Dr Sunil Kaul, Bongaigaon, Assam: Dr Kaul left the army as he wanted to focus on the rural poor, and is now a public health activist working in the remote Bongaigaon region, where health indicators are among the worst in India.
In India's jungles, remote hills, dusty plains these specialist doctors have sacrificed all they had to spread hope
A low, broad ledge runs around a single-storey building, with 250 numbered spaces marked on it. Sitaram and his mother are on number eight. They left home 24 hours ago and took a 75-km bus ride to reach Jan Swasthya Sahyog at Ganiyari in Chhattisgarh by afternoon. First, Sitaram, a farm labourer quickly secured their place on the ledge with his
gamcha, then lowered his unsteady, trembling mother, suffering perhaps from Parkinson's disease, on to a mat on the floor, where she waited. For the day to pass, for night to fall, for morning to arrive, and for OPD to begin.
Now, finally, will this 65-year-old woman be seen by a doctor she can trust, for a fee of Rs 6. If she needs tests, they will be done on the spot, if she has to buy medicines, it will be at a fraction of market rates. That's how it will be for 249 others too who've come on foot, by bus, bullock cart, or wedged between two attendants on a "motorcycle ambulance", making a beeline for the "Ganiyari doctors". There are no queues at the dismal government community health centre at nearby Kotah, where the block medical officer tells us: "It's the healthy time of the year."
For four doctor couples, most of them alumni of Delhi's premier AIIMS, this scramble to get treated at the centre they set up seven years ago is heart-lifting—and gut-wrenching. It validates, week after week, their decision to turn their backs on a world of prestigious specialist posts, lucrative practices, opportunities to go West, and take on the challenges of working in rural Chhattisgarh.
But it also drives home a shocking contrast between limitless need and the limits to what a bunch of good doctors can do. "It is obscene," says Dr Yogesh Jain, who gave up his post as Assistant Professor of Paediatrics at AIIMS in '99, to be here. "If that was my mother, sitting there, I would be very angry."
These highs and lows are woven into the daily life of a very small number of doctors scattered across the country who've opted to offer cheap, high-quality care to rural populations caught between "quackery and crookery", as Prof Amartya Sen once put it. In settings like Ganiyari, or Sittlingi in rural Tamil Nadu, where doctors Regi George and Lalitha Regi work among adivasis, you see doctors as you may never have done: non-intimidating, empathetic, humbled by their patients' struggle to make a living off the land; maintaining detailed case notes for the hundreds of patients who flock to their clinics.
You see them relieved to be able to end the immobilising fatigue and despair of a 30-year-old mother of two with anti-TB drugs, or be able to save a six-year-old suffering from deadly falciparum malaria. And you see them extremely proud of the barely literate women they've trained to become competent medical workers. Says Sunil Kaul, an ex-army doctor (he secured his release only after a long court battle), who now lives and works in Bongaigaon, Assam, "The 40 health workers we've trained are the kind of women who would make fantastic IAS officers—they look after 10,000 to 15,000 patients in villages with social indicators lower than Bihar."
As specialisation is a luxury the situation can't afford, you see specialists going back to their textbooks. ENT specialist Madhabi Bhargava also treats childhood illnesses and examines pregnant women, urologist Pradeep Trehan has found himself performing emergency caesareans in rural Haryana. You also see, in rural areas, doctors tested and yet exhilarated by the sharper levels of observation and superior decision-making needed to manage serious illnesses without recourse to a battery of investigations; or the improvisational skills required to carry out surgery under trying conditions. "I've been my lab assistant, my paramedic, my radiologist, my anaesthetist," says pioneering rural surgeon R. R. Tongaonkar, who has performed highly subsidised surgeries for four decades at his small hospital in Dondaicha, in Maharashtra's Dhule district.
Dr Jayesh Raval, Patan, Gujarat; Dr Raval (seated), trained at Tata Memorial Hospital, is today the only cancer surgeon in north Gujarat. Most of his patients are from interiors of the state and rural Rajasthan. His role model is his father Vinod Raval (standing), who after an FRCS from Edinburgh, became the first surgeon in north Gujarat.
But you also see rural doctors enormously frustrated. Firstly, in the poorest parts of the country, by chronic hunger masquerading as normality. Woman after woman walks into a forest clinic, in her bright, best nylon sari, with carefully applied sindoor and a tentative smile for the doctor. To my untrained eye, she doesn't look like a famine victim, but the doctor grimly—and accurately—assesses that she weighs what a 12-year-old should. Because she goes to bed hungry every night, more diseases will attack her, and in more severe forms.
Equally frustrating for rural doctors is their close-up view, whether in the hills of Uttaranchal or the plains of Maharashtra, of a state healthcare machinery that's cynical, corrupt, non-accountable and non-functional, forcing patients to opt for rapacious private practitioners, quacks—or no medical care at all.
What also angers doctors working in rural areas are misconceptions that are rife about the healthcare needs of "simple and hardy" rural people. Rural poor, they point out, are prone, not just to the worst communicable diseases, but all the so-called "lifestyle diseases" lazily correlated only with urban excess, and never with rural poverty and stress. For instance, the rural poor show up, far from obese, with diabetes so advanced that diagnosis and amputation happens in a single session. Yet, affordable access to insulin is a dream when even getting a basic malaria test is hard.
Finally, what also disheartens rural medics, despite the daily endorsement they get from those they serve, is the dwindling numbers of doctors willing to join them. Some come to help out for a few months, at a camp or two, but rarely, to stay.
But still, these doctors wouldn't rather be anywhere else—job satisfaction is very high among this tiny minority. Well known among rural doctors are Abhay and Rani Bang, whose pathbreaking work on infant mortality and women's reproductive health in Maharashtra's Gadchhiroli district has changed global health policy. Here, we focus on those known to far fewer.