I got up, went to yoga, then breakfast. Jamkhed is a pretty big place, I realize. We watched another video. This lady in the video talked about how she was pregnant at age 12 or 13, gave birth, but since the baby couldn’t get out, they cut the baby into 3 pieces, and her husband left her because of it. The Jamkhed model of training lower class women seems really effective, empowering, and sustainable.
We had Dr. Shoba talk to us about Jamkhed. She pointed out how a lot of healthcare research, development,and work is devoted to ailments that only affect a small percentage: 60% of the dying die from starvation, only 2-3% are dying from HIV/AIDS. That’s so preventable! Yet, there’s so much more money given to HIV/AIDS research. I can’t believe we are spending so much time and money on improving one thing, when so many more are dying from something with a simple solution! Basically, we already have the cure and we’re just not using it!
Also in rural India, there is limited access to vaccines. All that is available is: DPT (diphtheria, pertussis, tetanus), polio, and measles. because of financial limitations. The real solution, Dr. Shoba pointed out, is to change knowledge, attitude, and practices. And the concept of integration is very important to this; there are 3 components to integration:
1. health should be integrated with other systems (of economics, nutrition, farms, agriculture, women’s development, laws, business)
2. holistic health should be more emphasized rather than specializations. 80% of doctors need to be holistic, only 20% need to be specialists
3. Also, there should be some integration with alternative health systems.
Dr. Shoba also made a point that empowerment is important and is executed by increasing access to knowledge. People look to doctors like gods because they have this access while others don’t. One goal of Jamkhed is demystification in order to bring about empowerment. It is important to note here that knowledge and skills do empower, but there is a difference between education and empowerment. Empowerment requires not only knowledge, but also self esteem, money, decision-making skills, etc.
A problem of the US is that people are given too many rights. The result is selfishness and our country having more mental problems than even developing countries. What we really need to aim for is being, sharing, and caring.
After Dr. Shoba’s talk, we met some of the actual village health workers. They have actually delivered babies! They have an instruction/reference booklet that works well for them. It’s really great that these women were once untouchables (from the lowest caste) and now are looked up to as doctors/nurses.
^ village health workers
After lunch, we were off to the resorts in Aurangabad. Rebecca and I observed the rural scene outside the window, seeing women in saris out on the fields doing farm work, washing clothes by hand, and remarked again how privileged we really are. As usual, things ran late. Then we finally go there and it was dark. The place was nice. It’s nice to get (somewhat) away from all the smoke and incessant honking. And it’s cool that there was furniture and a bathroom with plumbing inside! There were monkeys around, so we had to be careful about that. We had a good time talking and some nice appetizers and a late dinner. Then I took a cold shower :( with buckets and slept without getting up for yoga.
^ the rural scene
The state of healthcare in India is not where it should be as proposed by the Indian Constitution. Unalike the US, the top causes of death and hospitalization are chronic disease states: cardiovascular diseases, diabetes, cancers. Meanwhile, the Indian healthcare system is struggling to control infectious diseases such as tuberculosis, measles, and whooping cough, all of which are easily preventable. This is due to the inability to develop a functioning general health system, regulate the private sector, and to address socioeconomic issues that are linked with health.
The healthcare system is ineffective and underdeveloped with insufficient regulation. For example, most of the costs of the 2001 polio-eradication caompaign went to the campaign and not improving sanitation, which would have yielded better outcomes. The healthcare system fails to address the difficult to access necessary drugs, which, in the cases of life threatening diseases, was argued as a fundamental human right by the World Trade Organization in 2001. Furthermore, the costs of the private sector are unaffordably high due to the lack of government regulation. This forces communities suffering from diseases into worsened poverty. It is surprising that the lack of a comprehensive health insurance has still not been addressed. Healthcare facilities should be better established; currently almost 50% of primary healthcare centers in India do not have telephone access! While childbirth is a common reason for Americans to visit hospitals, some Indian hospitals do not have available obstetricians or gynecologists. This forces many into home births, which causes a host of other socioeconomic issues.
The socioeconomic issues associated with healthcare should also be addressed in the regulation by the government. With the majority (over 77%) of births occurring at home, most children born are not receiving appropriate vaccinations. This endangers children to easily preventable infectious diseases. Also, due to women’s low social status and poor access to quality healthcare, the maternal mortality is high at 408 per 100,000 births. Due to poverty and poor access to quality healthcare, child malnourishment, with 50% of Maharashtran children under 3 being underweight, according to a status report in “Health and Healthcare in Maharashtra.”
One solution that have been incorporated to address these governmental regulation and socioeconomic issues is to contract out health systems to NGOs (non-governmental organizations), as Jamkhed Comprehensive Rural Health Project and Rural Unit for Health and Social Affairs have. These organizations have been able to more successfully outreach to rural impoverished communities and provide affordable healthcare by having low expenses and training village health workers. Although this has been a successful approach, some may argue that this condones the government’s failure to regulate its country’s healthcare.
Generally, the Indian healthcare system is weak due to lack of government participation and inability to acknowledge the associated socioeconomic issues. Currently NGOs that manage health systems are more successful in addressing problems, though the future goal is to pass off the regulation to the Indian government.
A Critique of Healthcare Policy in India
Review of Healthcare in India by Leena V. Gangolli; Ravi Duggal; Abhaya Shukla; Health and Healthcare in Maharashtra: A Status Report by Ravi Duggal; T. R. Dilip; Prashant Raymus
Economic and Political Weekly , Vol. 41, No. 43/44 (Nov. 4-10, 2006), pp. 4579-4583
Health Care Delivery System in India: Alternative Approaches
Economic and Political Weekly , Vol. 11, No. 22 (May 29, 1976), pp. 817-819