Saturday, August 20, 2011

Field survey on medical access and human trafficking in the Sundarbans

Field survey on health access and human trafficking
Kankandighi and Nagendrapur
South 24 Parganas, West Bengal
Thursday 28th and Sunday, 31st July 2011


The inhabitants of the Sundarbans are facing difficult living conditions. Some fundamental rights are violated, including access to care, professionals and health facilities, due to bad roads, too big distance with the infrastructures and lack of money. In addition, the 2009 Aila cyclone destroyed many arable lands, which compromises the ability of families to answer their food needs. Often the girls decide to go in city, which is a less mouth to feed and future source of income for relatives. They hope to find a job but land in human trafficking networks which leads them into prostitution or forced marriage and work.

The purpose of this study is to understand the importance of these problems by the state of access to water, health facilities and understand the lifestyle and socio-economic environment in which live the women. This last point will be used to apply for the 2011Human Rights Award of the French government. Otherwise the report will be used for the project of mobile van clinic and primary cares.

The study was conducted by Aurélie Bezault, along with Bala for the translation, guided by Arabinda Mondal, a member of Mukti and coordinator of the SAM program.
The mission took place on 2 separate days, Thursday 28 and Sunday, July 21, 2011, mainly in Nagendrapur GP.
To reach this place, a train was taken from the Jadavpur Railway Station, in the south of Kolkata. After 1:15 journey, an auto-rickshaw is taken during one hour to reach Raidighi, where we have a second auto-rickshaw to reach Nagendrapur one hour later. We need a little over 3 hours to come there.

Areas studied:

24th South Parganas district
In Nagendrapur GP, the study took place in Nagendrapur and Purba Sridharpur where Mukti has an office in which could be interviewed women from a Self-Help Group.
In Kankandighi GP, the study took place at Kankandighi.

Interviews based on questionnaires prepared in advance
Meeting with a group of women, a Self-Help Group, a nurse of a Primary Health Center
Meeting with Prodhan of Nagendrapur G.P
Meeting with a woman member of the board of the Prodhan’s Council in Kankandighi GP

Details of the survey:

Thursday, July 28
The day began with an interview with a woman whose teenage daughter has disappeared. A young girl told the forced marriage of his sister. Then we had an interview with a group of women on their medical needs.

Sunday, July 30
Meeting in Kankandighi with a woman belonging to the Council of the Prodhan. Then interview of the Prodhan of Nagendrapur GP. Visit of a Primary Health Center and discussion with the Nurse. Meeting and questions with a Self-Help Group.

The objective of the study is to determine at first what are the needs of the population in terms of health and improvement of living conditions in order to respond in the future by the mobile clinic program. It was necessary to understand which diseases were most prevalent, what people wanted as common infrastructure and medicine. Special attention is given to women including the issue of pregnancy during which they remain fragile.
The second point was about the state of human trafficking, especially women in the region. These are first victims: they do not go to school after primary school, marry early to avoid paying a dowry and work very early. They hope of a better pay and living conditions in the city. Some are sold by their parents. The study wanted to understand, through interviews with authorities and victims, the mechanisms of poverty that make them the victims of human trafficking networks in order to prepare a program on the issue.

Reports by sector clusters
General data on Nagendrapur G.P

Total: 21 335
Total number of women: 10 135
Total number of men: 11 220

5-6 girls are missing in the 15 villages. They are unmarried, between 16 and 20 years.
The abduction of young girls concerns very poor families whose activity does not provide sufficient income
The girls all moved on the promise of a job in the city
All did not go to school
The police is informed only at the insistence of the Panchayat (fear of corruption and lack of money, trust)
When they work, women have no safe collective place to rest
NB: During the interviews, it was said that domestic violence did not exist

People wait before seeing a doctor if the healing comes by itself. Everything depends mainly on their money. They wish more modern medicine.
According to the women, they are more affected by diarrhea, asthma, fever and anemia, especially those pregnant and elderly. Muscle pain, soreness and itching are also common. During the rainy season, cough and fever affect older women.
Skin diseases are increasing.
Women give birth at home. There has been no maternal deaths for 12 years and only some premature births. Although they prefer to go to the centers, they lack of money (they blame the hospitals to have to pay for everything) and sometimes lack of time (the nearest hospital is Raidighi, 1:20 to reach it (16 km). This requires finding a means of locomotion quickly). Moreover, as women work very hard, they realize late that delivery has begun.

Women have 5 to 6 children. Their first child is born when they’re 17-19 years (depending on the women interviewed). They married between 15 and 16. The use of the pill and condoms is widespread.

Meals are mostly composed of rice, vegetables and fish from the pound.
During pregnancy, women do not have particular dietary or nutritional supplement. They take iron tablets and have injections against tetanus.
They are breastfeeding for 6 months.
Children at birth weigh between 1.5 and 2 kg
Women state that they have little food and difficulties in feeding their children

Water, hygiene, sanitation
The tubes are not in good condition and do not work 24/24. The water contains impurities: the non-clean water is the cause of many diseases affecting people.
- 1 / 3 of the population does not have private latrines (on 30 000 people, nearly 2,000 families involved)
There is no collective sanitation
Women need to walk 10 minutes to go relieve himself. They go into the woods or fields, only even if it is risky.
Women wash twice a day at the pond with soap purchased in town
During their periods, they use a towel they have made themselves but that are not properly cleaned. This causes itching, the appearance of viruses. Women don’t understand where it comes from.
- The waste is buried, thrown everywhere. There is no place for this purpose. Some people recover it as fertilizer for the fields. Nothing is burned and the plastic is a problem.


97% of children attend (mandatory). 80% goes to the 8th standard and 40% until 10th standard
2 High School, attended by 10% of students (250 children)
Most girls stop their education after primary school (compulsory) to work with their parents.

Some married too young, because then there is no dowry demanded. Most left school at 15 because the family cannot pay (Legal age in India: 18 years).

Socio-economic, livehood
Women's SHGs grow coconut and breed exotic birds
Most houses have walls of clay and a thatched roof
The animals live near homes or in the yard
Poverty of the people whose activity is not sufficient to enable them to live

General data on Kankandighi G.P

15 villages


Total: 21 824
Total women: 10 417
Total men: 11,407

No cases of missing woman
An NGO has campaigned against human trafficking

Water, hygiene, sanitation
A tube-well for about 350 people
The pipes are in poor condition and are often broken
The water tube is not sufficient for daily life so the vegetables for the meals are washed in the pound
There is no private latrines in most homes and there is no common health infrastructure
-The waste is deposited in a large container and a few days later recovered as fertilizer. The plastic is burned, causing respiratory problems.

11 primary school
1 Governmental High School
2 Governmental Secondary School
A school up to 8th standard and led by an NGO
2 Child Education Center
70% of children go to school

The nearest hospital is the Raidighi (4 km): Many women will give birth there even if the beliefs, superstitions make that the home is preferred to give birth
The most common health problems are fever, cough, diarrhea, colds, stomach acid and pains
The hepatitis B is increasing (5 / 100)
Cases of depigmentation are more frequent (parasols and sun lotions are expensive)
90% of people are not aware of health problems, immune system and health

Socio-economic and livehood
30% of farmers (Main industry: Agriculture)
Most houses are built of clay and a thatched roof.

General recommendations by clusters

Organize awareness campaigns for parents and children (what procedure?)
Workshops on women's rights, AIDS
Create groups of women to ensure the movement and why not build a place where they can rest, provided with health facilities where they can go not far from the field?
Train the police to offer effective, listening and following the procedures in case of disappearance

Create a warning board about women trafficking at the entrance of the road of the Sundarbans

Water, hygiene, sanitation
Organise regular audits and reviews of the status of the tubes and water quality
When the tubes are bad, replace them with more modern so as not to have a series of failures in the long-term
Offer at least a set of communal latrines per village
Building private latrines for those who request
Organize a campaign to boil water and the importance of washing hands regularly
Create one place in each village where waste is stored, destroyed or burned
Awareness about the dangers of plastic for the environment (including land and water)

Provide basic medicines to treat diarrhea, fever, cough and asthma

Assure a medical follow (especially for asthma)
A prevention campaign about prolonged sun exposure and its consequences
Build a clinic with beds and professional equipment. Staff of the Medical University?
Provide ambulance service
Provide food supplements to pregnant women until the end of breastfeeding
Finance a vaccination campaign against hepatitis B?
Make a campaign of information on genital diseases and how to prevent them

Create a garden with vegetables at school, administrated by the kids themselves
Identify families in great difficulties and assist them to feed the relatives

Create a specific program on girls' education (scholarship system for them to continue their education until 18 then TSS)
Form some girls to trades (hairdresser? Nurse?) A useful job for the locals

Diversify the activities of SHGs: women ask for more aid to have domestic animals (cows) so that each home has its own farm (chicken, duck, goat).
Develop the activity of weaving (local specialty) or manufacturing paper bags

While living in the Sundarbans is already difficult environmental conditions and climate, the inhabitants suffer from more difficult access to care and medical staff. This is a vicious circle because people, especially women, if they are sick, are not capable of ensuring their work, therefore, can’t earn money and feed their families as needed. The mobile clinic project must meet the needs of these women, longing for such an initiative.
In addition, we can also provide structures improving the lives (and health) of people, including a system of latrines.
It appears that one of the priorities is to ensure education for all, especially girls so that they remain in control of their future and a job as a domestic in the city is not a lure to help financially their families.
The SHG project should also be extended to other women and offer other activities. It is the wish of the participants because they recognize an improvement in their financial situation.