Srinagar: When 45-year-old nomadic Gujjar woman Fatima (name changed) from the frontier district of Kupwara, felt the urge to urinate more than usual, she put it down to all the water she was drinking. Of late she had begun to feel thirstier. Soon, however, the thirst seemed to be more and more insatiable.
At the peripheral hospital, the doctor prescribed a mild dose of analgesic and antiemetic drugs. Things, however, didn’t improve. Soon, she developed a searing pain in her stomach and a severe bout of vomiting. Her family was left with no choice other than to rush her to SMHS Hospital, Srinagar.
“After examination, she was diagnosed with long-standing diabetes and immediately put on insulin,” the doctor treating her said.
Similarly, another middle-aged Gujjar woman from Gurez was reported to the SMHS Hospital, Srinagar with general swelling throughout the body.
On examination, she was clinically found to be in heart failure. Surprisingly, her echo test (this test diagnoses problem that affects the heart) came out to be normal.
“This was her first visit with such complaints. On further evaluation, it was found that she has been visiting peripheral hospitals with complaints of getting tired easily, cold intolerance, and constipation for the last two years,” the doctor examining her said.
Subsequently, her Thyroid Stimulating Hormone test (A TSH test is done to find out if your thyroid gland is working the way it should) came out to be about 35.
“The test reports showed she has been a case of long-standing hypothyroidism. Currently, she is on hormonal replacement therapy of Thyroxine and is doing fine,” the doctor said.
Of late, Gujjar-Bakarwal tribes have found themselves increasingly at the receiving end of non-communicable diseases. A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another.
NCDs include strokes, thyroid disorders, diabetes, heart diseases, cancers, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer’s disease, cataracts, and others.
This even though most members of the community are always on the move and do not fall into the usual description of “lazy” or “inactive”, traits generally considered cause of lifestyle diseases.
A recent study titled, ‘Thyroid Function, Urinary Iodine, and Thyroid Antibody Status among the Tribal Population of Kashmir Valley: Data from Endemic Zone of a Sub-Himalayan Region’ shows that 33 percent of the population suffers from various thyroid disorders and 30 percent show iodine deficiency.
The study conducted in October 2020, estimated the prevalence of thyroid disorders and evaluated urinary iodine concentration (UIC) and thyroid autoantibody status among Gujjar and Bakarwal tribes of Kashmir valley.
A total of 763 subjects from the five districts– Anantnag, Pulwama, Ganderbal, Kupwara and Srinagar were evaluated for the study.
“33 percent of the tribals had some form of thyroid dysfunction, (including 24.1% subclinical and 6.8% overt hypothyroidism) while 30 percent had urinary iodine concentration less than 100 micrograms which means they had iodine deficiency in them,” the study shows.
Dr. Tajali Sehar, co-author of the study and Scientist-B, Department of Clinical Research, said Gujar-Bakarwals are mostly concentrated in the mountainous regions of the valley.
“Their housing, sanitation, and health care facilities are very sub-standard than other sections of the population. They carry behavioral risk factors including a less nutritious diet, skipping meals, and increased tobacco use, which makes them susceptible to non-communicable diseases,” she said.
She noted that they were trying to find the prevalence of non-communicable diseases among the tribal population of Kashmir as there was no data with respect to Non-Communicable Diseases (NCDs) like thyroid, diabetes, hypertension, and vitamin D deficiency in them.
Dr. Tajali pointed out that the burden of non-communicable diseases is immense.
“The tribals already have less access to healthcare and remain unaware of the risk factors related to NCDs. It can lead to significant disability and premature death, having long-term consequences on people’s health and finances, pushing the families into poverty,” she said.
She noted that NCDs are also affecting a relatively younger population. “This is likely to be due to malnutrition early in life, which paradoxically increases the risk of NCDs and an unhealthy lifestyle in early adulthood. This means the younger population in tribals needs to be screened for chronic diseases,” Dr. Tajali said.
As a follow up to these findings, the doctor explained that they are now focusing on community-based intervention.
“This intervention will help to curb the rise of life-threatening complications in the tribals. We have started with a few villages in some districts—Pulwama, Anantnag, and Ganderbal and will slowly extend to other districts,” she said.