Earlier this week I was out on the road, travelling to two villages, both close to Bandipur National Park but about forty kilometres away from each other. As we neared the first village, I noticed a vehicle that looked like an ambulance parked by the side of a road in an hamlet. I stopped the car, got off and decided to learn a bit about how rural health care worked.
The vehicle, owned by a foundation, was a rural mobile clinic really, not an ambulance and does a round of four villages a day, covering about twenty villages a week.
The driver of the ambulance was welcoming and invited me to take a look inside. The doctor – a young, thirty year old fellow, who could speak English only with an effort - was sitting by an empty bed, inside the vehicle. I introduced myself and asked him if I could learn more about their work, to which he nodded.
“Are you an allopathic Doc ?” I asked.
“Siddha, allopathic, anything.” he replied.
Anything?
“Yes, depends on the ailment,” he answered.
He sensed the doubt in my voice and shifted his gaze to the cardboard box by his foot, which was full of used syringes – there must have been a fifty or more in there. By his side, were eight bottles of injectables, some of which I recognised as paracetamol, B Complex and pencillin. All these injections were this morning’s work, he said, not without a tinge of pride.
As I spent the next ten minutes watching him as he attended to patients, the conclusion was clear : here was a Siddha medical practitioner (Siddha being a largely Tamil variant of Ayurveda), who was shooting a syringe of allopathic formulation (about which he would know a damn) into every patient who popped in, the indication of his success not being the state of the patient, but being the number of syringes in the box. His choice of injection seemed bizarre and, without any particular line of questioning. This is not healthcare and can indeed harm ignorant, largely illiterate people, whose unspoken contract of trust is being mis-used with nonchalance.
If I take this up with the foundation, I will get predictable answers such as, “Which allopath would want to spend his days in a vehicle in a remote rural area?” or “Villagers have a fetish for injections and do not accept tablets or syrups as solutions.” Both these are right, yet they do not justify doing the wrong thing.
The next morning, I was at Karemala – at the primary school there - and another rural mobile clinic toddled up, this time belonging to another foundation, run by a remarkable man of high personal integrity. At the sound of the vehicle, all the children in class stood up and asked the teacher permission to visit the doctor – every single one of them! It was remarkable to see a line of them standing patiently by the ambulance, even as I decided to board the vehicle from the front.
For starters, there was no doctor inside, only a bored-looking chemist. He had decided that he would elevate himself on this day and had therefore taken the doctor’s chair. The first child – a scared six year old - shuffled in; he spent ten seconds taking the child’s pulse and asked her the problem. She had a cold. Out came a strip of tablets. “Take half a tablet in the morning and half at night, and now make way for the next child.”
Fifteen minutes later, the man had dismissed seventeen patients – all the chidren of the school - and I was suspicious. I went back into the school and, as the children trooped back in, I took the tablets from them. Here’s a sample of what he had given them, other than paracetamol, which he seemed to ration out at the rate of one tablet per child to most of the kids, as if it was some delectable toffee.
• Etofylline – 1 tablet per head for five children. I learnt later that this is an anti-asthmatic drug and would be useless if given this way.
• Amoxycillin 250 mg ( an antibiotic) – he gave 5 capsules to a child who complained of throat pain. This child had no temperature, no white spots near the tonsils, no cough or cold and seemed to be fine otherwise.
….and so on.
In addition to his frivolous dispensation of medicines, he seemed to have touching faith in the ability of the six year olds to remember dosage and regularity; there was no need to write something down for the teacher to monitor or even ask if a parent was around to join the consultation.
I tried to hide my anger and, instead, taught the child with throat pain to gargle with salt water, while the teacher, at my request, took the medicines away from the children. We both decided to work urgently on a better system that ensured minimum quality at least for this village.
What is common to these ‘clinics’? They are both set up by remarkable people, whose integrity and intentions are beyond doubt and who would not tolerate such slack. In their ambition to scale the program, though, they have lost sight of just what it is doing for its target audience.
In the train to Bangalore, I pondered on the old maxim of quality being inversely proportional to quantity. Perhaps, in humankind’s most important needs of healthcare and education, less is more.
