Another aspect of Thamate’s work is to address the general and specific health issues faced by Manual Scavengers (MS)/Safaikarmacharis (SK). The healthcare needs of MS/SK have to be understood in the context of three specific aspects. Firstly, because of the nature of the unclean occupation engaged in by MS/SK, which involves direct contact with human excreta and dead/decomposing animal carcasses, their risk of exposure to infectious and communicable diseases is much higher as compared to the general population. The work of MS/SK involves handling garbage, cleaning sites of open defection, urinals, dry latrines (without water and flush), removing dead animal carcass and unclaimed human cadavers. Many private hospitals and nursing homes indiscriminately dispose waste into general waste without following the guidelines of medical waste disposal. The waste handled by them often contains sharp glass objects, used syringes, contaminated blades and metals making them highly susceptible to cuts, injuries, abscesses, which if ignored can lead to sepsis. They are also at increased risk of exposure to HIV/Hepatitis B. This work also brings MS/SK in contact with hazardous chemicals and substances exposing them to serious health risk. Very often toxic chemicals and acids are disposed without any thought for the persons engaged in cleaning. Most often no protective gears or equipment are provided to them and neither is any first-aid facilities made available if an injury is caused. Several persons engaged in these occupations have undergone amputation of fingers and limbs. The MS/SK are exposed to a wide range of skin and respiratory ailments due to direct contact and inhalation of toxic fumes and chemicals.
Secondly, because of greater incidence of malnutrition and under-nutrition among MS/SK families along with associated syndromes like anaemia, they have a lowered immunity to fight illness and therefore are likely to develop more serious consequences and complications. Thirdly, the habitat where most of the MS/SK reside are not provided with proper sanitation, housing amenities and drinking water which further increases the health risks from communicable diseases faced by the community such as gastro-intestinal, respiratory and skin infections. The very act of entering a stinking man-hole or septic tank can only be done by the numbing influence of alcohol. The incidence of alcoholism in the community that engages in manual scavenging should be seen as an occupational hazard rather than a social evil. Furthermore the act of manual scavenging cannot even be classified as an occupation but rather as a caste based discrimination where ‘choice’ is not an option.
A study published in National Medical Journal of India found that injuries and chest pain were the most commonly reported illnesses among most of the sanitation workers monitored over several months. Most workers continued to work without appropriate treatment as they ignored their illness, and did not want to miss their wages or lose their job. Self-medication was common. Intake of alcohol was prevalent to cope with the inhuman task of cleaning filthy sewage, and as a modality to forget their health problems. The pattern of illnesses reported during monthly monitoring was also reported as long-standing illnesses. Health and safety mechanisms at workplace did not exist and were not mandated by regulatory bodies. The study concluded that health and safety of sanitation workers has been inadequately addressed in public health research. Observing that sanitation work lacks specific protective regulatory guidelines to address health hazards unlike other hazardous occupations, it recommended that government should institute an adequate health-monitoring system and healthcare system for sanitation workers.
The psychological health of persons engaged in manual scavenging cannot be neglected either. The caste stigma and the nature of manual scavenging can cause low self-esteem, depression, suicidal thoughts, aggression, domestic abuse, drug abuse along with alcoholism. Children whose parents are engaged in manual scavenging can face harassment and bullying by peers, denial of education, neglect and victimisation which can directly increase the drop-out rates among the children. The long standing impact on the mental health of children cannot be ignored.
Given this context, to improve the health conditions of MS/SK, Thamate has adopted multi-pronged strategy of:
- Working towards strengthening the existing public health system;
- Linking the community to various government-run healthcare programmes and schemes to ensure access to health-related entitlements; and
- Organizing FREE and Regular Medical Camps for screening of various medical conditions as immediate health interventions.
Health Camps for SK/MS
Health camps specifically for the Safaikarmacharis (SK)/Manual Scavengers (MS) are important for three reasons. Firstly, since rampant discrimination is being practiced by the staff in several government facilities in the taluka by denying them care and health entitlements because of the work engaged in by MS/SK, they are not able to access the government provided facilities. Secondly, because the workers are on job till evening, the only time they can avail medical care is after work and on holidays when public facilities are closed forcing them to go to private providers requiring out-of-pocket expenditures. Often because of these reasons, MS/SK skip treatment altogether or make do with getting tablets from medical stores without consulting a doctor. Thirdly, in general, public facilities are extremely under-staffed and lack resources like medicines and reagents for conducting tests leading to further exclusion from access to healthcare.
Health Issues Faced by SK/MS
The posters given below describe the health issues faced by manual scavengers and safaikarmacharis in their own words.