POSSIBLE SOLUTIONS FOR RURAL INDIA

I traveled to Saragur in southern Karnataka to meet Dr. R. Balasubramaniam for possible solutions. I chose him because he is one of four young graduates who, inspired by Swami Vivekananda's message to serve the poor and disadvantaged, resolved in their final year of medical school, to live and work in the forests amongst the tribals displaced by the construction of a dam on the Kabini river. That was 23 years ago. Today, due to their dedication and efforts, there is the original clinic and dispensary established in the forest and the more recent Swami Vivekananda Youth Movement Hospital (SVYMH) in Saragur, a small and well run hospital, serving both the tribal and non-tribal communities.

Dr. Balu not only agrees with the conclusion reached in Part One, but adds that today, it is unrealistic to structure any healthcare for rural India, around a doctor. He believes what rural India needs is a system of grass roots health workers (HW) who shall be trained professionals traveling to villages where people live providing both preventative and remedial care - just short of what a physician can provide.

WHO IS A HEALTH WORKER?

A person local to a village
Willing to commit to live in the village
Serving a population of 3000 (bicycle) and up to 5000 (two wheeler)
Preferably a male and a female working as a unit/team
Passed SSLC or PUC or +2 (science emphasis helpful but not essential)
Selected by community or panchayat to serve the community.
Paid a salary and allowances by the panchayat or the community

To put this proposition to practice, the medical team in SVYMH has developed a curriculum and has been training HWs in their hospital. It is a residential 18 month course - covering both theoretical and practical aspects of health care. It takes the student through preventative healthcare, prenatal and infant care, nutrition, early detection, epidemic symptoms detection, basic public health measures, HIV/AIDS awareness, personal hygiene, first aid and aspects of traditional medicine. All this is in addition to assisting nurses and doctors with real patients and cases. Presently the course is taught in Kannada. The cost for one HW is about Rs 30,000/- which covers the tuition, training, lodging and food.

DO WE NEED DOCTORS?

Of course, doctors are needed and so is a nurse, a clinic or a hospital for surgery and other types of care that only a physician or hospital can provide. The HW however, can become a vital link between the doctor and the patient - at a minimum by a telephone and perhaps by the internet. HWs can provide the doctors with a history of a patient's condition or even that of a village as a whole, from a public health perspective. A relationship can be established between the villages and doctors in the nearest clinic or hospital to collaborate with the HW system.