Against the backdrop of what has been happening in central India over the past few months, Putting Women First possibly has several lessons to offer to policymakers. Situated in Gadchiroli, the image of which in the public mind is that of a “naxal-infested, backward tribal district”, the book provides an insight into what moves the sinews of that community.
Rani Bang, the primary author of the book, along with her husband Abhay Bang — both qualified doctors — set up a clinic for the Society for Education, Action and Research in Community Health (SEARCH) to cater especially to the medical needs of the major tribal groups in the region — Raj Gond, Madiya Gond, and Pradhan. This settlement, which adjoins the Dhandakaranya forests, is said to go back to the pre-historic era.
The harrowing tale of Gadchiroli women is told graphically — how they are impacted by economic deprivation, illiteracy, social discrimination, exploitation, rampant alcoholism, et al. In the process, the failures, deficiencies, and shortcomings of the government's health policies are brought into focus. For instance, it is revealed that 92 per cent of women in the region had no access to treatment for gynaecological disorders, a crucial area of health concern for women. Another significant finding is that, more than anything else, it is the nightmarish experience they go through at the Gadchiroli civil hospital that drives women to seek the services of quacks.
This book is also a primer for young, aspiring medicos because it has valuable lessons in understanding patient behaviour, and providing care.
“A doctor's understanding must encompass anthropology, sociology and economic factors that shape people's lives,” Rani Bang writes on the strength of her experience. “We doctors need to be educated about why people behave the way they do.” Clearly, doctors are not taught these “niceties” at medical school.
Bang is honest enough to admit that her interactions with the community led to her revising her opinion about sex workers, incest, and the reasons for alcoholism. It is this ability to absorb the ground realities even when they are contrary to their long-held beliefs that accounts for whatever success the Bangs have achieved in their venture in a closed community. “I had set out to bring about a change in their lives, but ended up changing, learning from them,” Bang adds.
It is these insights, beyond the numbing facts of the Bangs' research, and the real life stories of women that bring to the readers the harsh realities of tribal life and the reasons why things are the way they are. Be it the story of Chitra, who went to the hospital for a tubectomy only to find a foetus in her womb, or of Kumud whose baby died because her father-in-law, a quack, refused to allow her to seek medical help, the tales take the reader to the heart of the issue.
A far cry
True, government policies have resulted in a drop in birth rate and better immunisation coverage. But then, the maternal health component is a far cry from a wholesome reproductive health care; it remains oriented towards target-driven family planning. The focus should be rather, Bang emphasises, on prevention — or improving the health of the woman before she conceives. Compounding the problem is the lack of trained staff at the Primary Health Centres.
For a community health care initiative to succeed, it needs to be based on a proper understanding of the notions that prevail among the people about male and female relationships, sexuality, fertility, child bearing, motherhood, and fatherhood, infidelity, and so on. That infertility and infidelity are social issues that go beyond medicine renders them difficult to discuss or explain without one's own value judgment creeping in.
Clearly, the Bangs have managed to retain the essence of their first lessons in Gadchiroli. While imbibing the prevailing set of values, they directed themselves to the task of correcting/finetuning the popular perceptions about the sexual process, sex selection, menstrual hygiene, safe abortions, and how to resist exploitation by non-tribals.
By far the most interesting part of the book is where Bang uses her empirical knowledge to map out the missing links in government policy. Paying heed to her suggestions may well change the social dynamics of the long-ignored community and lead to a positive impact on more than just women's health.