I was on my first field trip, from my first ever job as a Development Professional to Gwalior. Access to health, they said, is the whole issue but yes developing a channel for selling our trustworthy brand of contraceptives was a SMALL part of my deliverable. Excited and pumped up with a heady mix of the red theories and aspiring for that blue collared intellectual space, I started with an open mind. Disappointment crept in when the 'channel' got exposed. Registered Medical Practitioners/Rural Medical Practitioners/RMPs/Jhola chhap doctors was the concept I had to work with (of course rendezvous in person happened much later). How can an organisation promoting health for all work with an illegal group? Why am I the chosen one? My ethical sensibilities don't allow me to work like this. Still, with an open (read:disappointed) mind I started.
RMPs is this sect of unqualified people who pose as medical practitioners.There degrees can range from whatever ABCD, MABBS,BUMBS and what not. I reached Gwalior, Madhya Pradesh and started for the journey into the remorse right away. The field executive was very enthusiastic and had taken the entire list of RMPs in the region, it had close to 150 names. We reached (Dr.)Anil Kumar's clinic (dawakhana), a dingy side room, with one bulb, stained yellow un-plastered walls and a board elaborating his medical accomplishments. He sat behind the table on a broken wooden chair chewing tobacco. There was other chair but yes a bench that also functioned as the operating table, I preferred to stand. The table had a prescription pad provided by some pharmaceutical company and the most interesting a pen stand with inverted syringes, a bowl with many needles. He said, its difficult to get supplies from the city, so he uses them but cleans them religiously with spirit after every use. He learnt to do deliveries as hands on experience and also does most kinds of surgeries. My fears got stronger, however, I headed for my next point, (Dr.) Rajiv's clinic. A young, not more than 20 yrs, (Dr.) Rajiv was attending to a patient for fever. I was about to talk to him about women's health when a man on a motorbike arrived. He was covering the head of a seven year old girl with his handkerchief that was now soaked in blood and blood had trickled down till her neck. An emergency, while playing the girl had fallen from the terrace. Our doctor sahib runs from his seat, he apparently knew the guy by name and out were his instruments. Very promptly he stitched the wound up and wrote for some medicines. I couldn't take this and shouted at the girl's accomplice that why didn't he take her to the hospital or a proper doctor and if intends to do it now? "Madam ji, nursing home yahan se 70 kms door hai, agar wahan le kar jata toh ladki raaste mein he khatam ho leti" (Madam, the hospital is 70kms from here, she wouldn't have survived if I would have taken her there). He also said that the doctor was very close to their community and residents have family like relation with him. On this journey I met RMPs who were also counsellors for any kind of marital dispute to feud over property. There was a (Dr.) who on the model of a cyber cafe charged Rs.50 for an hour of saline water through intravenous. Then the same set is used on another customer. But yes, all of them were located where no other medical/health service was available.
Is this mushrooming of RMPs there because any other health system cease to exist? Till date I haven't been able to place the RMPs in a positive or a negative light. All theories went for a toss in front of the human necessity. How will a poor family take a woman in labor to a clinic that is miles away? Why will a mother-in-law trust an angrezi (english) doctor who scolds and misbehaves vis-a-vis her own local doctor who also has an ear for her worries? However, is this an excuse to continue this dangerous, irresponsible and risky business of health?
My journey had just begun and with an open mind I started.
