Tuesday, September 29, 2009

AlJazeera on health care in rural India

I just chanced upon this video on the state of health care in rural India by Al Jazeera English. For a network which is new to covering India they have produced a remarkably balanced report. In a span of a few minutes they give us a glimpse of India's huge burden of common yet potentially deadly infectious diseases such as diarrhoea, the worry and hardships faced by poor rural patients, the ailing government health care system, the frustrations of a doctor working for low pay in a remote area, the corruption within the system, the health movement with its activists and the private medical industry which is far away from all this reality.

Kudos Al Jazeera.

Thursday, September 24, 2009

Snapshots of a doctor in rural Tamil Nadu

A few days ago the our health minister announced that that doctors will get better pay and 10% extra marks in competitive postgraduate entrance exams for every year spent working in a rural areas up to a maximum of 3 years. The proposal may not address to problem of the severe shortage of healthcare personnel in rural areas completely but it is indeed welcome news.

But what does working in a rural area actually mean? I spent two years working and taking pictures at the Tribal Health Initiative in Sittilingi in the Dharmapuri district of Tamil Nadu. Here are some snapshots.

Rural Tamil Nadu is beautiful.

This is the view from the kitchen window of the cottage I stayed in while working for two years at Tribal Health Initiative in Sittilingi, Dharmapuri District, Tamil Nadu as part of my rural service. Students from St. John's Medical College in Bangalore have to spend the first two years after graduation in one of the college's 400 recognised rural bond centres or pay Rs. 3,00,000 (Rs. 6,00,000 for the current batch).

The work is rewarding.

Apart from the three doctors and a couple of technical staff Tribal Health Initiative is run exclusively by people from the local community. Here is one of our health workers the day after the birth of her son. She was delivered by fellow health workers all of whom have grown up in the villages surrounding the hospital.  She had her baby in the sun when I came for morning rounds and we all shared her joy.

You might just get to live in your dream house.

I lived on the hospital campus at the edge of reserved forest land with a small stream a few metres away. My cottage had a small kitchenette, a shower and a high speed internet connection. (thanks to BSNL WLL technology). More than I could have asked for. Meals were in a common mess for all staff who stayed on campus.

You get chances to do surgery.

I learnt more in the two years I spent working with Dr. Regi and Dr. Lalitha than in all six years at college. One of the advantages of working in a rural hospital is that senior doctors have the time and patience to teach you unlike the competitive, hierarchical atmosphere of a city hospital.

You get chances to visit patients at home.
Every doctor should try this. If you visit your patients occasionally at home then you immediately understand what is making them sick and you realise that many conventional remedies are quite foolish to say the least. Practicing medicine also becomes a challenge when you realise that most patients can't read time, read labels or even begin to understand the nature of the medicines you prescribe.

You work with a dedicated, highly skilled team.

The health workers at Sittilingi are all drawn from the local villages and are predominantly from the Malavasi tribal community. I have never seen more competence and dedication. Our neonatal unit has a high success rate only because of the energy put in by our health workers in 24x7 one on one care of sick babies.

Things get scary occasionally.

A city boy like me had to get used to the occasionally enormous, allegedly poisonous spiders that used to sit nonchalantly on my cupboard door. My room was closest to the forest and a sort of immigration desk for snakes, scorpions, spiders and suchlike.

You learn about a different culture.
Living in Sittilingi meant I also saw a part of India I missed in the city. Pongal is one such amazing festival with anticipation building up for months before the actual date and the actual festivities being dissected for months thereafter.

You become family.

Being on duty 24x7 for a month at a stretch means you really get to bond with your staff. We worked, lived, ate and joked together and there was never a time when my inexperience and bad Tamil got them visibly  impatient. Here they pose with the newborn of another fellow health worker they helped deliver. Their pride in their work is obvious.

Monday, September 14, 2009

Come together, right now

I have just finished attending a workshop by the International People's Health University on 'Health and Equity', where for nine days we concentrated on understanding the growing difference between the health of the rich and poor, the economic and political forces that are causing this and the social movements that have arisen as a response to this. Most participants had years of experience working for health at the grassroots level and their shared stories contributed to making it the workshop a rich experience grounded in practical realities.

The course helped us link what many of us witness as local phenomena to the much more distant economic and political arena. This can be a discomforting connection at times once you realise that as an individual you are quite powerless against such distant, undemocratic institutions such as large corporations and international bodies. This was the point in the course where the answer to such an essentially political problem emerged.

In an era when economic and political decisions made by big businessmen and our politicians have a large influence on both our individual health as well as the health of the communities we belong to, the only protection against bad, corrupt decisions is community organisation. If communities come together from the street to the global level in order to monitor the decisions our leaders make, only then we can protect ourselves from the decisions that are detrimental to our health and lives.

What do I mean by community organising? This video says it much better than I ever could.