The Hindu Business Line : Healing heartland

In a small, remote Chhattisgarh village, quality medical care is within the reach of its poorest of poor. Meet the ‘village doctors’ who are making this possible.

We hope that this ’silent revolution’ will spread - Dr Anurag Bhargava

Chitra Ramaswamy

End of long wait? The JSS centre in Ganiyari village attempts to reach medical care to neglected sections of society.

Chitra Ramaswamy

It’s pitch-dark on the road, which is lined by a row of yellow, single-storey buildings. A few neon and yellow lights glow inside the main building, where the T-shaped corridor between the OPD (out-patient department) and the ward is lined with men, women and children curled up in whatever little space they can get to catch a night’s sleep before their OPD appointment the next morning.

They have travelled several kilometres — on foot, bullock carts, bus or even hitch-hiked on passing two-wheelers, trucks or tempos — to reach this institution which has come to be known as ‘JSS’. It is peopled by members of the medical fraternity who have given up lucrative practice or prestigious posts in premier institutions in India or abroad, to champion the cause of the rural poor.

The Jan Swasthya Sahyog (JSS) was established in 1996 and registered in Delhi by a group of socially-conscious health professionals who shared a common concern about healthcare facilities, particularly in rural areas. The group turned a set of rundown buildings belonging to the irrigation department into a healthcare and referral centre, providing a ray of hope to communities from far-flung villages having no access to any medical facilities.

Indigenous, low-cost kits

The Referral Centre at Ganiyari village of Bilaspur district in Chhattisgarh not only provides low-cost, quality healthcare but also trains village health workers in delivering primary healthcare. JSS has been equally active in developing low-cost technology for rural health — simple diagnostic and other kits that are user-friendly for the illiterate or semi-literate village healthcare workers, many of them women.

These kits are used to diagnose a range of diseases (urinary tract infection, anaemia, sickle cell anaemia, tuberculosis, diabetes, vaginal infections, respiratory infections and so on) that are widely prevalent in the region. JSS has also developed simple-to-use apparatus to detect water contamination, to purify water, stadiometer to measure height, easy-to-read thermometers and blood-pressure gauging instruments, and stethoscope.

The deadly Falciparum malaria is rampant in the tribal areas of Chhattisgarh. Thanks to the multi-pronged efforts of JSS, mortality due to this disease has reduced significantly in and around Bilaspur district. Besides offering timely diagnosis and treatment, JSS has developed low-cost mosquito repellent creams and oils based on herbs obtained from this herb-rich State. Similarly, they have developed special Oral Rehydration Solution (ORS), which is made and packed by the village healthcare workers. Safe delivery kits, first-aid kits and soaps are the other products that JSS has developed besides inexpensive and wholesome nutritional formulations. Dr Pramod Upadhyay, who lives in Delhi and is with the National Institute of Immunology, offers substantial help to JSS by developing low-cost aids, says Dr Anurag Bhargava, a general physician and one of the co-founders of JSS. Dr Bhargava had worked as a Senior Resident at All India Institute of Medical Sciences before shifting to a rural medical college in Gujarat.

Cost-effective, timely care

At the Referral Centre, a mind-boggling number of surgeries are performed ranging from the simple to the more complicated ones, including cancer surgery, says Dr Bhargava. “Cervical cancer is very common among the village women here. We are performing surgery on breast cancer and other cancer patients where we see a curative chance. We are even giving chemotherapy here but we don’t have facilities yet to give radiation therapy. We are referring these patients to the government hospitals.”

Dr Raman Kataria, specialist in general and paediatric surgery, who has just completed an operation on a three-day-old baby with a congenital problem of an absent anal opening, says, “This kind of surgery is quite routine here, as inner rectal malformations are amongst the most common congenital problems seen here in the lower socio-economic strata. This is the first of three surgeries that such a baby would require and is done at our centre at a highly subsidised rate of approximately Rs 12,000 to Rs 13,000, which is all-inclusive — operative procedure, hospitalisation, medication, whatever is involved. Even in a government setup, this cost would be much more.”

JSS is doing yeoman service in the more than 53 villages surrounding Ganiyari. The circumstances have been stark for the villagers trapped between an overburdened and dysfunctional public healthcare system and private doctors.

Their economic status is pathetic, their livelihood dictated by whimsical monsoons that often fail or don’t ensure sufficient crop yield. Villagers are often forced to mortgage or sell their land and even animals to meet treatment cost, which the JSS group worked out to be as low as Rs 63 a month for the treatment of a drug-resistant disease like tuberculosis! This figure of Rs 63 has yet another important implication for healthcare providers: It serves as a pointer to the illogical and exorbitant MRP of drugs in our country. “If priced judiciously and generic drugs are used, health costs can be reduced monumentally which, unfortunately, is not what is happening in our country,” says Dr Bhargava.

JSS is a one-stop clinic where patients consult doctors, have facilities for diagnostic tests which are kept to the bare minimum required, are operated upon when the need arises, are hospitalised in the inpatient ward and dispensed medication at the cheapest price. There have been occasions when the doctors have had to tackle diabetes so far advanced that diagnosis and amputation have happened in one single session! A big hall has been taken on lease to house pregnant women categorised as high-risk cases, to facilitate safe delivery.

The relentless and dedicated work of JSS’s doctors and 70 support staff has infused new confidence among the village people who now believe that the agents of change are truly here for good. Evidence of this is seen in the increasing number of village women opting as volunteers in the community healthcare programme. A beaming Dr Bhargava says, “Now we have 20 different kinds of drugs which the village healthcare workers are able to dispense. These workers can suspect TB, treat childhood diarrhoea and mild pneumonia, take care of wounds and also some problems related to women’s health.”

To the farmer’s aid

As part of its research work, JSS support staff has been working on producing high-yielding seeds for rice and millet crop suited to the region’s inclement weather and insufficient rains. Also, they have trained staff in dispensing first-aid to farm animals so that the animal-dependent villager does not have to spend scarce or absent resources on tending sick animals. In addition a crèche for children of farm labour, diet plan for these children, and mobile clinics that serve the interior jungle community are other programmes that are run well by JSS-trained healthcare workers.

With the presence of even an ayurvedic doctor, who recently joined the team, JSS members take full advantage of the herb-rich State to dispense herbal preparations wherever possible.

JSS doctors have been advising the Chhattisgarh government on some aspects of its health programmes. In the recent past, the Planning Commission nominated JSS as one of the members of the Steering Committee for Secondary Healthcare for the 11th Five Year Plan.

This labour of love is certainly worthy of emulation, particularly by those in the “business” of healthcare.

Caring revolution

Patients wait overnight at the JSS centre for their doctor’s appointment in the morning.

“The eight of us who are here felt very strongly about health and healthcare system, or rather the lack of it, in rural India. At the AIIMS I didn’t know where a patient comes from or goes to. Mostly it is technology-driven care in the big metros and urban areas. We are not addressing problems at the source… that’s how JSS and Ganiyari came to be. May be this will set in motion similar efforts elsewhere and the silent ‘revolution of sorts’ will gather momentum and things will improve for the marginalised people,” says Dr Anurag Bhargava, one of the co-founders of the Jan Swasthya Sahyog.

Dr Yogesh Jain (paediatrician) and Dr Rachna Jain (gynaecologist), who also moved from AIIMS, echo similar sentiments. “We view our work here at two levels. At AIIMS if you quit the job, there’s someone to replace you. But here, there is no one to easily replace you! Secondly, in an urban hospital patients come to you and you treat them. But we don’t see the secondary issues that have a bearing on the disease cause itself. We are interested in looking at the ‘whys’ and ‘hows’ of illness, the socio-economic angle to ill-health and, finally, the political issues involved in the healthcare field,” says Dr Yogesh.

Dr Rachna clarifies further, “We may be overworked here, but it is by choice. We know the great difficulties patients go through to arrange money for treatment. In the big urban hospitals we have no time to relate in this manner with patients. So our focus here is more on preventing conditions before they can actually occur because a lot of the problems rural people face is related to hunger and impoverishment, all of which can be avoided with appropriate measures.”

Dr Madhuri Chatterjee and Dr Biswaroop Chatterjee are equally happy being here. As Dr Madhuri says, “Out here, we see for ourselves the difficulty people have even in commuting to the centre and transporting patients. Often the sick person has to walk long distances to reach some kind of medical help. We are forced to think beyond medicine, treatment and cure.”

Dr Kataria and wife Anju, a paediatrician, share the vision and mission of their colleagues, “to give back something significant to society”. Dr Anju says, “It is a myth that rural people have simple health problems. Besides other infectious diseases and the so-called diseases of the affluent like hypertension and diabetes, we find a lot of children and also adults suffering from rheumatic heart disease and they are not even aware of it and, if aware, they don’t do anything about it because of poverty and lack of health facilities.”

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Healing heartland