On a recent visit to Chattisgarh, I had the opportunity of visiting the Jan Swasthya Sangha (JSS). This is a NGO launched by doctors in 1999. Currently there are 5 doctor couples and between them, they cover the following specialities – Medicine, Paediatrics, Surgery, Community Health, Obstetrics, ENT and Anaesthesia. Their main objective is to serve the underprivileged in the remote corners of Chattisgarh. Today, while there is a raging debate on how to motivate young doctors to serve in rural areas, it is heartening to see these 10 doctors working in the heart of tribal India, ignoring the Maoist and State violence that rages around them. Almost all of them are from urban upper middle class backgrounds, but have sacrificed this to serve the people.
Working in difficult conditions and with limited resources, they provide mind boggling services. It is customary to see patients being treated for cerebral malaria, TB empyema, intestinal volvulus, bear bites, eclampsia, acute renal failure, tracheo-esophageal fistula, … The list goes on and on. They get patients from near and far, some walking days together to reach this hospital. Other than this, the doctors have trained community health workers who provide preventive care to the far flung tribal villages. When necessary they treat patients or refer them to the hospital for further care. Other than hospital duty, most of the doctors visit the villages on a weekly basis to provide care right at the doorstep.
I have come across many such NGOs who provide services in needy places. But what makes this group different is their combination of empathy, commitment and scientific rigour. Even in this remote corner, they practice evidence based medicine, using available resources to generate local evidence. For example, they found that TB patients put on the routine RNTCP regimes returned within a year with relapses. They conducted studies and showed that the alternate day regime may not be adequate in our Indian conditions. Similarly, they were able to argue (with empirical evidence) against the Ministry of Health’s policy of witholding chloroquine prophylaxis for pregnant mothers. This matter has now reached the Planning Commission level.
Yet another activity that they are proficient in is developing low cost and appropriate technology for local problems. Patients in remote villages could not access any lab services, and so all fever cases were being empirically treated for malaria. To provide lab services, they trained their health workers to make a blood smear. This smear is then sent via the local bus and handed over to the hospital. When the bus returns back to the village, it collects the lab reports from the hospital and hands it over to the health worker. Thus the health worker is able to provide appropriate and effective treatment without resorting to shotgun therapy.