Kasaragod: On a Sunday last month, Mufeeda's parents rushed her to Kasturba Medical College (KMC) at Jyothi Circle in Mangaluru after her condition deteriorated. The Kerala government has an agreement with the super-speciality hospital to provide cashless treatment to endosulfan victims from Kasaragod.
But the hospital was reluctant to admit Mufeeda from Udma grama panchayat because the Kerala government had not cleared its bills for around seven months, says Munisa Ambalathara, president of the Endosulfan Peeditha Janakeeya Munnani -- an NGO working for endosulfan survivors. "We spoke to the doctor at KMC and he says Mufeeda was not in a condition to be shifted to any other hospital. She should be on a ventilator. But he says the management will have to take a call on admitting her," says Munisa.
The activist got in touch with an official in the Cell for Rehabilitation of Endosulfan Survivors, also called Endosulfan Cell. "The official convinced the hospital to treat Mufeeda," says Munisa.
It was a short victory. Mufeeda succumbed to pneumonia the next day.
KMC at Jyothi is one of the three hospitals in Karnataka empanelled by the Kerala government to provide super-speciality or tertiary care to endosulfan patients from Kasaragod.
On record, the hospital says the district administration of Kasaragod has been very "cooperative" and it also treated the endosulfan patients with "empathy".
But the hospital's officials will be meeting the District Medical Officer in Kanhangad on Friday (February 10) to settle bills pending for "six to eight months'', says its PRO.
Yenepoya, another empanelled hospital in Mangaluru, has stopped treating endosulfan patients from Kasaragod. The Kerala government has not cleared its bills of Rs 30.54 lakh. "The bills have not been cleared since 2016-2017," says Dr Nagaraj Shet, Assistant Medical Superintendent at Yenepoya Medical College Hospital.
He says the government has refused to even renew the memorandum of understanding, first signed in 2011, to treat the patients.
At 43 km from Kasaragod bus stand, Yenepoya is the closest empanelled hospital for endosulfan patients. "If the government is not prompt with clearing the dues, the hospitals in Mangaluru will be reluctant to treat endosulfan patients. And they are the best options we have," says Munisa. To be sure, Kasaragod does not have a tertiary care hospital.
'No budget for endosulfan treatment'
The government has no budget for treating endosulfan patients. For 12 years from 2010-2011, the Union government used to fund the treatment and transport of endosulfan patients in Kasaragod through its National Health Mission (NHM).
"It stopped with 2021-2022," says an official of the Endosulfan Cell, the government agency that reviews and implements projects and schemes for the affected patients.
In the initial years, the NHM used to release around Rs 5 crore. "It dwindled to Rs 3 crore and then to Rs 2 crore. In 2021-2022, we got only Rs 1.5 crore," says the official.
Kasaragod's collector Bhandari Swagat Ranveerchand released another Rs 1.5 crore from the contingency fund to meet the needs of endosulfan victims for 2021-2022.
For the year 2022-2023 and 2023-2024, the government did not make any provision despite the NHM pulling out, and the unpaid medical bills are piling up at empanelled hospitals and pharmacies.
Dipping into Kasaragod Development Package
Cell officials say they require around Rs 4 crore to Rs 5 crore to meet the medical needs of endosulfan patients in Kasaragod.
Apart from settling medicine and hospital bills, the NHM fund was used to transport endosulfan patients from the 11 affected panchayats to referral hospitals, physiotherapy (Rs 5 lakh) and buy diapers, and foot the dialysis cost (Rs 10 lakh) for endosulfan patients at the District Hospital.
In 2022-2023, the NHM allocated Rs 63 lakh for transporting patients, says another official of the Cell. "So we did not face any difficulty in shifting patients to hospitals," she says.
If the state government conducts a special medical camp to identify endosulfan victims by March as promised, it will require another Rs 5 lakh, she says.
With medical bills piling up, the state government in November 2022 gave 'administrative sanction' to release Rs 4.5 crore from the Kasaragod Development Package -- a special fund to develop the backward district -- to the Endosulfan Cell. Three months on, the Department of Finance has not yet given its approval, says the two officials at the Cell.
Kasaragod Development Package was set up based on the P Prabhakaran Commission report released in October 2012.
The report proposes free of cost treatment to endosulfan patients, but since its inception, the fund was used for building roads, and schools, developing infrastructure to promote small businesses, creating value-added agriculture products, ecological restoration, water conservation, developing health infrastructure and projects in fisheries and animal husbandry.
But in 2022-2023, when the district MLAs and officials sent their Rs 250-crore proposal for Kasaragod Development Package, endosulfan treatment, and medicine were not one of them. That is because NHM was taking care of treatment expenditure, says Kasaragod MLA N A Nellikkunnu.
But Finance Minister K N Balagopal slashed the fund by 40 per cent from the previous year and earmarked only Rs 75 crore for it. In 2023-2024, the finance minister retained only Rs 75 crore despite knowing that the government will be tapping the Kasaragod Development Package to foot the medical bills, says Nellikkunnu.
'Endosulfan Package is not for treatment'
In his budget speech, finance minister Balagopal announced that Rs 17 crore has been earmarked for Endosulfan Package, which will be implemented through the Kerala Social Security Mission (KSSM).
The allocation was the same as last year.
When contacted, a KSSM official in Thiruvananthapuram says the money is used to pay the pension of endosulfan survivors, scholarships to survivor students, and provide financial assistance of Rs 700 per month to the caregivers. "It is not for paying medical bills," he says.
Under the Snehasanthwanam scheme, the government gives monthly financial assistance of Rs 1,200, Rs 1,700, and Rs 2,200 to three categories of endosulfan survivors, he says. The categories are decided by the collector. "Around 4,900 survivors are receiving the money," he says.
The Endosulfan Package is also used to provide annual education assistance to students up to class 12. "This year we gave the scholarship to 658 students," he says.
Students up to class VII, are given Rs 2,000; those in classes VIII, IX, and X are given Rs 3,000, and students in Classes XI and XII are given Rs 4,000 annually.
Then there is the Special Aswasakiranam scheme, which provides Rs 700 per month to the caregivers of endosulfan survivors. "Around 800 caregivers are receiving the money," he says.
For all this, the expenses would come to around Rs 14 crore to Rs 15 crore, he says. "We won't exhaust the Rs 17 crore because the beneficiaries aren't too many," he says.
At the end of the financial year, if the Endosulfan Package has any unused money, it will go back to the government. "It cannot be carried over or used for any other needs of the patients," he says.
To be sure, the Endosulfan Package and its benefits predate the Prabhakaran Commission recommendations.
Pharmacies stop supplies of medicines
The budgetary announcement Endosulfan Package of Rs 17 crore is misleading because the money is for providing pensions and scholarships to survivors, says activist Munisa. "The government provides welfare pensions to various categories of people in the state. But when the finance minister announces Endosulfan Package, it creates a perception that the medical needs of the endosulfan survivors are taken care of," she says. "That perception is behind our MLA's statement that the endosulfan survivors can never be satisfied," she says, referring to Udma MLA C H Kunhambu's statement to a TV channel when Daya Bai was on an indefinite hunger strike in December.
The reality is harsh. Some stores of Neethi Medical have stopped supplying free medicines to endosulfan patients because the government has not cleared their bills for months.
Most of the Neethi Medical Stores are run by primary service cooperative societies and the warehouses are run by Consumerfed or Kerala State Cooperative Consumers' Federation.
Arunima, the mother of a 10-year-old endosulfan survivor in Muliyar panchayat, says she gets her medicines from Neethi Medical Store in Kasaragod. "The store is always helpful. If it does not have medicines, it will get from other stores for us," she says.
But that is no longer the case. "It has not stopped supplying medicines. But it does not go the extra length to help us now," she says.
When contacted, the pharmacy acknowledged that the government owed it money but did not share the details.
Arunima buys medicines worth around Rs 5,000 and diapers worth around Rs 2,000 every month for her son. Both are supplied free of cost by the government. "Of late, the supply of diapers has become erratic, missing up to three months in a row," she says.
A mother in Panathady panchayat says the Neethi Medical Store in Panathur and Poodamkallu stopped supplying medicines in February. Both stores are run by Panathady Service Cooperative Bank.
A staff at Neethi Medical Store at Panathur says the Family Health Centre gives the available medicines. "But FHC does not stock up on expensive medicines, which the endosulfan patients take from us," he says.
Some patients buy medicines worth around Rs 7,000 every month, he says. The bills are later reimbursed by the state government through the Endosulfan Cell
The government owes around Rs 10 lakh to the Panathur store alone.
Munisa said the government owed around Rs 25 lakh to the Neethi Medical Store at Periya. "We do not know how long they will supply medicines," she says.
Arunima says she dreads the days of Covid when she struggled to get medicines for her son. "I pray the government will not take us to those times again," she says.
