A
question we have been asking for at least the last five years: what can doctors
do on social determinants of health? Not least, I posed this question when
accepting election as President-elect of the World Medical Association. I
finished my speech with a quote from Ghandi. Dr Jitendra Patel, (now immediate
past-) President of the Indian Medical Association, said: I will start a hunger
strike and won’t finish until you come to Ahmedabad. We will take you to a
tribal area and show you what we are doing to improve the lives and the health
of tribal people. People, that is, who have been socially excluded from the
mainstream of Indian society and live in great poverty.
I
had to go to check on Dr Patel’s state of nutrition. Indian hospitality
certainly enhanced mine.
Gujarat
is not one of the most populous Indian states – population “only” 60 million;
Uttar Pradesh is 200 million. About a three hour drive from the big city of
Ahmedabad, near the Pakistan border, is the Virampur area of the Banaskantha
District. Getting there was an ordeal of embarrassment and gracious
hospitality. At four stops organised by local branches of the Indian Medical
Association we were greeted by dancers, drums, pipes and banners saying:
Welcome to President-elect of the WMA. There followed garlands of flowers,
shawls draped round the neck, and a slight sense of disbelief on my part that
this could be happening.
At
Virampur, we were part of a ceremony of opening a new multipurpose facility to aid
the work of the Samvedana Trust in improving the lives and the health of tribal
people in the area.
The
work began when Ketan Desai, also based in Ahmedabad, was President of the
Indian Medical Association at the beginning of the century. He proclaimed the
Ghandian slogan: let’s go back to the villages. Dr Jitendra Patel picked up the
challenge and began with medical camps ‘under the Banyan tree’ in the tribal
area of Virampur. He and his willing colleagues voluntarily treated the
illnesses of tribal people from 42 villages in the area. What began with
medical camps and on the spot treatment of disease grew. Over a ten year period
from 2004, more than 40,000 tribal, and other poor, patients were treated – not
at their expense – including over 11,000 operations at a nearby hospital, or in
Ahmedabad.
Medical
care to the under-served is vital and filling a gap, but as we said on the
CSDH: what good does it do to treat people and send them back to the conditions
that made them sick.
Note the goat
sharing this woman’s front room.
These
doctors went further and established the Samvedana Trust. A key figure is Dr
Jitendra Patel’s older brother, Hasmukh Patel, social worker, social activist,
and all-round good person. He lives simply in the tribal area on the site of
the new building.
One
among the many reasons, including prejudice and discrimination, for the
marginal existence of the tribal groups here was the dry parched nature of the
landscape. Hasmukh Patel, and the Samvedana Trust, were instrumental in
establishing a system of 90 ‘check-dams’ to capture the water from the
surrounding hills. With irrigation, agriculture is being transformed and
migration to seek work has been reduced.
The
Trust is actively involved in education, in helping gifted children to go on to
further training, in promoting handicraft production as a commercial activity,
and in generally promoting community development.
One
of the lessons I have been taught in India is that government activity is
central to improving the lot of the vast population of the nation’s poor. But
so, too, is civil society. With an Indian population of 1.2 billion (in the
2011 Census) it is hard for any government to reach into the remoter corners of
tribal areas, quite apart from issues of endemic corruption. An inspired and
inspirational civil society organisation such as the Samvedana Trust can be
transformational.
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