India File

Diabetic due to poverty

Maitri Porecha | Updated on: Oct 22, 2018

Poor follow-up Bechain walks around 7 km barefoot to get his monthly dose of insulin jabs. - Maitri Porecha

How malnourished tribal adults come to have the ‘rich man’s disease’

About 50 km from Bilaspur town, a narrow road to the left leads to the Achanakmar Tiger Reserve in neighbouring Lormi district of Chhattisgarh. The Reserve is also home to 13,568 tribals in 40 hamlets inside the protected area.

As one ventures deeper into the jungles, paintings across walls of tribals’ homes hailing Chief Minister Raman Singh’s benevolence stare back at us. Painted in bold font beside the BJP’s lotus symbol are the words: “Ek Rupaiya Kilo Chaawal, Shauchalaya Ki Saugaat, Dr Raman Singh Zindabaad,” (One rupee a kilo rice and the blessing of a toilet, hail Dr Raman Singh). Singh is fondly referred to as Chaawal Wale Baba, in the region. The question is whether this has led to a rise in diabetes.

Sixty-year-old Bechain has walked 7 km barefoot from his hamlet Jakadbandha through thick forest to seek treatment for his soaring sugar levels at Jan Swasthya Sahyog’s sub-centre in Bamni village, inside Achanakmar Tiger Reserve; 3 km away, the government-run dispensary lies locked. Bechain looks scrawny and withered. He has been diabetic since he was 50. After he fainted suddenly, he sought to find out what was wrong, trying, in the bargain, Ayurvedic medicines too. Getting nowhere, he finally trekked to JSS’ hospital in Ganiyari, upto 60 km away from his home, where he was given a prick, his blood was tested and he was termed ‘diabetic.’ Since then he has been on insulin jabs. He knows how to take a jab on his own and comes to the Bamni sub-centre to collect his monthly dose. But he is not regular with his insulin. His sugar often hovers at 600 mg/dL, a dangerous threshold.

Diabetes of poverty

Economist and PDS researcher Reetika Khera, now at IIMA, says that it is hard to establish the correlation between subsidised rice and diabetes, as there is little data to suggest that the monthly consumption of 10 kg per capita has increased. Under the food security Act, the entitlement is 5 kg. “However, there can be no denying the need to supplement rice with coarse grains,” she says. The issue is not the incidence of diabetes per se, but the difficulties posed in terms of diagnosis and treatment in regions where health systems are abysmal.

Type 2 Diabetes is popularly referred to as ‘The Rich Man’s Disease,’ attributed to lifestyle disoreder. “Diabetes is mostly never linked to under-nutrition. Undernutrition and low quality food are related to poor glycemic control. Most people rely on government subsidised carbohydrate-rich food, such as wheat and rice, which have high glycemic index and lead to derangement of sugar levels,” says Dr Yogesh Jain, co-founder of JSS and alumni of AIIMS, New Delhi.

Rice is rich in carbohydrates, and needs to be supplemented with pulses and vegetables in diet.“It is the diabetes of poverty, the diabetes of hunger, not excess nutrition,” says Dr Jain.

Over the years, the tribals have lost access to local herbs from the forest. Experts observe that while in earlier decades, tribals would just scatter seeds of local grains bajra (millets), makka (maize), lobia (pulses), such agriculture has decreased and the varied nutrition such grains provided has been replaced by a single type of rice under the food security schemes, even as, traditionally, Chhattisgarh has 22,000 varieties of local paddy and a large variety of other grain.

The recently released Tribal Health report observes in this regard that malnutrition (stunting among children and low Body Mass Index among adults) in tribal people is more than among non-tribal population. “The food intake and the intake of nutrients such as proteins, calories, vitamins have decreased in the last decade in tribal population. Only 29-32 per cent children and 63-74 per cent adults were consuming diets adequate in both protein and energy,” the report says.

Most tribal adults record a BMI of 18.5, which qualifies for being underweight. “When the body grows poorly and is under-nourished, the pancreas, which produce insulin, shrivel up. Digestion of carbohydrates in rice demands more secretion of insulin. By the time a person is 35 to 40 his pancreas dry up, insulin secretion dips, and sugar levels hover at dangerous levels. This could be a plausible theory so as to why we see diabetes in tribals. We are researching further on this,” explains Dr Jain.

Relative prices have wreaked havoc. In 2007, the price of rice was ₹19 a kilo, and 10 years hence it has almost doubled to ₹35 a kilo. The tribals get rice at ₹1 a kilo, under food security schemes. But dal, which is even costlier at ₹80 a kilo, is non-affordable for Bechain. He has cut it out of his diet though he desperately needs protein. Most tribals earn nothing at all or up to ₹100 a day in jobs as day labourers, while insulin costs up to ten times more at ₹1,000 every month.

Bechain is walking barefoot. Dr Jain is quick to point out, “Going barefoot increases the chances of foot ulcers, cuts, poor wound healing which can result in foot amputation.”

Counselling patients like Bechain is a huge problem, doctors point out, as he may not have the time or money for regular check-ups, buy footwear or eat right. Introducing a 2011 study by the Public Health Foundation of India (PHFI), Dr Srinath Reddy says: “Increasingly, poor people are becoming vulnerable victims of diseases which have diffused across all social classes with alarming speed. A comprehensive response is, therefore, urgently required to reverse this rising tide.”

With inputs from Poornima Joshi

Published on October 22, 2018
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