. Besides, oxygen support, the trust provides free of cost medicines and other health care services across Kashmir.“We have 150 oxygen concentrators and distribute them on a rotational basis. We give away 10-15 cylinders on a daily basis. Besides, we have 11 ambulances (one critical care and 10 oxygen-fitted),” Lone said.A burgeoning need for home-cooked food for hospitalised Covid positive patients, their attendants and families in home isolation is taken care of by food delivery services in Srinagar like Tiffin Aaw, who provide free food under ‘Food for Kashmir’ initiative.“In the second wave, we began receiving distress calls from Covid affected families and patients. We realised the need for serving them hygienic, healthy food to combat the disease in this difficult hour. We also decided to deliver food to those who suffered the loss of livelihood due to the pandemic,” said Rayees Ahmad, owner of Tiffin Aaw.With an eight-member team, Ahmad delivers around 100-150 free food boxes every day across Srinagar including to all the major hospitals in the city like SKIMS, Soura, Chest Diseases hospital, SMHS, GP Pant Children Hospital, JLMN, and Kashmir Nursing Home. It's a challenge to ensure that the orders are not jumbled during distribution, he says. Rayees plans to add to his team in future and is currently appealing to people to donate a vehicle.” We are in dire need of another delivery van beside the two that we already have. The graph of inquiries is increasing and we want to ensure that we cater to 400 people daily,”Team Tiffin Aaw delivers food to COVID-19 patients (left) while a volunteer with SRO Kashmir distributes relief (Pictures courtesy: Tiffin Aaw and SRO Kashmir)

NGOs keeping healthcare, education on track in Kashmir

With a crumpled handkerchief in her frail hand, Shameema (name changed), 50, a resident of Bemina locality in Srinagar of Jammu & Kashmir (J&K), awaits her turn to receive treatment at the dialysis centre of a local non-government organisation (NGO), Athrout, in Nawakadal area of the old city. After the repeal of Article 370 on August 5, the region faced a breakdown of numerous services such as healthcare and education. However, organisations such as Athrout are coming together to ensure the flow of critical services.  Even when thinking of the day her husband, who works as a labourer, mentioned that the golden card issued by the government under their flagship healthcare scheme Ayushman Bharat had stopped working, Shameema gets anxious. Absence of internet connectivity meant that she wouldn’t be able to receive her treatment as schemes by the government can only be accessed after online verification and her financial status prevented her from being able to afford treatment at a private hospital. She had given up hope of receiving treatment and was certain that she would not be alive for long. However, after making several rounds of the government hospital, her doctor suggested her to approach Athrout, which is where she goes for her regular procedure.After all avenues for the downtrodden had been shut, Athrout picked up the mantle and is ensuring that the less fortunate continue to receive healthcare services. Their dialysis centre has helped multiple patients across the Valley since the lockdown began and treats about 20 patients in two shifts every day.Mudasir Ahmed,  manager at Athrout, told 101Reporters that 59 patients, including patients from Srinagar as well as north and south Kashmir, are registered with the centre currently.He highlighted that there has been a heavy influx of patients since the abrogation. “It was a difficult situation as we had to accommodate so many in one go, but there was no way we could deny them given the circumstances, and we managed due to the relentless efforts of our volunteers,” he added.The NGO has four ambulances and has around 35 volunteers who work round-the-clock in shifts. They also offer ambulance services to many patients and attendants to ferry them home. Apart from the healthcare services, the NGO has also been distributing monthly cash to widows, medicines to the sick and marriage kits to brides with limited resources.Helping the poorLike Athrout, Help Poor Voluntary Trust (HPVT), has striven to fill in the gaping hole left by the clampdown. Inside the crowded emergency at a main tertiary hospital of the Valley, Shri Maharaja Hari Singh Hospital (SMHS Hospital) in Srinagar, one might fail to notice a small kiosk by HPVT that has sprung up next to the ticket counter. However, hundreds of financially poor patients benefit from it daily since August 5.The person in charge of the initiative at SMHS Hospital, Mohammad Ali Lone, is an employee in the agriculture department of Srinagar. After he finishes with his day’s work, he gets ready for another. Donning the red and yellow vest with a motto which says, “Help us to save lives”, he sets off to the hospital.Lone asserted that it has been a testing time for the residents, especially the financially weak ones, who have been pushed to the wall by the unending restrictions. Those who suffer from life-threatening ailments have been particularly hard-pressed, he highlighted.Currently, with over 1,700 patients registered, HPVT has been providing medicines and several other service free-of-cost. The trust has around 100 volunteers, which include students, government employees, doctors, teachers and lawyers, working with them and set up kiosks in five hospitals of Srinagar—Sher-i-Kashmir Institute of Medical Sciences, SMHS Hospital, Super Specialty Hospital (Srinagar), Jawahar Lal Nehru Memorial Hospital in Rainawari area and Bone and Joint Hospital in Barzulla area.In addition, the trust has been offering free services like trolleys, wheelchairs, Nebulizers, urine containers, patient guidance and assistance.Educating children A dimly lit corner of a newly plastered room is abuzz with the chatter of three kindergarteners. They are bent over their notebooks forming letters of the alphabet on the ruled pages of their notebook. A young man barely in his mid-20s watches over them twiddling with the eraser. In the centre of the room, a group of tenth graders is solving problems of trigonometry. Another young man in his 20s supervises them, and explains the solutions with patience. These are not the scenes from the private tuition centre but a makeshift community school that runs every afternoon from 1 to 4pm at Pattan in the northern part of the Kashmir Valley.Community schools have sprung up in various parts of the Valley to ensure that the students who miss out on schooling stay in touch with their education. These schools are entirely run on the resources and labour pooled by young men and women united by the spirit of self-services.Three young men in their twenties who chose to remain anonymous are behind this initiative. Two of them are teachers in government schools, while one teaches at a private school. All three decided to join forces after realising that the current upheaval is unlikely to end soon.“We don’t see any improvement in the situation. The biggest casualty is the education and mental growth of young ones. Each day they spend absent from school adds to the rust that eats away at their mental growth,” asserted one of the young teachers.  He added that couldn’t bear the situation affect the mind of the children any longer and while they concede that they can’t replicate a conventional classroom, they opened the school in his house as “desperate situations call for desperate measures.” Presently, the school has enrolled around 100 students right from nursery to grade 10.When asked how he feels about the community school, Saqib Wani, 16, asserted that he felt lost for the first few days of the curfew and was terrified that he would fail his matriculation examinations, which were held in October, until he came to this school. “There was no one to talk to at home. At the school, I have made friends, and I have completed most of my syllabus. I no longer feel lost,” he mentioned.Similar schools have sprung in several parts of the Valley which run solely on the selfless efforts of educated youth. A community school at Harwan in Srinagar is being run by two youth, Sameer Ahmed and Younis Ahmed, and 25 students have already enrolled for classes which are from 8-10 in the morning, and after 5 in the evening. On the outskirts of Srinagar, a community school in Zakura functions with twenty students and two volunteer teachers.“These schools exhibit once again the selfless streak of Kashmir that comes to the fore during crises,” stated Farooq Ahmad, a resident of Srinagar.

Tackling misinformation around menstruation behind Kashmir’s closed doors

Srinagar, Jammu and Kashmir: In the narrow decrepit lanes of Nandpora area in Saidakadal Srinagar, two girls with veiled faces walk in a secretive manner towards a health centre, which is housed in a two-roomed hut. They talk in whispers and seek directions to the place. A passerby points them in the direction of an old gate, which has worn out by the passage of time. It creaks loudly as it opens to a large group of women whose faces are equally covered. The veiled faces of these women are focused on a young female doctor, who is sitting in the middle, with rapt attention.The doctor speaks in a quiet but confident tone asking questions on the group’s understanding of menstruation. “Do you get cramps and backache? Do you suffer silently or share the pain with someone? Do you still use a cloth when you bleed? Have you ever tried using a sanitary napkin,” she asks. Dr Auqfeen Nisar, 28, has taken upon herself to carry forward the mission of menstrual hygiene and create awareness among the women in the area. Dr Nisar is currently pursuing MD in Community Medicine at Government Medical College in Srinagar.“My mother would not allow me to go out to school during periods. She would even tell me not to share about periods with anyone as it is a matter of shame and a big sin,” says 16-year-old Rehana (name changed).She reveals that her mother would give her some old unclean pieces of cloth for her to use during her menstrual cycle. As a result, she developed urinary tract infection and was on medication for a month.“My mother said that dirt should be treated with dirt,” she says.Henna (name changed) in her early twenties stopped telling her mother about her period and goes to her maternal grandmother’s home during her menstrual cycle. “I silently endured the backache and hid the napkins in the innermost pocket of my bag or else all hell would break loose,” she says.Surprised with discomfort and taboo on menstruation, Dr Nisar says that she was approached by an adolescent girl last year whose mother had claimed that sanitary pads lead to infertility.Disturbed by these experiences, Dr Nisar, a resident of Lal Bazaar locality in old city Srinagar is determined to confront the issue. She is charting a silent revolution with her team by spearheading a campaign called ‘Panin Fikir’ (To take care of oneself) in the area.“A woman takes care of everyone but forgets to care about her self. I want to ensure that women of this area should get over misconceptions about menstruation and start caring about themselves. Hence the name, Panin Fikr,” she says.The project began in January 2019. Her team comprises of two nurses and four ASHAs (Accredited Social Health Activist) as staff at the sub-centre. The sub-centre caters to a population of around 4000 out of which 200 are adolescent women.The ASHAs help in mobilising women, especially the antenatal females, for immunization, antenatal check-ups, and outdoor sessions. The team has conducted around 15 workshops in the area so far.Adolescent females often come to her with many health-related issues (like itching, whitish discharge, reproductive tract infections) and it was found out that their menstrual hygiene is deplorable, reveals Dr Nisar.She claims that the women often use cloth during their menstrual cycle, often repeatedly without washing it properly while only a marginal section use sanitary pads. Dr Nisar and her team began their research by finding the barriers and learnt that “affordability and lack of awareness” came as the biggest hurdles for women to practice menstrual hygiene.As part of Panin Fikir, Dr Nisar and her team have short-listed two low-cost sanitary napkin companies. Each pack consisting of two napkins is sold at Rs 5. She says that here idea transformed into a result through crowd-funding. Acceptance of such a product was also a barrier, and Dr Nisar, distributed few packets for free initially and sought feedback on it. Another challenge for Dr Nisar is sustenance. She feels that people resort to old ways once you stop providing the pads for free, which is why they provide sanitary napkins at subsidised rates. Dr Nisar and her team aim to bring a behavioural change through her workshops and awareness campaigns. “The cultural taboos and superstitions associated with periods have persisted at the cost of women’s health and safety. Someone has to come forward and bring a change. If not today, then when?” she adds.