“Two roads diverged in a wood, and I—
I took the one less travelled by,
And that has made all the difference”
– Robert Frost
India has emerged as one of the fastest-growing economies in the world. It will soon be a $5 trillion economy. A digitisation wave has swept across the whole country. India ranks 63rd in the World Bank’s Ease of Doing Business Index ranking. These are some of the news I generally come across; but is this the real India?
A quick glance at India’s health indicators would help answer this question. More than one-third of the world’s malnourished children live in India. At the global level, the largest number of child deaths in 2017 occurred in India. Millions of women in the country can’t avail the same healthcare as men. Such is the disparity within India.
Born and brought up in Delhi, and now working in a corporate set up in the capital city, I have never really seen this face of India. One day while segmenting rural/urban population for calculating the market size for a company, I made up my mind to see this true Bharat as they call it.
Though I have worked with rural women living in the Delhi-NCR region during my college days as part of a social entrepreneurship project, those women if I may say so, are the privileged rural population, since they have the accessibility to health care facilities, education, etc. living in this region.
This search to uncover the deeper layers of the country took me to the remotest part of Udaipur, where I decided to work with Basic HealthCare Services (BHS), a not-for-profit organisation providing primary health care facilities to last-mile communities in Udaipur.
Travelling along the vast expanse of barren land, with gobar (cow dung) cakes lying at all places, agriculture/animal husbandry being the occupation of the most, I was able to see rural India in its truest form. Houses in the villages were spread across distances, making commuting a challenge.
The villages were separated with thin streams of water. Each village had a mini dialect and culture/mindset of its own, depending upon the influence of nearby regions and accessibility of basic amenities. Women of the household wore ghunghat (veil) at all times and were not active decision-makers in the house. Women empowerment clearly is a foreign concept to this community.
Interacting with the villagers as part of this initiative and staying with the nurses in the clinic campus also made me understand the dire straits of the healthcare situation prevailing here and the deeply rooted traditional beliefs of this region.
“Hum Do Hamare Do” (a family of four) is nowhere to be seen, with family sizes ranging from 6-10 members, all living in a compact room, with bare minimum household amenities. The children are mostly malnourished. Men of most families migrate to other parts of India in search of employment opportunities, mostly construction, mining and other such manual labour activities.
Working conditions in such activities are hazardous, which makes them vulnerable to injuries and diseases like tuberculosis. Food is cooked on smoky chulhas (stove), which poses a number of health hazards and an increased risk of respiratory diseases.
There are no accessible quality healthcare providers near the villages, which leads to the prevalence of local doctors, or ‘Bengali’ doctors as the villagers call it, most of whom exploit the villagers by prescribing wrong medication and charging exorbitant fees. Such doctors prescribe drip/injection for all medical conditions without conducting a proper diagnosis of the symptoms.
This has led the people to believe drip injection is the right treatment for everything and fail to understand the efficacy of tablets, hence do not complete the tablet course when prescribed by a qualified doctor.
“Even if we give them free medicines and explain them the benefit of tablets over drip/injection, all they do is throw away the tablets and storm out of the clinic believing that how will they be cured if they aren’t given an injection. This mental block is one of the major causes for the healthcare condition not improving in these areas,” a doctor at a Primary Healthcare Centre told me when I asked him about the healthcare condition in these areas. A large number of deliveries are conducted at home, due to the absence of accessible healthcare centres and low awareness among the people.
Well, not everything looks bleak. Several people in these areas have pucca houses. There are quite a few parents sending their children to vicinity schools. The government program of ASHA workers is implemented in these areas. Almost all the nurses in the clinic have a smartphone and are loyal users of WhatsApp and YouTube.
During my stint here, I was part of an active Malaria surveillance campaign run in Kojawada (a village in Udaipur) and nearby areas. In the year 2019, the Kojawada region saw a surge of malaria epidemic from the month of September onwards, with 500+ malaria cases being detected in November, 400 of them being PF+ cases (there are 2 types of malaria, Plasmodium vivax (PV) and P. falciparum (PF), with PF being the more deadly one).
On being asked about the spread of malaria in his village, a Gram Panchayat member told us, “4 deaths were reported in the month of November and December across different villages. Two children died in a duration of 2 days. Yesterday a woman died. Malaria is very widespread here.” It is a shame that even today, people are dying in our country because of malaria, which is an easily treatable disease.
The AMRIT clinic team (the clinic run by BHS) in Kojawada took it upon themselves to control this epidemic. The team identified and mapped the key areas where the malaria surveillance campaign would be undertaken. As part of the intensive field visits, 12 villages were covered where we went out in the field to educate people and spread awareness about malaria, its symptoms, methods of prevention, etc.
Training sessions were also conducted in schools. We prepared songs on malaria in the local language (Vagdi) and used slogans to mobilise community members. Skits were prepared and performed by team members to demonstrate the importance of early, appropriate care-seeking. Charts, posters and pamphlets with visuals were used during community awareness meetings. Demonstrations of managing stagnant water sources were shown to community members.
Children, adolescents and adults were actively engaged in the demonstrations – digging small passageways for flow of water, putting burnt Mobil oil in areas with potholes. The team made home visits undertaking a fever survey. Household members with suspected symptoms of malaria were tested using a rapid diagnostic test for malaria. Patients detected with any form of malaria or with clinical symptoms were handed a referral slip, counselled and referred to AMRIT Clinic Kojawada or nearby Primary Healthcare Center for treatment.
The outcome of malaria testing as part of this intensive field visit campaign was extremely terrifying. We conducted 400+ blood tests on the field during these 5 days, out of which 250 were malaria positive, 75% of them being PF+, which means they had a high chance of dying due to malaria if not treated immediately. 65% of the malaria detected patients were children under the age of 14 years. Not being from a medical background and this campaign being my first such experience on the field, these outcomes perturbed me to a great extent.
The first home visit I did was on its own enough to make me realise the gravity of the situation. That household had 7 members, out of which 3 displayed malaria symptoms. After testing their blood, we found out that 2 children, both about 5 years of age, had PF malaria. And they weren’t aware of malaria and how it could be treated.
They presumed the malaria fever to be normal fever which they hoped would subside in a few days, unaware that this fever could be the cause of death of these 2 young children. Another male member of the family I recall interacting with mentioned, “Out of my family of 6 members, 4 have had malaria in the past 2 months, with me being infected with malaria for the second time.”
The proactive actions based on this testing ensured that these patients were put on a path of recovery. Considering the alarming level of prevalence of malaria, our actions in the field would enable saving many lives. Lives of young children pregnant women, lives which would have been lost had we not referred them to the clinic for immediate treatment.
My experience here made me realise that while privileged individuals like us fret about petty matters, a large section of the country still grapples with the availability of basic healthcare amenities and is exposed to life-threatening health issues. I deeply respect and admire the work that BHS and other similar organisations are doing to uplift the hinterlands of India. This is a long continuous and arduous journey requiring efforts by the community at large.
Unless the elitist section of society joins hands with the less privileged, change in conditions at ground level would take years, maybe even decades. But as Rabindranath Tagore says, “The one who plants trees, knowing that he will never sit in their shade has at least started to understand the meaning of life.”