When they came to Jamkhed, the Aroles [a couple who have M.D.s] started a small hospital in an abandoned veterinary clinic. A hospital was necessary to treat complicated illnesses and emergencies, and it gave the project political support and credibility. It also brought in fees from patients who could pay. (Those fees, together with donations, contribute the bulk of Jamkhed's $500,000 annual budget for their village work even today.) But the Aroles knew that curative medicine could do very little for the poor. They needed to emphasize preventive medicine, and bring it to the villages. So they decided to engage the villagers themselves. A village health worker, Arole says, can take care of 80 percent of the village's health problems, because most are related to nutrition and to the environment. Infant mortality is actually three things: chronic starvation, diarrhea, and respiratory infections. For all three, you do not need doctors. "Rural problems are simple," Arole says. "Safe drinking water, education, and poverty alleviation do more to promote health than diagnostic tests and drugs." [Emphasis added]I am reminded of the famous Barefoot Doctors in revolutionary China. They were shut down in 1981; a mistake, I think.
Monday, February 23, 2009
Village health workers
If you have access to the National Geographic, online (not so good for slow modems) or in print, please have a look at "Necessary Angels" in the December 2008 issue. Women native to their communities, deliberately recruited from the most impoverished and least respected class (Untouchables), train as health workers, revolutionizing health care in communities that cannot afford doctor bills (let alone hospital care). This may be the model for many, many more areas in time to come, so now is the time to learn from this program.