Will Yatras Solve India’s Problems?

My day at the outpatient clinic was interrupted by a sudden change of plans. “Doctor, you will have to go for the Viksit Bharat Sankalp Yatra,” said the medical officer in charge of the center where I was posted. Leaving a line of patients waiting to see me, I picked up a BP apparatus and got in a rickshaw to reach the location of the health camp. 

Arrangements were made for our medical team to examine patients. People from the post office were also present there to make Aadhar cards and an official from the Ujjwala Yojana (a scheme which provides free cooking gas cylinders to below poverty line families) was also there to facilitate service provision. The Viksit Bharat Sankalp Yatra aims to reach out to as many people as possible and enroll the eligible ones into the government schemes that have been included in this yatra. The schemes have been listed for urban, rural, and tribal populations and active measures are being taken to reach saturation of coverage for these schemes.

The responsibility of the medical team was to screen people for diabetes and hypertension, identify people with a prolonged cough and refer them to get tested for tuberculosis, and provide primary care to others coming to the camp. The camp started with a photo session. Photos with the banner were clicked from multiple angles. Finally, after an hour of waiting, a person came to the camp seeking care. 

“My back and legs hurt. They have been hurting for more than 6 months now,” told Sanjay, a 60-year-old gentleman who sold eggs on the street for a living. A thorough history and examination did not reveal any physical illness. 

I was taught that people visit a health center only for two reasons - either their pain is unbearable or their anxiety and stress. Having made sure that there was no physical cause for pain and that it was not really unbearable, I moved on to evaluate for the other reason that I was told often brings people to a healthcare center.

“How is everything at home?” I asked Sanjay. 

“I have been struggling to earn enough money to make ends meet. My son moved out with his wife. My wife and I now live with our younger son who tries to make ends meet by doing menial jobs.” The reason for his feeling unwell suddenly became evident. It wasn’t a disease I had a cure for. Psychological stress and depression often present as physical symptoms, the most common one being pain. I prescribed some pain relief to him along with some other drugs knowing that I wasn’t treating the root cause of the problem. Soon the nodal officer of the area arrived and we rose to take another set of photographs.

Two young men walked in shortly after I had finished posing with the banner. “My chest burns,” said Md Ali, a 30-year-old papaya seller. When I asked him if he ate too much spicy food, he told me that most of his meals consisted of the papaya he sold. That is all that he could afford. After ruling out a heart problem clinically and all external causes of heartburn I moved on to my next question - “How is everything at home?” “I have three kids to take care of. My monthly house rent is 5000 rupees. I start my work at 8 am and finish at 11 pm. I am still not able to make ends meet.” 

It is well known that psychological stress can induce gastritis and gastric reflux. I prescribed antacids to him knowing that his symptoms would recur as soon as he stopped taking the medication. Did I just add to his financial woes by prescribing a tablet that will make him feel better only while he is on it? 

Before I could give more thought to the social evils that made people sick, we were asked to pose for the next set of pictures, this time with a local politician. As we all stood in a row to take the sankalp (pledge), I wondered if the words of the pledge really meant anything to anyone. 

After ensuring that the moment had been fully captured in at least five cameras from five different angles, we resumed our work.

I saw Ali’s friend next. Prem, a 35-year-old vendor. “He is like my brother. We work all day together,” said Prem while looking at Ali, smiling. I smiled back at them, feeling like I had time-traveled back to the India I grew up in.  Prem complained of pain in his entire body, tiredness, and increased sensitivity to spicy food. I noticed his stained teeth and asked him to pull out the tobacco pouches from his pocket. I was still looking for a reason behind his entire body aching. My pet question this time received an unexpected response. Without saying a word, Prem burst into tears.

“My son passed away 6 months ago. He was 10 years old. He had a high fever and all hospitals were full. He died before he could receive treatment,” said Prem who was now being consoled by his friend Ali. “My son used to come every morning with me and help me set up the stall. He had started supporting my work. He is gone.”

The diagnosis was clear. The treatment, however, was not easy. I counseled him to quit tobacco as his mouth was showing very early signs of oral cancer. Ali assured me that he would make sure Prem quit tobacco. Understanding the harmful effects of the legal revenue-generating poison, Prem handed his tobacco pouches to Ali and asked him to discard them. 

Prem then rushed home to bring his wife to the health camp. She had been suffering from psoriasis, a skin disease, and had tried all possible treatment options. Her disease had flared up over the past few months. “He comes home and fights with me. With the little money he gives me I have to run the house and raise our younger son,” said Rekha as tears rolled down her face. 

What played a bigger role in the flare-up of her disease, winter, or the emotional stress, I was not sure. With a feeling of helplessness, I prescribed her some tablets for symptomatic relief. 

As we started packing up our bags to leave, the medical officer in charge of the camp arrived. We took the final set of pictures, this time being extra careful to not include the inebriated man, who had passed out on a chair in the camp, in the frame.

Even though the above-mentioned people presented with different complaints to the camp, they were all suffering from a common disease - poverty. Of course, there is no quick solution to the underlying troubles these people faced every single day. They may benefit from government schemes and subsidies, but how far do these schemes go? How do we combat increasing unemployment, lack of welfare schemes for the elderly, and a hundred other social injustices that push people into sickness and ultimately extreme poverty, forming a vicious cycle?

The Viksit Bharat Sankalp Yatra website mentions that 19.5 crore (195 million) people have participated in the drive so far. How many have been left viksit (developed) after this yatra (drive)? Will taking a pledge and countless pictures be enough to solve all the problems of the people in this country? 

At the risk of sounding cynical, this yatra feels worse than a stop-gap bandaid on a gaping wound of unmet targets. How much will it really help in the absence of real solutions for real-life problems? While the intention of the drive might be to do some good, our leaders need to ponder over and find solutions to more basic questions surrounding livelihood, poverty, and healthcare to make this country truly viksit.

 

This is the first article in a series that will critically look at the Vikasit Bharat Sankalp Yatra.

Edited by Radhikaa Sharma.