Correspondence Address:
Dr. Sonu Goel
Assistant Professor of Health Management, Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012
India

Full Text

A key public health challenge is to determine and address the health needs of indigenous and marginalized populations in context to emerging and re-emerging communicable diseases. [1] One such community is Gujjar clan which has origins around 6-12 th century at the time of Huna invasions of Northern India. [2] Initially classed as Kshatriya and Brahmin, many of them converted to Islam during the Muslim rule in South Asia. They are recognized as a tribal community. [3],[4] They are located in almost all parts of Northern India mainly in Rajasthan, Gujarat, Delhi, Haryana, Punjab, Western Uttar Pradesh, Uttarakhand, Northern Madhya Pradesh, Jammu and Kashmir, Himachal Pradesh (HP) and Maharashtra. [5] Today, the Gujjars are classified under the Other Backward Classes category in many states in India, including HP. [6] The most reliable data on Gujjars is over 60 years old, where, the Census of India (in 1931) reported around 2,038,692 Gujjars inhabiting eight provinces and Indian states. [7]

Basically, two types of Gujjars have been identified - The Dudh-Gujjar (known as Bakarwal or Buffalo herders or small stock herders) and Van Gujjars (forest Gujjars). The latter are found in the Shivalik hills area of North India and are seasonal visitors (May till September) to HP. They live in specific hilly areas like Khada Pathher, Patti Daank, Sheelghaat, Chhajjpur, Nandpur, Jakhi, Giltari, Mandal, Bolar and Mural etc., in Jubbal Tehsil of Shimla district, HP. They live in poor hygienic conditions as documented in a study by Meelu et al. in Chamba district of HP. [8]

Since the Gujjars happen to live in interior forest area and happen to visit caves inhabited by wild animals frequently, from where the index case of 2002 plague outbreak contracted the infection, we attempted to study their lifestyle in context to 2002 outbreak of plague in HP.

It was a qualitative study conducted among Gujjar population who regularly migrate to Jubbal Tehsil of Shimla district, HP. The 2002 plague outbreak surfaced in this area and is vulnerable to plague outbreaks. All the Gujjar deras (huts) were enrolled for the study. Focus Group Discussions (FGD) guide was prepared beforehand, which had information about education, livelihood, dietary pattern, relationships, personal hygiene and habits and health care utilization. A team (trained in conducting FGD) comprising of one research associate, one junior research fellow and one field worker visited these Gujjar deras between May and October 2011. Informed consent was obtained from all the respondents after assuring confidentiality and explaining them about the context and objectives of the study.

Three FGDs were conducted (one per Gujjar community having 8-12 participants), wherein, detailed notes were taken, supported by audio recordings. The notes were translated into English, supplemented by transcript of audiotapes, and principal domains/themes extracted. Each FGD lasted for around one to 1½ h. All interactions were held in local language (Hindi).

A total of three Gujjar deras were present on the up hills of Mural forest in Jubbal Tehsil; which was around 90 km from mainland area of district Shimla. The studied Gujjar deras is a settlement of small group of seasonal migrants from Uttarakhand state of India. They live in a joint family with size of Gujjar family approximately 8-10 persons. Their deras are temporary thatched hutments, covered by tarpaulin, which is partly folded up for ventilation during daytime. Huts are closely spaced together with very little space between them.

During FGDs, following key findings emerged. No one was literate in Gujjar deras. They indulged in cattle breeding and selling of milk products particularly "Khoya" to earn their livelihood. Earthen pots, old buckets and used containers were used to store drinking water. Most of them go for open-air defecation. They are primarily Muslim by religion and nonvegetarian. They have mobile phones for communication and occasionally listen to radio (on batteries). There is no electricity facility. Gujjar Community has a close-knit social structure where interchange of family members for marriages (called as Chala) and early marriages (as early as 6 months of age) are common.

The personal hygiene was poor as they take bath infrequently, sometimes once in a month, particularly in the rainy and cold seasons. They use blankets to protect themselves from rains and even utilize them to carry articles or other food items. Repulsive foul smell emanating from deras was witnessed. They use dried grass as sleeping mattress. Two to three families occupy the single room accommodation in the same dera at a time.

Government health care facilities are not routinely utilized by the Gujjar community due to their distant location (physical in-accessibility), in-sensitive attitude of health care providers towards them (cultural in-accessibility) and poor out-reach program of health system. "Nobody attends to us when we go to hospital," a local community member said, "health workers never come to us in our deras for health checking or immunization" another dweller said. They generally use their local medications (Desi dava) or contact local chemist shops to get allopathic medicines. Their children were not covered by routine immunization (as also verified by absence of Bacillus Calmette-Guerin scar or immunization card).

They had never heard about common communicable and noncommunicable diseases. "Hum sirf bukhaar ko jantey hai" (we only know fever) said a dweller. They were aware of an outbreak in HP, which occurred in 2002, and that it had spread to Uttarakhandstate. However, they were uncertain about the nature of the disease. They were aware that in plague patient had fever, which they called it a disease of cold (Thande Ki Bimari). They believed that plague outbreak started when a person visited forest for hunting and that there he consumed the meat of a bird and had stayed at hunter's cave. They told that they have seen "plague wale lal chuhe" (wild brown rats) many a times primarily in and around their hutments, and also when they roam around on upper hills. They sometimes stay in caves build by wild animals when they go into forests for their livelihood.

The poor hygienic conditions, overcrowding in hutments, frequent visits to forests and living in caves during their visits might lead to increased proximity and exposure to wild rats among Gujjar population, thus increasing their susceptibility to plague. It has been reported that in 2002 plague outbreak in HP, that the index case acquired infection from the caves in forests (where he lived during his hunting expedition), which later spread to different states of India. [9] Further, illiteracy, unawareness about illness and poor utilization of health care services may in-fact increase their vulnerability to disease and its spread within the community. They are, therefore a potential link between any source of infection in forests and in native population of HP and other states. Being regularly exposed to the microclimate of rats/cave etc., their community can be a "sitting duck" for potential spread of plague.

As Gujjars are one of the most backward communities, the government agencies should take various measures to improve their quality of life. This may include improving outreach health programs; increasing awareness about local diseases and health conditions, and improving living conditions etc. However, despite their presence in 'hot zone', the government, reports on plague did not have any reference to Gujjar. [10] There is a need for in-depth study to analyze the link between socio-epidemiological factors related to lifestyles of Gujjars and plague outbreaks.

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