Pathalgaon, 1992

Pathalgaon in March. Home is a small room attached to St Anne’s Convent, half a kilometer off the main road. It has place in it for a small string cot, a table and a bookshelf. A small bathroom cum toilet is attached. We have learnt to live with the minimum number of possessions, as there is no space for more, but we managed to keep our books. This is the only place we could find after leaving the hospital, which allowed us also to continue our work with RAHA. Dawn, and the drawing up of water from the well nearby, for washing, cooking and bathing. It is only March and already the water level is too low for it to be pumped out. Things will be much worse in summer.

A bath, a quick breakfast of upma and we hurry away to work. Ravi and I walk three kilometres down the road towards Ambikapur, to Asha Deep where RAHA has its training centre. It is 7.30 in the morning and the sun is already hot on our backs. Today we begin training a new batch of village health promotors (VHPs).

RAHA is a co-ordinating centre for over 80 dispensaries and health centres of Raigarh and Surguja districts of Madhya Pradesh. We work with RAHA as resource persons and at present we are training health workers as well as holding refresher trainings for them.

We meet the VHPs, thirty in all, including twelve women. All but one of the women have a toddler with them, and this woman has two young children with her. They will be living at Asha Deep for the next ten days, and group of us will be training them. They will then return after six months for the second training camp.

Introductions take up part of the morning. All of them are Oraon, though fortunately they speak Hindi too. The women have made time to come away from home: the older children will take care of the home and the fowls.

I take the first session in a large hall where we sit in circle on the floor. I tell them the story of Lakshmi, a young unmarried girl who dies of tetanus after a thorn prick. Her parents are too poor to take her to a good hospital. We then discuss all the possible reasons for her death. Everyone participates animatedly, and people recount their own experience of finding health care too expensive; of having to go into debt for treatment; of difficulty in finding transportation to reach a health care facility when someone falls sick. They recount how their own children are unimmunized because the Government health worker is so irregular in her visits. They compare conditions in towns and in their own villages. And finally conclude that the cause of ill health and death is much more than only a “disease”. That social, economic and political factors play a vital role in health too. I am glad they arrive at these conclusions: they are beginning to see that as health workers, they will be involved in much more than just “treating” patients.

We break for lunch. It is past noon and very warm. The toddlers have all already been either breastfed or taken out and given a meal. The hot rice, daal and potatoes makes us sweat even more in the heat. We take a two hour break as the trainees use this time to bathe and wash in a stream nearby.

Back for the afternoon session, which Ravi and I conduct jointly. The trainees sit in two circles and each is provided with a paper and pencil. They are asked to draw the picture of a man or a woman and to label the body parts. Laughter and protests that they cannot draw. Giggles from the women. Meanwhile, one toddler has chewed up his mother’s sheet of paper and she is provided with another one. With some encouragement, all of them concentrate on their drawing. We are doing this so that we have an idea how each of them views the human body and its organs before we teach them body anatomy.

After they finish, a volunteer comes and draws the outline of the body on the blackboard. Each trainee then comes up and marks one body part. There is unanimity in the opinion that all body parts - heart, lungs, liver, stomach, uterus and intestines lie in the midline inside the body. Some body parts are not represented at all.

We stop at this juncture for the day. Ravi and I have to go back and prepare the next day’s anatomy lesson based on their perceptions and what they already know.

The walk back home is pleasanter than the one in the morning. It is 5.30 pm and the sun has set, but daylight lingers on. Back home to a cup of tea, then to relax for a while, then to draw water, prepare the evening meal of chapatis and daal, trying to finish before the inevitable power failure at 6.30 pm. As it gets darker, the mosquitoes buzz around and bite viciously.

I can hear the children singing their evening prayers at the large wooden cross outside our window. These 30 girls live in a hostel attached to the convent and attend school in Pathalgaon. Their ages range from 6 to 12. My interaction with them has been limited to greetings and smiles when we meet occasionally. Fortunately they are healthy and do not require medical intervention often.

The power goes off at 6.30 pm and I light the two kerosene lamps in the room. Tomorrow’s lesson is to be prepared, a letter to be written. After these are done, we go out and sit at the base of the cross in the cool breeze of the evening – the mosquitoes are not as bad here.

The village is very quiet, and the stars in the sky are numerous and I feel I can reach out and touch them. We are cut off from the outside world – no newspapers and what we do get are a few days old. If we are still awake when the power is restored and if the voltage is good enough, we may be able to listen to the radio. I realize I am exhausted.

Am I wasting my time? I wonder. Was three years of hard work for an MD in community medicine meant to prepare me for this life? Did my prepare me for this sense of loneliness I sometimes feel? How do I reconcile Chi-square tests and Poisson distribution and systems analysis with hauling water from a well and teaching village workers about scabies and malaria; and with coping with life in a village in rural MP? I know one day it will all fall in place….

Reflections are interrupted by dinner and more preparation and we go to sleep at 11.30 pm, still by lamplight. The mosquitoes are worse now and as I crawl into bed under the mosquito net and stretch myself out, I realise I am looking forward to another day.