BOOKS
Rakku’s Story:
Structures Of III Health And The
Source of Change
By Sheila Zurbrigg,
Published by Centre for Social Action,
Bangalore, 1984
Price : Rs 19/US $ 5.
THIS study of rural ill health is focused on child malnutrition consideration for rural patients. She manages to bribe the
and mortality. It begins with the true story of the struggle of gateman and get the child attended to as an emergency case.
Rakku, a harijan agricultural ‘labourer in a Tamil Nadu village, For the doctors and nurses, Rakku is just another ignorant
to save the life of her 11 month old son who is afflicted with village woman who has brought in her baby too late. The baby
diarrhea, caused by chronic malnutrition. is given intravenous glucose drip. Seeing him improve, Rakku
The story is told in a simple, moving style with careful decides to stay overnight and continue the treatment even,
attention to detail, Rakku and her husband are daily wage though her husband will be angry. This is “perhaps, the first
workers in the fields of a local land-owner. The bareness of decision she had ever made on her own.”
their existence, geared to survival, comes out through such Next morning, the baby is hurriedly discharged with no
facts as that their most precious possession is a brass water follow up treatment or advice. Rakku has had to remain without
pot, they have no money to replace Rakku’s torn sari. they food throughout her sojourn in the city. By the time she reaches
cannot afford to fill each family member’s stomach twice a day, home, the child’s condition is deteriorating. She passively bears
and a meal of rice and lentils at a festival is their idea of luxury. her husband’s scoldings and sits up all night with the child.
Rakku’s days of toil, doing back-breaking work in the fields, He dies in the early hours of the morning.
grinding millet for family consumption and fetching water, are Zurbrigg points out that, despite regional variations, Rakku
starkly depicted. is typical of the 48.8 percent of the population who live below
Rakku’s younger son is left in the care of his five year old the poverty Une. Ill health for them is inextricably embedded
sister, and her older son tends the cattle of landowning families in poverty because for such daily wage worker families to stop
for a pittance. Rakku is not allowed to take time off to breastfeed working, even for a day, immediately results in even less food
her baby during the day. The family cannot afford rice being available or in increasing debt, which is usually a worse
throughout the year and subsists on millet. So all that the alternative than acute hunger.” Amongst this section of the
baby gets in the day is a little millet gruel. population, child mortality is very high, and most of the deaths
When he develops diarrhea and resultant dehydration, are from easily preventable illnesses such as diarrhea, measles,
Rakku tries her best to save his life. She uses all the options tetanus and tuberculosis.
available to her—herbal medicine from the village midwife, a Demolishing the myth that population growth is the cause
visit to the temple and, later, an injection, which she can ill of poverty, Zurbrigg points out that an Indian couple must
afford, from a private dispensary in a neighbouring village. bear an average of 6.3 children in order to have a 95 percent
She does not know that the injection is a mixture of aspirin and certainty that one son will survive until the father is 65 years
sedative which would be cheaper in pill form and which, in any old, and that, in the absence of social security, sons are the
case, cannot effect a cure. When the baby’s condition worsens, only old age insurance for most people. Thus, the high child
she decides to follow the midwife’s advice and take him to the mortality rates are directly related to the high birth rates.
government .hospital in the city, even though this means losing Therefore, rural families cannot be called “unplanned.“ They
a,day’s wage, borrowing Rs5 from the,moneylender for the are and have been significantly planned, with intent to retain
bus fare, and with her husband who is reluctant to let her go. an average of four or five surviving children.
She reaches the hospital only to find that the out patient Another crucial reason to have more children the children’s
department has already closed. Its timings are devised with no labour contribution and income earning capacity is needed by
NUMBER TWENTY EIGHT, 1985 43
the family. “The widely advertised family planning Zurbrigg also feels that such organising cannot be locally
motivation—that a small number of children allows a family to successful unless it is linked to a wider movement for political
better provide for them, including education, remains fantasy change, by which she implies a socialist government coming
for the poor.” to power. She points to the success achieved by Kerala under
Zurbrigg goes on to ask why it is that precisely those who the Communist Party government, in lowering child mortality
perform most of the strenuous physical labour in society must .rates, and raising literacy, life expectancy and female education
subsist on an unbalanced, monotonous and inadequate diet, levels.
thus remaining chronically unhealthy. She presents many facts The most enlightening portion of the book is the story of
and figures to reveal the blatant biases in the health care Rakku which is valuable for its fidelity to facts and its
system. documentation of women’s survival struggles. Zurbrigg
Rural Urban comments on women’s double work burden with its damaging
Population 80% 20% consequences for their health and longevity.
Doctors 20% 10% - , It is surprising, however, that when discussing the problem
Hospital Beds 17% 83% of infant mortality and its causes, Zurbrigg overlooks the fact
Protected Water 4% 90 % of far higher mortality rates amongst female than male infants.
An even more basic flaw than this bias is the government Her emphasis is on poverty as the cause of high child mortality.
emphasis on medical treatment as the primary element in health But many studies have shown that even in relatively more
care, that is, the prevalent idea that disease is, caused by germs prosperous areas .like Punjab and Haryana, discrimination
add infection and can be cured by administering medicine. against female infants and deliberate neglecting of them to the
Whereas the truth is that most ill health in India is caused by point of letting them die is also one cause of ,a high, infant
lack of basic necessities such as food, water, housing and mortality rate. Even in socialist China such discrimination, in
sanitation.’ The elite sections of society not only have a the form of female .infanticide, persists.
stranglehold over the health system and the medical profession Similarly, while she does document the everyday details of
which serve their own interests, but their “power in Indian discrimination against the girl child in Rakku’s family, she makes
society is represented by access to food; The way in no comment at all on the implications of this for the health of
which,food is distributed reflects the.social power structures.” girls.
Critiquing in detail government, medical “establishment It is surely significant that the baby whose life. Rakku is
and foreign aided develppment programmes’ approach to the desperate to save is a boy but Zurbrigg: masks this by
issue of health, Zurbrigg suggests that the only solution is to consistently referring to him as “child.” rather than “son.”
organise the poor to insist on basic care from the health system, When she does mention Rakku’s partiality for her older son,
and to make it accountable to them. there is a tendency almost to romanticise it :_ “She loved this
She feels that health can be an issue around which the son with undiminishing relief and joy that all Indian women
poor can organise because firstly, unnecessary illness and know who have been blessed with a son as their firstborn.”
death are common problems for all the labouring poor, and (emphases mine).
secondly, “responding to a specific health problem can help Although this vital dimension is missing, the book can
change an unquestioned assumption regarding the condition serve as a good introduction for anyone wanting information
of their lives”—the assumption that such illness and death on the state of health of India’s population.
are inevitable for them. —RuthVanita
44 MANUSHI
