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1 Doctor For 483 People: India’s Medical Services Need An Urgent Revamp

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Health is wealth and doctors are god!

We thank them for being our life saver whenever we fall ill. They are next to God for all of us. A deity in human form and shape. But what if when there is a fatal disease spread across an entire community for which there is no cure or no doctors available to save them from the paws of the disease? Risky, isn’t it?

The thought of our life ending definitely brings chills and goosebumps through our entire body. India has always been involved in the discussion when it comes to health care and proper medical treatment. Though India is developing and medical facilities are advancing rapidly, there are still cities and areas which require care and nourishment. Advancement is limited till urban areas, but when it comes to rural areas, it is a matter we should all think of.

It has been found that over a short span, there have been tragic medical emergencies, leading to the unfortunate deaths of over 150 children in Muzaffarpur in Bihar triggered by malnourishment, and the recent nation-wide protests over the alleged assault on a doctor in West Bengal by a patient’s family.

There has been an increasing shortage of medical professionals from doctors and paramedics to lab technicians and surgeons. Doctors essential to our lives. Without them, we can never recover from a disease, be it small or be it fatal. And if there is a shortage of doctors and people die due to a lack of treatment despite knowing that a small dose of medicine can cure us completely, it is even more heart breaking and heart wrenching.

The decline in access to medical professionals is detrimental to the Indian rural healthcare system, as the quality and availability of care for rural communities are significantly worsening.

According to a survey report by a daily leading newspaper by Washington DC, there has been an estimated shortage of about 6,00,000 doctors and 2 million nurses, say scientists who found that lack of staff who are properly trained in administering antibiotics is preventing patients from accessing live-saving drugs.

In India, 65% of health expenditure is out of pocket, and such expenditures push some 57 million people into poverty each year.

Additionally, as mentioned before, there is one government doctor for every 10,189 people (WHO recommends a ratio of 1:1,000) or a deficit of 6,00,000 doctors, and the nurse: patient ratio is 1:483, implying a shortage of two million nurses.

Junior doctors from NRS Medical College and Hospital continue the strike which caused the Out Patient Department (OPD) to close, and partially interrupted the emergency services inside the hospital campus in Kolkata, India. (Photo by Samir Jana/Hindustan Times via Getty Images)

What Are The Diseases That Impact Rural Life?

Diseases such as diarrhoea, amoebiasis, typhoid fever, infectitious hepatitis, worm infestations and poliomyelitis, measles, tuberculosis.

Malnutrition is one of the most dominant health related problems in rural areas. There is a widespread prevalence of protein energy malnutrition (PEM), anaemia, and Vitamin A deficiency.

Nearly 100 million children do not get two meals a day. More that 85% of children in rural areas are malnourished and 1,50,000 die every year. Pregnant women while giving birth die due to lack of proper treatment and lack of suitable environment to give birth. The mother as well as the baby come under huge clutches of diseases and it becomes a struggle, sometimes killing the newborn.

During farming, the pesticides and fertilisers used can prove to be poisonous for those ill or vulnerable. There is also a higher chance of developing certain types of cancer, from exposure to chemicals used in farming.

Reasons For A Lack Of Doctors In Villages

While India has one of the largest medical education systems and reputed institutions such as AIIMS, educated and ‘city-bred’ doctors/healthcare providers are not willing to serve in rural areas, many of which are still difficult to access and lack electricity.

Doctors mostly accept offers to practice in those where there are favourable opportunities and high-income areas, which is quite natural. Working in the private sector has been seen as a most enriching experience and of value whereas the public sector often proves to be a humiliating and demoralizing experience.

There is a lack of proper occupational development opportunities, accountability, and access to basic medical resources and ways to fulfill their roles as a health professional. People in rural areas do come under the clutches of diseases which if spread across can also take lives of the healthcare professionals themselves. Poor supply of medical equipment, lack of proper sources of medicines, lack of proper curable drugs and remedies, lack of proper rooms to work upon the medical facilities lead to the lack of motivation for doctors to work in rural areas out of own interest.

According to the Global Monitoring Report 2008 published jointly by the World Bank and the IMF, an emphasis that increases spending on education and health programs alone is not the only solution, but the quality and equity of spending are equally important.

What Can Be Done?

Being a citizen of my country and according to my perception, I feel that:

1) Medical institutions should motivate the upcoming doctors to provide their education and services in rural parts of the country as well as remind them that the profession revolves around saving lives, no matter what.

2) NGOs and other healthcare institutions should connect with as many doctors as possible and put up health campaigns and information about the treatment of diseases on a frequent basis.

3) Rural areas should have access to easy travel and help patients get to hospitals for betterment and cure. If a city is too far, then there should be smaller hospital branches/health centres well equipped to handle emergencies.

4) All medical equipment should be updated and advanced so that just like patients in urban areas, rural regions too get the same treatment and access.

5) It was seen that the Indian government is of limited capacity in delivering health services, it should therefore, devise a shift in strategy that allows for the rural communities to choose between public and private providers – providing cash to the economically disadvantaged for out-patient care and insurance for in-patient care would be worthy.

6) More and more awareness programs should be conducted so that people lead a healthy life which also includes physical exercises and eating healthy.

7) While working, people should cover their mouths so as to avoid the worst effects of inhaling dust.

8) Big industries should too join hands in the initiation of coming up with healthcare facilities in rural areas, thus making India a completely safe and healthy country.

Featured image for representative purpose only.
Featured image source: UNICEF Ethiopia/Flickr.
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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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