Malaria in Malkangiri

Sourav Mohanty & Sujit Kumar Mishra

Developmental interventionsin India have seldom been inclusive of vulnerable groups, especially tribals. In Odisha, examples abound of the vulnerability of tribal communities to development interventions. The acclaimed 2022 Odia film DAMaN, written and directed by Vishal Mourya and Debi Prasad Lenka, depicts real-life events in the Malkangiri district of Odisha, India–a district with around 60 percent tribal population, hilly terrain and water bodies which are a fertile ground for mosquito breeding. DAMaN stands for DurgamaAnchala re Malaria Nirakarana (malaria eradication in inaccessible regions), which is a part of the state government’s efforts to eradicate malaria in inaccessible regions. India aims to eradicate malaria by 2027, but may find it challenging to do so in districts such as Malkangiri, with their poor health infrastructure and difficult terrain.

The film prologue states that the construction of Balimela dam–a multipurpose river valley project on the river Sileru–created a 60 km long waterway that separated 151 villages from the mainland, leading to their disappearance from the official map. The film, set in the riveting locale of secluded villages in Malkangiri, underlines the inaccessibility of healthcare facilities and displacement in the region through the heroic story of Dr Sidhharth Mohanty. Highlighting the skewed social impact of a development intervention, it revolves around four important and interlinked issues–the Balimela dam, the state’s infrastructure to adapt to health challenges, the prevalence of superstitions, and the need for effective quality of leadership, mobilisation, and collective action at the grassroots level.

The film begins with a bus ferrying the young promising doctor to the first assignment of his life–a posting at a remote Primary Healthcare Centre (PHC) in Malkangiri. Alighting from the bus, the doctor undertakes a perilous, bumpy journey atop an overcrowded jeep and then by boat to finally arrive at the PHC. His journey signifies the inaccessibility and lack of safe public transport in this region and the grim reality of Odisha’s lop-sided development. In fact, patients hardly ever come to the PHC due to their over-reliance on witch doctors from the hills.

The lack of proper water facilities or mobile network implies that the city-bred doctor finds himself ill at ease as he battles long power cuts and mosquito-infested sleepless nights at his dingy official residence and dilapidated chamber. A three-year rural posting is mandatory for fresh medical graduates as per government norms. The protagonist is critical of this policy, citing the lack of basic facilities in such regions. He consequently shows his disdain for remote districts of Malkangiri, Phulbani, and Koraput, and is disinclined to serve in such areas. He unsuccessfully attempts to get himself transferred and even tries to resign.

Meanwhile, he hears disturbing stories about how a pregnant woman had to be carried on a big pot across the river, and how both the mother and the child died upon reaching the Malkangiri hospital. He notes the gulf between Malkangiri and Bhubaneswar, the state capital. The compounder remarks that Malkangiri is hundreds of years behind in terms of development–the failure of the state, since 1982, to connect as many as 151 villages by a bridge exemplifies the sorry state of affairs.

The night before the doctor plans to depart, a villager comes running for help for his dying daughter. Cognizant of the dire health conditions in the area, the doctor treats the patient diligently. The father claims that his daughter is possessed by a ghost. The compounder explains that the absence of treatment facilities forces the villagers to approach the dishari (a shaman or witch doctor), who performs biru (an exorcism) to supposedly rid the patient of the duma (ghost). A nurse, however, suspects that the girl may have malaria, which alarms the doctor. The doctor is shaken by this single incident, compelling him to seriously self-reflect. Ultimately, he decides to stay back and take up the fight against malaria. He persuades his assistants to join him in the arduous task of trekking up the hills to the villages to treat malaria cases. Braving difficult terrain, hours of mule rides, and Naxal attacks, the team carries out its mission.

To understand the dynamics of healthcare in this region, Dr Mohanty navigates through prevalent issues and institutions, both formal and informal. His first shock comes in the form of guniamela (exorcist’s fair), where he witnesses superstition in action. For a girl bitten by a cobra, the suggested remedy of pouring 108 vessels of water over her makes her lose her life in the doctor’s presence. Anguished, the doctor realises the intricate relationship between the tribals and the exorcist, one that has developed over centuries and cannot be destroyed in a day. As the tribals consider the exorcists equivalent to God, the young doctor realises that his battle is not only against the disease but also against an entire ecosystem of blind faith and superstition.

Thereafter, the doctor takes up a mission to visit 151 villages to assess the severity of the situation. While serving in one such village, he faces a Naxal attack but manages to rescue a pregnant woman forsaken by the villagers. The doctor comes forward with the help of his pharmacist tied to cloth hanging from a wooden log. The movie is inspired by similar heart-wrenching visuals from real life–flooded the headlines–which shook the nation to the core. Troubled by the non-cooperation of the villagers, the doctor decides to discontinue his services. Later, he realises that the fear of the Naxals had prevented the villagers from supporting one another. The exemplary leadership qualities displayed by the doctor ignites stronger social cohesion and collective action against the situation.

As he gets further acquainted with the area, the doctor discovers the problem of asymptomatic malaria. He forwards a solution of maximum testing and regular use of mosquito nets, specifically Long-Lasting Insecticidal Nets (LLIN). He persuades public health officials to roll out this costly intervention. Thus, the distribution of LLIN in the malaria-affected areas of Malkangiri is overseen by the district administration.

This intervention is initially encouraging, with a drop in malaria cases being reported. However, the triumph of a public policy initiative depends on sustainability, with the intervention withstanding the test of time to yield positive results. Six months after the LLIN distribution, malaria cases spike again due to a lack of awareness and misuse of the nets for fishing and other activities. The mere distribution of nets was clearly not enough; public awareness regarding its usage had to be raised too. Thus, the doctor requests the government officials to induct staff from other departments for such a campaign. The district collector approves the doctor’s proposal. The entire district administration participates in a containment drive, which includes the use of DDT spray, awareness programmes, compulsory testing, treatment, and sanitation.

DAMaN successfully reduced the incidence of malaria from forty to four percent in a brief period. The collective effort of the district administration, the public health officials, and the local people resulted in a positive outcome for the district. The film is not only about an individual’s effort in mending a broken system, but also pervades multiple dimensions. It shows how clinical policy intervention, public awareness, collective effort, and effective channelisation of resources can tackle the most grievous of health emergencies. What it really requires is a display of leadership across issues such as curbing superstition, promoting awareness, and creating a sense of community.

[Sourav Mohanty, Assistant Professor, Gokhale Institute of Politics and Economics, Pune Email: sourav.mohanty@gipe.ac.in
Sujit Kumar Mishra, Professor, Council for Social Development (An ICSSR Research Institute), Hyderabad, Email: sujitkumar72@ gmail.com]

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Frontier
Vol 58, No. 8, Aug 17 - 23, 2025