Sunday 2 September 2018

Beginning of Success to Reach Health Care to Rural Communities with Extremely Low Resources and Access Problems


Shakuntala Chhabra


Social accountability in health care and medical education has been the hallmark of Kasturba Health Society, Sevagram, which runs Mahatma Gandhi Institute of Medical Sciences, Sewagram in Wardha District of Maharashtra, India. KHS also runs a Nursing School, Nursing College and Kasturba Vidya Mandir (School for children) in the same campus. Institute’s birth is also the consequence of social accountability by none other than Mahatma Gandhi, in the form of a 2 bedded dispensary in 1938 in the village Sewagram where there was a epidemic of Cholera and women and children were finding it difficult to get treatment. The sapling has now grown into a blooming tree with nearly 1000 bedded well equipped, Kasturba Hospital at Sevagram village in the centre of country. Expanding health services to Melghat region in Amravati, Maharashtra, is another step towards social accountability in health and education. The step was taken in view of rural communities sufferings.

In view of the problems of high maternal, perinatal, infant and child morbidity / mortality step was taken to help rural community. So government of India and Government of Maharashtra were approached with the proposal for Mother and Child / Multispecility Hospital at Utawali, but delays in the system were worrisome. So it was decided to do whatever was possible. Agriculture land was bought more than dozen no objections were procured and plans of hospital as expansion of existing institute in the nearly district was planned.

Fortunately a Mumbai based charitable trust “Shri Brihad Bhartiya Samaj” came forward with the generous donation for the building and major equipments for the proposed hospital. Before this hospital could be built a beginning was made on first January 2012 by alterations / additions in the existing building of a minihospital constructed by KHS, Sevagram some years back where a physician and ophthalmologist deputed by KHS were working. A make shift birth area, operation theatre for caesarean section, hysterectomy and other surgeries was done. Other needed changes were made in the building and equipments / instruments were procured. In the existing guest house in the campus, alterations and additions were made so that the health teams could stay for 24/7 for emergency services. A nearby hut was converted into kitchenette, dining area cum office. A mini-library and online Maharashtra University of Health Sciences library were made available for every one to remain updated. Sports too were arranged and mobile phones and televisions to make the life of health providers in the hilly forestry region with access problems little easy and to try to reduce the general reluctance of health providers to work in the region. Now since Feb 2016 a reasonably well equipped. Multispeciality Dr. Sushila Nayar Hospital in Utawali has come up with basic facilities available in much better way with reasonability comfortable place for the health provider team in the building. A building with 4 flats and some land have been procured in the vicinity keeping in mind needed accommodation during the development.

With the guidance, support and help of KHS/MGIMS, Sewagram the team of Obstetrician – Gynaecologist, Paediatrician, Anaesthetist, Physician, Medical Officers, Interns, Administrative Officer, Nurses with other paramedical staff have been managing emergencies and day to day problems in outpatient, inpatient and operation theatre, 24/7 days. While paramedical administrative staff has been exclusively appointed, doctors are deputed in rotation from head quarter, the medical institute in the near by district, a dozen doctors are always available. Author as officer on special duty with support of management and a big number of colleagues at base institute are trying since beginning their best, from buying agriculture land to health services now in a reasonably equipped hospital. Caesarean sections, minor and major gynaecological surgeries are being performed in addition to normal and instrumental births. Everybody is trying to give his/her best with whatever available in the given circumstances with limited resources. The very first caesarean section was performed on 21st January, 2012, mother and baby discharged healthy in a week. The first hysterectomy with removal of a uncommon cancer of ovarian tumor ‘Struma Ovari’ performed on 15 February, 2012 and the woman doing well, 6 years. Now services for prevention of blindness complete eye care are also being provided.

Everybody is trying to give his/her best with whatever available in the given circumstances with limited resources.

There is good understanding and cooperation between Sub District Hospital Primary Health centres of Government of Maharashtra and our centre.

While trying to do whatever we could, we have had many challenges, many practical difficulties and have also realised that though. nutrition, anaemia, poor health, are responsible for many problems, their causes are deep, in the social and economical conditions, in the nonavailability of food, in ignorance, when the food is available, gender bias, unemployment, addiction and many other issues. Hindrances also include lack of awareness, lack of resources to seek services at health facilities and their own faith concepts of traditional healing, beliefs and disbeliefs. Sometimes making the patient stay in the hospital for her own good or her child’s good is a tough job, testing the patience, the best of counselling skills and dedication. 

We realized within months of opening the hospital unless Community based services, community motivation, mobilization and behaviour change, were done not much was going to change. So a step was taken in this direction way back in Feb 2013, just a year after starting the services. Now seven nurse midwives provide community based antenatal services, advocacy about intranatal, postnatal, neonatal care in the villages. We started with 52 villages in February 2013 and 13 more were added from July 2013, a total of 65 till recent past. Later 35 more have been added from April 2016 and 40 more in August 2017, making a total of 140 villages. The team visits villages 5 days a week. Medical officers posted under Rural NGO posting scheme of the Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha used to run Community Based health clinics in these villages with the nurses, in rotation while services at base hospital at Utawali. However the current rules of postgraduates medical admissions with national eligibility examination, no medical officers are available. Some laws for some good spoil other good work. So interns of the Institute in the near by District at Sewagram  are posted in rotation for 15 days, task shifting. So while each NM visit their assigned village, once in a month, doctors run clinic in assigned villages by covering 7 villages in one visit by one doctor. Things will change. It needs some time before awareness will come in the tribal population and their many unlisted social and economical issues are really addressed.  


Now seven nurse midwives provide community based antenatal services, advocacy about intranatal, postnatal, neonatal care in the villages.

Diagnostic cum therapeutic camps have been made annual event. First camp was held in March 2012 with 226 patients, February 2013 the number was 1036, in 2014 February it was 1107, in 2015 it was1883 and 2016 it was 2197. In 2017 attempts were made to help differently abled and 216 needy were help. In 2018, 3872 Surgeries have been performed on camp days and left over cases are operated within days of camp, some at Utawali and complicated at the institute at Sewagram. Camp for Cleft lip Cleft Palate was also conducted in December 2014. Attempts are being made to help Elderly women and elderly men too for diagnosis and therapy of illnesses, including noncommunicable diseases, (Hypertension, Diabetes and Cancers) vision problems. Research was done with help from US based Global Health through Education and Service, (GHETS) Indo Canadian Institute from Canada. Now Mumbai based philanthropists including Jan Kalyan Trust help in services for elderly. Research about ‘Abortions’ under Indian Council Of Medical Research, New Delhi Disability Detection program was done and Aids, including Wheel chairs provided to nearly 225 people. Now beginning has been made for trying to make adolescent, young school drop outs learn skills to become self sufficient, with support from Jan Kalyan Trust Mumbai. Camps for cataract surgery are being done. 

Research is being done about effects of Bio-fuel mass on health of family specially mothers and new born with plans for providing and Chimneys related to Agriculture status and malnourishment, low body mass index, Anaemia, Vit A deficiency etc. There are plans for Family Life Education Program for Adolescents, Preconception literacy and care also, finding how Wellness can be created for them.


Presently the biggest need is of finances so that in the reasonably equipped, furnished hospital, free services can be provided to the real poor, especially mothers and babies in emergencies. It is not possible for KHS, Sevagram to provide free services to everyone without support. Though services are provided to everyone, who reports, irrespective whether the patient can pay or not, it is not possible to Declare free services due to lack of resources. Also financial support is needed for providing children the needed nutrition at home till the time they are in a position to become self sufficient. Major issues are also awareness of many things, access issues and safe water, working on their beliefs and disbeliefs.
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Shakuntala Chhabra is an meritus Professor - Obstetrics Gynaecology, Chief Executive Officer - Woman Child Welfare, Officer Special Duty - Dr. Sushila Nayar Hospital, Melghat. In addition to DGO, MD, Diploma - Advanced International Maternal Health Sweden, Certificate Courses- Maternal Child Health, U.K, Problem Based Learning- Netherlands, others- Logistics Management, Teaching Training, Human Resource Management etc. Receive the awards: FIGO’s Distinguished Community Emergency Obstetrics, Best Teacher, MUHS, Nashik. Short term WHO Consultant, Technical Consultant, Technical Temporary Advisor - WHO. Supervisor for SIDA. Member of Women’s Health Task Force, Network TUFH, USA. Member of World Rural Health Council 2018. Special Interest- Maternal health, Social Obstetrics, Gynaecological cancers, Health Professionals education.

Curated by Ana Júlia Araújo and Mayara Floss

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