BackPhoto Essay: The distance to healing
A healthcare system set up by a group of doctors is the only ray of hope for tribals in this corner of Chhattisgarh
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The afternoon sun filtered through the yellow-tinged leaves of teak and sal, creating kaleidoscopic patterns as we drove through the Achanakmar Tiger Reserve in Chhattisgarh. Ajay, the ambulance driver at Jan Swasthya Sahyog’s (JSS’) hospital in Ganiyari, was driving us to the remote village of Boiraha, where Matwarin, her husband Chherturam, and their daughter were to be dropped off at their home.
The JSS is a not-for-profit set up in 1996 by a group of nine doctors, five of whom were pursuing their master’s at the Delhi-based All India Institute of Medical Sciences (Aiims) at the time. Instead of plotting their way to plush clinics in metros, they put their heads together to set up a healthcare system in a much neglected tribal region of Bilaspur district. “We went around the country identifying places where doctors were needed most and, after three years of exploration, decided to establish ourselves in Chhattisgarh with the help of local groups," says Yogesh Jain, one of the founders. The need for primary and secondary medical care was all too evident, and the group was keen to put in place an effective, community-based healthcare system with preventive medicine at its core. Four of the founding members, including Dr Jain, are still practising in Ganiyari.
The not-for-profit began slowly, trying to get a holistic view of the lives of the people it intended to work amongst—the social structures of the tribal groups, their customs and rituals, agricultural practices and their implications on diet, areas of disengagement with the system, and a clear mapping of the prevalent health issues in the area such as “under-nutrition", maternal health, tuberculosis, malaria and snake bite. Dr Jain says they leased the land on which the hospital stands today from the government in May 1999; it already had structures built for an irrigation colony. In just a year, as the organization, its supporters and sponsors grew, it turned into a referral hospital. An operation theatre was added the next year.
Today, the JSS is funded by grants, donations from trusts, primarily the Tata trusts, as well as private donors in India and abroad, who contribute via a network called “Friends of JSS".
The hospital now has 70 beds, a fully functional lab, two large operation theatres, and runs a diploma course in family medicine. The four doctors here see up to 350 patients a day, three days a week, in the OPD, or out-patient department.
The JSS has also set up three sub-centres in the far-flung areas of the tiger reserve, in Shivtarai, Bamhani and Semariya, to dispense basic medical care to people living on the fringes of the forest.
It was at the Bamhani sub-centre that Matwarin and Chherturam first presented themselves. The doctors recall that Matwarin looked frail and distressed, weighing a mere 35kg and had a swelling in the abdomen, coupled with recently worsened pain. Chherturam complained of a persistent cough with occasionally bloodstained sputum. Matwarin was diagnosed with cancer, Chherturam with tuberculosis, and their treatment begun.
The idea behind taking Matwarin and Chherturam home was to witness first-hand what accessibility to healthcare really means in this part of the country. It is hard to fathom why a 76km journey should take more than 3 hours until one actually treads this landscape, where a four-wheel-drive ambulance with a skilled driver is the only ray of hope in a medical emergency.
Ajay was doubtful we would get past the village of Katami. The Maniyari river had to be negotiated, and even though it was October, the tail end of the monsoon, he anticipated an unfathomable level of water. However, nature’s frugality went in Ajay’s favour; the season’s scanty rainfall, combined with consecutive dry days, enabled us to ride gingerly through the river and, from there, along a 100ft-wide clearing in the forest. It was dark and beautiful, the kind of place where you might expect to see Rudyard Kipling’s Mowgli.
After a bum-numbing three and a half hours of travel, we finally made it to Boiraha. Entering her house, Matwarin fished out a much crinkled plastic cover hidden deep in her bag, pulled out two hundred-rupee notes and thrust them into Ajay’s hands. She only had five more notes left. Ajay refused to take the money, saying he was just doing his job.
Matwarin sat down on the earthen floor and broke down.
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