( By Radhika Ramasubban, Bhanwar Singh & Nigel Crook )

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Govind And Shanti Take A Position

How Poor Nutrition Aggravates A Sickness

It was time for Govind to return home from his shift at the textile mill in Byculla. His mother, Shanti, was waiting anxiously in their chawl near the Bellasis Road, for he was already much later than usual. Nowadays he was often very tired and took longer to walk home.

When at last Govind walked in he looked quite pale. He sat down and said slowly, " I have some bad news. " "His mother and younger brother and sister who had joined them in their small stuffy room waited patients. " I lost my job today, " he concluded. There was a momentís silence. Then Shanti said, " How are we going to live ? How can we earn more than the little we do already ?" She and her daughter Rekha sold garlic on the Belasis Road.

"We have the rent to pay and also Harishís school fees. The only thing we can cut down on is food until you find some work. "

Govind replied sadly, " The Welfare Inspector told me I am not fit enough to do my work for three months - only then if Ií m lucky I can get back this job or I might have to look for another. "

"Three months!" exclaimed Shanti. " How ever can we survive for three months with myself a widow, and my eldest son without work ?"

Then Harish, the younger son, suggested ; " I can also do some work."

"What can you do ?" asked Rekha his sister. "You are going to school. "

"I can also sell things, " he said. " I can sell those things other boys sell on the trains, like combs. As to school, what is the alternative; I will have to drop out. "

"We may have to do this," his mother said. Then she looked at Govind. "But how can they stop you from working for three months ?" she asked.

There was another silence. Then he spoke. " Last week they took some tests at the clinic when I went for cough medicine. " "You never told us, " replied Shanti.

"Today the doctor told me I have tuberculosis. " Govind concluded.

The news filled the little room with horror. The younger children looked at Govind, unable to speak. Shanti stared at the ground.

"The doctor says it can be cured within three months or so with some pills. He says itís caused by a germ I must have breathed in staying in these crowded chawls. He says it got worse because I am not eating sufficiently. But how can we improve on our food with the rent to pay and everything else?"

"Then we must all work," said Harish,." and I will sell combs, so that our food is enough. "

"Tell us all that the doctor said, " urged Shanti. " Why does taking inadeqaute food make the disease worse ?"

"That is what I asked him myself. Then the doctor explained to me : "The germ entered your body from the air. If your body was strong and healthy before, those germs after entering your body would have been resisted by the natural enemies of those germs (antibodies ) that live in your body. If your body is weak the battle is lost, and the germs of the disease take over. Many well nourished people take in germs of tuberculosis, or leprosy, and other serious diseases, but they never even become sick. Others may get sick only for a short while. In both cases the bodyís own defences, being well-fed and strong, are winning against the disease. Even children with diarrhoea will get quicker if they are already well-fed !"

"But doctor, " I said, Ď I am a poor man. I have to support my mother and two younger siblings. Food is very costly. WE get a limited quota from the ration shop. What can a poor household do?í


Many of the poor people who work in the city need to stay close to their work. This means they have to live in highly congested chawls. They cannot afford better accommodation in the inner city. The congestion itself makes it more likely that one person will pass on an air borne disease like TB to another.

At the same time poor nutrition worsens the development of a disease in the individual. But the poor are faced with many essential expenditures in a city, as for example, rent, fuel, new clothes and books for school children. They are often compelled to cut down on food, and hence risk their health.

The prevalence of tuberculosis is highest in parts of the inner city. These are the most congested areas, containing pockets of severe poverty.

The doctor understood. Then, he told me about Karim, your rakhi brother. "

"Ah, yes" said Shanti, " he also had tuberculosis. He was very ill, and so thin. He nearly died. "

"Thatís right,"Govind said. "But he had another problem you know. "

"I know," interjected Rekha, and she pretended to empty a bottle down her throat.


Most people acquire a natural immunity to most diseases. When a germ enters the body, the body generates antibodies to defend it against the germís attack. But only those who eat sufficiently and take proper rest can do this effectively. That is why diseases like tuberculosis and leprosy most often degenerate into a serious condition among the poorest.

The interaction between disease and nutrition is important in most diseases. Diarrhoeal disease is much more likely to become a life threatening condition in a malnourished child. And recovery will be quicker in a well-nourished child.

The TB germ is often inhaled in childhood, but it lies quietly in the body without doing any harm. Later in life, usually after the age of 40, adults who have become poorly nourished or subjected to much stress and strain, especially affecting the chest, will often suffer from re-infection. In those conditions without treatment it will often kill.

Those who are addicted to alcohol often do not eat properly themselves, and they often cannot afford to buy sufficient food for the household either. Too much alcohol eventually causes liver disease also ; and accidents at work and on the road frequently result from intoxication with liquor. Accidents are one of the main causes of death in Bombay today.

"Thatís right, " said Govind, " he was spending so much money on liquor there was nothing left for food. But I suppose he felt as if his stomach was full. Yet all the time he was getting thinner, and his cough was getting worse. "

"That day he collapsed at work they made him to see the doctor, " said Shanti.

There are several collective activities people may undertake to make sure they get enough food to protect them from the effects of disease.

  1. Those who belong to trades unions must make sure their wages at least are made to keep up with the rise in prices.

  2. A campaign should be started for larger quotas from ration shops so that an adequate diet can be afforded. Also a better quality of food grains should be demanded.

  3. Make sure your ration shop displays the prices ( as it is required to do by law).

  4. If your ration shop claims it cannot get or cannot store the quantities required, take up the matter with your Municipal Corporator or MLA, to get more space allotted to the ration shop.

  5. In some communities a medical cooperative has been set up by the residents. Each of them contributes a small sum each months. If someone falls seriously sick, for instance from TB, and cannot work for a while, with the result that the household is at risk of malnutrition, then the cooperative agrees to pay some of its funds towards the householdís welfare

"Thatís right," Govind went on. " It was nearly too late then, the doctor said. He also told Karim to eat better. And he told him to stop drinking so that they could afford to buy more food. This saved his life. If only father had stopped drinking , he would have been alive today. "

"If Karim had died, his wife would be having a very difficult time," said Shanti, " Aftab, their boy, is the same age as Harish. "

"Sometimes in school I give him my food, " said Harishí " he is always hungry. "

"The doctor said the child also would probably breathe in the germs from his father, " Govind continued, " but if the child was well fed the germ might not cause any trouble. Even I myself may have taken in the germ when I was a child but it cured itself. But only now because we cannot afford food my body is weak ; so that when I became re-infected the disease broke out. But if I take the pills he gives me regularly, and take good food also, and plenty of rest, I will get well. "

Later that night Shanti was thinking over Govindís conversation with the doctor.

"Why did you tell him we are so poor that we cannot get enough to eat ? It doesnít sound good. "

" But it is true, " Govind replied.

"Only because we have to pay so much for food , " said Rekha.

"If we got a proper quota of food grains at the ration shop we would not have to buy so much at the high prices in the market, " said Govind.

"Often the food grains from the ration shop are very bad," said Harish.

"Thatís why give yours away to Aftab," Rekha chastised Harish.

"Stop this talk, " their mother interrupted. "Letís be serious. We may be poor. But we have the right to eat well enough not to get sick. That is why the ration shop is there. Next time I go to the ration shop I will demand that they give us better quality wheat and rice. "

"Speak to others too," Govind urged, "like Karimís wife and the other women in this chawl. If we all demand that our quota of food grains and edible oil is not of the poorest quality and is available at the right times, and refuse to go away until we get it, they will have to do it this way. Sufficient food is a basic right ; if we do not stand up for this basic right who ever will do it for us ?"

"Another problem, " said Shanti, " is those long queues. Why canít they have greater storage space for those shops and keep proper stocks so that everyone does not have to queue up to get their ration within a span of 2 to 3 days ?í

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