Sumedha Raikar-Mhatre: Doctors on the go

On A rainy September day in 2012, 21-year-old Chimpi Bora faced the prospect of going into labour at home. The floods had cut all communication to her flood-ravaged home in Jorhat district's (upper Assam) Bhimpara island on the Brahmaputra. Her husband called an ASHA (Accredited Social Health Activist), local community workers, who connected with the nearest boat clinic. Wading through knee deep water in darkness, torchlights in hand, a team of doctors and nurses arrived at Bora's doorstep to conduct the delivery of their baby. The child was named Plaban, Assamese for "high water".

Dr Anita Patil conducts several short day camps and counselling sessions with tribal women. At a recent camp in Jamsar, she advocated a safe hospital-assisted delivery. Pics/Satej Shinde

Hope Floats: The Boat Clinics of the Brahmaputra (Academic Publication) is a recently book with several such accounts of tough medical outreach done on inaccessible river islands along the 724 kilometer sweep of the Bramhaputra river.

Dr Bhakti Sathe checking on a patient at the National Mobile Medical Unit van in Jawhar. The mobile unit outreach by Dr Patil by NRHM comes with a team strength of 12. Private stakeholders like the Hinduja group provide her a van with a team of five. When on her own, Patil has one assistant with her own vehicle

Authors Sanjoy Hazarika and Bhaswati Khaund Goswami are part of the Centre for North East Studies and Policy Research (C-NES) which runs these 15 clinics which cover 13 districts and reach out to 2.5 million islanders. There are similar initiatives closer home, with doctors devoting themselves to the remote, hilly and inaccessible parts of Maharashtra.

Each boat has a team of 10, including two doctors, three nurses, one pharmacist, one lab technician, three ASHAS who inform villagers that a boat clinic visit is due and tell the boat staff if a particular area needs attention

Battling poor hygiene
For Dr Anita Patil, 37, a routine visit to the interiors of Jawhar taluka in Palghar district, 150 km from Mumbai, denotes a road trip to padas under thick forest covers where patients, especially pregnant women, have to be "brought into'' the primary health centre. Vehicles are sent to individual households, with free lunches and allowances to incentivise the visit.

Patil, who has been working in Jawhar since 2006, is an independent doctor who joined the National Rural Health Mission in 2012. Her private visits are now sponsored by the the Hinduja Group or Rotary Club of India.

Her job as a gynaecologist had several unknown shades that she hadn't dealt with as a private practitioner when graduating from the Lokmanya Tilak Municipal Medical College, Sion. When she started, tribal women resisted the idea of check-ups or blood tests. Unwed teenage expectant mothers - a sizeable majority - did not like to be asked questions or subjected to pelvic exams. Young pregnant girls ran away in deep jungles to avoid check-ups. Questions on menstrual cycles evoked silence. In her demonstrations on hygiene, Dr Patil recalls visits to sub-centres where she took a hose pipe to administer collective baths to mothers and infants who had developed diseases due to poor hygiene.

Now, a known face in Jawhar as well as some villages of Mokhada, Dr Patil conducts several short day camps and counselling sessions. At a recent camp in Jamsar, Jawhar taluka, she advocated a safe hospital-assisted delivery. "We have to convince them that it is not advisable to risk a delivery at home. The terrain between their homes and the sub-centre is uneven and it is always good to take refuge in a hospital before it's too late."

Dr Patil, who is based in Jawhar with her husband Dr Bharat Mahale (also a gynecologist) feels "starting small and unambitious" is the key to medical outreach for marginalized communities. "We have to suggest small changes in eating habits and hygiene standards. Only then can we move on to lifestyle changes or changes in sexual practices. Very slowly women here have started accepting oral contraceptives as a family planning device."

Pleading on a bamboo
Dr Kantilal Tatiya, 67, a doctor and medical-social worker based in Nandurbar district since 1976, is convinced that 400 remote padas of the Bhill community (particularly those falling in the Akkalkuwa, Dhadgaon and Taloda tehsils with the mountain range of Satpuda to the north and river Tapti to the south) will always need the makeshift ambulance, dotingly called the bambulance - a cotton zholi sided with bamboo sticks.

Dr Tatiya, who adopted five padas in the Veli village of Akkalkuwa in 2005, says it is a matter of shame that malnourished children and adults, women in labour, old patients on the verge of death, are put in this zholi and rushed to Nandurbar city even in 2016.

"After every major incident of children's malnutrition deaths, chief ministers (of all parties) fly to the district and declare special action plans and fancy-named schemes. But that makes no difference to the mode of transport for patients."

Schemes and statistics presented by the government look great on paper, but do not reflect reality. For instance, the district has eight primary health centres, 250 sub-centres, 12 rural hospitals and 2,000 anganwadis.

But, those who live here know that these support structures survive on a token staff strength. The medical staff on duty seeks transfers or takes offs frequently, leaving medical services to individual doctors who are stationed permanently in the area. Likewise, the dial 108 service for an ambulance is often unusable because mobile phones do not work in remote areas. The government recently launched the first ambulance boat for the Maharashtra health department which will transport critically ill patients on the banks of Narmada to Nandurbar. Dr Tatiya says the idea is great but poor staffing cripples the purpose. "Who is to ensure the staff during the emergencies?

Medical self-sufficiency
Amhi Amchya Arogyasathi (We for Our Health) is an apt name for Dr Satish Gogulwar's 30 years of medical research in Kurkheda, Gadhchiroli. It centres on empowering the locals to integrate the indigenous system of medicine into everyday use. His work for the Gond, Madia and Kawar tribals started with addressing landholding and land encroachment rights issues and implementation of employment guarantee schemes in Wadasa and Armori area in the eighties. He was part of the movement that led to the formation of the Forest and Construction Laborer's Union. However, he realised that tribal welfare can be successful only if it addresses livelihood, water and the wholeness of life, which led to the birth of ‘Amhi Amchya Arogyasathi' which banks on the traditional wisdom of the tribals.

Dr Gogulwar, 63, has formed the Vaidu (derived from Vaidya, the doctor) Sanghatana, a traditional healers' organisation, resting on the inherited insights of those who utilize natural biodiversity for medicinal use. At present, around 50 vaidus covering around 250 villages of Gadhchiroli area are part of his national Vaidu network which conducts annual workshops and training-sharing sessions for exchange of best practices. These vaidus are tied with self-help women's groups, so that tribal women are empowered with knowledge of easy-to-make/use-at-home remedies that can handle medical emergencies. A leucoderma case has remained with Dr Gogulwar over the years. A 35-year-old woman was cured by a vaidu whose skin related dermatological medicine was a breakthrough in that region. As her recovery started she became a piece of good news which further strengthened the vaidu network.

Amhi... is an NGO with its own funds, labs and a headquarter in Kurkheda which has a 80 full timers, 100 part time medical assistants.

Dr Gogulwar's chief concern is teaching tribals to fight malnutrition by eating right. The movement strives towards reconnecting the tribals to their original diet of unpolished rice, millets and moha flowers which are rich in calcium. "These flowers are solely and wrongly associated with country liquor. We have to reinvent moha and the rest of the plant kingdom for our everyday remedies."

Sumedha Raikar-Mhatre is a culture columnist in search of the sub-text