Barefoot Doctors

It is rare that highly qualified medics who have the option of either migrating abroad or staying on to run lucrative little shops in India’s rapidly expanding urban economic skyline, opt to work in the boondocks. Welcome to the world of Dr Yogesh Jain, co-founder of Jan Swasthya Sahyog (JSS), a peoples’ health support group in Bilaspur, Chhattisgarh. Quite literally, a healthcare unit has been carved out of an abandoned mud house.

Starting from scratch, the JSS has conducted research on the villages, on availability of food, annual incomes, peoples’ needs and their ailments. Painstakingly, different departments have been set up, equipment has been arranged, as have low-cost medicines and tests, earning the trust and goodwill of the people by constantly upgrading their knowledge on healthcare.

Today, their gains can be called impressive. Nearly 1,500 villages access their referral centre, 150 forest fringe and forest villages use their mobile clinics, and 53 villages have adopted their intensive health worker programme.

Their out-patient clinic at Ganyari is self sufficient, with a dispensary, radiology and laboratory services, and has provided low cost healthcare through more than 3 lakh consultations to over 1,25,000 patients drawn from more than 1,500 villages and towns of Chhattisgarh as well as adjoining districts of eastern Madhya Pradesh.

An in-patient ward with 30 beds and an operation theatre complex, including three major operation theatres and a labour room, have been functional since June 2001, providing high-quality surgical services to more than 15,000 patients.

JSS also acts as a technical resource group for the Chhattisgarh government, the Planning Commission, and other agencies devoted to advocacy for primary health care and a rational pharmaceutical policy. In the process it highlights the centrality of chronic hunger as India’s most important and persistent public health problem.

The circumstances of eminently qualified doctors opting to work in the country’s backward and bleak medical landscape out of devotion for a cause or commitment is so surreal that there is a natural tendency to see them as creatures of the zoo.

“We are not urban monkeys here on a rural picnic. We don’t want media attention. Instead give us two doctors and a nurse every year,” is Dr Jain’s lone cry, literally in the woods. By any reckoning, it is a tall order. Or, take the case of Dr Surjit Bhardwaj and Dr Arun Sharma, both ex-alumnus of the prestigious PGIMR at Chandigarh. Despite attractive offers from high-end global hospital chains mushrooming in the Indian market, they were fired with a missionary zeal to serve in Himachal Pradesh’s backward districts in government hospitals where health infrastructure is still at a pretty nascent stage.

Reminisces Dr Sharma, “The look that patients gave me at the Hamirpur government hospital, (In Himachal Pradesh) - as if I was their savior - made my day.’’

In Chhattisgarh, three of Dr Jain’s colleagues, like him, are formerly AIIMS alumnae. The other three are from Vellore, Calcutta and Allahabad Medical College. In the normal scheme of things, this crowd could have been practicing their rich man’s medicine in any of India’s burgeoning metros, but they preferred to be different. And how. It is slightly difficult to conjure up the image of a doctor at a rural health clinic which is critically understaffed and overflowing with patients, a number of whom have been waiting for three days before they can even get a check up done.

As in Chhattisgarh, so in Himachal Pradesh. Rushing between wards, the doctors have their work cut out, not difficult to imagine why, considering that the cases of poor patients range from labour pain, tuberculosis, hypertension, epilepsy to rheumatic heart diseases, malaria and animal bites, virtually anything under the sun. Then working with very scarce resources, our own barefoot doctors provide hope to patients at the lowest rung of the economic ladder, diagnose them, conduct their tests and then hand them over to the nurses and subsidiary health workers, explaining to them the follow up medication process.

Which is quite different from, lets say, an adjacent primary health centre (PHC). Unlike the rush of hapless patients at the NGOs, PHCs are deserted and tell us why voluntary action in the health sector is critical to India’s development plans.

Typically, the PHC is devoid of many patients. It is marked by an absence of doctors and blessed with just a lone nurse, who supervises patients on four beds in a room. Which is why Dr Jain and his team are so popular. In the case of Dr Surjeet Bhardwaj of Himachal Pradesh, even his parents endorse his decision. “Our son did the right thing. This country needs committed doctors,’’ says his father.

In his native village in Himachal’s Bilaspur district where he grew up, Bhardwaj, after being exposed to the plight of ordinary patients, swore to become a doctor and work for the benefit of the poor. “The country needs doctors who can work in the villages. I could never accept fancy offers and work in high-end hospitals,’’ he says.

Increasingly, despite the glitz and fizz of urban life, there are young medics who are willing to spare a thought for those who don’t get noticed.

Consider this:

l Dr Jugal Kishore Mishra, a high-profile heart specialist at Escorts, multi-lingual, founder of the Member of Indian College of Cardiology and winner of a Lifetime Achievement Award conferred by former President APJ Abdul Kalam amongst others, recently conducted a visit to eastern Uttar Pradesh and after an examination of 400 people, found 200 suffering from heart diseases.

l In Rajasthan, many young MBBS degree holders are opting for less lucrative careers as government doctors. In Sikar, a 21-year-old Ved Prakash, who took his MBBS examination in 2010, says he is excited about working in a rural hamlet that needs health care.

l In Jodhpur, a SMS Medical College MBBS of the 2010 batch, Dr Rekha Singh, works with those affected by polio. “I realised early on in life that I wanted to work for polio eradication,’’ she explains.

l After doing her MD (Obstetrics and Gynaecology) from the then King George’s Medical University in 1997, Dr Seema Dev, 42, put in a stint at the Hinduja Hospital in Mumbai before returning to her roots in Lucknow. She now runs a small private set up in Nehru Nagar. By 2006, she had branched out to giving her time to imparting health education in the girls’ colleges.

She tried to rope in colleagues, but when that didn’t work out, she zeroed in on medical students to help her. That is in addition to the health education camps she organises for NCC programmes.

“There is a lot of ignorance about health issues, and females are the most neglected. If I can teach young women how to take care of themselves, it will build healthier families,” she reasons. That’s comforting. lf In Mumbai, 29-year-old Dr Ravikant Singh was so driven to do something different that when the Bihar floods came in 2009, he, along with a fellow team of 110 doctors going by the name ‘Doctors for You’, an NGO, decided to camp in the flood-hit areas. People hit by swirling waters need not just instant care, but even long-term treatment.

And that is something that Dr Singh and his team were keen to pursue. Slowly but steadily, the organisation has taken a shape of its own and continues to work in Bihar and other areas. In what can only be considered a happy occurrence, the list of ‘Doctors for You’ is also growing and currently stands at 500 professionals willing to do social work.

Despite this interesting trend, work for those who opt for the harder way of life can be frustrating. Doctors Jain and Raman Kataria in Chhattisgarh, for example, lament: “No one is willing to let go of lucrative offers or the tag of being a city doctor at a posh private hospital and help us out even for three months at a stretch.”

For Dr Kum Kum Bhasin though, the story is different. She left India after graduation, and settled in Boston. At Boston, she participated in conferences and seminars related to medical help and services, where she met Dr. Jain delivering a speech on JSS, and decided to help. Today she is inspired by the array of services provided by JSS. “I realise my country needs me. I am glad these people have taken up the cause of rural healthcare and community service,’’ she avers. Better late than never. But one Kum Kum Bhasin will not be enough.

It is no surprise that no other batch of AIIMS doctors have subsequently been motivated to keep up this rather unusual passion. The main point is how long can they continue? Confesses Dr Jain: “We have reached that level of ‘burning out’. It is difficult to carry on like this. We need more people.” Sure, but where will you get them?

On the other hand, cynics would be well advised to remember that a few years ago, even this trend appeared unlikely. Maybe there are more barefoot doctors waiting to emerge out of the woodwork. Maybe this is the spark that may provide the inspiration to other young doctors.

(Reports by Rajnish Sharma, Shimla, Kalyani Vaishnavi, Delhi, Shatrughan Prasad, Mumbai)