New Delhi: Back in 1986, when Dr Rani Bang and Dr Abhay Bang decided to return to India after completing their masters in public health in the USA at Johns Hopkins University, it was not an easy move. But they were determined to use their training in changing the face of healthcare in the rural areas of India. The husband and wife duo, who could have gone to practise medicine anywhere in the world, chose to work in the rural and tribal belt of Gadchiroli, Maharashtra which is one of the most impoverished districts of India. They founded the Society for Education, Action and Research in Community Health (SEARCH) and transformed the way India tackles high infant mortality and reproductive health in rural areas. On this World Health Day, meet the doctor couple, who was awarded Padma Shri in 2018 for their immense contribution to medicine.
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While talking about his journey of over three decades as a health reformer in rural India, Dr Abhay Band said,
It was my good fortune that I was born and brought up in and around Mahatma Gandhi’s ashram in Wardha district of Maharashtra. I studied in a school that was started by Mahatma Gandhi. I think, exposure to Gandhian philosophy and villages at that time, inspired me to become a doctor. My goal was to improve health and healthcare in rural India. That’s why I went to medical college and studied there and then went to the US and studied public health there. On returning, my wife Rani and I decided to work in Gadhchiroli, a tribal-dominated district in Maharashtra. This was a newly carved out district in Maharashtra, with dense forest covers, too far from Mumbai. So, Gadchiroli needed healthcare more than any other district in Maharashtra. That’s why we cam her in 1986 and started SEARCH- for health and healthcare for villages in India.
According to Dr Abhay Bang, In 1988, SEARCH measured the child mortality rate in Gadchiroli in nearly one lakh population. It was found that the infant mortality rate at that time was 121 which was very high and Pneumonia in children and newborn deaths were the two main causes of mortality among children. At that time there were no national or global programmes to address these two specific issues. He said,
The biggest challenge was how to provide child and neonate care in rural areas. Gadchiroli had only a few doctors at that time, and even among them, nobody was serving in the rural areas. So, we thought a literate man and woman in the village will be the best solution. We called them ‘Aarogya Doot’ (messengers of health). We selected one man and one woman from each village and trained them in taking care of a sick child by examining, diagnosing and if it is Pneumonia then giving oral antibiotics.
Dr Abhay further said that Pneumonia treatment alone brought down the infant mortality rate from 121 to 80 within two years. But the problem was still there. Out of the 80 children, 60 died in the neonatal period which is the first month of their birth. He added,
A newborn is a fragile human being and its survival is very difficult. In Gadchiroli, at that time, no care was available as there was no doctor or hospital in the entire 300 kilometre. So, we decided to train village women to become village level Neonatologists to take care of newborn babies. Therefore, I designed home-based care in 1990 and started implementing in 1995. We developed a team for implementation by selecting 39 female community health workers as ‘Aarogya Doot’. So the community health workers, mothers, grandmothers and midwives became the main pillars who provided newborn care at home. With our approach, newborn mortality decreased by 62 per cent in 3 years in 39 villages of Gadchiroli where we were working. We repeated this in other parts of Maharashtra with voluntary organisations and then the Indian Council of Medical Research replicated it in five districts and everywhere the infant mortality steeply came down. So the Government of India selected this approach for expanding in the entire country. At the same time, the ASHA programme was developing. ASHAs were to some extent developed on our ‘Aarogya Doot’ model. We were asked to design a system to train nine lakh ASHA workers in home-based care of newborns. With six years of work, this became a national policy.
According to Dr Abhay Bang, their innovation in home-based care of newborns does not depend on doctors, nurses, hospitals or costly equipment. It empowers women to use simple medical knowledge and skills to save their newborns.
In order to be responsive to the cultural sensitivities of the area, and to create a tribal friendly space that wasn’t intimidating, the Bangs’ clinic, set up in 1993, was modelled on a typical tribal home. Their Shodhgram campus not only houses the Ma Danteshwari Hospital, but also a temple for the tribal deity whose blessings are essential for healing. It is their home, research campus, and the quarters for their voluntary organisation. On why it was important to build tribal-friendly hospitals and spaces in order to develop care-seeking behaviour among the tribal people, Dr Abhay Bang said,
For one thing, the tribal people felt scared of the doctors and nurses in white coats. They were not comfortable going inside the big buildings, the language spoken there and the way people treated them. So they refrained from visiting hospitals. So, we decided to build hospitals that looked like tribal homes with rooms in the shape of huts.
Drs Rani and Abhay Bang have also started new initiatives that focus on non-communicable diseases such as hypertension/stroke and alcohol addictions in the district. Dr Abhay Bang pointed out that it was the villagers who forced them to take up the issue of alcohol and tobacco addiction.
A study in 2015-16 revealed that the 1.2 million people in the district spent Rs. 350 crore a year on alcohol and tobacco. This was way above the Rs. 157 crore the Government spent as part of the district’s development plan, he added.
Today, the duo have successfully managed to bring total prohibition in the district.
Talking about her pathbreaking research on the gynaecological and sexual diseases among women from two villages in the district, a first of its kind study, Dr Rani Bang said that the study that was published in the prestigious Lancet in January 1989, revealed that 92 per cent of the women suffered from some or the other gynaecological or sexual disease and only 8 per cent had received treatment of any kind. Her study brought attention to women’s reproductive health on a global scale. She said,
When I started working in Gadchiroli, I was the only gynaecologist in the district. I did the first caesarean in the area. I found that very little was known about the issues faced by women here. I did a computerised literature search at the National Library of Medicine (in the US) and, to my surprise, there was not a single community-based study to show the prevalence of gynaecological morbidity; all existing studies were clinic- and hospital-based. I thought it was important to get a deeper understanding of what was happening to the health of women in these communities. So, I decided to do the first-ever research on this.
To understand how women felt themselves, Dr Rani bang talked to several women from different villages in the district. She asked them what their common health problems were, they listed many; so, she asked them to list these problems in the order of seriousness. She said,
To my surprise, all of them put obstructed labour and infertility in the most serious category. I was surprised because I always believed that only a life-threatening condition could be seen as a serious disease. Thus, while listing obstructed labour as a serious issue was understandable, I was taken aback to see infertility as a top concern because nobody dies of infertility. I asked the women why they put infertility as a serious disease, and they said, ‘A woman can die of obstructed labour only once, but if she has infertility, she dies every day because everybody blames her.’ This set me thinking and I realised how deep the problem ran.
Dr Rani Bang added that the problems being faced by women were not just pregnancy and childbirth-related. There were other problems too, such as menstrual problems, reproductive tract infections, sexually transmitted diseases (STDs), and others. Dr Rani Bang asserted that women’s reproductive health is the most neglected thing in the society.
Dr Rani bang said that it is important to focus on girls’ health in order to break the vicious cycle of mother and child disease burden.
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