medico friend circle bulletin 15 - March 1977 · medico friend circle

medico friend circle bulletin 15 - March 1977

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Title: medico friend circle bulletin 15 - March 1977
Date: March 1977
extracted text: medico friend
circle
bulletin
MARCH 1977

Health Care Delivery Through ESIC
YIDYUT KATGADE
*

EBRUARY 24th, 1977 is a date that will be written
in silver letters ( if not golden ) in the history of
Employees State Insurance Corporation (ESIC) and
the Corporation has quite a legitimate reason for this
gesture. She has completed 25 years of her precious
service to the working masses of Indian private sector
establishments. The ESI scheme has been advanced
as a social security scheme, almost the only of its
kind in this country. What more could an indifferent
industrial worker wish for himself and his family ?
The benefits extended to the insured individual are in
kind as well as cash covering him in times of short
or long transient disabilities. Social security in form
of disability benefits, pregnancy benefits, compensation
benefits and funeral benefits are. by no measure,
mean. But a bit of rethinking might be rewarding
at this stage of a silver milestone in the history of
the corporation.

F

Cash benefits : an illprojected incentive
The whole business of ESI has been to project
their benefits in terms of hard cash which is a catchy
lure for most workers. A glance over statewise or

nationwide statistics of ESI functioning in the country
shows how much has been done for the workers and
at what cost, to what gain. It is said that our ESI
is a mini model of nationalized Health Services ( on
the blue-print of U.K. ). To speak of figures, it is
said that the health services were nationalized in U.K.
over a span of 125 years, while the population they
took care of is only near 4 crores. Our ESI has
extended its aids to some 6 million persons in organi
sed sector of this country in just 25 years.
ESI began its activities in 1952 in Delhi and
Kanpur. Adopting the ESI Act (1948) was not an
unpleasant task for increasing number of establish
G° to the people

________ _____________ ___

ments for many reasons. Firstly the implementation
of act in itself was something with which the labour
organisations felt content that they were doing some
thing for their men. On the other hand the manage
ment or employer was relieved by throwing the baby
of social security in the lap of the Corporation.
The administrators felt that increasing attention was
being paid to the needs of working class and the
worker was happy that cash benefits were now well
within his sight. Slowly and steadily ESI scheme
gathered momentum in various states and union
territories of India.
By 1965 the scheme covered some 2.8 million
families (11.75 million persons). Its health activities
(which renders the scheme of some relevance to us )
were carried out through 11 hospitals. 226 centres
and more than 5000 beds at that time. The scheme
was applied to personnel in working, technical, super
visory, clerical and such other catagories in power using
perennial factories with more than 20 employees on
payroll. The scheme was applied with great vigour
by certain states like Karnataka. Tamilnadu and
Kerala while in states like U.P. it showed a very
slow progress.
By the time another decade passed. ESI had
further established itself, now (March 1975) it had
4.5 million families (some 18.6 million individuals) to
look after, which they did through 56 hospitals, 365
centres and some 12.5 thousand beds. The activities
were further extended in November 1975 by an
amendment in the ESI act. In its present shape it
envisaged to give a cover to persons working in
smaller power using factories, non-power using facto
ries, shops, hotels, restaurents, cinemas, theatres, news
* D 57/50 D, Maulavi Bagh, Varanasi-221001

papers and transport undertakings also.
Further
there is provision of the act being extended to any
other agricultural or commercial establishments.
This might appear to be a provision too good to turn
down. The ultimate aim may or may not be to
simply magnify this picture a hundred folds and rest
back in chairs that health care is doled out to all the
60 crore heads of this country. But to dream of such
an extension in areas heitherto unattended is not a
reality bound thinking. The magnanimity of the cost
and manpower problem is probably ignored or
unattended. True it is not customary to brood over
darker side of the picture on such auspicious occasions
as a Silver Jubilee Celebration. But only a look at
present functioning will show us how unrealistic.
expensive and fantastic the situation would be. The
hazard is all the more alarming if one does not examine
the present cost and benefit pattern in the health
aspect of ESI scheme.
The concept of insurance and social security has
two principles implicit in its form and philosophy.
They are : (a) Sharing the cost on a general basis
where both the employee and the employer put in their
bit of resources. At present in general 2.5% of one’s
wages are directly deducted from worker’s pay bill
towards ESI and the employers give an amount equi
valent to 4% to 5% of their total salary bill. The
state too shares l/8th the cost of health expenses of
ESI. Thus here appears to be a system which is al
most self-sufficient, without aids or grants, a kind of
cooperative project for welfare of commenman, (b)
—While the cost is uniformly shared by most insured
persons the help and benefits jgo to the needy and
temporarily indisposed persons and the healthy
counterpart continues to pay for a security granted
under the scheme. Here again is a healthy attitude
of ‘ love thy fellowman, help the needy ’ kind of
sermon put into practice. It might appear that a
* third party ’ has no business to be nosy about the
activities of ESIC as far as her health programmes go.
The medical benefits which are freely delivered
almost at the doorsteps of an employee are : but
patient care, supply of drugs and dressings, patholo
gical and radiological investigations, special services,
domiciliary and emergency services, family planning,
antenatal, natal and postnatal services, inpatient
care, immunisation and health education. The list is
comprehensive and has not left any lacuna for further
improvement. Overcrowding is no problem in ESI
clinics. In the direct care every 1000 or more emplo
yees family units insured have a full time, part time,
or mobile dispensary of their choice. In the indirect
care system an Insurance Medical practitioner is

allowed no more than 750 employee family units.
The doctors at dispensaries see roughly 80 patients and
carry out one house visit on an average working day.
The ESI doctor population ratio is 1:585 as against
the national doctor population ratio of 1 : 4370. The
insured employees have 2.62 beds per thousand as
against the national figure of 0.49 beds per thousand.
Prescriptions are profuse and wholesome, sickness
leave is their privilage and facilities range from
dressing to denture, spectacles to surgical and hearing
aids to hernia belts. Above all periodic cash benefits
are paid to insured persons in case of sickness duely
certified by Insurance Medical Officer to the time of
50 days’ continuous absence in a year. This cash
payments are calculated at the rate of 7/12 daily
wages. (Besides these of course there are specified
special extended sickness benefits with absence upto
124 and even 309 days in conditions mentioned in the
list of ailments. But we shall suppose that they are
not of usual occurance). This brings the cost of such
services to an understandably high figure.
The
per capita expenditure on ailing individuals for
the 1 years 1961-62,
1969-70 and 1973-74 were
Rs. 23.79, Rs. 58.91 and Rs. 67.53 respectively. It
is unethical, though tempting, to compare these figures
with national per capita expenditure on health and
social security. The solution to the problem does not
lie in pinching off bits of the aforesaid expenditure or
trying to evenly spread the butter however thin the
layer be. The Corporation also realizes that she can
not go escalating the ladder of cost. They thought of
a short cut instead. They put a ceiling of Rs. 50 and
said that all the extra expenses shall be met by the
state. The shortcut has by-passed the major issue
which is of prime concern to us.
Evaluation

The organised private sector establishments have
done their bit by sharing the Insurance Premium, the
insured persons have given their share but are the
resources thus collected spent in a rational and effective
method ?
Tackling health problems in a working population
engaged in industrial and business world is in fact an
occupational hygiene activity. Occupational health work
has to have a consideration for environmental factors
in causation, perpatuation and complication of health
problems. It is well known that communicable
diseases are more prevalent in. industrial workers
than in general population. Besides, special occupa
tional diseases like Fibrotic Pneumoconiosis in miners,
Byssinosis in cotton workers, high lead absorption
in batteries and smelting industry, Dermatoses in
workers in cement and mineral oil industries Pose

2

Live among

problems specific to their worksite and environment.
But a major organisation like ESI does not see that
these facts have any relevance to the service they
have been giving. ESI hospitals and centres as a
whole function only as General Medicine Practice
Centres in the vicinity of an industrial setting.
Practice of Industrial Medicine is a job of ‘ plant
physician ’ according to ESIC. There is no need
for a physician engaged in ESI dispensary to know
the immediate environment of the patient who
visits him. An ESI doctor deals with insured
individuals with a registration number, his chief
concern is symptoms, signs and diagnosis. He is
often bullied
to refer these insured workers
to special clinics for investigations or treatment. It
might appear that at times he functions a little better
than a medical receptionist or a post office of health
problems. To remain in his seat he has to .write certi
ficates of ailments and copious prescriptions which a
paying worker thinks he has a right to obtain. The
records mantained over year are nothing but separate
medical histories on individual workers and thus are
in no way different from records in a practicing phy
sician's chamber. The all too important enquiry about
worksite is just never engaged into. The folders man
tained in the ESI dispensaries have no provision at
all if one wishes to systematically gather parallel data
about conditions of work and health of the worker.
Individually when a doctor make such observation he
has to keep his impressions ‘ up his sleeve ’ rather than
record it on a folder. This brings in subjective elements
and their confirmation becomes almost impossible.
Needless to say that true preventive medicine
plays a marginal role, if at all it does. It amounts
to saying that at present there is no comprehensive
occupational health service in India inspite of the fact
that ‘Health Insurance’ is practiced in a misunderstood
or misinterpreted sense of the terms involved. The
ESI health services function in a way that does not
insure health per se and instead what is assured is
probably an immediate and adequate (at times even
an exaggerated) attention to the illness in the families
with insured employees. Environmental monitoring
is not possible and even if practised can not be
measured as a team approach by physicians and
hygienists. The ESIC could infact shoulder a part
of the environmental monitoring by involving her
doctors in viewing problems of masses rather then
individual cases. The very pattern of organisation of
health care delivery through ESI could be used to
achieve more ends than just theraputic practice.
A well organised medical team is already
functioning in the neighbourhood of these work

Love them

site purely at a diagnostic and curative level of
practice. A fresh endeavour would only require
opening their minds to one more aspect of health
and illness of workers. As ESI doctor could look
at the health status from a different and yet a
relevant angle so that expenditure now incurred is
better utilised. This could also do away with the need
for a full-fledged department for research and basic
data collection for implementing environmental moni
toring in future. At least the ESI doctor would not
have to await reports and communication about basic
data from Central Labour Institute or Occupational
Health Research Institute. If it could be made man
datory to record some basic demographic, ergonomic,
chemical and psychosocial observations in the folders
of ailing workers, just within a year’s time they (ESI
doctors ) could have the basic data to go ahead with.
At present the environment of a worker is either
totally ignored or its scrutiny is entrusted in the
hands which have failed to deliver the goods. The
Corporation has her own Factory Inspectors but the
kind of work they do has no direct impact on
employee’s health. He goes visiting factories counting
heads employed as against heads insured, checking
contents of first aid boxes, water in tap, number of
urinals, spitoons and lavatories in the plant, inspecting
ventilations and illumination within the workshops.
He has to count the masks, crash helmets, gloves and
aprons and above all the entries in the accident
registers which are better mantained now that the
employer does not feature in the compensation busi
ness. The Factory Inspector from the local office of
ESIC is more a census man or a little bit of an
account officer who checks registers of the weekly
paid premimum etc.
The Directorate General, Factory Inspections which
has been functioning as the Government’s instrument
in this field has a history which antedates ESIC itself.
But it functions ‘ as an integrated service to advise
Government, Industries and others in the matters rela
ting to helth, welfare and safety of workers. The
Central Labour Institute which has been functioning
since 1960 with three other regional labour institutes at
Kanpur, Calcutta and Madras seems to be geared into
a more global and comprehensive work but its impact
on health care pattern through ESIC is obscure. Like
most educational and research centres these institutes
mantain museum of industrial health safety and welfare,
industrial hygiene laboratory, library cum-imformation
centre, sections for training, industrial physiology
and industrial psychology. At state level, department
of health and labour, through chief inspectors of
factories and industrial health inspection services,

3

are known to be 4 rendering assistance by making
studies and undertaking studies at plant level and
imposing acts
Whether
these bodies function
in harmony with ESIC or in a competitive spirit is
not clearly understood as the latter seems hardly to
be influenced by them. ESIC has the resources which
it collects from both the employees and the employers.
It is conceivable that they have some amount of
control over them and thus over the whole scene.
It is only fit that they step in the environmental
monitoring aspect of worker’s health.
Future of health care delivery through ESIC

It is learnt that the corporation has set up a high
powered committee for suggesting comprehensive
amendments to the ESI Act. It is also likely to
suggest steps for extending its coverage in seasonal
industries such as sugar and other agrobased indus
tries. It is now that a bit of rethinking, ordering
and improvement on present pattern of expenditure
on medical benefits is required. The corporation has
crash programmes to build more hospitals, annexes and
dispensaries all over the country. It is also noteworthy
that after a period of relative stagnation, industrial pro
duction has recently shown unmistaken signs of growth.
This calls for some more benefits to the workers. An
improved health programme is a proposal which
sounds promising but there is also a need for cost
oriented planning. Two announcements (which need
confirmation) to mark the silver jubilee celebration
are awaited. The first is regarding the extension of
sickness benefit period under the scheme from 50 days
to 90 days. And other which arouses concern is
further increase in expenditure on medical benefits.
One is left wondering about the wisdom in such ince
ntives. An ever-rising cost of medical benefits does
not necessarily mean better working conditions or
better health for the workers. If at all it reflects
anything it is the failure of tools heitherto employed
in Occupational Health Work.
And hence some
amount of soul-searching is prescribed to the healing
organisation on its silver jubilee. ‘Physician, heal
thyself’ is the simple advice.
References
1.

2.

3.

4

Dear friend,
Needed-New Managers for Medical Colleges
I. Received the 14th issue of the printed MFC
bulletin a few minutes ago. While rolling my eyes
hastily over the pages, I got them stuck on the 1st
column of the 5th page, on 44 Dear Friend ”. Undo
ubtedly, the point raised in it, and the manner in
which it has been raised, deserve praise. It’s a pity
that the destiny of thousands of ailing patients and
innocent students and doctors, is being controlled in a
‘ puppet-on-a-string ’ fashion by these incompetent
players.
To me, the article is an incomplete one. It had
the scope of discussing the problem to its fullest
extent, instead it has been concluded in a fugitive style.
Difference also exists regarding the remedy posed by
the author.
It is obvious that in the moribund society of
ours, we can’t get anything better than these worth
less 4 managers ’. The article would have reached
the zenith or perfection, if it could throw some
light on this aspect-the ‘ soil ’ and 4 crop ’ aspect. I
can’t restrain myself from labelling the solution
‘ futile ’ (I apologize ). With my very little under
standing ability I realize that, the 44 cadres ” adopted
on the 44 lines of Indian Administrative Services ”
will be of the same competency as the existing ones;
and nothing better can be expected from them
( though some thing worse can, even very pessimisti
cally, be-expected ), because they will also be the
fruits of this system, which has yielded these so
called 4 Deans ’, at its best.
—Shya ma 1 Kumar Dey, Calcutta

II. Being a junior I know very well to what extent
our big hospitals are inefficient; they do not lack
money but administration.
I was working in few
wards having fourty patients.
There were many
sophisticated equipments which were never used or
sometimes nobody knew how to operate with those
instruments. But for fourty patients there were only
three syringes, two forceps and two scissors.
And
due to want of these instruments; I used to waste
many hours daily.

Directorate of publicity, Ministry of Information & Broad
casting ( 1976): Years of Achievement, Labour Welfare, New
Delhi.
Pai, T. A. ( 1977): Highlights of Industrial Development,
Republic Day Supplement, Patriot, 26th Jan. 1977, New Delhi.
Park, J. E. and Park, K. ( 1976): Textbook of Preventive
and Social Medicine, V Edition, Banarasidas Bhanot Publi
shers, Jabalpur.

Above mentioned is one example but from
top to bottom today’s administration is full of lacunae.
A lot of money is wasted in the things of minor
importance while there is no money for things of vital
importance which strikes everyday. In recent past
there were hubble bubble in health ministry about idea
of starting Indian Medical Services like IAS It is
need of the hour.

( Turn to Page 8 )

_________________________ ___ _____ ~~~~T"cjpal Jindal, Sevagram

Serve them

Report

DOCTORS’

CAMP

AT

KISHORE

*
BHARATI

A PROBE INTO THE CYCLE OF POVERTY AND DISEASE

The initial stimulus for Kishore Bharati to hold
a camp for young doctors and medical students was
provided by the Medico Friend Circle. The aims of
the camp were threefold :
(a) to expose young doctors and medical students
to the conditions determining village commu
nity health and to deepen the perception of
their future role,
(b) to stimulate the inhabitants of one village to
explore issues arising broadly out of the
state of health, and
(c) to make Kishore Bharati’s workers more
perceptive of the barriers with holding commu
nity initiative in solving health problems.
The camp did not aim to do any preplanned
work or service of presumed use to the community
because campers armed with preconceived service
goals and work targets cannot be sufficiently perceptive
of the underlying needs and problems of the community.
Nor can villagers undergo the process of working out
and deciding exactly what they need, and why, but
remain passive uncommunicative acceptors of such
services.
Methodology
Given the stated aims, it was possible to approach
the problems in two ways : (a) a survey-questionnaire
approach or (b) an informal conversational approach
using free-association techniques.
The former method, if employed by skilled
surveyors fluent in local language and customs, may
elicit a mass of useful quantitative data. But the data
remain limited in depth.
In studying single-village
communities, where depth of understanding is critical
and where exceptional single-family incidents can
influence the whole village, it was felt an informal
conversational approach was more appropriate. This
technique would, moreover, involve both campers and
villagers in the important experience of active commu
nication.
This aproach was put into practice by arranging
for campers to stay overnight, in pairs, with families
chosen from a socio-economic and caste cross-section
of the village. The preparation of villagers and
prospective campers was undertaken gradually, over a
period of a month preceding the camp.
Selection And Preparation

A group of fifteen participants was selected.
They were sent relevant background material by post,
before the commencement of the camp. Five Kishore
Bharati (KB) workers, including a doctor, joined
Learn from them

them to facilitate communication with the villagers.
Half this group were medicos drawn from nearby
medical colleges so as to open up possibilities for
their long-term involvement in local health problems.
The rest were doctors and rural workers with some
special experience outside the immediate region.
Local doctors were too busy with their practices to
join the camp. In response to a wish expressed by
some villagers, the Joint Director of Veterinary Ser
vices (Bhopal) obligingly deputed the newly qualified
Assistant Veterinary Surgeon-in-charge of the Block
Veterinary Dispensary at Bankhedi. The Veterinarian,
however, failed to participate.
The village Palia Piparia was chosen partly for
its proximity to Kishore Bharati and for the familia
rity of Kishore Bharati’s staff with several of its
families. More important was the fact that its
existing socio-economic conditions, with its mixture
of tribals and non-tribals, are representative of
medium-sized village communities in Madhya Pradesh.
In order to arrange a doctors’ camp of this kind,
there was a lot of work to do to soften some barri
ers of fear and misunderstanding. Beginnings were
made in homes where a special personal contact had
arisen either through the various activities of KB or
through the illness of a family member when medical
help had been sought. The most challenging sections
of the village were those of landless and the marginal
farmers where frequent illness and death are coped
with indigenously and outside help shunned for fear
of exploitation. Here the contact was tenuous through
a handful of agricultural labourers who Work at KB.

Slowly the idea of the doctors’ visit to the village
was introduced. The villagers were told that the
doctors would come to learn, not to teach or practice
medicine upon them. Familiar examples were discu
ssed. such as the lack of appreciation of doctors for
village medicines or beliefs about sickness and health,
the emphasis of doctors on expensive foreign-looking
medicines and injections, and their insufficisnt know
ledge of the food consumed by villagers. Slowly it
was assessed in which homes two medicos might be
welcome for a night or two.
Then about a dozen families were approached to
be hosts to the doctors.
They were reassured
that no special preparations need be made in the way
of food and comforts as the young medicos wanted
* P. O. Malhanwada, Via Bankhedi, District Hoshangabad,
M. P. 461 990. From December 21 to 24, 1976.

to experience the everyday life of villagers. Care was
taken to assess that the family could at least afford
to share a total of two ordinary meals of any compo
sition with their guests.
Orientation

Most of the campers arrived by early afternoon
on December 21. In the first orientation session, a
background talk about KB was given outlining its work
and past experiences, and its present thinking. It was
explained why KB, despite the presence of a qualified
doctor, had decided not to launch a dispensary or
health care programme of its own. Rather, KB had
adopted a dual approach to stimulate and raise the
awareness of the people about what they could do to
improve and protect their health while simultaneously
promoting the improvement and optimal utilization of
the services of the government Primary Health Centre
and its subcentre system. KB's doctor explained some
of the ways in which her MBBS training had been
put to test by village conditions in the last two years.
In fact, her motivation in arranging this camp was
largely to share of this educational experience with
other young doctors.
An afternoon tea was arranged to get the village
hosts and their guests acquainted. It was surprising
to observe that the shy hesitation to initiate or sustain
friendly conversation was nearly equally distributed
between illiterate farm labourers and physicians with
MD degrees. The exchange allowed the medicos a
foretaste of the type of people they would be living
with. To the KB staff, it yielded a few tips to co
mmunication snags that might develop, and a couple
of minor rearrangements were made. A second ori
entation session was held to review what was to be
observed during the next two days in the village. The
next morning, some final instructions along with a
cyclostyled set of socio-medical case histories in
simple Hindi were given to stimulate the discussion
of relevant health problems with the villagers.
The Stay In The Village

The experience cannot be described easily as it
was multifocal and different for each of the twenty
campers. They created quite an impact on the
village. Everywhere the villagers were standing out
looking curiously and trying to talk to some of the
doctors. The campers on the whole found the villa
gers eager to tell their views ( right or wrong ) and
get the doctors
*
opinions.
Many of the doctors
were asked to examine ill persons and they tried to
prescribe medicines or some other cure. Here they
came face to face with the underlying problems of
the village. For some it was a shock to realize what
poverty meant or did to people. Others were stumped :
"d

“ What to do with patients who don’t have any
money ? ” Quite a few took the way out by stressing
preventive medicine.
Some doctors went to the fields to sec the working
conditions and crop patterns. Most of the campers
talked at length with their host families and their
neighbours. They also walked about the village where
people called out to them to come and talk. But the
villagers on the whole were rather puzzled and kept
asking them, “What good will your coming here do
to us ?”
At night spontaneous gatherings grew around
slow-burning fires at several places in the village.
Three big ones were in the Gond, Rajhar and Kotwal
homes. In most cases discussions started from health
problems but quickly shifted over to poverty and land
distribution. Quite a few solutions to these problems
were explored by the villagers in a couple of these
meetings. At the meeting in the Rajhar community,
some old people told a story of how their lands had
been snatched away by the manipulations of the
landlord family. In all the meetings the villagers kept
saying: we are illiterate - you tell us the way; we are
poor-nobody listens to us; you can do something.
Some doctors took this as an invitation to lecture the
villagers on preventive health care and hygiene, which
the villagers listened to with equanimity, never point
ing out the flaws in the arguments.
Discussion at Kishore Bharati

The campers returned to KB form the village on
December 23. Two long discussion sessions were then
held that afternoon and night. Some villagers parti
cipated intermittently. The campers decided to discuss
under the following headings :
I Problem Identification
(1) Economic, (2) Social, (3) Health
Il Opinions of the Villagers about KB
III Relevance of Medical Education and Research
IV Possible Solutions.
Herewith follows a point-wise summary of what
the discussions yielded :
I
Problem Identification
(1) Economic Problems. The following were listed :
(i) Disproportionate land distribution.
Some
families own large tracts, the majority have
little or no land.
(ii) Absence of alternative sources of income,
like cottage industry.
(iii) Low agricultural output and poor knowledge
of new agricultural techniques. This often
leads to frequent misapplications.
(iv) Low wages of agricultural labour. Rates range
from Rs. 2 to 2.50 per day for 6-8 months

Start with what they know

per year or 4 quintals of wheat for 6 months.
(v) Low storing capacity of the poor. This
leads to distress sales of agricultural produce.
(vi) Lack of credit facilities for the landless and
for marginal farmers.
(vii) Large numbers of children produced. Consi
dered as economic assets, they are needed
for security under conditions of high child
mortality.
(2) Social Problems. The most outstanding were:
(i) The all-pervading influence
and rights
enjoyed by six to eight high-caste families to
the exclusion of others. This is reinforced
by interlocking relationships with influential
powers in the area, including the police and
government officials.
(ii) Untouchability. The basoards have to bring
water from the river, a distant and unclean
source.
(iii) The purdah system in the upper caste. This
cuts off their women from the outside world.
(iv) Lack of relevant education for poor children.
Villagers perceive school education as some
thing that takes children away from home and
livelihood (“
fain
). As a result
more than half grow up illiterate. Incidentally
people educated outside the village do not re
ceive a very high intelligence rating within the
villagers’ framework of realistic common sense.
(v) Early marriages of boys and girls.
(vi) Children burdened early with adult responsi
bilities such as child care and earning.
(vii) Lack of a spirit of cooperation for projects
of community health. This is due to :
(a) opposition from the upper class
(b) lack of free time
(c) lack of motivation
(d) anxiety over intercaste mixing
(e) money involved
(f) lack of organising skill
(g) lack of information and guidance
(h) failure of previous efforts.
(3) Health Problems. These mainly included :
(i) Intestinal amoebiasis. It is so common that
it is accepted as a normal discomfort.
(ii) Malaria. It takes a high toll from peoples’
ability to work.
(iii) Skin infestations, infections and abscesses.
These are very common and arc treated with
local applications.
(iv) Colds, coughs and nondescript fevers.
(v) Water contamination. The campers felt it
to be a major problem but as there were few

Build upon what they have

cases of acute gastro-enteritis during the camp,
the villagers were not much interested in it.
(vi) Finance. Many people had no money to
spend on medicine or preventive health.
In the context of the need for “ preventive medi
cine ”, it was pointed out that the high mortality
rate of children under five years is not attributable
to diseases preventable by immunization programmes.
It is due, rather, to the complex of malnutrition,
gastro-enteritis and infectious respiratory diseases
which characterize the rural poor. Major changes
like the provision of a safe and convenient water
supply would have to come from sources sufficiently
powerful, probably the Government.
The villagers had several complaints to make,
the major of which were :
(a) Ineffectivity and remoteness of Government
health service
(b) Exploitation by private practitioners
(c) Expensive and over-charged medicines
(d) Prescriptions and drug-labels in English
(e) Loss of wages incurred to reach doctors
(f) Unavailability of transportation for the
poor.
Most of the campers could realise by now that
the practice of hygiene, especially personal hygiene,
was largely determined by availability of leisure time
and facilities, both of which are aften in short supply
among low income groups.
There was a lot of fear associated with the heavy
drive for vasectomy operations. Stories of coercion,
abuse and even death were being circulated.
Most communities, especially the poor, had strong
beliefs in spirit medicine and magic. There was also
a feeling that indigenous medicines were more suited
to the village people. Villagers, thus, often felt closer
to unqualified practitioners who have strong commu
nication advantages.
II

Opinions of the Villagers about KB

This part of the discussion was offered by the
campers for the benefit of the K.B workers and was
not directly related to health.
Relevance of Medical Education and Research
“ The things we learned in college are not reach
ing the people ”, remarked one camper. “ It has not
been made sufficiently clear as to what is the role of
poverty, and the removal of poverty, in Preventive
Medicine ” said another. Poverty is, indeed, listed in
textbooks among the causes of ill-health. It is, however
passed over in sections on preventive action. The
words of a villager underscored this deficiency succinctly
Ill

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R.N. 27565/76

Regd. No. GBA-96

mfc bulletin : March 1977

The campers generally realized that much of
college medicine and research is not applicable to the
present unbalanced socio-economic set-up, especially
in rural areas. It is based largely on urban upper
and middle class conditions, values and environment.
High quality training and research are necessary in
the most basic areas of rural medical and health
practice, heretofore unexamined in college classrooms.
IV Possible Solutions
(i) Launching a hospital or dispensary. This
view was still expressed by a few doctors.
Some disagreed. Several remained silent.
Most seemed to sympathise with the aim of
building up and utilising the Government
health system, through the active initiative
of the villagers.
(ii) Improving the economic conditions of villagers
through the development and promotion of
cottage industries. The campers could not,
however, suggest a suitable cottage industry
for this village. Also, it was realised that
the benefits accruing tend to be siphoned
off by the rich.
(iii) Maximising the use of local resources, inclu
ding the culture and energy of the people
themselves.
(iv) Exploring ways by which the benefits of
higher agricultural
production reach the
weaker sections.
Most campers eventually realised the inadequacy
of their own understanding of the complexity of rural
problems. They observed soberly that there were no
‘ quick and easy ’ formulae to be offered. A deeper
study is, therefore, necessary.
Follow-up
It is being assessed whether there is any change
in the awareness level of the village as a result of the
camp. This feedback has already helped KB in plann
ing future activities. KB’s workers have decided to
share their own newly gained perception of health

♦1. An audio-visual exhibition portraying the cycle
of poverty, malnutrition and ill health was put up
by KB at the Vasant Panchami Mela organised
by the Bankhedi Panchayat in January. The
Mela was attended by several thousand people
from roughly 100 villages.

problems with the people of this region through in
formal discussions, meetings, exhibitions and special
activities with school children.
*
The doctor-campers are also being followed up to
find out what impact this camp has had on their per
spective of medical work. A change in perspective
would prove the utility of the camp. If so, this method
of raising awareness among young doctors must be
repeated and developed.
-Mira Sadgopal
- Vasanthi Gupta
Contd. from page 4
Sunday Standerd, News item in the issue dated 30-1-77,
New Delhi."
5. WHO ( 1967): Tech. Report Ser. 354; ILO/WHO Joint Ex
pert Committee Report on Occupational Health, Geneva.
6. WHO (1973): Tech. Report Ser. 535; Environmental and
Health Monitoring in Occupational Health, Geneva.
7. Personal communication with officials at various levels of
functioning within ESIC.
©
4.

Form IV ( See Rule 8 )
Vadodara
Monthly
Ashvin J. Patel
Indian
21, Nirman Society,
Vadodara - 390 005.
Ashvin J. Patel
4. Printer's Name
Indian
Nationality
21, Nirman Society
Address
Vadodara
Ashvin J. Patel
5. Editor's Name
Indian
Nationality
21, Nirman Society
Address
Vadodara
Medico Friend Circle
6. Owners name and address
21, Nirman Society
Vadodara - 390 005,
I, Ashvin J. Patel, hereby declare that the particulars given
above are true to the best of my knowledge and belief.
A. J. Patel
Date : 24-3-77
Signature of publisher

1. Place of publication
2. Periodicity of its publication
3. Publishers Name
Nationaliiy
Address

2. About 150 eighth class students from 11 middle
schools of Bankhedi Block spent a full day at
KB in early February participating in exhibition,
tape-recorded drama ( composed and recorded
with villagers), and competitions on the themes
of poverty, food production, nutrition and health.

Editorial Committee : imrana qadeer, kamala jayarao, mira sadgopal,ashok bang.anant phadkejalit khanra, ashvin patel(Editor)
Views. &. opinions expressed in the bulletin are those of the authors &. not necessarily those of the organisation.

Edited and Published by - Ashvin J. Patel for Medico Friend Circle, 21 Nirman Society, Vadodara-390005 and
Printed by him at Yagna Mudrika, Vadodara-390001, INDIA, on 31-3-77. Annual Subscrpition Inland — Rs. 10/For U.K. by Sea Mail £ 4/ by Air Mail £ 5/-; for U.S.A. & Canada by Sea Mail $ 6/- by Air Mail S 9/-

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