As Delhi’s Commonwealth Games approach and gaping holes appear in efforts to parade the country as an economic powerhouse, organisers could perhaps take a leaf out of one of India’s more successful projects.
India’s Lifeline Express is the world’s first hospital train that travels all over rural India to bring free medical treatment to the neglected poor. The train parks for one month at a selected location where patients are treated for orthopaedic, hearing and visual impairments, cleft lips, and more recently for epilepsy, neurological and cardiac disorders, dental and gynaecological problems – most of which are pre-screened in the nearest local hospital.
It is a hot and dry afternoon in the district hospital of Umaria, a small town in Madhya Pradesh, where Dr Ashok Kumar Agarwal, 62, a volunteer orthopaedic surgeon from CSM Medical University in Lucknow, is assessing patients for corrective surgery. If suitable, they are invited to board the Lifeline Express train in the coming week for their operations.
An elderly lady staggers into a hospital room carrying an 11-year-old boy over her shoulders. She heaves him onto a chair and his legs swing like rubber pendulums, a result of suffering polio at birth. Dr Agarwal examines his lifeless limbs and sends him to join the row of children and babies at the side of the room.
“Next.”
In two hours, Dr Agarwal and his team have screened 90 adults, children and babies and selected 17 who are suitable for surgery – one of whom is Preethi Chaudhuri, a three-year-old who suffered with polio as a baby. As her limbs have not fully formed she has a great chance of successful surgery. She’s asleep in her grandmother’s lap, her right foot curved inwards like the letter C. Her grandmother explains that if she doesn’t have surgery it will be impossible to find her a husband.
On average, 5,500 patients register for treatment at each of the 12 annual projects.
Some 90% are provided with free treatment, while the remainder are referred to nearby hospitals. Since Impact India, an NGO, started the train in 1991, an estimated 600,000 people have received treatment and approximately 85,000 operations have been performed. The success rate is a staggering 100% due to Impact’s partnerships with local sponsors and district health services that ensure monitoring and follow-up at each location.
The pristine train has two shiny carriages that function as sterile operating theatres – one with two tables and the other with three. There are air-conditioned offices, a kitchen and a waiting area fitted with closed-circuit cameras. A dormitory houses a few of the eleven permanent staff: two cooks, six theatre assistants and a driver, all of whom are paid by Impact.
Each project costs around £40,000 and is covered entirely by one sponsor who pays for medicines, the volunteer doctors’ travel and accommodation costs, patients’ food and lodging, ambulances, fuel and water. Recent sponsors have included the Rajiv Gandhi Foundation, Tata Steel and Dr Michael Chowen, a private sponsor in the UK.
Mona, a seven-year-old with polio deformities, has also come with her grandmother, who is desperate for her to have surgery so she doesn’t become sidelined at school.
There is a distinct lack of fathers and mothers in the room – most small faces are buried into the bright saris of their grandmothers.
“The mother-in-law is the key person in rural Indian families because we still have a joint family system which does not exist in developed countries,” says Dr Agarwal. “90% of marriages are done on approval of parents and in the villages the mother-in-law has the maximum say on policy-making, food for the family, expenditure and assigning family resources to healthcare,” he adds. “She is a major player in the rural set-up and the daughter-in-law has almost no say. Education of mothers-in-law is the one thing that can change health issues in rural India.”
Mothers-in-law often have direct control over the family income provided by their sons and make key decisions on expenses. A qualitative study in Nepal published in July by the BMC Pregnancy and Childbirth journal concluded that the use of antenatal care was strongly influenced by mothers-in-laws and that female family members, especially mothers-in-law, must be engaged and educated about the benefits of antenatal care for it to reach those in need.
As India’s economy grows at 8.6% a year, the country’s healthcare system is, for the most part, antiquated and poor. The World Health Organization estimates that the Indian government’s spending on health stands at less than 4% of its total budget and although the train alone cannot plug the gaps in India’s public health system, it can be effective in bringing about change and educating the poor about their rights and medical needs.
Zelma Lazarus, chief executive of Impact India, says: “Mothers-in-law have traditionally occupied a privileged position in Indian families, playing a key influence in decision-making as far as their daughters-in-law and grandchildren are concerned.
“It is hoped that with increased exposure to education and advertising of health messages based on scientific facts, the situation will change for the better.”
In the past, the poor thought that giving water to children with diarrhoea encouraged the illness to persist. Once they realised rehydration was of paramount importance, rural deaths from diarrhoea drastically reduced. In the case of smallpox, inoculation was traditionally carried out by making cuts in the skin, but educating the poor about newly introduced bifurcated needles has led to the eradication of the disease.
However, Professor A R Vasavi, a social anthropologist at the National Institute of Advanced Studies in Bangalore, warns that relying on mothers-in-law alone could be an unfair burden.
“Mothers-in-law as grandmothers do occupy a special place, and in the context of the labouring poor, they are the ones who are actually the caregivers for young children, but asking them to take responsibility for initiating changes in attitudes to healthcare is problematic,” says Professor Vasavi.
The day after her surgery, little Preethi is being fed in her grandmother’s lap and smiling at her plastered leg stretched out ahead. Her shy parents watch on, happy that their daughter now has a positive future. But for the thousands of other children suffering in rural India, their fate still lies, for better or for worse, in their grandmothers’ hands.
The Guardian UK