Dr. Abhay Bang
There is a story by Mulkraj Anand. A little boy is off to a village fair holding his mother’s hand. The fair is full of captivating shops. The boy sees colourful balloons in a shop and promptly demands one. But the mother has no money. In another shop he sees embroidered red, green and yellow caps. The boy wants a cap. But the mother says “no”. As they pass the sweetmeat vendor the boy smells mouth watering barfis and jalebis. He wants to taste them. The mother again says a “no”. By now the boy is furious at his mother. “You’re a bad mother,” he says. Just then the boy looses his mother’s grip and is lost in the milling crowd. Suddenly he feels afraid and terribly lonely. He starts weeping and desperately searches for his mother. The balloon seller appeases him saying, “Come boy, take a balloon, don’t cry.” The boy replies, “I don’t want the balloon. I want my mother.” The cap seller tries to gift him a cap. But the boy says, “No cap, I want my mother.” The sweet seller says, “Eat this barfi.” “No, I want my mother,” the boy insists. When his mother was around he wanted every single goody but now he wanted none of them. He only pined for his mother.
America offers all the luxuries and comforts but somewhere the mother is lost! Today we gather here in search of our lost mother and to rediscover our common roots.
What prompted me to choose today’s topic “Sevagram to Shodhgram?” While thinking about the topic I chanced across a quote which said: “I hate quotations, tell me what you know!” That jolted me into thinking. So, my talk will not be a display of verbose scholarship and I will only speak about what I know.
I haven’t anything to flaunt – no status, power or wealth. So, coming here, what could I possibly bring? I am like poor Sudama entering the golden Dwarka. What could I possibly carry? I have just brought a story for you. It is my own story. The important part in the story is not “me” but the journey. I am just the tail of the tale! The heroes in the story are ordinary people – simple folks who make our society. I’ll be just narrating my experiences. Though it’s my own story it could be yours too, or anybody’s. The famous psychiatrist Carl Rogers never tired of saying, “Things we consider most personal are the most general.” An experience we consider exclusively ours is often felt by all human beings. In essence human beings are the same everywhere - whether in California, Calgary or Gadchiroli. So, this story could be anybody’s and everybody’s story.
I spent my childhood in Gandhi’s “Sevagram” Ashram. The place where I have done most of my work is called “Shodhgram”. Today, I’ll be recounting my journey from “Sevagram to Shodhgram.”
Gandhi influenced my life even before my birth. Under Gandhi’s guidance the late Sri Jamnalal Bajaj started the first college in Wardha where students were taught in their own mother tongue. My father a distinguished scholar majored in economics from the Nagpur University – winning five gold medals. Sri Bajaj invited my father to teach economics at the Wardha College. In 1942 the Quit India Movement started and my father went underground. He was imprisoned for 2-3 years and was released only in 1945. By then the British rule was on its last leg and freedom was very much in the air. My father thought that to serve India better he should do an advanced course in economics from an American University. He got admission in Ohio University. He also got a scholarship and his visa.
In 1945, going to America for higher studies was a singular achievement for any Indian. Before proceeding my father went to the Sevagram Ashram to seek Gandhi’s blessings. Gandhi sat cross-legged on a mat in Bapu Kuti. He was writing and his body was bent down. After salutations my father went and sat next to Gandhi. Gandhi’s demeanour – his bushy moustache, round glasses and piercing gaze gave him an aura of a historic figure. My father said, “Bapu, I have just been released from jail. I am leaving for America to study economics and have come to seek your blessings.” After listening to my father Gandhi spoke just one sentence, “If you want to study real economics then instead of America, go to India’s villages.” After this Gandhi simply got back to his writing.
My father quietly came out of Bapu Kuti and tore up his admission letter and travel documents. Within a month of this he went to live in a village near Wardha with a group of 10-12 students. He lived there like a farmer trying to understand the rudiments of rural economics.
Fifty five years have passed since then. At 83 my father still travels to all corners of India, spreading Gandhi’s message with the same missionary zeal.
In what lay Mahatma’s magic? His one sentence was enough to change the course of my father’s life. Practise what you preach was the Mahatma’s mantra. After coming to Wardha from Ahmedabad, Gandhi went straight to live in an ordinary village named Shegaon – which later got transformed to Sevagram. So when Gandhi gave the slogan, “Go to India’s villages,” he spoke the truth and millions followed. His strength lay in his deeds, not words! It is here that I spent my childhood.
While I was growing up Gandhi was no more. But still his presence was palpable everywhere - in his hut made of bamboo and mud; in the Ashram’s prayer ground and in the fields. You felt him in the cow shed; in ‘Kabir Bhavan’ where khadi was woven; in the hut where Gandhi massaged Parchure Shastri; and certainly in my own school! My school was started by Gandhi and Rabindranath Tagore and my mother was its principal. This “Nai Talim” school was the most amazing school ever – almost magical. The school remained shut on the days of the Bhoodan March to enable children to participate. I took part in it too. Once walking alongside Vinoba holding his hand I mulled for long time before asking him a serious question: “You urge people to donate land and develop village granaries. That’s fine. But won’t the rats feast on this booty?” Vinoba was flummoxed by my query and had a hearty laugh.
Such was the inspired atmosphere of my childhood. Later I studied medicine where I learnt a lot too. It was in medical college that I met my life partner - Rani. On the very first day in college a friend drew my attention to a girl sitting on a far away table deeply absorbed in a dissection. He said: “Here, look at Rani Chari from Chandrapur. She topped the entrance test last year but being under age she could join only this year. As you are this year’s topper so from now on, you’ll be directly competing with her. She is very clever, so be careful!” But as my friendship with Rani grew, I found that despite coming from a wealthy family she still preferred to wear a cotton sari and stay in a hut. Our life’s dreams and aspirations were quite similar.
After completing M.D. we got married and started medical work in a few villages around Wardha. Our choice was in tune with the political climate of that time. The emergency had just been lifted. In 1978, Jaiprakash Narain beckoned India’s youth to go to the villages for constructive work. Many people like me enthusiastically responded to this call. Our dream was simple. The majority of our people suffered ill-health in far flung villages with no access to modern medicine. We wanted to bring them medical aid and simultaneously transform the villages! “Social change through service” was the simple motto with which we commenced medical work in Kanhapur – a village near Wardha. During our three years stay we perhaps examined and treated every single villager! The farmers of Kanhapur liked us personally but didn’t quite approve of the reforms we proposed.
Then suddenly a terrible mishap occurred. A labourer by the name of Ajabrao Evante was working on a threshing machine. In an accident his hand got completely crushed in the thresher. We went immediately for rescue but there was not much we could do. His hand was amputated in the hospital. He recovered in a few months but having lost one hand he became a beggar. We believed not just in dispensing medicines but also in social justice. So we pleaded with the employer to compensate Ajabrao with three ‘bighas’ (measure of area) of land. The majority of farmers disliked our suggestions and vehemently disapproved it. They feared it would set a wrong precedent and all future “accident” victims would demand compensation! We still persisted. A village assembly was called at night to debate the issue. Normally hundreds of people would attend our meetings but only three turned up that night! When we picked the microphone to address the issue, people pelted stones at us. The village where we lovingly dispensed tablets and capsules was ironically returning the favour with bricks and stones!
This happened on a cold, wintry night in December. Our limbs were cold and our hearts frozen. The dream we cherished lay shattered! We were shell-shocked but somehow managed to return home from Kanhapur. This taught us our first lesson – village problems cannot be solved by just providing medical facilities.
Where did we go wrong in Kanhapur? We tried to list the reasons. (Add some explanation)We wanted to identify those health issues which affect a very large section of our population and then try and find relevant remedies. During this search we discovered that the basic research on diseases affecting the majority of our people had been done by foreigners. Here are a few examples.
Malaria a disease transmitted via mosquitoes is widely prevalent in India. But the basic research on this Indian disease was done by a British doctor - Ronald Ross. He researched in India and then unravelled the mysteries of malaria to the world. Cholera is another endemic Indian disease. Its cause - the Vibrio cholera germ was discovered by Robert Koch – a European, who did his research in India. A pattern seemed to emerge. Whereas foreign scientists extensively researched Indian diseases, Indian doctors scrupulously stayed away from their own villages. There were good reasons for doing that. How can research work be in a village - in conditions of abject poverty, with no facilities, laboratories or hospitals? The question of how to do relevant medical research in Indian villages led us to John Hopkins University, Baltimore, USA. Our intention was clear - to learn the nitty-gritty of public health research. America is a rich country because of its strong dollar. But it is also a country rich in knowledge. The John Hopkins University is the richest repository of knowledge on medical research in Indian villages. Here we learnt the fine art of research and ways to generate new knowledge. After finishing our course we decided to return to India. Before our departure our teacher Prof Karl Taylor asked us, “As you are returning to India for good, what all gadgets and equipments are you carrying back?” While returning we had cartons of books, loads of papers and one lone slide projector as an educational aid! With this cargo we returned to India in 1984.
We wanted to find ways to reduce diseases and death in India’s half a million villages. We started searching for an appropriate work place. We had already received invitations from several big institutions based in Mumbai, Delhi and Pune. They provided good research and residential facilities. But there was a problem – all these places were far removed from the villages. We were still grappling with the problem, unable to decide. That’s when a comic book helped us. We had bought this collection of Akbar Birbal stories for our four year old son Anand.
In one story King Akbar asked his vizier Birbal, “Go and bring the ten greatest fools from my kingdom!” The first nine idiots were easy to round up. But, the tenth fool eluded Birbal. As the time allocated by the emperor was running out so Birbal decided to intensify his search. Even in the pitch of dark he went up and down the streets of Delhi looking for a fool. Around midnight he spotted a man searching for something in a shaft of light. The man searched here and there without any apparent success. Birbal inched closer and asked him, “What are you searching?”
“I lost my diamond ring. I’m searching for it but just can’t find it.”
“I can see that you are not able to find it. But, tell me where did you loose it?”
“I lost the ring in the far away jungle, on the other bank of River Yamuna.”
“Then go search there. What on earth are you doing here?”
“It’s dark where I lost my ring. So I’m searching it in the light here.”
The ring was lost in the dark jungle far beyond, but the fool was searching it on the road of Delhi, simply because it was lighted. Birbal found the tenth fool.
Unfortunately this is how most medical research is conducted in India. Our villages are plagued with health problems, but most of the research institutions are located in the cities – where electricity, air-conditioned offices and facilities abound in the absence of medical challenges.
This was the reason why we chose to work in Gadchiroli. In 1982, the district of Chandrapur was divided. Gadchiroli being a very backward area was declared a separate district for the indigenous people (the Adivasis). Situated in the west of Maharashtra, Gadchiroli is flanked on one side by Madhya Pradesh and on other by Andhra Pradesh. Gadchiroli is located 200 km south of the big city of Nagpur. Almost 60% of the land is covered by forests where teak, mahua and bamboo grow in abundance. The district is flanked with rivers on three sides. The Vainganga River flows on the west front. When this river is in spate it causes all small rivers and rivulets to flood and wash away roads. Farming is the main source of livelihood and paddy is the staple crop. People spend four months in the monsoons cultivating rice. The other eight months are tough when people live off the forest by collecting– wood, mahua, tendu leaves, seeds and fodder. This in essence is the rhythm of life in Gadchiroli.
Poverty abounds – according to government estimates 80% of the people live below the poverty line. After being there for three months one day we saw a woman collecting something in the grass. This quizzed me, so I went close by and asked her, “What are you doing?” She was collecting grass flowers and seeds in her basket. “What will you do with them?” I again asked. She told me that there was not a grain to eat in the house. She would cook the grass flowers and seeds and feed them to the children. Even in this 21st century the people of Gadchiroli are doomed to eat grass! There are times when food becomes totally scarce and people have to starve and sleep on an empty stomach. Slowly, they become weak and their bones begin to show. This month of scarcity is termed “Haduk” (meaning bone).
The indigenous people constitute almost 40 % of the district’s population. The Madia Gonds primarily live in the forests. The other 60% population is non-tribal. Tribal art forms and icons adorn many houses. Superstition and blind faith abounds. Many still firmly believe that all diseases are cured by goddesses “Marai” and “Gaddevta”. To ward off diseases people place wooden idols under the mahua tree on the outskirts of the village. People resort to witch-craft and charms to rid them of diseases. On the outskirts of every tribal village, is constructed a hut. During menstruation women cannot stay with their families and are supposed to stay in this hut. Menstruating women are not supposed to touch anyone, so some of them even spend up to ten days every month isolated in this dismal hut! Primitive beliefs and age old traditions seem to govern every aspect of the people’s lives.
In 1984 bullock carts were the mainstay of transport in Gadchiroli. But at times, even they failed. During summer after the river dried up, it was decided to construct a bridge across the river. But because the contractor mixed too much sand in the concrete, the central pillar of the bridge sank bringing all work to a complete halt. Since then the work has never begun. Today this unfinished bridge stands testimony to corrupt government schemes and has become a symbol of stalled progress in Gadchiroli. During monsoons the overflowing rivers wash away roads and cut villages from the rest of the world.
In 1986, Rani and I reached Gadchiroli. I am able to address you today because Rani is ably managing the work in Gadchiroli. I may be alone here, but she is very much with me in spirit. On our arrival the people of Gadchiroli affectionately offered us a run-down warehouse where they stored tendu leaves. “Do whatever you want in this,” they told us. So, we started our research and training there, even housing the computer centre in the warehouse. We placed a board with the word SEARCH on the warehouse. To find relevant solutions to rural health problems – this was our SEARCH!
A month after we arrived there were massive floods. Gadchiroli was submerged and our rented house was inundated with water on all sides. We were cooped inside the house for full seven days! There was no electricity, drinking water, vegetables, telephone, post, nothing whatsoever. This was our first direct experience of depravity. This is how our real SEARCH started in Gadchiroli!
Our earlier experience in Kanhapur had taught us that health problems cannot be solved by foisting our “ideas” on people. So this time we decided to let people articulate their own needs and priorities. We met lots of tribal people and asked them “What are your main health problems?” “What can we do?” We soon realised that only the village leaders spoke in formal meetings, but ordinary people kept mum. So, we gave up that format and instead met people informally at night by a small bonfire. In such a congenial atmosphere the tribal people poured out their hearts. We held such meetings in forty villages asking people questions like, “Even when seriously ill, why don’t you go to the government hospital? Why don’t you avail the existing facilities?”
The tribal people replied, “We dread going to a hospital.”
“Why are you so scared?”
“We are afraid of the huge hospital. We get lost in multi-storeyed buildings. We are terribly afraid of all the doctors and nurses dressed in pristine white.”
“Why does their white uniform trouble you?”
“We wrap our dead in white before we bury them. So, how can people wrapped in white, save our lives?”
“In the hospital people speak a strange language which we do not understand. After our patient is admitted the hospital asks us to leave. We are told that we can visit our patient only between 3 to 6 PM. We don’t have watches. Our homes are far away – sometimes over a 100 km away from the hospital. There is no place for us to stay. Often when the patient sees his relatives leaving, he also wants to return home. Sometimes he runs away from the hospital. He would rather die at home in the company of near and dear ones than be left alone in the hospital.”
Their final problem was: “There is no god in the hospital. How can a patient get cured in a place where there is no god?”
So we decided to have a hospital which would respect the fears and feelings of the people - a place where they would feel loved and cared; in short a place where the tribal people would feel at home.
Keeping this in mind we started constructing a house which resembled a tribal hamlet. It had a waiting room for the patient’s relatives to rest and stay. Traditionally, the Gond tribal villages have such a hut - the “Ghotul”. It is a guesthouse for outsiders and also a place where young boys and girls come to sing and dance in the evening. So, the hospital’s waiting room was designed after a “Ghotul”.
Hospitals are not hotels and have no place for the patient’s relatives to stay. How to solve this problem? A modern hospital ward with 40 patients in a hall is tailor made for the convenience of doctors and nurses. They can treat many patients simultaneously. But they are awful from the point of view of the patients! How about a hospital made up of several huts – each patient staying with his own relatives in a hut! In turn the relatives take care of their patient. The tribal people simply loved this idea. Before we could get into the act the people from Udegam came and starting erecting huts for the patients of their village. Other villages followed suit. So, within a year our hospital – an assembly of huts was ready.
The hospital was being built in consultation and in accordance to the wishes of the local tribal people. What should be the name of the hospital? The people named it “Ma Danteshwari Hospital.”
Danteshwari was the supreme goddess in the tribal pantheon. Hence the name: “Ma Danteshwari Hospital.” I had returned from the USA just a few years ago. I did not quite relish the name and suggested, “Let’s give a more modern name.” Just then one woman got up and said, “Doctor, this is not your hospital. It is ours.” This is how the name “Ma Danteshwari Hospital” came into being.
Danteshwari is the supreme goddess of the Gonds. Faith in their goddess inspires the people to go to the hospital to get cured. Why shouldn’t we leverage people’s faith for a good end? So, we built a temple dedicated to Ma Danteshwari right at the entrance of the hospital. On arrival, the patient first prays at the temple and only then enters the hospital. We tried to reach health care messages to far flung villages through the medium of goddess Danteshwari. If we told the people that germs called diseases they would have disbelieved us and perhaps asked us for a proof. However, if people were told that Ma Danteshwari wanted them to stay clean and get vaccinated then they would be convinced.
An annual fair was started in the name of goddess Danteshwari which attracted people from 50-60 tribal villages. This fair was a full of singing and dancing interspersed with sessions on health care. Here village committees discussed health issues threadbare and chalked strategies to tackle them. These were the people’s own initiatives. They were not dictated by us or by someone from Mumbai. After returning home these committees further discussed and refined these proposals with the whole village. This is how the final action plan evolved.
People were unanimous that Malaria was their number one health problem. Usually half the villagers were down with fever, so they were unable to work in the fields or do other chores. How to combat this dreadful scourge? We usually suggested a few alternatives from which the people were free to pick and choose the ones which suited them best.
In every village we trained a health volunteer. The temple priest “Pujari” who dispensed medicinal herbs and performed religious ceremonies was also trained. SEARCH teams went to those areas where malaria had taken a huge toll and reached epidemic proportions. They went with their medical kits and trained people in combating malaria. Thus malaria control programme began with the active participation of the local tribal population.
Shodhgram is the name of the campus from where we conduct our work. It was designed keeping in mind the nature of our work, a place where we could seek solutions to people’s health issues with their active participation. This is how Shodhgram was established in Gadchiroli.
Everyday Rani examined patients’ in the hospital. She was a competent gynaecologist so village women came to her in large numbers. Soon Rani realised that majority of the local women suffered from massive gynaecological problems. It’s a general belief that women in underdeveloped countries suffered only due to pregnancy, delivery and family planning. But here the women had many other gynaecological problems too. The overall health picture could not be pieced together by studying only those women who came to the hospital - they were ill anyway. Hospital patients alone could not give an estimate of the overall prevalence of disease in the villages. We needed accurate data to ascertain the spread and extent of gynaecological problems. Were the problems really as grave as we thought them to be?
We tried to dig out data from the National Library of Medicine in Washington. We desperately searched for statistics and details of gynaecological problems in developing countries but found none. There was large amount of data and hospital statistics about developed countries but it was irrelevant for our situation. So, a research was planned to gauge the extent of gynaecological problems in rural women. For this all women – ailing or otherwise, had to undergo a medical check-up. This was the only factual way to establish the nature of women’s diseases and the extent of their spread. We were quite stumped when two villages Vasa and Amirza actually invited us to conduct this research. The day of “check-up” was celebrated like a festival in both villages. People of this very backward region not just welcomed research on women’s sufferance but celebrated it too! This surprised us no end.