Business Line
24 July 2009
Pune, India
By Taru Bahl

Two doctors fell in love, married and went on to heal a village in Maharashtra. Their services are now emulated by the National Health Mission.
About 200 km from the bustling IT city of Pune lays a village strategically located at the boundary of four districts–all drought prone and underdeveloped, connecting backward districts to the more prosperous region of western Maharashtra, which includes Mumbai.

Jamkhed remains untouched by modern developments that have swept the State. Men in dhotis and tantia topis and women in divided saris go about daily chores that range from farming of traditional crops to the more lucrative jatropha, cottage industries making gold wires for jewellers in Mumbai to tailoring units, and weaving wall torans.

There is a healthy glow on their faces as well as unmistakable pride. Showing you their pucca houses, boasting simple drainage systems and cost–effective water pits, they tell you how clean water helped their village become disease–free. Some beamingly point towards the toilet located within their house, a luxury but one they know indicates good sanitation.

Each household is brimming with plans. Shanta Bai has just paid the last instalment on a tractor loan, Devki Nandan has opened a PCO and Murli has made the down payment for a scooter. Prosperity and healthy lives were not the norm in this region four decades ago, when the Aroles chose to start their medical practice through the community–based Comprehensive Rural Health Project (CRHP) catering to 130 villages. Today their daughter, Dr Shobha Arole, is dedicated full time to the project and their son, Ravi, divides his time between New York and Jamkhed.

Most families in the Jamkhed cluster have two children each, and in some cases just one–a far cry from the average of five in 1970. The birth rate dropped from 40 per 1,000 to 19. Use of family planning rose from less than 1 per cent of married women before CRHP began to 68 per cent today. With education, skill training and counselling, there has been a steep drop in teen pregnancies, and sexually transmitted disease is rare.

Beginnings in Love

In a fairytale sense, Jamkhed’s CRHP owes its existence to a tender love story. Two doctors, Rajnikant and the late Mabelle Arole, met in medical college, married and decided to devote their lives to the marginalised people in rural Maharashtra.

In three years they realised that villagers’ medical problems began and ended with safe drinking water, hygienic food, occupational hazards such as injury from agricultural implements, drowning in water bodies and snakebites to developing complications in appendicitis and childbirth.

Healing with Social Activism
So the doctors, with their Masters in Public Health from Johns Hopkins University, got down to work in an expanded role that made them social activists, environmentalists and trainers all rolled into one. Taking the clinic to the villages, they found 80 per cent health problems stemming from malnutrition and chronic infections which could be prevented and managed with simple tools.

It was not so much a surgeon or doctor that was needed but a trained Village Health Worker (VHW) drawn from the community who could identify local problems and use cultural and traditional norms to help empower women. They developed a model whereby VHWs were the bridge between doctors and villagers–respected ‘mini doctors’. Even the Government of India was inspired to model its ASHA (Accredited Social Health Activist) in the National Rural Health Mission (NRHM) along the lines of the VHW.

With an annual operating budget of $500,000, CRHP is funded through a charitable trust, grants, modest income from its training centre, hospital fees and sale of products. Nearly one lakh health workers (international, local, NGOs, State and central governments) have been trained so far. “Funding is not easy as the perception is that if you have survived for three decades, you must be a solid player, self–sufficient and entrenched in the local space. Also you need time to make proposals, follow up and depute a person in Delhi, which we really can’t do, given the constant battling we do with human lives and situations,” says Dr Shobha.

Making a Difference
Change became evident when people took issues of health and wellbeing in their own hands. Prior to the 1970s, people built houses with poor planning. Smoke–filled and dark, they bred infection. Women contracted chronic diseases like asthma and bronchitis. Snakebite was not treated in hospitals but in temples. Says Sobha, “When they saw that health depended on development, improved agriculture and clean drinking water which actually raised their lifestyles and standards of income, they started discarding harmful traditions followed during menstruation and childbearing.”

Caste–based divisions are disappearing and in all the villages you find more girls than boys going to school. Babai Sathe, a Dalit, was a VHW for 15 years before being elected Mayor of her village. She was seen as better than her male predecessors and her five–year tenure brought her village electricity, water and roads. Mukta Bai, another Mayor, built school buildings and started a mid–day meal scheme for children. She too was a VHW for four years. Farmers’ clubs were set up, loans procured for tractors and pumps, and technical knowledge shared on growing agricultural crops instead of cash crops.

All children are immunised against polio, diphtheria, pertussis and tetanus, prenatal care has reached 99 per cent of the women, from less than 1 per cent at the start of the project, maternal death rates have fallen from 700 per one lakh live births to 70, and infant mortality dropped from 176 infant deaths per 1,000 births to 24. Life expectancy went up from 27 years in 1947 to 65 years in 2007.

Partners in Change
“Change has been gradual in coming‘¦ When villagers saw we were here to stay that is when they became our partners,” says Dr Rajnikant Arole. The Arole couple was awarded the Magsaysay Award for Community Leadership in 1979.

Today, a mobile team of nurse, social worker, paramedic and doctor visits villages to provide higher–level care, a 40–bed hospital handles emergencies, surgery and diagnostic tests. Senior VHWs recount how they were singularly responsible for uplifting the financial and social status of their families. In the beginning all the VHWs were illiterate, today the second–generation has studied at least till Class VIII. For 17–year–old Sarita, granddaughter of Raji Bhen, a VHW, “it is a wonder I can wash my hair with soap, use my mother’s mobile phone and fend off ruffians with kicks and punches I learnt in self–defence at CRHP.”

As Dr Shobha puts it, “Medical knowledge cannot be the monopoly of doctors alone, it should be owned by the people.”