Shubha Madhukar

Medical treatment used to spell debt or death for the tribal communities of Bilaspur district before the Jan Swasthya Sahyog began bringing health and hope to the beleaguered

Meluram Yadav was in moribund condition when his neighbours brought him to the community health centre in Ganiyari village. He could barely turn in bed on his own, had an incessant, violent cough and weighed all of 28 kg. Back home Meluram had no support. His mother is nearly blind, his brother is handicapped and his father had passed away 10 years ago. Six months of care and free treatment for advanced tuberculosis at the Ganiyari centre has helped Yadav recover his health. His weight is now up to 42 kg and the 28-year-old can look after his family once again.

Seven-month-old Shravan Kumar Suryavanshi suffered from Hirchsprung's disease, a malformation of the large intestine requiring surgical correction, and weighed less than 4 kg when he was brought to the Ganiyari centre in March 2002. Over the next two years Shravan underwent three surgeries. Today he weighs more than 10 kg and is in good health. The only child of a poor farmer, he had been nearly given up as a lost case by his parents.

Yadav and Shravan are among the thousands of patients who throng the Ganiyari centre, which is run by the Jan Swasthya Sahyog (JSS), an organisation of healthcare professionals that provides low-cost community health services in the tribal and rural regions of Bilaspur district in Chhattisgarh.

The founding members of JSS were C. Sathyamala, Pramod Upadhyaya and four doctor couples: Yogesh and Rachna Jain, Raman and Anju Kataria, Anurag and Madhavi Bhargava, and Biswaroop and Madhuri Chatterjee. Its team, many of whom received their professional training at the All India Institute of Medical Sciences, New Delhi, comprises specialists in the disciplines of epidemiology, paediatrics, surgery, microbiology, internal medicine, obstetrics and gynaecology.

Registered as a society in 1996, JSS began operations in December 1999. The initial funding support for the organisation's clinical services came through a three-year project supported by the Sir Dorabji Tata Trust; today the Sir Ratan Tata Trust contributes substantially to JSS's community health programme, while the Sir Dorabji Tata Trust continues to back it for a final three-year period.

The JSS team started with a small kitty and a Herculean challenge. The organisation commenced operations from an abandoned irrigation department colony offered on lease by the district administration. It was a daunting task, considering the colony was no more than a set of ruined buildings with a small campus used by cattle, drunks and gamblers of the surrounding area.

When JSS zeroed in on Bilaspur district as the location for its community health programme, it found a simple and warm people reeling under poverty and suffering a heavy burden of diseases. About 60 per cent of the population that JSS serves lives below the poverty line, while 54 per cent do not have sufficient food through the year. Given the circumstances, it is far from surprising that malnutrition, infant mortality and communicable diseases were major problems.

Rarely being able to cope with the high costs of treatment, the people here often fell into debt traps when confronted with ill-health, paying as much as 60 to 120 per cent interest on loans that were often taken with land as collateral. The villagers had little choice, since the care available oscillated between a dysfunctional government health apparatus and an exploitative private healthcare system.

JSS's vision for this underserved and impoverished area was to place strong emphasis on evolving a community health programme with the participation of village communities. The plan was to train village health workers drawn from the communities themselves, who would provide first-contact care for health problems. Their work was to be supported by mobile clinics and a referral community health centre based at Ganiyari.

The idea was to use the organisation's diverse academic skills to develop low-cost technologies and techniques at the field level, to do field-based research in public-health conditions such as tuberculosis, malaria and childhood illnesses, and to act as a training and resource group for other organisations.

This vision of JSS has, over the years, taken substantial shape. A community health programme now runs in 35 tribal villages, many of them deep in the forests of the Achanakmar game sanctuary. Today there are 70 village women, chosen by their communities and trained by JSS, functioning as village health workers. They deliver first-contact care in a variety of illnesses affecting children and adults. Many of these women were illiterate to start with, but their commitment and the continuous training provided by JSS has made them capable of managing health problems rationally.

The abandoned colony where the JSS community health centre at Ganiyari arose, literally from the ruins, began with a small outpatient department, a small laboratory and a pharmacy. Within a period of three years the abandoned colony got transformed into a 15-bed rural hospital, with an outpatient department, an operation theatre complex, and a fully equipped laboratory, the only one in the state that has culture facilities for tuberculosis. A low-cost pharmacy provides quality drugs at rates much below their retail price.

The registration fee for a new patient at the Ganiyari centre is Rs 6 and Rs 3 for repeat visitors. There are no separate consultation fees and investigations procedures are also subsidised. To lower the cost to patients, only essential investigations and drugs are prescribed (tonics are a no-no). The tremendous need for these services and the popularity of the centre can be gauged from the fact that it is accessed by villagers from over 1,200 villages (more than 130,000 consultations have taken place here).

Surgeries are among the most accessed of JSS's services. Since 2001 more than 2,500 surgeries have been performed for diverse problems, from gynaecological and abdominal to thoracic and ENT-related. Additionally, with the full-time senior paediatric surgeon from the All India Institute of Medical Sciences, New Delhi, on the team, Ganiyari has become a referral unit for the surgical problems of children for the entire region.

JSS's initiatives are not limited to delivering low-cost healthcare to the deprived. The organisation is involved in tackling the social, technical and operational problems and challenges of public health delivery in rural India; innovating solutions in the form of initiatives at the community level; developing, adapting and validating low-cost techniques and technologies; and sharing these experiences with government agencies, policymakers and academicians.

The organisation's efforts in the areas of malaria and tuberculosis control, in devising innovative diagnostic methods, in curbing water-borne diseases, and in advocacy on rural health issues have had an impact far beyond the regions where it operates. Getting this far has been a slog, though, with problems ranging from getting trained personnel and securing financial support to infrastructure glitches and the balancing of myriad priorities.

The concerns, plans and vision of the JSS team and the Sir Dorabji Tata Trust were and continue to be in resonance. It was the Trust's backing that got the programme up and running. The continuance of this backing, complemented by the support of the Sir Ratan Tata Trust, has facilitated the fruition of this initiative into a centre for public health.

JSS also addresses issues such as sanitation, literacy and livelihood since they have a direct bearing on the health of rural communities. This kind of holistic evaluation of the health equation has had a tremendous effect on the communities where the organisation functions. With the broad goals of serving the people and also learning while serving, this is only the beginning and there are many miles left to traverse. Be that as it may, the exertions of JSS has enabled a tiny corner of rural India to breathe a bit easier.

Uploaded on March 2005