Public Health Service Delivery, Nitish Kumar and that one bidi, I smoked…
Several years back in 2005 at a UNDP knowledge management workshop in Udaipur many of us – Public Health professionals were discussing about channelizing the huge ‘health worker’ resource we have in the name of ‘quacks’ in India (quacks are the millions of unregistered, un trained medical practitioners). It was the month of February and Udaipur was beautiful with a soft bright sun shining gently; tree-swaying-breeze and the temperatures in the twenty degrees along with a very low humidity.
It was primarily a maternal & child health discussion forum and we had over five hundred development professionals and doctors as members in that specific visioning workshop – the third Visioning Workshop of the MCH (maternal & child health) community of Solution Exchange (the knowledge sharing portal) – led by Mr Meghendra Banerjee those days. Along with several other emerging issues related to MCH, like ‘in-accessibility of health centers in rural India’. Issues relating to ‘birth preparedness’ and ‘family planning’ in rural India we also discussed about the quacks at length. With over five hundred top and mid level Public Health honchos and ‘knowledge banks’ the workshop became a treasure trove of downloadable knowledge.
Eleven years later, today I clearly remember that most of the core group members at that workshop all agreed about one easy solution to many of the emerging health issues especially in rural Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and West Bengal – was to be able to channelize the available resource of the quacks. Some Bureaucrats had mentioned that the most important problem being – most of the doctors do not even visit their posts in the rural areas; they stay in the cities and visit their stations once a month to collect salary. Even they had agreed – Quacks could be the answer actually. But the problem was – they were not trained.
‘They can be trained – if not as a medical person but as a para-medic.’ Some of us said as it was a simple principle of resource management.
Unfortunately most of the doctors present in the workshop didn’t like the idea then.
July, 2015
My Sunday mornings are for cleaning. First I clean up my mind and then I try the same process for my study – and more often than I know – I fail performing the second task. Now this given day I chose to clean-up my desk. I dug through the piles of papers and scribble pads from the top of it and then somewhere deep down I found this news paper cutting – I didn’t remember when had I done that but I read it and I thanked myself for it anyway.
I held the four by three inch piece of paper in my hand. It was surely from Times of India (because that’s the paper I am given to read at my home). The piece had a headline in clear bold Times New Roman font announcing:
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‘One year course for quacks announced’
My mind was paused for a couple of moments and then read on….
‘Patna: Bihar Chief Minister Nitish Kumar announced that a one year technical training will be launched for quacks to enable them to get recognized as community health workers. Earlier inaugurating ‘Swasthya Samagam 2015’ an event organised by the medical cell of JD(U). He said this course would help the quacks get a new degree to meet basic medical needs in villages of Bihar.
“As Bihar has a big population and the number of doctors in the state is not sufficient to cater the needs of all, the role of such trained health workers will become important. However, if people build toilets at their homes and avoid going out in the open (for defecation), the need for doctors will be much less.”
“The new course is a joint venture of the national institute of open schooling (NIOS) and Bihar Government. Candidates will be given training at referral units located in every district. The syllabus will include the study of anatomy, physiology, health, sanitation, nutrition, pharmacy, communicable and non- communicable diseases along with basic training to act in medical emergencies,” said the Chief Minister. The degree will help the quacks to work as volunteers under different health schemes.’
‘Wow!’ I told myself – this is something what we talked about several years back and especially this is what I always wanted the government to do – if not the Central Governance the state government could anyway do it. Because through all of these 11 years I have seen things and believed many.
Because, by now I have seen and known many of these people and seen them saving lives. I somehow had developed a faith in these people. I think I have to share one story to end this note….
It was April, 2012 – and I had started fitting into yet another Public Health role among the many that I played. I worked in FHI 360 as the National Manager and found the program was designed to mobilize quacks in rural UP and Gujarat to promote ORS & Zinc as the first line therapy to manage diarrhea among children. We never called them Quacks though – we called them Rural Medical Practitioners. Good enough – for the next two year I visited innumerable RMPs in several villages of UP and Gujarat and learned something new….. what amazing role these guys play in the public health service delivery scene of our country. Had they not been there – innumerable rural communities must have collapsed. They are the people who help communities live; they are the people who actually provide what the government should have provided; they are the ones who help regions survive and yet they are out-caste and get almost nothing.
I remember a village in Unnao District Uttar Pradesh, where on a summer afternoon I waited with my colleague on a bench under a huge banyan tree to talk to the RMP who was busy dressing a little boy’s leg wound which went bad. Suddenly there came a cycle rickshaw and along came three badly injured people – bleeding profusely from different injuries. The rickshaw was followed by another and then another…… within minutes there were fourteen injured people bleeding, groaning on the ground under the tree, in front of the small ‘shop’ of the RMP.
The way most of the men cried and moaned and bled I thought some five-six of them were going to die the very day on that ground for sure. One of the rickshaw-puller said – they were two communities who fought over some little nothing and injured each other with their lathis. I could see that pretty well as some groaning men still carried their lathis – as if they were going to have a second season after the clean-up job. The RMP finished his dressing work, collected his fee, gave the change back to the boy’s father and called up his assistant to put up the bottles.
By then I had forgotten why I was there – I was more interested in what would happen next and how this man would treat all of this badly injured men.
As the assistant boy worked, I – with all my amazement stared as if I watched history occurring in front of my eyes. The boy quickly got several bottles of intravenous fluids arranged and one by one he hung them from different branches of the banyan tree and dragged attached pipes to the groaning people. The RMP followed him – one by one he inserted the IVF niddle in the arms of lying men.
Phase one was done. He stood up straightened his back and asked his assistant to get the BIDIs.
At first I thought – I heard it wrong; but as the assistant actually brought some packs of bidis (cigarettes of rural India) from the shop, I started comprehending the meaning of that one sentence which my grandfather often said – “there are many Indias in one India.” The RMP lighted one Bidi from another and pushed them one by one through the groaning lips of the lying, bloody people.
‘That will help them to think they are feeling better.’ He smiled at me and got cotton balls and a large bottle of antiseptic cleaning agent. He was ready to start his third phase of treatment now.
Starting from the most badly bleeding man he then carefully checked each wound one by one and cleaned and if required stitched.
I wanted to see it all – to be able to tell the story some day to many others– which I am doing right now. I waited for over two hours and witnessed how amazingly, how carefully, how compassionately an untrained person saved so many people from death by sheer loss of blood.
After over two long hours the RMP was done with his fourth phase – which was dressing up the wounds.
Some more minutes later the rickshaw puller re appeared and pulled the men on to their rickshaws and left. None of the men paid anything. As the rickshaws turned at the twisted muddy roads and vanished behind the greenery, I asked – ‘they didn’t pay you?’
Prompt came the reply… ‘Oh! They are all land labourers – they do not have any cash on them… where would they pay from? And they have wasted the day already so they will not even be paid anything for today.’
‘Waise bhi hum nehi karenge toh kaun karega saab…apna hi toh log hai…’ he added (they are all our people after all…. someone has to treat them!)
I looked in his eyes…..and raised my hand almost in oblivion – in a trance, and said… ‘ek Bidi milega…’ –
I asked him, ‘can I have a bidi. Can I have the pleasure of smoking a bidi with you under this tree?’
He said, ‘sure sir, but why?’
I said, ‘to mark and remember what I witnessed this day – till the last day of my life.’
Victor Ghoshe
15th Aug, 2016
Patna, Bihar
