A TYPICAL MORNING OF CHARITABLE MOBILE HEALTH CARE WITH SHANTI AROGYA MANDIR

Outside the ashram at Magod Welcome Center stands a white van emblazoned with a red cross and the Shanti Mandir logo: the Shanti Arogya Mandir mobile dispensary. It’s a quarter to nine in the morning and Dr Rakhee Thakar has been joined by her assistant Veena Pathak and the driver to finish loading the van with boxes of medical supplies.

We are joining the medical team as it does its rounds of nearby local villages. The motor starts up and we clamber hastily into the van and sit on bench seats, squeezed on either side of all the equipment and medication which takes up most of the room.

First stop is Bhagod, ten minutes away, where we pull up under a big shady tree.

With the efficiency that comes with practice, the team gets organized, setting up plastic chairs on either side of a table where Dr Rakhee arranges her equipment: stethoscope, blood pressure machine, notebook, jars of commonly required drugs, and anything else she might need in attending to the diverse needs of villagers.

It’s just on 9am and within seconds a crowd gathers. It is composed mostly of women and children but the first patient is an elderly man with high blood pressure. Dr Rakhee checks him with the BP machine and Veena dispenses the required tablets, carefully ensuring he understands how to take them.

Next a sari-clad woman ushers forward her little girl. The child is suffering from earache and, after inspecting her ears with a penlight, Dr Rakhee inserts drops to dissolve the impacted ear wax she has found. Next in line is an elderly woman suffering from anemia and hypertension who is examined and dispensed a week’s supply of iron and low sodium salt.

Between painstakingly explaining procedures and preventive measures to the patients Dr Rakhee keeps careful notes. Meanwhile Veena spends her time alternately controlling the crowd and selecting medication from the stack of bottles and boxes still in the van, quietly assisted by the driver.

A wan-looking woman, prematurely aged at 35, is given painkillers for injuries inflicted by her drunken husband – an occurrence sadly common in these villages where alcoholism is rife. Two women receive non-sedating antihistamines for streaming eyes and noses. A significant number of patients have high blood pressure, anemia, infections and diabetes. Tuberculosis and waterborne hepatitis are also common.

Many patients have brought along empty tablet foils to show their drug history, a clever move in a charitable regional health care system too stretched to keep sophisticated medical records.

An elderly woman with fever and bronchitis is given antibiotics and put on a nebulizer to relieve the congestion in her chest. A little girl, wheezing loudly, is found not to have been taking the worming tablets prescribed a week ago. Picking up a syringe and waving it in the air, Dr Rakhee threatens: “If you don’t take your medicine I’ll have to give you one of these!”

One woman has come on behalf of her diabetic and nerve-damaged husband. She goes away with vitamin B12 and diabetes medication. She has to be told verbally how he should take them, as, like most of those attending today, she cannot read or write. An undernourished little girl with a chest infection is followed by a woman with indigestion and constipation. Rakhee laments the fact that the villagers’ eating habits are poor and that many children’s staple diet consists of fried salted snacks which come in temptingly bright packets. “For one rupee they get a pack of processed, artificially colored, crunchy junk.”

She begs them, “Stop drinking plastic pouches of fizzy drink.” This equally cheap and enticing confectionery contains dangerously unacceptable food grade artificial coloring. The combination of poor nutrition and unhygienic conditions develop allergies in the villagers which in turn lead to full-blown infections.

Two more people with lung complaints pass through the rapid but efficient diagnose-and-dispense system before it’s the turn of a little boy with a badly burnt foot and a nasty cough. He nods his head solemnly as he listens to the instructions for applying a lotion and taking cough syrup. Yet another boy has gastroenteritis, and an old woman with asthma is followed by an elderly man who regularly attends the clinic on behalf of his neighbor who is immobilized with osteoarthritis. He leaves with a supply of anti-inflammatory drugs and glucosamine tablets to take back to the sick man.

Still the cases come: a little boy with bronchitis is sent to the side to be put on the nebulizer by the driver, a woman in her fifties is treated for osteoarthritis and conjunctivitis, a middle-aged man with a cough and reflux is attended to and a woman receives treatment for an abscess in her cheek.

A two-year-old boy is brought by his twenty-two-year-old mother. Dr Rakhee points out a burn mark on the child’s torso. “Some mothers deliberately scar their children with hot pokers in the superstitious belief it will help them,” she says.

Another little boy with red raw cracks on his bare feet approaches with his mother. A mother with a baby-in-arms complains of her painful joints and the baby’s cough. More sufferers of hypertension are given blood pressure tests and issued with a week’s supply of pre-cut foil-sealed drugs. An alcoholic man whose body is numb is given an injection.

Finally the last patient presents: a woman who has developed an allergy from cleaning rice. 

It is time to pack up and by now Dr Rakhee’s team has seen and treated 65 patients, all in the space of an hour and a half.

The van was donated by a local family of long-time devotees. Some of the supplies are samples donated by drug companies, other drugs are donated by doctors who are also devotees or supporters of this work. Some of the donated medications are traditional Ayurvedic preparations. In all cases use-by dates are strictly adhered to. Dr Rakhee says straightforward donations of money are also vital as those funds can be directed to specific needs as they arise.

We are almost ready to depart when another woman with a baby rushes up. Rakhee examines the pair in the back of the van, bringing the total number of patients seen in this village to 67.

En route to the next village, Dr Rakhee laments the fact that the general lack of work opportunities in the region creates an endemic lethargy in the local men. They seek solace in a potent alcoholic brew prepared with battery acid which results in lead poisoning and the numbing condition known as peripheral neuropathy. Sufferers lose the ability to feel either heat or cold, and if they are already afflicted with the commonly occurring diabetes, they develop ulcerated sores.

It’s 11.20am when we arrive in Hariya, and, sure enough, there are groups of men hanging around idly smoking bidis and passively looking on as our team unloads and sets up.

There is a local government health care system but it does not provide any social welfare or follow-up.

It’s clear these communities need to have their outlook changed, especially about alcoholism and hygiene. They need to be shown alternatives. Dr Rakhee says many of the men use the excuse that they can’t find jobs while allowing the women to work in local fields for a pitiful daily wage.

There are state health care workers whose job it is to bring aid to poor villages like these, but either out of laziness or ignorance some are careless with record-keeping or simply dole out paracetamol without even examining the patients, often blaming unwieldy bureaucracy for such neglect.

However, change is unfolding.

When Shanti Mandir started operating this mobile clinic in May 2003, Gurudev, Mahamandaleshwar Swami Nityanand stressed that not only did volunteers need to provide medical aid and regular post clinical care, but they had to become acquainted with people’s grassroots needs so they could also provide appropriate remedial education and ongoing training.

As a result of this policy, Dr Rakhee explains, Shanti Arogya Mandir’s ventures into villages around Magod developed into a children’s educational project which is similar to the Shanti Hastkala scheme whereby adult villagers are trained to make handcrafts for self-sufficiency.

“Every alternate weekend we conduct programs in local schools. The children here are sadly deprived of creative stimulation, so alongside health care lessons we offer craft classes. Unlike in most city schools, these village schools don’t even teach basic needlework, so simply learning how to make something as basic as a paper bag can make a big impact.

“The government infrastructure itself is not so bad. There is a system called DOTS – Directly Observed Therapy under Supervision – but it doesn’t run smoothly and there are many cases of inconsistency. For example, alcoholic patients won’t comply, others don’t take their medication, few understand about the dormancy of bacteria and everywhere there’s laziness.”

Our next stop is a re-settlement colony of Bhagod called Navinagri. Many of the people already waiting for us are bare-footed; several have rashes from poor nutrition; most wear threadbare clothes. Most of the men in this village are alcoholics. An old woman over 70 – bent, thin and weak – is given calcium, Vitamin B12 and Vitamin E. A girl who doesn’t look more than fourteen brings her 25-day-old baby. The girl says she went back to work in the fields just eight days after the baby was born. The baby has difficulty breathing. Another young mother brings her two-year-old who is still living on breast milk. Treatment includes an iron supplement for the child’s diarrhea but the mother has to be told to feed the child rice and dhal, too. A man comes to get medication for his wife’s tuberculosis of the spine. He says she is walking again and is a lot better. Dr Rakhee has to stress that despite her improvement the drugs must be continued or his wife will be immobilized again. Misunderstandings can easily occur and there are cases where patients have taken the wrong dosages prescribed the previous week. In fear some even halve the dosages to make their medication last longer.

One after another they come for help and by 12.30pm, Shanti Arogya Mandir has seen, examined and treated 105 patients. Throughout it all, Dr Rakhee Thakar remained calm, patient and actively compassionate.