Social_audit_Report

Social Audit on Kalachhir:2014
Kalachhir Therapy
The inhuman practice of hot iron marking on the body of new born children.

Kalachhir practice in Nuapada district
1 
Kalachhir Therapy
The inhuman practice of hot iron marking on the body of new born children.
Report of a survey and social audit conducted by
ASHA-ODISHA and Save the Children
in six Gram Panchayats of Nuapada district of Odisha during December 2014.
Report prepared by Ajit Kumar Panda

Kalachhir Practice in Nuapada district
2 
The child was 10 days old. She had 25 red spots of two mm width
each on her body — 18 on her belly, one each on the left and
right wrists, two on both sides of her forehead and two above two
ears. The spots look like small boils caused due to burns. What
are those spots for? One would get scared hearing the answer.
“Those are wounds caused due to marking by hot iron stick. The Vaid (traditional medicine man)
did it to treat Kalachhir,” explained the child’s grandmother. What is Kalachhir?
“Kalachhir is an illness of children, which cannot be treated with government medicine
(Sarkari Uso) or by a doctor. The only way is to get hot iron marks from the Vaid” says
Bhumisuta, mother of the child. The child was given the hot iron marks, when she was only 3-
day old as a treatment for a disease called Kalachhir.
The practice of giving hot iron or bangle marks on the body of new born children in Nuapada
district to treat Kalachhir, is rampant. Children especially in the rural areas of this district
undergo sever torture due to this inhuman practice. It is not only practiced by young mothers like
Bhumisuta, who has studied only up to class seven; educated parents of this area also adopt this
method to treat their children for Kalachhir.
This report speaks about the findings of a study on the practice of Kalachhir therapy adopted by
the people of Nuapada district. The study has been conducted in 6 Gram Panchayats of Boden
block.
The study was undertaken by the organisation Asha-Odisha with support of Save the Children.
The objective was not only to collect information and analyse the ground situation on the
practice of Kalachhir but at the same time, the aim was also to share the findings with the
frontline service providers of department of health and ICDS (Integrated Child Development
Services), administration and media personnel in a public interface for formulation of a strategy
to address the identified gaps and problems. As per the plan the public interface was conducted
on 17.12.2014 at Nuapada, which was attended by more than 50 participants. The report was
shared with the participants and their suggestions / opinions were documented and incorporated
in this report.
We hope this report will be helpful in addressing the issue of Kalachhir therapy in a proper way
to save the children from the torture of hot iron marking and consequent deaths.
Preface

3 
Introduction:
When we go through various documents and reports on development scenario of Odisha we find
that, Odisha has shown significant improvement in economic growth, poverty reduction and
improvement in various social indicators in last few years. The growth rate of the economy has
remained very high in past few years. With increased emphasis on human development and
attainment of Millennium Development Goals (MDG), the social sectors have gained greater
focus. As a result, the healthcare system in the state has gained considerable improvement.
Accessibility of the poor and marginalised people of undeveloped areas like Nuapada to health
care services has undoubtedly increased. Still there is a lot to be done.
In 2012, the crude birth rate (CBR) in the State was 19.9 against the national average of 21.6, but
the crude death rate (CDR) stood at 8.5 compared to 7.0 for the country. In Nuapada district, the
CBR was higher than the state and national average. While CBR stood at 22.5, the crude death
rate was at 7.6 for the said year. Other health indicators of Nuapada district and their comparison
with state and national figures in 2012 were as follows,
Table-1: Vital statistics
Indicators
India Odisha
Nuapada
District
Boden
block
Natural Growth Rate 11.4% 14.9 12.5
Total Fertility Rate (TFR) 2.2% 2.4
Crude Birth Rate 21.6 19.9 22.5
Crude Death Rate 7.0 8.5 7.6
Institutional Delivery 82% 82%
Infant Mortality Rate 42 53 52 65
Maternal Mortality Ratio (MMR)
(in 100000 live birth)
245
.

4 
Health condition of the people primarily is influenced by their income and poverty levels, which
determine their affordability for and accessibility to food, health and education services. Looking
in to the poverty level of the people of this district (which officially stands at more than 70
percent), it can be stated that, availability of free and quality health services have considerable
influence on their health conditions. The National Rural Health Mission (NRHM) initiatives in
this district thus carry a lot of importance.
The institutional delivery in the district was less than 7 percent when the NRHM started
functioning. This figure has increased now to 82 percent, which has surely influenced the infant
mortality figures of the district in last 7 years. Availability of different services from ASHA and
Anganwadi Workers at village level is gradually influencing health behaviours of the people.
Things are gradually changing but, in spite of all these efforts, there are some gray areas which
are totally under the influence of the superstitious beliefs of local people and various crude
methods of treatment by quacks. The practice of Kalachhir treatment is such an area, which
requires much attention due to the uncivilised treatment practices, where the life of new born
children is put to a lot of risks and hazards. It can be roughly accessed that, 13 percent of the
total deaths of infants in Nuapada district might be occurring due to the practice of hot iron
marks on the body of the new born children. There should be a total stoppage of such practices.
The study conducted in 6 Gram Panchayats of Boden block to dig out the truth about the torture
given to new born children and the social audit organised to share the findings with the health
and ICDS workers as well as with the media personnel is the first step towards eliminating the
practice of Kalachhir Therapy from the district.
1. Objectives of the study:
The objective of this study on Kalachhir and the Social Audit Programme was ;
1. To collect detail information on the practice of giving hot iron marks on the body of
children.
2. To know about the opinion of the parents of children who have been treated with hot
marks,
3. To know the opinion of village level health workers about the practice, and;
4. To share those findings with the service providers, government officials and media
representatives in an interface / social audit.
The social audit was an event in a process to sensitize different stakeholders as well as
community about the negative impact of Kalachhir practice on the children.

5 
2. Study Area: The selection of study area / Gram Panchayats was done on the following
criteria;
- Proximity of the Panchayats to Community Health Centre;
- Community and caste groups
- Literacy level of local population
The following 6 Gram Pachayats of Boden block were taken up.
1. Boden: This is the headquarters town of Boden block. In addition to local population, the
town is also inhabited by outsiders like (business community, government servants etc)
The Community Health Centre (CHC) is located here having two doctors and many other
health staffs. The literacy rate of this Panchayat is higher than other Panchayats of the
block.
2. Babebir: This Panchayat is 15 kms far from the CHC, Boden and 6 kms far from the
PHC, Karangamal. Majority of the population here is nontribal.
3. Domjhar : There is a Primary Health Centre at Domjhar. Most of the people in this
Panchayat are nontribal.
4. Buergaon: It is one of the remote GPs of Boden block. 60% of the population is tribal
here and SC constitute 15%. The nearest health centre is CHC, Boden, which is 12 kms
far from the GP.
5. Farsara: Farsara is located at a distance of 8 kms from the CHC, Boden. 42% of the total
population in this Panchayat is tribal. Nontribal constitutes 46% and the rest are S.Cs.
6. Litisargi: It is located at a distance of 12 kms from the Boden CHC. Most of the
population (61%) is nontribal.
No. of revenue villages covered - 40
Detail information on child birth / delivery in last three years were obtained from all the Angan
Wadi Centres (AWC) located in the selected villages. Subsequently door to door survey was
conducted to verify the information obtained as well as to collect other necessary information on
Kalachhir practice from the people. It was not easy to obtain information from people as they
were afraid that the revelation on Kalachhir treatment might lead to legal action. The people
were reluctant to say about the treatment they have availed from the Vaid. Thus the data on
treatment by Vaid presented here in this report are suppressed figures.

6 
3. What is Kalachhir:
Kala means black and Chhir is vein, thus Kalachhir means black vein. When the veins in the
body of a child are prominently visible, the villagers feel that the child is severely ill. This
ailment forces the child to;
- Stop breastfeeding
- Cry continuously
- Vomit repeatedly
- Swelling of stomach and
- The veins become black
As per the belief of people, the only method to treat this problem is to dot the body especially the
belly portion with hot iron stick/hot glass bangle or iron ladle.
4. What the doctors say?
The doctors say that, it is a superstition. “It is a superstition. It is not an illness; the visibility of
the veins in a child’s body is natural due to thin skin. Kalachhir is neither even a symptom of a
disease nor it leads to any disease,” the CDMO of Nuapada says.
5. Method of treatment:
• A thin iron stick (used in umbrella) or a black bangle is put in the flame to make that hot.
The hot stick / bangle in put on the body of child.
• In some cases, the iron ladle (Jali Chatu) is used, but in such cases, the Chatu is only kept
close to the bally. The skin is severely affected due to this.
6. Findings of the Study:
Data collected from the 76 AWCs of 6 Gram Panchayats reveal that, a total number of 2760
children have born in last 3 years (January, 2012 to December, 2014). Out of this total birth 86%
is institutional delivery. The rest 14% of the birth has taken place at home under the care of
traditional birth attendants. This figure is encouraging because, the corresponding figures of the
district and Boden block on institutional delivery are 4% less than the study area. Institutional
delivery in Boden and Domjhar Gram Panchayats are more than the rest 4 G.Ps. Buergaon

7 
panchayat has the lowest figure, which reveals that, the distance of the health centres as well as
the caste categories still play an important role in opting for institutional delivery. Domjhar GP,
which is inhabited mostly by non-tribal educated people, has a PHC with two doctors. Most of
the households here take the service from the CHC at Kharir, which results in more number of
institutional deliveries. In any case, the percentage achieved in Buergaon is also very much
encouraging considering the remoteness of some of it’s villages and low awareness level of the
tribal population in the Panchayat.
Table-2: Institutional Delivery
Name of G.P. Total Birth Place of birth/No. of children
Home Institutional
DOMJHAR 537 10% 90%
FARSARA 595 18% 82%
BABEBIR 428 15% 85%
BODEN 629 07% 93%
LITISARGI 465 18% 82%
BUERGAON 106 24% 76%
Total 2760 14% 86%
Increase number of institutional delivery in last 7 years has resulted in a decrease in IMR, which
was more than 80 before the institution of NRHM. But, NRHM has still a long way to go to
address the superstitious practices like Kalachhir treatment.
Exten
t of
use of Kalachhir Therapy:
Figure 1. (Marks in the circles: given by hot glass bangles. Still exist
even after 10 years.

8 
The information obtained from the people on use of Kalachhir therapy reveals that, 12% of the
new born children are given the hot marks within one month of their birth. In most of the cases
the marks are given on third day of birth.
Table-3: Kalachhir Treatment
G.P.
Children treated for
Kalachhir /age group
(months)
Treated by
quack (hot
marks)
Treated in Hospital
Only in
hospital
After
hot
marks
Total
> 1 1 - 2 2 - 3 Total Once
2
times
DOMJHAR 66 0 0 66 63 1 2 5 7
FARSARA 78 3 4 85 79 3 3 2 5
BABEBIR 59 2 0 61 56 5 0 0 0
BODEN 52 0 1 53 52 1 0 0 0
LITISARGI 24 0 0 24 20 4 0 0 0
BUERGAON 21 0 0 21 19 2 0 0 0
300 5 5 310 289 16 5 7 12
Out of 2760 children born in last 3 years, 310 have been treated for Kalachhir. This means about
12% of the new born children (One in every 9 new born children) suffer from the so called
ailment of Kalachhir. Only 12 out of the 310 children have availed treatment of the doctors,
which is less than 4% of the total cases. Out of the total children treated by doctors, 5 are fresh
cases and other 7 are after hot iron marks treatment by quacks. So, in fact, less than 2 percent of
the cases have directly gone to the health centres / doctors.

9 
Table-4: Children treated for Kalachhir
Panchayats > 1 month 1 to 2 month 2 to 3 month Total treated
DOMJHAR 66 0 0 66
FARSARA 78 3 4 85
BABEBIR 59 2 0 61
BODEN 52 0 1 53
LITISARGI 24 0 0 24
BUERGAON 21 0 0 21
300 5 5 310
Discussion with the villagers reveals that, the symptoms in the children forces the parents to run
to the quack as if it were a near to death situation. “I had shown my child to the doctor in Khariar
hospital, but he could not save my child. He said that, the child had no problem but the child
died” says Jire Rout of Dharnimal village. She informs that, her child was born in District
Headquarters Hospital (DHH) at Nuapada. They were relieved from the hospital on 2nd
day.
“When on 13th
day the child became ill with all the symptoms of Kalachhir, we took her to
Boden CHC. The doctors there referred to Khariar CHC. Dr. Achary saw the child and said that,
she was healthy, but the child died on the next day when we returned home” adds Jire.
The doctors say, the child might have died for other reasons, but Jire is not convinced. This
shows that, there is a lack of effort in building awareness among the people on this particular
issue of Kalachhir problem. Perhaps, due lack of proper counselling by the service providers the
parents run to the quacks even if the doctors say that the child is healthy.
The people claim that most of the children get immediately well after getting hot marks.
Table-5: What the people claim of the treatment by quack
G.P. Treated with Quack Recouped from Illness after hot iron marks.
DOMJHAR 64 62
FARSARA 82 80
BABEBIR 61 59
BODEN 53 52
LITISARGI 24 14
BUERGAON 21 15
Total 305 282

10 
From the above data, a contrast
picture between the first 4 GPs and
the subsequent 2 GPs is revealed.
When the percentage of death after
Kalachhir treatment in Domjhar,
Farsara, Babebir and Boden is
about 7 percent, this figure for
Litisargi and Buergaon is more than
35 percent. The difference has been
caused due to the suppression of
information by the people. When
the news of Kalachhir treatment was published in print and electronic media, the district
administration sent information to the villages through the field level workers that, strong steps
would be taken against the people who are practicing hot iron therapy. It created fear among the
people and thus most of them were reluctant to provide information. But the data in Litisargi and
Buergaon Panchayats had been collected one month ahead of these initiatives by the
administration and thus are near to accuracy.
Table-6: Percentage of death in Kalachhir in comparison to total death
Panchayats Total Birth Death in
last 3
years
treated for Kalachhir Death after Hot
marks
% died in
KalachhirQuack Doctor Total
DOMJHAR 537 39 64 2 66 02 05
FARSARA 595 30 82 3 85 02 07
BABEBIR 428 26 61 0 61 02 08
BODEN 629 44 53 0 53 01 02
LITISARGI 465 29 24 0 24 10 34
BUERGAON 106 17 21 0 21 06 35
Total 2760 185 305 5 310 23 12
7% of total
birth
98% of total
treated
2% of total
treated
7.42% of total
treated
12% of total
death
The death rate of children in the in the age group of 0 to 3 years in the study area is 67 in 1000
LB. A total of 185 children have died in last three years. Most of these deaths as per records of
the AWCs have occurred due to low birth weight and various infections. But, analysis of field
data reveals that, 12% of the total deaths have occurred due to Kalachhir treatment and about 7%
of those children who were treated by the quack for Kalachhir have died after the treatment.

11 
The health status of the children in the study area can be accessed from the following data, which
have been obtained from the registers of the AWCs.
Table-7: Children of 0-3 age group in Green, Yellow and Red zones (4 G.Ps)
Gram
Panchayat
S.C. S.T. O.B.C. Total
G Y R G Y R G Y R G Y R Total
DOMJHAR 34 10 4 91 24 6 235 65 20 360 99 30 489
FARSARA 23 17 0 172 83 10 201 83 8 396 183 18 597
BABEBIR 35 8 1 31 6 0 274 37 13 340 51 14 405
BODEN 91 31 8 102 60 25 196 72 8 389 163 41 593
Percent 70 25 5 65 28 7 75 21 4 71 24 5 100
The data above shows that, percentage of tribal and scheduled caste children in red zone is more
than the children of OBC category. Eventually, their percentage in green zone is less. The death
rate of children among the tribal is also more than the other two communities in the study area.
However, the practice of hot iron / bangle marking treatment is prevalent among all the
communities, irrespective of their castes categories. The practice is a little less in the Panchayats
which are located nearer to the Community Health Centre. Thus proximity of the villages to the
CHC influences the decision of the people to avail modern health care services for Kalachhir to
some extent.

12 
7. Government efforts:
A news on Kalachhir practice was published in an English daily in August, 2014, which drew the
attention of the district administration on this issue. The District Collector of Nuapada along with
the CDMO visited some of the villages to get a firsthand knowledge. They also met the Vaid of
Dharnimal and warn him of criminal action if he continued the practice. The Collector
subsequently conducted meetings of frontline workers of health and ICDS departments to
sensitize them on this issue. Due to involvement of the Collector the issue has taken a
momentum and the health service providers are now conducting meeting at village level
regularly. However, the step taken by the administration has created a fear within the people but
the superstition still persists.
8. Conclusion:
The death rate due to Kalachhir in rural areas of Nuapada district is alarming. The death might be
caused due to severe pain of the dotting or subsequent infections. Whatever the cause may be the
cruelty should be stopped. But all these go unnoticed, because there is no reporting about the
treatment. Verbal autopsy of the deaths is also not done in a majority of cases. Verbal autopsy

13 
means documentation of the cause of deaths by the field level workers of the Health and ICDS
departments, which is the only source of information to establish the causes. But, the field
records of the workers do not have any mention about Kalachhir treatment or death; rather they
are shown as deaths due to infections, low birth weight and others.
The cause should be recorded in detail and if the practice is there in large-scale, awareness
generation programme should be conducted. If the practice still prevails, the people involved in
such cruel practice should be treated by law for their cruelty and torture.
Vaid of Dharnimal Village in Boden Block Vaid of Arada village of Khariar Block

14 
District Level Workshop for sharing findings:
The district level workshop for sharing findings of social audit on Kalachhir was conducted at
Nuapada on 17, December 2014 to discuss about the impact of Kalachhir treatment by quacks
and to prepare a strategy to fight this inhuman method of treatment.
The participants were service providers of health and ICDS departments, NGO workers and
media persons. The discussion was based on the findings of the above study. The study was
conducted by Ajit Panda, who has been writing on this issue continuously.
The presentation of the study was made by district programme officer of Save the Children
Bidyadhar Meher. The study has revealed that 13 per cent of the total deaths in the study area
have occurred after the hot mark treatment. The quacks in some areas have stopped the treatment
in their houses due to fear of police action, but they are being taken to the houses of the children
to provide hot marks.
The workshop was presided over by District Project Manager of National Rural Health Mission
Biswambar Behera. Asha-Odisha president Saraswati Mishra spoke on maternal and child health.
The following suggestions came from the participants after the presentation.
1. A workshop on Kalachhir for the quacks/vaid should be conducted to sensitize them on
the negative impact of the hot marks treatment.

15 
2. The study on Kalachhir should be extended to all over the district to get a clear picture on
the practice in the district.
3. Home visit should be given priority on the Village Health & Nutrition Day (VHND) and
Immunisation Sessions.
4. The HBNC format filled up by the ASHA should have a space for mentioning about the
Kalachhir.
5. Information about death in Kalachhir should be provided in the MIS register maintained
at block level.
6. The field workers while mentioning about the causes of death in their Monthly Progress
Report (MPR), should also mention the statement of people on Kalachhir (If the people
say that the cause of death is Kalachhir, that should be mentioned).
Case Studies
1. Jamuna and Lokesh Bag of Jubamalpada in Babebir G.P.
Lokesh and Jamuna are daily wage earners. They have 3 children one daughter and 2 sons.
All the 3 cases of delivery of Jamuna are Institutional. Her 1st
son developed the symptoms
of Kalachhir when he was one month old. He was taken to a Vaid for treatment and got better
after hot iron marks. The second child is a daughter. She also suffered from the same ailment.
She was first marked with a hot “Jali Chatu” when she was 7 day old. The Kalachhir came
again after a month, so she was given the second phase marking. The marks were bigger

16 
than the iron dot marks. Lokesh took the third child to the Vaid although he had no
Kalachhir.
Case: 2. Hemangini Kata daughter of Birendra kata of Dharnimal village has 46 marks on
her bally. The first child of Birendra had no Kalachhit, but Hemangini developed that. She
was given hot marks in two phases. She 5 days old when the first marks were given. The
second phase was, when she was 15 days old.
Case: 3. Ajaya Majhi of Boden has 2 sons. Second son Rahul suffered from Kalachhir, when
he was 15 days old. He was brought to Khariar CHC and the doctor treated him but the
problem started again after 25 days. The doctor treated him again. The problem reoccurred
and Ajaya took him to DHH, Nuapada. When the problem re-occurred again in 4 months, he
was treated by the quack (hot iron marks) and got better.
These case studies reveal that, the superstition of Kalachhir is deep tooted among the people of
the study area. Awareness drive and proper counseling have to be undertaken to eliminate the
superstition of people.

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