Fact: More than ninety per cent of the healthcare facilities existing in India are concentrated in urban areas. Not only the medical education & training, but the scope of practicing of modern medicine is not designed to serve the rural population.
Fact: According to Govt. of India publication, 33.5% incidents of death, followed medical intervention in by unqualified practitioners . A third of the population dies without any medical treatment by a qualified person . They get some kind of medical interventions in their villages and the providers are known as 'quacks'.
What then is the alternative?
The alternative lies in the utilization of the huge man power waiting in the villages to be nurtured into an effective army to take the burden of rural healthcare needs.
The word 'quack' is an ugly term to the urban medical community; quacks have no systemic training in medical science; their practices all are often irrational, sometimes dangerous; their medical practice is illegal in the eyes of the Government. On the other hand, there is a lot to be said in favour of the unqualified practitioners. For one thing, no fewer than 700 million people of India depend exclusively on them. Most important of all, both the prescriber and the patient know each other well enough, they speak the same idiom, and the prescriber is always available, day and night, for consultation & house-call.
The fact of the matter is that the system of medical practice in the rural area by unqualified prescribers is so deep rooted that one cannot wish it away.
Idea is to give training to serve better
The huge man power who live in the villages, trained them in modern medicine up to a level to see about the primary medical care needs, particularly in the villages where there is no qualified medical practitioner within a radius of few kilometers. Once these learners get through 3 - 4 semester courses, they will have accreditation to work as 'rural medical assistance'. Obviously, this army of rural medical assistance will have to be brought under a regulatory body as ASHA (http://www.mohfw.nic.in/NRHM/asha.htm)
All this may appear to be too tall an order; Foundation for Health Action however has started to implement this idea to a reality. It has started a pilot project on a very limited scale without waiting for the Govt. to give the lead. The experiment may be taken up by other organizations including People's Council of Education at the national level and finally a model may emerge for the whole country with enough flexibility to accommodate the needs constraints of each area. Foundation for Health Action, of course will be ready to help any efforts in this direction .
Ground work has been started by FOUNDATION FOR HEALTH ACTION
- A not-for-profit public welfare trust having its head office in Kolkata has been formed.
- Purchased 6.5 acres of land in a remote tribal village in Bankura ,West Bengal (India)
- Constructed AMADER HASPATAL (our hospital) for giving basic medical services to the rural patients; it will also facilitate hands on training to the interns and other paramedics. It has an out-patient complex (an examination room, a pathology lab for basic tests, X-ray unit for simple X-ray, stock of medicines,); the outdoor service, with Rs.10 per visit, has been opened for public since October 2009. The salient features of the clinic are: demonstrating rational therapy, dispensing inexpensive medicines at cost and providing patient counseling.
- The project is being implemented in cooperation with the local village committee (Panchayet)
- Organization is building an indoor unit with 12 beds, a small OT cum labour room. a training institute with a hostel for the trainees
- Has started organic cultivation, plantation of fruit trees, backyard kitchen gardening, crop rotation etc. to set an example to the patients who are predominantly cultivators and the surroundings villagers. The agricultural produce is utilized for consumption of the inpatients and the excess if is sold to meet the cost of cultivation round the year
- Organization has already spent substantial amount on purchasing of land, construction of building and other infrastructures, and has been spending around Rs. 15 lakh annually from donations and contributions by the trustees and well wishers.
Villagers falling ill are compelled to suffer due to poverty, ignorance as well as proper healthcare facilities. It is often late when they see an unqualified village doctor, who often treats the patients with irrational medications about which he hardly has any clear idea. Instead of helping the patients, these untrained doctors often create more problems; then the desperate poor patients mortgage their meager source of living, the cultivating land and come to city hospitals for better treatment. This is a very common scenario of Indian village. O bviously a good number of common aliments may be effectively treated by an army of properly trained rural medical assistants.
We are aware of the obstacles of this mission. On the one hand, effective implementation of the initiative calls for a first hand acquaintance with the ground reality. On the other hand, one should not conclude that we are putting forward a panacea that will remove all the ills of the present healthcare system. All said and done, there will be a section of the population who will not be able to afford to buy medical care and will be left out of the pail of the healthcare system. However, our efforts may extend medical care facilities, which are at the moment absolutely inaccessible to a large section of the population, and therefore eminently deserves a fair trial.