When I started this journey, I had no destination in mind; the desire to see places was lost, transformed into the desire to see life. So I navigated by the dictum to choose the path less travelled. My ability to do this may be dictated partly by hubris, partly by privilege, but I feel at peace with the journeys I have made along this way. While backpacking, I kept my getaway destinations far apart and chose to visit central and central-east India; I listened when my mentor said, “Go see hunger & poverty.”
After spending a trimester in Kalahandi district in Odisha and, inspired by my experience there, I wanted to witness rural India from a much closer angle; the shelter and comfort provided to a city doctor was a limitation clouding my perspective. I was guided to IDO (Indigenous Development Organisation, Kothagudem, Telangana), which would eventually become my green passport to the Bastar division.
Tribal communities served by IDO are some of the worst-affected people in the country, as they belong to displaced tribal communities. About 50,000 tribals were dispossessed about 20-30 years back due to Maoist violence and the state’s anti-Maoist campaigns, especially around the 2000s.
Due to escalating violence, killings, rapes, and village destruction (undocumented), they fled to neighbouring districts in AP and Telangana and sought refuge in forest areas. They settled and cultivated the land, and have lived here for three decades.
However, the lack of documentation denies them ownership of land or recognition as scheduled tribes. Living in forest lands far inside the jungle, they often make do without road connectivity, electricity, or water supply. However, they live in fear of double displacement, as the Telangana government is pushing them back to Chhattisgarh.
Despite the lack of basic amenities at home, their new addresses provide them with improved economic opportunity and better healthcare services. In summer, they collect Mahua flowers, earning less than ₹100 a day. Many seek manual daily wage work, such as picking chilli or construction, earning 250-300 in neighbouring districts of Telangana and AP, and only post-monsoon, as the water finally becomes available, they could do agriculture.
Often, families living in Telangana bring relatives across the border for healthcare services, traversing over a hundred kilometres with limited transport. Taking note of this, IDO expanded its services to South Chhattisgarh. A conversation with Dr Narendar, the founder of IDO, inspired me to volunteer basic health services at one of the villages in Chhattisgarh. They wanted to expand their services and determine the health needs of the residents. That is how I came to find myself in Potakpalli, Sukma.
“Left Extremism”, “Critical Poverty”, “Strongly Militarised Area”
These were all abstract ideas to me until I traveled around the district of Sukma for the first time to meet the district collector. I saw hamlets one after the other in a shade of brown against the background of a dry forest. Even the early summer was quite hot, with temperatures hovering around 35-40°C.
As I recall, that car journey extended over a hundred kilometres of unpaved road with hamlets along the way. Mud brick huts and CRPF camps dotted the route, dwarfed by the vastness of the Mahua forests. Though there were checkpoints everywhere, I couldn't spot a single shop– I wondered how I could even live there.
At long last, we reached the village of Potakpalli. It was the most hopeful of the hamlets I had seen all day, with a little green in its landscapes, a mountain view to wake up to, and an LP school across the subcentre, somewhere I felt at peace. A week later, I shifted to Potakpalli with a haversack, medicines and rapid test kits, a bag of mother and child care supplies, a stove, and utensils to establish a kitchen.
And there I was– living in a subcentre, a temporary building made of concrete sheets and a metal roof, infested with mice. I was anxious about not going to the toilet outside, so I set up the indoor WC as soon as I could. Though I tried to disinfest my living quarters, the mice outnumbered my efforts, and I had to coexist with them and their weird tails!
Meeting the community
Slowly, I acclimatised. I had plenty enough to survive there, and some days later, I started walking around the hamlet with a bag full of medicines and supplies. “Who are you, and why are you here?“ was one of the questions I faced on my first barefoot drive in the hamlet.
Equipped with little Hindi and a smile, I slid through resistance to meet new people and patients. Such active health interventions were alien and unusual for people in Sukma. Few called me into their homes; others guided me to houses with sick children; some closed doors in my face.
The very person who had asked me to go back home soon guided me to my first patient, and this was my icebreaker. She was two years old with severe malnutrition, skeletal arms, and pneumonia. Malnutrition, mostly caused by a lack of nutrition, harms immunity, causing severe infections in young children. I started visiting her every day to ensure she took her medicine and food. These visits became a chance to get people talking to me.
Of the 16 hamlets that come under the subcentre at Potakpalli, only three are approached by motorable roads. The others could be reached by bikes or tractors, if the weather favoured. I rode a bike to visit these other hamlets, starting off with small medical camps.
I had only expected to build rapport with the community, but was invariably met with a bunch of patients. I would see around 25 patients- a mix of malaria cases, diarrhoeal episodes, respiratory infections, pregnancy checkups, and other cases. The village heads welcomed these camps, urging me to conduct them even more frequently.
Before Potakpalli, we had this prejudice– that patients would prefer faith healers over conventional medicine, and our efforts would be unfruitful. However, the lived truth I learned was that these underserved populations understand their own needs and are accepting of medical services, if they come their way.
No healthcare without access
A total of 85 pregnant women were registered at our subcentre, but proper pregnancy care often didn’t reach them. Tetanus injections and supplementation, par for the course elsewhere, were hard to come by. Ultrasounds for the baby and institutional deliveries were a distant dream.
However, the data collected for reporting failed to paint the real picture. Instead of visiting the hard-to-reach areas, most parameters for reporting were cooked up through data collection from Anganwadi teachers. This meant that children like my first two-year-old patient, and their malnutrition, stayed off the official books.
Malnutrition and anemia were rampant, reflecting their level of poverty and standard of living. People find work 2-4 months a year, depending on ill-paid coolie work in the neighbouring districts. Water is scarce here, making agriculture scarcer. With little money and even fewer prospects, nutritious, balanced meals were hard to come by.
I remember a child brought to me– a case of tetanus infection– carried on a bed through the jungle. I had only ever seen tetanus in a person on the front page of the book ‘Where There Is No Doctor’by David Werner. And here it was, a grim reminder of a time when tetanus vaccines didn’t exist. Even though tetanus is a thing of the past in most of the world, Potakpalli seems stuck in time.
Reaching the last person
When the electricity goes out, there is not much to do in Potakpalli once the sun sets. Late one night, I was battling mosquitoes and heat when a knock on the door caught my attention. I had predetermined not to open the door at night, but as the knocks grew louder, I opened the door to flashlights.
I was asked to see a patient who had a chicken bone trapped in his throat. With rusted forceps and a torch, I accompanied them to Ganga’s home. I shone a flashlight into his throat but did not encounter any chicken bones. The traditional healer arrived soon, with a much longer torch and a bamboo stick, and found no success either.
Together, we opined that he needs to be taken to a hospital. “We too figured it out, bro, but how do we take him?” his neighbours asked. I offered them my bike, but they didn’t drive- especially at night, for 70 kilometres, through the jungle.
30 minutes later, Ganga’s son and I were riding through the jungle across the checkposts, carrying Ganga between us on my Splendor bike. At about 1 AM, we reached the taluk-level government hospital in Bhadrachalam (Telangana state), and went through the process of mistreatment of a patient and bystander. We were hurriedly referred to the district hospital. The journey continued, and by 3 am, we reached our next destination. After a long hustle, an X-ray was taken, and again we were referred to the medical college about 200 km away. At that point, Ganga’s son and I were running out of hope. We decided to return to another hospital in Chhattisgarh. But after the grueling night, the family decided to get the procedure done in a private hospital back in Bhadrachalam, where we reached by 5 am.
I took the father and son to all the private facilities there, enquiring if they had an ENT surgeon who could do the procedure. They managed to borrow 15k for the operation, and it was done in a private facility. It struck me as ironic, how all the hours of shuttling from referral to referral in the public health system came to naught. It didn’t prevent the out of pocket expenditure for the family, nor did it alleviate Ganga’s discomfort all through the night.
Soon, this became a routine trip for me, as I ferried patients to the hospital. I found it much easier than waiting for 6-10 hrs for the 108 ambulance to reach the centre– so my Splendor served as a bike ambulance! Slowly, as days went by, people started recognising me and started visiting the centre for small talks. I reciprocated, starting to visit homes for talking, where they served toddy as sweet as honey. The trust-building process was much easier than we presumed, and I found it easier to convince patients for referrals when needed.
Prevention precedes cure
One day, out of the blue, a man came to the centre and asked for a mosquito net. My awareness as a healthcare provider took yet another hit. Amidst treating malaria with antimalarials and antipyretics and preparing for the monsoon ahead of us, when the number of cases is going to rise, it somehow slipped my mind to take any preventative steps; I assured him I'd see to that.
That night, I couldn’t find any sleep, and more than malaria, I thought of how difficult it would be to sleep with all the mosquitoes, given the temperature; you can’t use a sheet to cover yourself, and I’m the only one sleeping in the hamlet with the luxury of a fan on a mattress. (People sleep on the floor or on a rope cot, so mosquitoes bite them from underneath too.)
The next day, I tried arranging mosquito nets for distribution. “Go there, stay with them, listen, and they’ll come up with their needs.” This was told to me, and it was the most unreal experience in front of me, and the next two weeks were about arranging nets to distribute to the hamlets, helped by IDO and another NGO, SFN (Samaritans For Nation); we procured about 300 nets and received about 100 from the district malaria officer, which were distributed to 4 hamlets.
At each hamlet, when we went with what they needed, the entire village gathered without delay; at least one person from each household came, and together we treated nets with LLI (long-lasting insecticide), dried and distributed them.
And by the first week of May, I vanished. For me, the weather was too extreme to remain there, but my security was also raised as an issue by friends and mentors, so I left and never returned. I was confused and relieved, but felt incomplete, and I had to accept it.
Sukma was a hard but worthwhile effort; I learnt to see things from a public health perspective in contrast to the curative medicine we learn in medical school. I realised how easy it is to learn languages (I started speaking Hindi freely and learned enough Gondi to take medical history) and discovered a new way of travelling – travelling as a doctor.
Every time I ride my bike near the border of Chhattisgarh and Telangana, there is always a ‘visible difference’. The looming Mahua forest gives way to rice fields (availability of water affects agriculture); suddenly, there are concrete houses, children smiling, dressed well and playing on roads, people smiling at you, more shops, and no checkposts or CRPF camps altogether – what a suburban boy thinks of as ‘more life’. I quote what Dr Narendar told me introducing Sukma: “Sukma means life, but there isn’t any.”
Edited by Radhikaa Sharma
Image by Gayatri
