If adverse socio-economic factors are preventing patients from accessing hospitals for timely and attentive care, often with fatal outcomes, healthcare must go to their doorstep, Abhay Bang, public health expert and founder of the Society for Education, Action and Research in Community Health (SEARCH), has said.
In his address at the recent 12th convocation for medical courses at JIPMER, Dr. Bang drew attention to the fact that an estimated 5 lakh neonatal deaths were occurring in the country owing to multiple factors, ranging from poverty to lack of transport in which the babies were either reaching the institution late or were denied the best possible treatment because of overcrowding.
On successive days at JIPMER, Dr. Bang and his wife Rani Bang — co-director of SEARCH who gave the special address at the 10 th convocation for nursing and allied health science courses — shared their experience of developing an alternative healthcare model in Gadchiroli district of Maharashtra, a district with 1% of the population that was accounting for 50% of the State’s malaria incidence when they arrived in 1986.
According to Dr. Abhay Bang, who served as chairman of the expert committee for tribal health, an estimated 11 crore tribal people live in India largely scattered across 809 blocks in 150 districts. “Healthcare hardly exists there. Until some medical practitioner goes there as a pioneer with the light of medical knowledge and empowerment, neonates will continue to die because the bridge of healthcare is broken,” he said.
And, given the odds stacked against the survival of sick newborns of Gadchiroli, the duo decided to design a model of home-based, rather than hospital-based, neonatal care. There was self-doubt initially about training the women in the community to be basic neonatal care providers — such an initiative went against even the counsel of the World Health Organization, which was to rush a sick neonate to hospital without thinking twice. But, they still went ahead with developing a model of home-based newborn care because the nearest hospital with a paediatrician was several hours away, Dr. Bang recalled.
Eventually, some of the top-most paediatricians in the country would train the first batch of women in newborn care. On conclusion of training, none other than a physician of the stature of neonatologist Meharban Singh would observe that the 39 village health workers of SEARCH know more about newborn care than the MBBS graduates of AIIMS, Dr. Bang said.
Further vindication of the model would come when a field trial conducted later showed a 70% reduction in neonatal mortality in the tribal community. “This goes to show that rural women are a huge resource base who can be trained and empowered to fill the critical gaps in primary care delivery,” Dr. Bang said.
If the story was not inspiring enough, Lancet, when it came out with some of the vintage papers published in its 180 years of history, featuring breakthrough research by the likes of Louis Pasteur, Robert Koch and Alexander Fleming, devoted a paper to the home-based newborn care model in an obscure place called Gadchiroli.
Dr. Bang’s advice to young doctors was to be mindful that they were leaving a prestigious institution equipped with knowledge and skills, which was a “blank cheque on which to write your destiny”. Do not write a price on the blank cheque as your life as the value of contributions are worth much more, he told them.
“The best of training institutions can give you knowledge and skill sets but not your life purpose. The purpose is what you decide. Go to the places where problems are, and not to the places where facilities are,” he said.
Dr. Rani Bang stressed the importance of listening to patients as she narrated how she was surprised when tribal women identified infertility among their top health concerns. But, what would be an eye-opener, was their rationale: The women would say that if a woman dies only once in her lifetime in the case of obstetric labour complications, when infertility is involved, she dies every day due to blame and shame from all around.