India needs thousands of barefoot ‘ward boy’ doctors

By Abhay Vaidya After having relentlessly hammered the Bulandshahar district government hospital in Uttar Pradesh for allowing a ward boy to administer injections and stitches in a medical emergency, Indian news channels may now want to attack the late social worker Baba Amte’s son, Dr Prakash Amte for using tribals as medical assistants. Or, they may want to condemn the eminent social worker Bunker Roy who established the famous Barefoot College at Tilonia, Rajasthan. This institution, says its website, trains villagers “with little or no educational backgrounds” to serve as “doctors, midwives, pathologists and dentists” in rural India. [caption id=“attachment_374523” align=“alignleft” width=“380”]  A stitch in time. Reuters [/caption] At Hemalkasa, 360 km from Nagpur in the Maoist-infested region of Gadchiroli district, Dr Amte has established a 50-bed hospital and OPD centre that treats about 40,000 Madia tribals annually. Like in Tilonia and many other parts of India and the world of poor nations, Hemalkasa has a training programme for “barefoot doctors” who provide first-aid in the outlying villages. One would think that there is little difference between them, other barefoot doctors and the Bulandshahar ward boy or the Ballia sweeper who was found stitching wounds. Thus, the real story from Bulandshahar and Ballia is not that a ward boy and a sweeper administered injections and stitches to patients, but whether they did it flawlessly. If the ward boy followed the procedures correctly and helped save the lives of the accident victims, then he and his seniors deserve to be felicitated and not punished. Agreed that they should have been wearing medical gloves as a part of the procedure - but then, in which part of the world do barefoot doctors have access to disposable gloves? Also, why pick on them when many of us highly educated folks drive ourselves to death by not wearing helmets and seatbelts as per the rules? On Tuesday, Indian news channels went wild with footage showing a ward boy from the Bulandshahar district government hospital, UP, giving injections and administering stitches to an accident victim under the supervision of the hospital’s medical supervisor. A little later, another story of a sweeper stitching wounds in the emergency ward of the district government hospital in Ballia surfaced, further stoking the issue. At the Bulandshahar hospital, the medical supervisor did not feel intimidated and did not cow down before the sudden glare of media cameras. He explained that the situation was an emergency following a road accident in which over 20 people had been brought to the hospital. He boldly defended the ward boy by saying that he had provided medical assistance on numerous occasions previously and that he was doing so under medical supervision. On one news channel, a young anchor with beautifully streaked hair was not willing to accept the reality of rural India where there is an acute paucity of doctors even in district headquarters and taluka towns. The discussion soon turned political, with the BSP and the SP being blamed for neglecting rural healthcare, as though the problem of poor healthcare was restricted to UP, when in fact it exists in every state across the country. On another channel, Mr India was at his bullying best as he spoke on behalf of the nation and sought an explanation from the Bulandshahar medical supervisor, Dr Shishir Kumar. Rather than establish a dialogue with Dr Kumar, this anchor had already indicted the superintendent and hammered him adequately, forcing him to abruptly walk out of the live interview. None of these channels had a word to say about the celebrated model of Barefoot Doctors or suggest that what the ward boy or sweeper had done was to precisely function as barefoot doctors. The ward boy was not formally trained but certainly, he had been giving injections and administering stitches under the supervision of the hospital’s doctors. The poor state of public healthcare system in India is part of a larger debate and discussion. The renowned medical journal Lancet and the World Health Organisation (WHO) have extensively commented on the paddy farmers-based Barefoot Doctors model institutionalised in China by Mao Zedong. The WHO in 2008 noted that these village doctors “have dramatically improved access to health care in China’s rural communities over the last few decades”. They had helped control major epidemic diseases effectively unleash mega campaigns on health and sanitation and improve nutritional status. In a detailed report, Down to Earth magazine presented the story of an NGO, the Society for Social Health Care in Bihar which undertook a six-month course to train matriculates in basic healthcare in many villages in Arrah, Nalanda, Gaya and Patna districts. The NGO’s head, RD Singh, a retired health official explained, “Given the horrible condition of health service in Bihar, we thought that if China could produce barefoot doctors in 10 days, why couldn’t we produce ‘First Aid Physicians’ in six months? The article said that some of these barefoot doctors had actually saved lives and helped hundreds of people recover from common illnesses. Unfortunately, some were found to be administering injections without sterlising the syringe properly. This is better training is required for the barefoot doctors of India. The Bulandshahar ward boy and Ballia sweeper are excellent candidates for training and serving as barefoot doctors in rural India. Rather than condemn and punish them for what they did, it would serve a more constructive purpose if news channels paid a visit to Hemalkasa, Tilonia and other parts of India to report on villagers “with little or no educational backgrounds” serving as “doctors, midwives, pathologists and dentists”.