The Society for Education, Action and Research in Community Health has been a panacea for the tribals of Gadchiroli in Maharashtra
Chaitanya Malik has a busy practice and he attends to scores of patients every day, but he’s not your typical doctor. Choosing to work at the Maa Danteshwari Hospital in Maharashtra’s remote Gadchiroli district, among the most backward in India, Dr Malik’s patients are mostly members of the Gond tribal community of the area.
“It was a kind of reverse migration for my family and me,” says the 32-year-old Dr Malik, who chucked his job at a government hospital in Delhi to go where few doctors venture voluntarily. “I wanted to work in rural India after my post-graduation and Gadchiroli turned out to be the right place.”
The setting for Dr Malik’s labour is Shodhgram, or the ‘village of quest’, and he appears to have found what he was seeking. Dr Malik, who has been in the village for 18 months and has learned to speak Marathi during the time, is part of a multi-pronged initiative led by the pioneering Society for Education, Action and Research in Community Health (SEARCH).
Founded by Abhay Bang and Rani Bang, the famed doctor couple who have blended social activism and research with pioneering healthcare — particularly neonatal care — in a dirt-poor region, SEARCH has been at the forefront of a sustained effort that has won plaudits from the World Health Organisation and UNICEF.
The organisation’s efforts have reached 134 villages in Gadchiroli and benefitted more than 12,000 people. SEARCH has 48 ongoing tribal health programmes and there is also the Maa Danteshwari Hospital, set up by the Bangs to treat the underserved in an underdeveloped region. The Tata Trusts has since 2016 been supporting the initiative, which tackles a range of health issues in a geography that poses plenty of challenges.
Gadchiroli lies in eastern Maharashtra, some 200km from Nagpur, and borders Chhattisgarh in the east and Telangana in the south. The majority of the populace here are tribals and they lag far behind on almost all economic and human development indices. Adding to Gadchiroli’s woes is a Maoist insurgency that has been raging for long years.
Gadchiroli’s residents are mostly impoverished and illiterate. The only thing they do not seem to lack for are health problems. Malaria, anaemia and tuberculosis are common, snakebites are everyday occurrences and, surprisingly enough, conditions such as hypertension, diabetes, stroke and back pain have been increasing in recent times.
There is one physician for every 5,000 people in Gadchiroli (the ratio is 1:1,500 for India). SEARCH, headquartered in a sprawling 45-acre campus in Shodhgram, works to ease the rush and institutions like the Maa Danteshwari Hospital are critically important in the context.
Dr Abhay Bang, who grew up in Mahatma Gandhi’s Sevagram Ashram, and Dr Rani Bang started out on their mission to serve the marginalised communities in Gadchiroli in 1985. Following a one-year course to study research methodology at John Hopkins University in the United States, they got SEARCH off the ground in 1987.
In the three decades since, SEARCH has worked on a host of health-related issues, primarily malaria, alcoholism, backaches, gynaecological problems and child mortality. A distinctive feature of the organisation is the place where it has struck roots.
Established in 1993 after extensive consultations with the Gond tribal community, Shodhgram is modelled on Sevagram and has been designated as a tribal village. It incorporates tribal design traditions and has a unique architecture and ambience.
The Shodhgram complex houses a 20-bed hospital, office and residential spaces, and an agricultural area. It also includes a guesthouse, a hostel, research and training facilities, a museum and a library with more than 10,000 books and magazines. The residential complex accommodates around 100 people and a new facility is coming up to meet SEARCH’s expanding needs.
Led by the Bangs, SEARCH swears by the idea of community-based healthcare models, which are tested through research studies and made available by way of training and publications. Alcoholism, rife in the region, has been a continual concern for the organisation and this remains a key part of its work.
SEARCH launched a ‘liberation from alcohol movement’ in the late 1980s at the urging of local village women. The initiative soon developed into a mass movement with women and youth in 150 villages demanding prohibition in the district.
“The total value of alcohol sold in the district was about Rs200 million a year, whereas the government’s annual budget for Gadchiroli was just Rs140 million,” says Dr Abhay Bang. “We urged the government to impose prohibition in the district and women supported us in the thousands.” [In 1993, the Maharashtra government finally imposed prohibition in Gadchiroli but SEARCH surveys show that more than 40% of males in the district continue to consume alcohol, most of it illegally brewed.]
In August 2016, SEARCH began a collaboration involving the Maharashtra government and the Tata Trusts to launch ‘muktipath’, a district-wide tobacco and alcohol control programme. The aim here is to raise awareness about the ill-effects of alcohol and tobacco, create a social environment to reduce their consumption, and to rehabilitate addicts.
Muktipath has a five-pronged approach:
SEARCH currently has three clinics to treat alcoholics and this highlights what is a crucial facet of its work. “We plan to have such clinics across the district and we hope to provide services to about 4,000 people with addictive disorders,” says Arti Bang, a psychiatrist and a daughter-in-law of the Bangs.
A healthcare camp underway for members of the tribal community
When gynaecologist Rani Bang first began researching the reproductive health of women in 1985, she was stepping into new terrain. “It was mostly about maternal issues and family planning,” says Dr Bang. “All the other components of reproductive health were missing. But my experience at medical colleges and district hospitals told me otherwise.”
Dr Bang soon learned that there wasn’t a single study on issues such as reproductive tract infections, infertility and cancer. After teaming up with her husband, Abhay Bang, and setting up SEARCH, she decided to undertake the first such study.
What Dr Bang found out was revealing: 94% of the women surveyed had suffered reproductive tract infections. On average, each woman had four types of ailments, yet a mere 8% had sought medical help.
During her interactions with women in Gadchiroli, Dr Bang realised that they could not visit a health centre every time they had a gynaecological issue. “So we decided to create a cadre of traditional birth attendants [TBAs].It was a challenge but there was no other alternative.”
The TBAs led to a broader engagement with the tribals and their way of life. “At my camps I would tell them that I would teach them something about health if they taught me about the flora in the district,” says Dr Bang. “That’s how I got educated about the different trees in the region.”
Naturally, there were surprises along the way, like the time when a TBA told Dr Bang how a particular branch of a tree could be used to kill one’s husband. “I was taken aback,” she recalls with a laugh. “She told me that if her husband were to harass her or get involved with some other woman, she would use the branch to finish him off.”
Dr Bang’s documentation of her interactions with the tribal women, village healers and others led her to write a book Goin, which means ‘friend’ in the Gondi language. The book describes the relationship between tribal women and various trees.
Other discoveries led to other engagements. Dr Bang found that 48% of non-tribal married girls had pre-marital sex, although no one wanted to discuss it. She also had unmarried school girls approach her about problems relating to incomplete abortions. “I realised that when you talk to students, you have to discuss issues such as reproduction, adolescence and sex education.”
That got Dr Bang giving lectures on sex education to students and their parents. “People were shocked and reluctant to hear me initially. But now there is huge demand for such lectures and I’m invited to different parts of Maharashtra.”
Of greater import than treating alcoholism has been SEARCH’s long-running effort to minimise infant mortality in Gadchiroli, and it all began on a rainy day in 1993 when Dr Abhay Bang was at his home. There was a knock on the door and standing on the threshold were two women with a baby gasping for breath.
“I didn’t have an examination table at my house so they placed the infant on my bed,” recalls Dr Bang. “But before I could do anything, it stopped breathing and died right there on my bed. It was a shocking experience to have a baby die like that in front of me and to be unable to do anything.”
The good doctor’s first impulse was to scold the infant’s mother but then he heard her story. The woman’s husband was an illiterate alcoholic. She had lost her first child similarly and when the second became sick, she went to a local witchcraft practitioner. This provided no relief and that led her, finally, to seeking out Dr Bang.
The tragedy prompted Dr Bang to launch “an audacious experiment” — training women villagers to care for newborns like experts. Naturally, there was some trepidation before launching the intervention. Dr Bang consulted paediatricians from the All India Institute of Medical Sciences, Delhi, and other reputed institutions.
“They evaluated our programme for three days, at the end of which they concluded that the women who worked for SEARCH [there were about 30 at that point] knew more delivering a baby than many medical graduates,” says Dr Bang. “When we launched the scheme, infant mortality was at a high of 76 per 1,000 births. By the end of the third year it had come down to 30.”
SEARCH has gone on to replicate this initiative in other parts of Maharashtra and the central government has adopted it in five states. The success of what began as an experiment has fetched the Bangs several awards at the national and international level. Just as significantly, it has attracted budding physicians like Dr Malik to work for a cause that is as much social as medical.