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The right prescription

A group of doctors in Chhattisgarh is changing the way healthcare is delivered to rural populations, writes Syeda Hameed.

india Updated: Aug 29, 2007 23:59 IST

Despite the thousands of crores we have spent on healthcare over the five-year plans and the amount we are putting aside for it in the 11th Five-Year Plan, a vast majority continues to suffer from illnesses and lack of proper medical care. If they don’t die from the disease they are suffering from, they die from the resultant anxiety and poverty. Will the national rural and urban health missions rescue India’s poor from this cycle of ill health and penury? I don’t have a satisfactory answer. But every time I think that I have reached a dead end, an incident or a project lifts up my sagging spirits.

Take, for example, the Jan Swasthya Sahyog (JSS). This non-governmental organisation operates in a remote corner of Chhattisgarh. In 1999, four doctor-couples, who were trained at the Christian Medical College in Vellore and the All India Institute of Medical Sciences in Delhi, decided to give up their big pay packets to move to this tribal-dominated area in Bilaspur with their families and school-going kids. The 60-km drive from Bilaspur to the JSS’ area of operation was akin to travelling back in time. Nothing could be as remote. We first went to JSS’ Outreach Programme. Weekly outreach clinics are run in forest-fringe areas of the Achanakmaar National Park. People from over 150 villages mostly adivasis, Dalits and OBCs like Gonds, Baigas, Majhis, Oraons and Kols visit the clinics. We stopped at Banhani village. Here we met neo-literate and illiterate Baiga and Gond women who have been trained as health workers. Dressed in traditional clothes and ornaments, they proudly showed us their small suitcases stacked with medicines, breath counters for pneumonia detection, slides to take samples for malaria, dressing for wounds and pregnancy-detection kits.

By the time we reached the irrigation department building at Ganiyari, which had been leased for 30 years from the state government to run a referral centre, out-patient clinic and a ward, it was dark. But at the referral centre, people were beginning to queue up. They would spend the night here for their turn early next morning. This was in stark contrast to the empty 30-bed government hospital

at block headquarters, Kota. At Ganiyari, patients waited at the waiting area which has clean wooden benches, neatly marked with numbers. The place smelt of fresh leaves, not disinfectants. The OPD was packed with people. Young doctors, unmindful of their fatigue and lateness of the hour, were struggling to save an old woman who had developed septicemia due to an injection given by a quack.

I entered the 20-bed ward. A young woman was standing at the door. “Sukhna Murmu is HIV+. Her husband died of Aids. We cannot get anti-retroviral treatment for her but we are trying.” “This is Geeta,” one of the doctors pointed to a young girl. “She is a tuberculosis patient but she has refused treatment because her brothers died during the Directly Observed Treatment Shot (DOTS) course.” Geeta was just over 5 feet and weighed around 30 kg. How could her body sustain the DOTS dose?

The next day, we saw various low-cost technologies developed by the NGO. The method for early detection of urinary tract infection costs less than Rs 2 per test, anaemia Re 1, diabetes Rs 2 and pregnancy Rs 3. Village women trained by the doctors can do most of these tests. I saw low-cost delivery kits for Rs 40, a cheap and effective water-purifying system, and affordable technology to detect sickle-cell anaemia and falciparum malaria. The list is long, the impact far- reaching. “It is in the vast expanse of rural India, where majority of Indians still live, that the battle against disease will be won or lost,” I had often read these words. At Ganiyari, these lines acquired a meaning.

What lessons did I learn from Ganiyari? I learned about a set of dedicated professionals who work directly with people. They see patients as partners, not as ‘beneficiaries’ who are a burden. They develop low-cost technologies, use school-going children as couriers to drop and pick up malaria slides to expedite treatment. The result: for the first time, the tribals have access to a decent healthcare system. The biggest problem that I have encountered in my field experiences is the unavailability of human resources in health. This is a gaping hole but the immediate answer lies in recruiting from the community. This requires courage and faith.

As planners, we must ask ourselves whether we have the courage to replicate good practices like Ganiyari all over rural India. If it is possible in a difficult terrain and hostile environment like Ganiyari, why can’t it be scaled up to be a part of the National Rural Health Mission?

Syeda Hameed is member, Planning Commission