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A lone doctor for all seasons

india Updated: Apr 16, 2012 20:08 IST
Priya Ranjan Sahu

As a young boy, Rajendra Mandal watched his father, a teacher, idolise a homeopathic doctor in their remote village, Mandalsahi, in Odisha's tribal dominated Gajapati district.

Patients knocked at the doctor's door at odd hours and he never failed them. "You should emulate him," his father often told him.

In 2005, following his father's advice, this Sabara tribal youth joined the Odisha government as a doctor, after completing his MBBS degree from the MKGC Medical College in Berhampur. He was posted at the remote Tikiri primary health centre (PHC) in Rayagada district, more than 500 km southwest of Bhubaneswar.

A part of the Kalahandi-Balangir-Koraput belt, this hilly backward district is marred by acute poverty and hunger deaths. Starved of basic amenities and battling state apathy, the area has become a hotbed of Maoist activities where even doctors fear to tread. Poor sanitation ensures that diseases such as diarrhoea, cholera and malaria have a free reign.

Most government officials and doctors in Odisha belong to the coastal belt. When posted to tribal areas, they tend to remain 'on leave' for as long as they can.

Not Mandal, though. "Since I started working here, I haven't taken more than 30 days leave in total," he says, while examining patients in his modest 6x6 foot room.

He cannot afford to. Tribal patients have no idea of official timings. They come knocking at any time of the day, or night. He gets midnight visits almost daily - be it malaria afflicted children, women awaiting delivery or accident victims.

The Tikiri PHC covers about 42,000 people - mostly poor tribals and dalits - in at least 113 villages. The average daily inflow of patients is 75, which rises to more than 100 during the rainy season.

In 2007 and 2010, outbreaks of malaria and diarrhoea were a major challenge for Mandal. Of the 240-odd official deaths in Odisha since 2007, Rayagada accounted for more than half. "I lost seven kilos because there was no time to eat due to the continuous inflow of patients," says Mandal.

Learning from experience, the centre was better prepared during the 2010 outbreak, with the area not reporting any casualties, he claims.

Rupna Majhi, a tribal from nearby Panabandha village, says: "My children survived just because of him. He is at our disposal, anytime."

While most rural PHCs languish in perpetual neglect, the Tikiri centre now boasts of an ambulance, a six-bed ward and a better health record.

"Before Mandal, we didn't have a doctor for over a year. After 5 pm, the hospital used to be closed," says Binod Naik, another local.

According to the government's latest Hunger and Malnutrition Report, 44% children in Odisha are malnourished against the national average of 42%. In Rayagada, out of every 1000 children, 112 die before the age of five (second only to Kandhamal district's 154).

And the problem is compounded by the acute shortage of doctors. Officially, against 4,362 sanctioned posts, there are 510 which are yet to be filled. The state government recently appointed 350 ad hoc doctors, but most squirm at the thought of serving in rural areas.

"In reality, as many as 1000 posts, mostly in rural areas, are lying vacant as doctors do not join or go on leave after joining," said a health department official on the condition of anonymity.

Rayagada fares worse than most districts. Till December 2011, of the 123 sanctioned posts, 51 remained vacant.

"Lack of doctors is a major problem," admits chief district medical officer Benudhar Nayak. "We need more doctors like Mandal. People like him have kept alive the rural healthcare service."

Odisha health minister Prasanna Acharya tells the Hindustan Times: "I have asked collectors and chief medical officers to prepare a list of doctors who have been providing better health service in rural areas and reward them."

Mandal has already got his reward - the respect of Tikiri's people. "I am happy. I have developed a special bond with the locals," he says.

Since he does not find time to go home, his parents come to Tikiri to visit him. His father often asks: "Why don't you come over to Mandalsahi? We urgently need a doctor there." Odisha needs a thousand more Mandals.