‘An extremely poor nomadic tribe which wanders across the states of central India’ is how one would define the Sehariya tribe. As all Indian castes and tribes, Sehariya tribe has a mythical origin: they are companions of tigers. An allusion to their bravery. Today bravery has left room to the harsh realities of poverty, both economic and social. A lack of resources and social opportunity is emphasized by their low status in the caste hierarchy. On a recent work visit to Ghatigaon, a Sehariya settlement where my organization treats patient of Tuberculosis, I had the chance to observe the lives of Sehariyas closely.

 

Once in Ghatigaon, the extreme isolation of this community is the first thing I noticed. There are no other villages for miles on. Their isolation makes very difficult reaching them with basic services. During the rainy season, when roads get flooded and damaged, things get even worse. The extreme poverty in which the people live is shocking. Most children have obvious signs of malnutrition like a swollen belly and discoloured hair. None of the children is at school. Sehariyas do not own land. They work as agricultural labour in others people’s farms during harvest season. Some work in quarries or take up work provided under the Mahatma Gandhi National Rural Employment Guarantee Act, which provides work for one hundred days in a year to rural families. The rest of the year there is no guarantee of work.

 

The house of our patient was a small mud hut with a roof made of leaves and plastic covers. There was no electricity or running water in the entire village. The hut was just one room. Too small for us to enter. We sat out in the veranda, eventually. Our patient was about thirty years old but looked much older and emaciated. Because of his severe health status, he could not work anymore. The family’s income was entirely on his wife’s shoulders. Even his eldest daughter dropped out from school in order to give basic care to his father. His wife, their three children and other children from the neighbourhood came to watch us giving medicines. All the children look malnourished. We asked his wife to get a glass of water but the water she got was so dirty that we gave him the water we were carrying for ourselves.

 

This is one among many other possible sad stories of famine and poverty. TB medicines are effective only when the patient is on a balanced diet. When asked if he had eaten, he told us not to have had food since the day before.

 

This family represents thousands of tribal families, which are trapped in the vicious circle of poverty. Malnourishment and bad living conditions make the poorest ones prone to illness. Once facing severe health conditions, they are pushed even more strongly into poverty. Parents lose their source of income and children drop out from school in order to work. A full-time job deprives children. It prevents them from accessing education. It closes the doors of new opportunities. All these factors make present and next generations remain in poverty. And, the vicious cycle starts again. In order to break this cycle, the first thing in the agenda is an overdue improvement of health conditions of the poorest ones. A difficult task; a very difficult task when applied to tribal and scattered people.

 

Tribal populations in India are diverse. They vary in their geographical locations, the languages they speak, religious beliefs, access to resources, connection to mainstream society and their mobility. The heterogeneity of tribes requires that policies are tailored for the needs of each tribe. Yet tribal policy in India treats all tribes as a homogenous group and all policy interventions are designed with this assumption.

 

Specifically, the Sehariyas are poor nomadic people. Nomadic tribes migrate from one region to another. Therefore, providing essential services, such as health care services, to these populations poses different challenges from delivering the same services to stationary populations. Technology can be very useful in this respect; especially Mobile Healthcare services.

 

In rural parts of Andhra Pradesh and Telengana, states in the South of India, basic health services are provided through mobile health vans in rural areas. These mobile health vans are ambulances. They have specialists who travel from one village to another. Patients who require additional care are transferred to hospitals. Such a simple method has been effective against health problems in areas like maternal and child health.

 

A popular idea to improve the lives of nomadic tribes has been to make them stationary. This would make things much easier. But, by making these populations  stationery, are we forcing them to give up a form of life which is part of their identity? The answer to this question can only be found through a dialogue, one that gives the tribe a final say.

 

Before such a comprehensive dialogue can take place initiatives such as mobile health services are the best way of ensuring that Sehariyas have access to basic health services.