How 13 years ago young doctors from AIIMS and CMC Vellore resolved to provide quality health care to remote rural areas… and are actually making it happen
About 20-25 years ago, a small group of young medical students at the All India Institute of Medical Sciences in Delhi shared a dream. “One day”, they told each other, “we’ll pool our skills and energies to start a health programme in villages that will give genuine health care to the rural poor. We’ll start a hospital from where no patient will have to return for inability to pay for treatment and medicines.”
These students shared the dream with some of their friends in other leading medical institutes such as CMC Vellore as well as those friends whom they hoped to marry — further strengthening their resolve.
Cut to the present: 1,000 patients drawn from about 2,000 remote villages in a radius of around 200 km are treated every week in a rural hospital in Chhattisgarh. The idea of not turning away any patient has now become a reality.
Above all, these doctors have been able to take the lessons learnt from their work in such remote areas to the policy-making level so that a potential for policy changes has been created which can benefit millions in future. And all this has been achieved in the middle of various adversities and difficulties at almost every step.
Go back in time to 13 years. The first three doctors have just arrived at Bilaspur and are trying to use an old, abandoned building (in Ganiyari village) as a clinic after some renovation work arranged by their friends. One of the doctors is seven-months pregnant. The other two (Yogesh and Anurag) ride a rickety scooter to start their first OPD day. The morning turns into scorching hot afternoon; then slowly the sun starts receding and darkness sets in. Not a single patient has come yet. Silently the two doctors leave. Next day, the same experience is repeated.
On the third day, the first patient came. Next day four, then seven and very soon they were neck deep in work. This has been the experience since. The doctors are so overwhelmed with so many patients that despite their best efforts there is a never ending queue.
We are talking about Jan Swasthya Sahyog (JSS), one of the most-talked-about pioneering initiatives of young doctors in the country to make a real breakthrough in improving rural medicare.
This effort was initiated by a handful of doctors as its founder members — Yogesh Jain (secretary), Raman Kataria, Anurag Bhargava, Biswaroop Chatterji, Sathyamala, Rachna Jain, Anju Kataria, Madhuri Chatterjee, Madhavi Bhargava, Pramod Upadhya (who played a particularly significant role in appropriate technology programme) and B.R. Chatterjee.
This has been a rare effort in India when a group of doctors got together to create a community health effort. Some doctors joined at a later date while some took a break for some time and have returned or hope to return after some time.
On the whole, it is a story of several doctors sustaining united effort (overcoming some disagreements for the larger cause) with such relentless hard work and great dedication that it could become a role model and source of inspiration, in the process also treating/serving over two lakh patients drawn from about 2,000 villages in eight districts of Chhattisgarh and Madhya Pradesh.
JSS works at a three-tier level of community health workers in hamlets, health sub-centres and the main hospital at Ganiyari. One of its main priorities is a community health programme, providing preventive and curative services, based on about 120 trained village health workers, elected by their respective villages, in about 60 villages of Kota and Lormi blocks mainly (but not only) inhabited by tribal communities (mainly Baiga and Gond).
Clinical services provided by the JSS include an outpatient clinic at Ganiyari, well equipped with a dispensary, radiology and laboratory services, that has provided extremely low cost and effective care. This hospital is well-known for quality comprehensive medical, surgical, paediatric and obstetric care in the region.
This main hospital includes an in-patient ward with 50 beds and an operation theatre complex. Three sub-centres in three forest village clusters are located at Shivtarai, Semaria and Bamhni villages. They together serve over 150 forest and forest-fringe villages. Each sub-centre is served by two senior health workers and supported by doctor-based outreach clinic every week. Doctors and paramedics have to walk across river to the Bamhni sub-centre.
Research and training efforts of the JSS have linked it to possibilities of much wider improvement in health care both at the level of policy and implementation, in the government sector as well as in the voluntary sector.
This wider reach of JSS is further helped by its advocacy efforts which have a special emphasis on meeting the health and nutrition needs of the poor. A particularly effective part of this advocacy has been the advocacy for a rational policy for medicines, based on need and not on greed.
One basic thinking common to all these activities of the JSS is that inequality in health as well as broader inequalities have to be challenged, fought and reduced significantly so that the poorest people can have access to good health care as well as nutrition.
Another basic priority has been to establish a relationship with patients, which is based on the values of humanity, dignity and compassion.
These special strengths of JSS have started attracting a younger generation of doctors, several of whom (particularly from Maharashtra) are now contributing to the further programmes of JSS in meaningful ways.