Sunday 29 April 2012

KHS-Real Supporter

Kasturba Health Society, Sevagram is providing financial support to the Mahatma Gandhi Tribal Hospital.  Late Dr. Sushila Nayar, Hon. Dhirubhai Mehta and Hon. Halbe sir are extending their support as much as they can to Dr. Satavs for improving health status of tribal of Melghat. Their contribution is unparalleled.

Lead by Example-Beyond medical profession

A Road traffic accident:
            Once a truck carrying more than 50 passenger fallen down in river near Bihali village. More than 10 people died on spot and more than 12 were serious. No one was ready to help the serious patients. When Dr. Satav  noticed it, while passing by, he immediately stopped,  got down into the river and removed all 12 serious patients & sent them to hospitals. We could save 11 lives. Later on our team saved many lives in similar accident cases.

Friend of Snakes:-

‘Karmgram’  is surrounded by forest & farms.  There are lot of snakes including poisonous snakes like Cobra, Krait and Vipers, etc.
There are many interactions with these snakes. Few of them are worth mentioning.
·         Once Kavita was arranging cloths. She suddenly found a snake lying on the cloths.
·         I was about to go to bed. To my surprice black cobra was near the head end of my bed as if it was welcoming me.
These interactions offered us opportunity to learn snake catching. Subsequently we became Sarpamitra (friend of snakes). Being a Sarpamitra, we don’t kill snakes but catch and release them in surrounding forest.
One day morning we found a black scorpion lying quietly on bed of our son Athang.

Social Committment won over personal life

A}  It was September 6th, of 2011, I got phone call from Kavita’s sister in law that Kavita’s father is very serious and gasping.  She asked me to inform Kavita. At that time Kavita was examining 20 school children selected from school screening. I did not inform her till she finishes the work.  Later on she requested me to accompany her to Akola to save life of her father. At that time , there was one young patient of heart attack (angiography revealed 99% block in coronary arteries done after discharge) in our hospital who was serious. We discussed and decided that this young man’s life is more precious and if I leave for Akola the young patient may  die. So Kavita alone went to Akola.  At night around 11 pm , I got the message that Kavita’s father died.  I informed to Athang who was with me. He started crying like anything.
At that time two more patients suffering from ischemic heart disease were admitted in our hospital. At the same time one more patient of heart attack who was operated few months back (bypass surgery) came to hospital at 11 pm. She was the person who provided me food for few days during our initial period of Melghat hospital. 

Athang was very nervous, I was confused whether to go to hospital or counsel Athang who was alone. Any how I requested crying Athang to be with our servant Sanjay and went to hospital to treat that patient.  I could save all three of the patients. Next day when the patients settled down and discharged then myself and Athang went for the funeral.

B}   Few months back my mother was admitted in intensive care unit of Sevagram Medical college for angina. As there were patients of heart diseases admitted in Melghat hospital, I could not go to visit my mother.

Once when I was a lecturer, I got message from Hon. Dhirubhaiji (President, K.H.S.) asking me to rush to Sevagram for appearingfor the interview for the post of university Associate professor. At that time one 30 year young poor tribal lady was admitted in our hospital in comatose condition.  She had 3-4 children. I preferred not to attend the interview and tried to save her life at cost of own professional life.

C} Once Athang had severe attack of Bronchial Asthma and I had to attend important policy level meeting in Mumbai. Kavita & I, we divided the responsibility. Kavita took care of Athang (in absence of any paediatrician in Melghat) and I attended the meetingwhere I could significantly contribute in improving the policy which resulted in saving lakhs of poor children.

Personal Memorable Life Experiences:

A} Coming out of personnel comfort zone-
       Since birth,our son, ‘Athang’,who was brought up in Melghat only,has asthma problem & use to get  severe attacks.There used to be many health problmes of Athang specially during night time, like high grade fever, Bronchial Asthma, pneumonia, rupture of ear membrane&severe ear pain etc.,As there is no pediatricians in melghat, nearest  district hospital is 150 Km away, road is through dense jungle & ghats, no ambulance, every time we had to treat him at our hospital  only. Though we could manage it successfully, we thought, we both are highly qualified doctor, still cannot provide expert pediatric facilities to our son. But then we realized that we have to come out of our own personnel comfort zone to serve the society.    

 B} Supporters helped to extend work-
      For first couple of years, I used to go to interior villages through forest either by two wheeler or by bullock cart or walking for treatment of patients and health education. Melghat is famous for wild life like tiger, leopard, wild bear, etc. So Kavita was afraid of my life. My elder brother Avinash offered his tempo trax jeep (which we  used for next 7 years) , due to which we could extend our medical relief work to most interior part of Melghat. Now due to ambulances received from Mumbai group of friends, MASTEK & govt., we are able to extend our activities to a great extent in the interior of Melghat.        


C}  Determination of Kavita-           
       In 2007-08, Kavita developed heart problem-neurocardiac syncope leading to ventricualar bigeminny, but she never thought of running away from her work or Melghat. On the contrary she has expanded her work to more than 150 villages spread across Melghat reaching more than 17000 people & operated more than 700 cases.

  D} Life Time memory
      In 2004, MAHAN developed new hospital & residential campus. Most of the house work was executed with the help of local material & people. In rainy season while shifting the luggage, suddenly I got a severe shock. My mother who came to rescue me also got shock. Both of us were glued to electric wire.One of our staff, ‘Vitthal Pande’heard our shouting & saved us. We were unconscious for some time, but saved.


E} Baba, will you get time for me?-
            In Melghat, I have to shoulder many responsibilities in addition to a physician and the day become so busy that I couldnot spare time for Kavita and athang. For initial years, Kavita and Athang used to get irritated but now they have become habitual of the situation.  Still Athang asks me baba, will you get time for me? For what you work so hard?


Fighting with ill system for wellfare of tribal

A}Public Interest Litigation
MAHAN, KHOJ & some more NGO, together started a innovative ‘Counselor’ program. In India this may be the first innovative program of monitoring of government hospitals by voluntary organisations. This yielded very good results in terms of improving hospitalisation of patients, attendance of doctors & other staff, hygiene,availability of medicines, instruments functioning, etc. However it hurts vested interest of ill elements of system. Govt. stopped  this program. We filed a Public Interest Litigation, ‘PIL’, in Mumbai  High court.  Honorable chief justice JN Patel, Honorable  Chief Justice Mohit Shah and honorable  justice D.Y. Chandrachud ordered govt. health department to restart this program and also advised govt. of Maharashtra to replicate the model all over Maharashtra.


B}Truth can be troubled but cannot be defeated
            As we were exposing non performances, malpractices etc. in govt. health & ICDS system of Melghat, we were always made  target by ill elements insystem. Once  a  person lodged a false atrocity case agianst me and Kavita. Police tried to pressurise us for settlement saying otherwise we will be arrested. At that time Athang’swas appearing for exam. In next few days, I was supposed to go to Germany & Netherland for presenting papers in international medical conferences. But we were firm on our stand of not bowing infront of such wrong allegations and bear whatever will be the consequence. At last it was proved to be false case & we could escape the arrest.
We realised Mahatma Gandhiji’s sentence “Truth can be troubled but cannot be defeated.”

C} Set Back-
            There is a village named ‘Kharya tembhru’.In that village one child died due to negligence of a government nurse. After investingatign we got to know the truth. We also came to know that due to her, health condition in that village detoriated to great extent. But due to fear, she and some ill elements of the villages defamed us and stopped our work in the village and even tried to arrest our team. Later on we filed a PIL in Mumbai high court.


D}Story of community awakening :
            ‘Kokmar’ is the most remote & interior village of Melghat. Due to our efforts the facts about malnutrition & mortality rate in this villages was surfaced out. This exposed the grass root govt. workers. These people presurrised our Kokmar village health worker (VHW) to stop work. It was a great blow to our efforts.Myself along with Friend Aalhad kashikar & few of our staff, went to Kokmar. It was rainy season & we had to cross the dense forest and river to reach to Kokmar. People who got hurt, had told villagers that MAHAN team was defaming village by publishing name of the severely malnourished babies. So the villagers were reluctant to speak with us.
After 30 minutes, we saw a boy walking with a roti in hand. This was the same boy whowas severely malnourished 3 months back,was bed ridden, not getting proper nutrition from anganwadi. Howevere after we surfaced out his condition, he started getting benefit of special diet and health care from govt. As a result he could walk.
We explained it to the villagers. They  were  convinced with the example and started supporting like anything to us since then.

Great Work by Village Health Workers (VHW)

A}        Once a baby was suffering from birth ashphyxia. Sukrai Jambekar, 7th std. pass,  MAHAN’s tribal village health worker performedartificial respiration for 60min & saved baby. Sukrai showed her will power and dedication to save the newborn.
Sukrai was awarded ‘Jamshetji Tata National Virtual  Academy fellowship’ for Rural Prosperity

B}        Once a baby suffering from birth ashphyxia was admited to govt primary health center.  However hospital staff expressed their inability to save the baby. ‘Kantabai Wankhede’, totally uneducated village health worker of MAHAN saved a baby by artificial respiration.

C}        Doctors from subdistrict hospitalreferred a baby patient of neonatal sepsis to Amaravati. Relatives refused and took patient home. Later on , our Village health Worker,‘Sumantara Dhande’, 6th std. VHWsaved that baby by Injection Gentamicin, Cotra and proper newborn care.

D}        Sheela (Keli) and Urmila (Berdaballa) saved babies of other females,by breast feeding them.

‘Let him Die’ -Birth Story of ‘Children Mortality Control Program’:

Melghat is known for malnutrition and children mortality. As I am not pediatrician, I decided not to touch this issue. Once I was in my hut OPD, a tribal widow came with her 2 years old child who was severely malnourished and suffering from bilateral pneumonia. His chest wall was studded with rice, geru (red  liquid), feathers of hen and Damma(skin burnt with red hot iron rod) and garlic mala around neck. He was very serious and I advised the mother to admit that baby. But the mother was reluctant to admit and asked for injection. After repeated request, she denied admission. Then I used my ultimate weapon, saying that if she won’t admit him, he will die. ‘Let him die’- she respondedcoolly.‘at home,I have four more children, goats and chicken to look afterand any how he is going to die’ she continued. She went back with the child. After 3 days, I got the message that the baby died.
I realized rule of survival of fittest and thought if I would have been at her place, I might have thought similarly. But after listening repeated news of children deaths, myself and Kavita used to get anoyyed.
In 2003, five children from 2 families of 2 different villages died due to diarrhea. For two nights, Kavita did not allow me to sleep. She demanded to arrange camps in different villages to stop children deaths at cost of routine O.P.D.  In Melghat , there are 317 villages, our capacity was limited , government could not control the situation in last 10 years by mobile camp approach and whenever there is a disease in  villages , timely proper medical care cannot be made available . So I could convince Kavita that mobile clinic is not solution for reducing childhood mortality in Melghat. I was thinking of bare foot doctors.
During that time, I came across the ‘Home Based Neonatal Care’ approach developed by respected Dr. Abhay Bang, SEARCH Gadchiroli. I discussed it with Dr. Bang and realized its replicabilityand  acceptability in Melghat.
                        Our trust adopted 38 villages for this experiment(Randomised  control trial). We trained illiterate to semi-literate tribal female as Village Health Workers (VHW), for treatment of childhood illness. From May 2005, VHW from 17 villages of intervention area, started treatment of childhood illness. We could reduce the under 5 children mortality & Malnutrition by more than 60 % in those 17 villages which is cost effective and easily replicable model.

{This project received first best oral presentation in National Symposium on Tribal Health by Indian Counsel of Medical Research. I received Young Scientist Award.It was presented in 9 international medical conferences. }

Persistsance-A road to success

            In the beginning, people were suspicious whether a M.D. doctor can stay in Melghat or he will run away within months. Will tribal patient accept me (because tribal patients don’t go to doctors was a prevalent concept at that time) was itself a great challenge. In the beginning, very few tribal patients used to come to me for treatment. Many of them used to go to other unqualified doctors as I avoid unnecessary injections. But I continued my medical care without becoming depressed. People used to suspect whether a doctor living in hut, using bicycle and running hospital in hut is a really educated doctor or not. But when I treated and saved many serious cases of brain hemorrhage, heart attack, cerebral malaria and meningitis, people got confidence in me and I got recognition. Now those tribal who come to me usually become my permanent patient and I become their family doctor. Same is the story of Dr. Kavita. Initially patients were very reluctant for cataract surgery. But with great efforts, Dr. Kavita could operate upon more than 700 patients free of cost. We could influence many govt. policies.

         There are lot of obstacles, not only natural & geographical but man made also, while working in Melghat. Many elements whose vested intereste got affected continuously try to put hurdle in our ways. But now I think, these obstacles are not hurdles in the road but a challenge to test and prove ourselves. The life is like a river. The river is more beautiful when it flows through mountains, valleys, falls, etc.Many times our well wishers like various NGO, individuals, media, various professional, some govt emplyees etc. offered timely supports to strengthen our cases. We thanks all of them.

We never felt frustrated so as to leave Melghat. This is the greatest achievement of our life.

Formation & begining of MAHAN

Due to lack of propermedical facilities & superstitions, tribal goes to traditional faithhealers / quacks (pujari & bhumkas) for treatment of illness. Skin is burnt with red hot iron rod for reducing pain known as Damma.
Moved by such things, we started the project in Melghat in November 1997.
In 1998, I resigned from the post of lecturer in the department of Medicine of M.G.I.M.S. Sevagram and registered a voluntary organization,‘MAHAN’,with the help of like minded people, and started hospital in Melghat. In the beginning, there was no financial support from anybody. During post-graduation and lecturer ship in Medical college, due to simple living especially simple court marriage, I could save some amount. I used those money for running hospital in Melghat. After 4 months, honorable Dr. Sushila Nayar who was the great supporter of the project provided financial support and since then MAHAN &Kasturba Health Society, Sevagram are running this project.

I started hospital in  four rooms rented house in Dharni. It was used for out patient department and for indoor patients in addition to my residence.

Subsequenly started OPD in a hut in one of the farms, at Kolupur. Cycle/ bullock cart/ scooter/ walking were the only options I had at that time for going to nearby villages.

In the beginning, there was no money with our MAHAN trust for purchase of land. I purchased one hector of farm near village ‘Utavali’ and leased it to MAHAN trust for 25 years without any rent. This place was named as ‘Karmagram’  subsequently. Karmgram is surrounded by jungle & farms. One side of road are farms & on other side is complete jungle. One Km from there is a water reservoir where wild animals come for drinking water.Snakes of different species like kobra, viper, krait are like pets, keep visiting Karmagram anytime. Situation forced me to learn catching the snakes. We catch the snakes & release in jungle.Now karmagram is shaping up prograssively & is permanent address of MAHAN.

Melghat at a Glance

   A] Socio-geographics-

            MELGHAT,  known to the outside world by two words “Malnutrition” and “Project Tiger’’, a hilly forest area in the Satpuda mountain ranges is habitat for Tiger, Bison, Bear, snakes and many more animals. ‘Melghat’ stands for its name, which means ‘cluster of Ghats’.
It is 150 Km away from district place  & to reach there one has to cross the forest, mountains & zigzag road(sharp Ghats) of approximately 100 Km.
In summer temperature sore to 48 Deg C.,in winter mercury goes down up to 2 Degree C&It rains heavily (up to 1500mm)  in rainy season. During rain, many times electricity, communication & transportation system collapses completely, sometimes continuously for 8-10 days.
Total 320 villages spread over the area of 4000 sq. kmare located far away from each other having population density is about 60-70 person per square kilometer. Many of these villages are with very poor or no infrastructure like connectivity, transportation, communication, electricity, basic amenitites. This area is  highly lacking with advanced education and health care facilities.
Approximately  75% of the population is tribal in which Korku is main tribe. Most of the tribal (>90 %) are farmers or labors living very hard life. Most of the tribal (>75%) are below poverty line & illiterate (>50%), living in hamlets (>90%) without electricity.

   B] Observation on Health front of Melghat during initial days.

            Main issues in Melghat were very high  child deaths, Premature adults  deaths, Maternal mortality rate, malnutrition & home deliveries (>80%.)
[Under 5 children  mortality rate >100 per 1000 live births & Infant Mortality Rate (IMR) >70 per 1000 live birth. Prevalence of sever malnutrition more than 10%.].

Malnutrition & children deaths of preschool children were burning issue.  Cataract, Addiction, AIDs, Malaria, gastro- enteritis, anemia, respiratory tract infection, hypertension are other main health related issues. In addition, animal bites, illiteracy, poverty, unawareness about farming & good food habits, child marriages, exploitation were other problem areas &needed urgent attention.

Due to lack of proper medical facilities (hospitals, Doctors, staff, medicines, instruments etc) at local level & superstitions among tribals, tribal used to go to traditional faith healers /quacks (Pujari & Bhumka) for illness. ‘Damma’ a method to treat patient by burning skin by red hot iron was widely followed.
Average distance of District hospital is 150 km.