During my stay in the United Kingdom, I volunteered at a not-for-profit organisation which worked for the advocacy of human rights. As a case-worker, I had developed empathy for people’s problems and started to believe in the romantic ideology that people are devoid of opportunities and rights. So, if I can give them a little push, they will eventually develop the confidence to progress. It was probably one of the reasons which convinced me to apply for India Fellow. However, as I started working in the tribal belts of Kalahandi, Odisha, I realised I was wrong.
A few weeks ago, I was at the health centre when a field animator approached me and told me about two sisters – adolescent girls who were extremely sick, in a remote village. He requested me to go and see them. The next day, I took my backpack with a stethoscope, a few medicines and went to see the girls accompanied by him. The only way to access the village is by crossing a river on foot.
After hopping from one stone to another, I managed to cross the river and reach the village, making my way to their house. The girls looked underweight, malnourished, pale and weak. They couldn’t even walk properly and had a high fever.
Additionally, they were experiencing hemoptysis (coughing up of blood) for the last two to three weeks, which is highly indicative of TB. While listening to their body through the stethoscope, I found abnormal breathing, which could indicate a lower respiratory tract infection.
When I interrogated their grandmother for the medical history of the family, she revealed that the parents of these girls died of severe fever and the coughing up of blood a year ago. It could have been TB – and hence, I requested her to send the girls to a hospital, which was 75 km away. As she worried about the expenses, I assured her that we would take care of that, including transportation, hospital stay and medicines. Her immediate response was to refuse. It made us extremely angry, and my first thought was, “Even when I’m bearing the cost, why is she so stubborn? What the heck is wrong with her?”
She asked us to wait for the grandfather who had gone for donger kaam (farming). After a while, he returned, smoking a beedi. We told him the serious health implications for both his granddaughters and that they didn’t need to bother about the expenses. But he refused too, without a second thought. Surprisingly, most of the villagers were also supporting him. One of them had the audacity to ask if we were there to buy the girls.
After hours of making an effort to convince them, we understood that they would never go to the hospital and decided to go back to the health centre. I couldn’t wait to narrate this incident to Dr Aquinas, founder of Swasthya Swaraj, the organisation where I’m working. She was shocked to know the story and also suspected TB in the girls. The next day, she sent a jeep with the staff to convince them to come to the Kerpai Health Centre. This time, the grandfather was under the influence of alcohol. Both the girls were crying, but willing to go to the hospital. However, the old man and his wife refused to send them. After hours of failed pleading, the jeep returned.
I asked the field animator, “What could be the reason for the stubborn attitude of the old couple?”
He said that the grandparents were probably thinking that if the girls were treated, they would have to take care of them and get them married, which comes with the additional burden of dowry – something they couldn’t afford. It would be better for them if the girls died a natural death and became one with the nature.
Such a thought process isn’t new here. I’ve been in situations where mothers refuse to admit their children in medical care to be cured of severe anaemia, severe acute malnutrition (SAM) and severe malaria.
All this while, I was angry with the old couple for refusing to hospitalise their grandchildren. I was trying to show that my belief system, morality and ethics were absolute and universal, no matter the extremely different circumstances in question. I forgot to make an effort and understand morality and values from their perspective.
Think about it – they have lived all their lives in the tribal pockets of Kalahandi, which has a grim history of extreme poverty, starvation and famines for decades. If we put ourselves in their place, it makes sense, despite the conflicts with my belief system and morality. They have had to work hard to feed their families. Admitting the child to the hospital means letting go of their wages for that day, leading to a lack of food to feed the family with for at least two or three days. If the choice is to save one child over the rest of the family, obviously the latter is the priority.
After working here, I feel that people in the development field will always have this dilemma. It is crucial to understand the values and the background of the community where we’re working. Simply shoving our ideals and beliefs down their throats won’t help solve anything.
Sandeep Praharsha is an India Fellow of the 2017 cohort. He is working with Swasthya Swaraj, Odisha, supporting the overall health programme of the community by practising as a doctor, capacity building of the team and leading the community awareness initiative.