Dr Abhay Bang and Dr Rani Bang: Pioneering rural healthcare in India

TRANSCRIPT

Welcome to Grassroots Nation, a podcast from Rohini Nilekani Philanthropies, a show in which we dive deep into the life, work, and guiding philosophies of some of our country’s greatest leaders of social change.

Not many of us would spend years training as a doctor and then choose to live and work in community health in a remote part of rural India. But this is exactly the choice that Drs Abhay and Rani Bang made very early in their lives. Both Abhay and Rani gew up in families with deep roots in public service – Dr Abhay Bang’s parents were followers of the Sarvodaya movement and were deeply inspired by Mahatma Gandhi. Abhay grew up in the Mahatma’s Sevagram Ashram in Wardha Maharashtra. Rani Bang, born Rani Chari was born into a family of politicians and freedom fighters. They met at Nagpur University, where they both completed their MBBS medical degrees, and MDs – Dr Abhay Bang completed his MD in Medicine and Dr Rani Bang her MD in Obstetrics and Gynaecology, and both were at the top in the university. They also completed their Masters in Public Health from John Hopkins University in the United States. 

Both have always been committed to a life of service in India. After their studies, they returned to India and chose to work in Gadchiroli, founding SEARCH, the Society for Education, Action and Research in Community Health in 1985, where for nearly forty years, they have transformed health care and service. 

As you will hear, SEARCH’s contribution to the community and globally is unmatched not just because of the deep impact they have had in Gadchiroli but also their contribution to global medical standards of practice and research. Their work on infant mortality, malaria, women’s health, alcohol and tobacco addiction and so many other areas of medicine is highly cited and recognised. 

Through their work they have consistently demonstrated that it is possible to live in rural India and do high impact work, transforming lives on the ground while producing research of the highest level. Their publications and studies have been regularly recognized by international journals like Lancet setting global standards for medical practice. Even the WHO follows the methods  prescribed by their work. 

They have received innumerable awards and commendations, from the Maharashtra Bhushan Award, Stree Shakti Puruskar, the McArthur Foundation International Award and the Padma Shri in 2018. They have been honored for their service to public health the world over, including as a Global health hero by time magazine, and a champion of public health by the WHO as well being awarded as the mahatma gandhi award. Drs Abhay and Rani Bang have also been members of various state and national level committees for health and economics. Dr Abhay was the chairman of the national expert committee on tribal health, for the Government of India. Dr Abhay and Rani Bang are truly pioneers of health care in rural India. 

SUCHITRA

Welcome Dr. Abhay Bhang. It’s wonderful to be here. Four hours drive from Nagpur and just out of Gadchiroli we come to the beautiful campus of SEARCH or Shodhgram, which is a haven of trees, birds and beautiful buildings, and every building here has a name and a story behind it. But visitors when they come see this beautiful campus, we’d like to explore the history, the origins. So can you please tell us a little bit about how SEARCH or Shodhgram came about? How did you get started in Gadchiroli?

ABHAY

Well, in 1984, my wife Rani and I came back from the US. Both of us had completed our medical education – MDs in India, subsequently we worked for six years in the villages in Wardha district. I don’t think we produced anything, only thing we produced was mistakes and our learning but that’s a different story. So we had gone to the US for studying public health. On our return we decided to move to Gadchiroli for several reasons, (A) of course one was that one is useful where one is needed, and Gadchiroli obviously needed us much more than New Delhi or Mumbai.

SUCHITRA

Why is it obvious? Could you tell us a little bit about  data at that time?

ABHAY

Gadchiroli was the most backward district in the state of Maharashtra. Nearly thousand kilometers away from Mumbai. There were hardly any roads, there was no railway line, 40% population was tribal, 80% population below poverty line, women’s literacy 32%. So in Maharashtra Gadchiroli was considered Kalapani, Andaman Nicobar of Maharashtra. Government officers were not willing to come here. And a huge number of health problems.

So we said if you want to really serve people, solve the health problems. Gadchiroli is the place where there is no dearth of problems, so go where the problems are – this was our motto. 

And so we decided to come to Gadchiroli, in 1986 we moved to Gadchiroli. Initially for a few years we lived at the outskirts of Gadchiroli town. A local trader was moved, ki yeh log America se aaye hai toh theek hai, he thought that this young couple had come from the US, so he should be generous. He gave us his tendu patta godown to us. So we set up our office, our institutional headquarters, our research center, training center, everything in that godown. For the first eight days we actually lived in that godown. Now we named this public trust that we formed here as SEARCH. Obviously, it meant that we wanted to search the ways by which health problems of India’s villages could be solved. 

So it was a “search”. It acknowledged that we are ignorant, we are in the dark, health problems exist, we do not know the solution and we have to find out the solution. So that was the philosophy. Though the long form of SEARCH is Society for Education, Action and Research in Community Health – that describes the scope, but the spirit is of search. And that’s why when we established our headquarters village, subsequently, near the tribal villages… because when we were located in Gadchiroli district town, tribal people were afraid of coming to Gadchiroli town. And they said, “Doctor sahib, please come closer to us.” So we decided to move to the current place, Shodhgram. This is a geographically very, in a way, a strategic position. On the western side of it is the rest of Maharashtra, which is a Marathi speaking agricultural area. From Shodhgram onward to the east is all forest, Gond tribe, stretched up to 800 kilometers up to Koraput Kalahandi of Orissa. So this is the beginning of the Gondland or Dandakaranya. And so we decided to come settle here.

SUCHITRA

And why Shodhgram?

ABHAY

Look, there are two explanations, two reasons. One is that I grew up in Sevagram ashram of Mahatma Gandhi. He called it Sevagram because he wanted to serve villages, so he called his own ashram Sevagram. We had come to this conviction that mere Seva, mere service is not enough, it is necessary, but it’s not enough. And so you need to add to that search for newer knowledge, newer methods. So we called our organization SEARCH. Our headquarter village, we named it Shodhgram, a village in search of solutions for healthcare problems of rural India.

SUCHITRA

So one question that a lot of entrepreneurs and social entrepreneurs really struggle with is how do you build up an institution? How do you persuade people to come to Gadchiroli in those years where no doctors or others were willing to come? How do you build locally? So that sense of decade after decade of institution building, can you just tell us a little bit about that?

ABHAY

Look you said that, “How do you bring doctors to such areas?” The solution is very simple – go yourself, begin with yourself. That was the first thing. All doctors lament that, “Who will go to villages?” You will go to the villages and that’s how… So first, lead by example. I won’t take its credit because that inspiration comes from Mahatma Gandhi. He lived what he preached. So we had such a lofty example before our eyes that we were tiny followers of that. 

Second, look for any institution building, now I am talking in hindsight, but you need people and you need land. By land I mean area, not geographical land for constructing your buildings, but you need a population, you need your people and your land. In Sanskrit or later on in Mahatma Gandhi’s terminology this is called Swadesh. Your swadesh is the people, the community, the land to which you belong. So you don’t take up a village or area, the area takes you, you need to belong to that area. Unless you do that, there is no joy, then it is only career building. So you need to find your land, your area, your people. 

Third thing, you need to have a problem to solve. You need to have a vision and values. Institutions, I hope I am not sounding like an old man speaking, but institutions do need vision and values and these are far more important than funds. People most often come and ask me, “How did you get your funds?” That’s not how you begin, you begin with your swadesh, your people find out a problem to solve because that provides you purpose for the institution, your vision and values. And then you need to build your team. 

After nearly 38 years of working here I can say with some confidence that every human being has capabilities. Obviously in Gadchiroli we were not going to get big professionals immediately to begin with, so it was the local people. But we have a field supervisor called Kusum. Kusum comes from a village called Khursa, a very bright young girl. When we recruited her she was newly married. Unfortunately her husband was alcoholic, later on she divorced him. Now Kusum is 8th or 10th passed but she has blossomed into a very good home-based newborn-care community health-worker, then field supervisor and now she does our qualitative research about several problems. And we have taken her to Delhi and several state capitals to demonstrate how an ideal community health worker can be. 

Kusum was there in Khursa, it was only a question of our coming in contact with her. So local people, ordinary looking people have enormous capabilities, one needs to build your team from that. Funds come probably in the end. If you have a valid mission and credibility that yes, you can really perform something credible, you may succeed, you may fail, but then funds follow. You don’t have to follow funds, funds follow you if you have a community, if you have a problem and if you have sincerity. 

SUCHITRA

To go back a little bit to your childhood which I think is where a lot of the values that you’re talking about, I’d like to explore that a bit. So Vinoba Bhave said “I am a lump of rough shapeless rock. Shankaracharya made the rock strong, Gandhiji chiseled it and gave it form,” and he said “then Sant Jnanadeva really pierced the rock and gave my life sweetness.” So when you look back at your childhood, it’s a remarkable childhood and I was reading about it and thinking how many urban Indians don’t know about that kind of life? How many young people in their twenties don’t know? So can you tell us, just like Vinoba Bhave was shaped and chiseled, how were you shaped and chiseled?

ABHAY

I was extremely fortunate to have gone through that period of life at that particular place. And this place was Wardha. Almost at the center of India is this district called Wardha and Mahatma Gandhi chose that place to become his headquarter in the 30’s. But actually he sent Vinoba Bhave there, young Vinoba maybe 25 years old at that time in 1922. So from 1922 onward, Wardha had become one of the central places for the freedom movement and Mahatma Gandhi’s various experiments about Satyagraha and rural reconstruction. Then later on Mahatma Gandhi himself moved to Sevagram and established his ashram and his school. 

So I grew up in this atmosphere in these ashrams founded by Vinoba and Mahatma Gandhi. This was the period immediately after independence. So I was born in 1950, I of course don’t remember the initial years, but from 1955 onward I grew up in these ashrams. Vinoba at that time was moving all over India on his Bhoodan padyatra. My parents both had joined Vinovas Bhoodan movement. So my father used to be always away on Bhoodan padyatra.

SUCHITRA

Could you tell us a little bit for listeners who may not be familiar with the history of Bhoodan?

ARCHIVAL AUDIO – Bhoodan protest in Bihar 2017
https://www.youtube.com/watch?v=bVYg-fqcZ5A

ABHAY

In 1950-51 the major issue in India… India was largely rural at that time, an agricultural economy but the ownership of land was very unequal and few landlords owned most of the land and most of the men women in the villages were landless laborers. So this kind of economic inequality that also led to social inequality was very unhealthy for democracy and for human justice. On the other hand, China was knocking on the doors of India and a bloody violent way of revolution to bring this equality. And in Telangana part there was a Marxist upsurge for distributing land from landlords to people, by killing landlords. That movement was of course controlled by the Government of India but Vinoba was very disturbed by this issue that the new free India if it wants to retain its democracy and wants to attain Swaraj not only Swatantra but Swaraj then this inequality of land ownership has to be solved. And then one day in Telangana village, on his appeal, a landlord called Ramchandra Reddy in a village called Pochampalli, he volunteered to give his 80 acres of land to the landless laborers, and that was the revelation. 

Vinoba had thought that as if God had sent him a message that this is how this problem could be solved. And he started this movement called Bhoo-dan, land donation movement. And he appealed to the landowners in the villages that they should voluntarily gift a piece of a portion of their land. He usually would say, “1/6th of your land you should donate to those who do not have land. This is a social injustice and through daan we must establish social equality,” and that became successful. Vinoba, for the next 14 years moved all over India on foot called Bhoodan padyatra. Thousands of Gandhian workers in different parts of India moved to Bhoodan padyatra. And 45 lakh, 4.5 million, acres of land was voluntarily donated. 

Now imagine people fight on a small hundred square feet of land and go to court cases and cases go to the Supreme Court. Land for Babri Masjid and Ayodhya mandir, it was basically a land dispute. And here people donated 45 lakh acres of land… So it was a great social reform movement. And, when I was growing up, that movement was around me. My father was, during his time, he had won a record number of gold medals in the university.

SUCHITRA

He was an economist?

ABHAY

Yes, and then he was planning to go for ICS to the UK but then on Mahatma Gandhi’s appeal he quit that dream and joined as a professor of Economics in a college which Mahatma Gandhi had started in Wardha.

Then, in 1942, he joined, Quit India movement, and was jailed for three years. Then later on the new Congress government, at that time, state level government, they decided to send him to the US for studying economics further with the idea that after coming back he would be placed in the finance ministry somewhere higher up. 

Now he got his admission, PhD admission, scholarship. In those days people used to travel more commonly by ship. And a week before his scheduled departure he went to see Mahatma Gandhi to seek his blessings. Now I am narrating what I have heard from my father. This is the year 1946. Bapu was sitting in his hut, a bamboo hut, on the floor and writing something. My father, who was 28 years old at that time, went in bowed to Bapu. He looked up and asked him, “How do you come Professor Bang?” He knew him personally. So he said, “Bapu, I am freed from jail and I am going to the US to study economics further, please give me your blessings.” So Gandhiji looked at him for few seconds and my father felt as if yugapurusha was looking at him. And then he uttered only one sentence. He said it in Hindi, so let me say it first in Hindi, Bapu said, “Arthashastra seekhna hai toh America ke bajai, Bharat ke dehaton mein jao.” And that’s it, he continued his writing. What he said, just to translate in English, is that if you want to study economics, go to the villages of India rather than going to the US. My father quietly came out and right outside Bapu kuti, he tore away his admission papers and scholarship papers and within one month he moved to live in a village called Barbadi few miles away from Mahatma Gandhi’s ashram to live like a farmer and actually experience the economics of rural India. 

While my parents were there, I was born at that time. So even before I was born the message of, “Go to the villages of India,” was around me, in that atmosphere, practically everybody around me was a freedom fighter, everybody had gone to jail in the freedom movement, everybody was a khadi user. My father had given his whole life for the Bhoodan movement so he used to move either separately or with Vinoba. So I had the good fortune of spending some time with Vinoba. So this is the atmosphere, this is the atmosphere, post independence, 50s atmosphere in Wardha. 

I had another good fortune of studying in a school which Mahatma Gandhi himself had started. He believed that the educational system started by the British, primarily by Macaulay, he designed the educational system, was very bookish, primarily to produce clerks for the British empire. Gandhi had a very profound vision, he believed that a human being, a child learns much more through life rather than through books. So real learning can happen in real life and not in the classroom. So this education system was so designed that children learned science and art and philosophy and ethics and history – everything through real life experiences. Now this might sound a little abstract, so let me give a concrete example. 

For example, when I was studying in the 7th standard in this school in Sevagram ashram, every day we had to work for three hours, you work to earn your own bread. So I was given a small piece of land and I was told that you plan what do you want to do in this land, but you have to produce some production. I was a lazy boy, I used to love reading books and not so much working in the field, but I thought probably, “Baingan ki kheti karenge,” eggplant. So I planted eggplants, my plants wouldn’t grow. As a child I was very eager, every day I used to go and see how tall they grew. They did not grow as fast as I expected. So I went to my teacher. He said, “Go and ask experienced farmers.” So I went. They said, “You need to give nitrogen.” So where do you find nitrogen? What is nitrogen? My teacher said, “Go and read chemistry.” You find nitrogen in urea. So where should I bring urea from? I didn’t have money. So I used to bring cow urine from the dairy in buckets and give it to my plants. They grew up very rapidly, finally they bore eggplants – my one eggplant was 1 and 3/4 kilogram. 

Now my teacher said, “Go and market it.” So I went to the market to sell. Nobody would purchase, they would say, “This one fruit would be enough for the whole week for the family.” So my eggplant came back. Finally we cooked it in our kitchen, a community kitchen. 

Now look, with this one responsibility over a period of six months I learned agriculture, I learned botany, I learned chemistry, I learnt marketing, I learned farmer’s economics, everything. And we had to keep records and accounts and everything. So through real life responsibility and real life living, one could learn so many sciences. 

We were posted for one month in the kitchen and we were given the responsibility to run the kitchen for the school. We were eight… In batches, eight boys. 

I was in 8th standard at that time. So we were told that you have to plan the menu, it should be nutritious, you have to cook, it should be palatable and it has to be within the given budget. And the budget was very low, ₹20 per child per month, that was the budget of my school. 

So for days together we struggled, “How to plan the menu?” If you want to give protein, protein is available in milk but milk is costly. If you want to give vitamin A again it is available in butter but butter is costly. So how do you balance this within ₹20? We studied National Nutrition of Nutritions’ Tables, an ICMR publication in 8th standard to design a diet for that kitchen. 

And I still remember that because we had a vitamin A deficient menu, we were looking… So coriander leaves have 10,600 units per hundred grams. Now I did not learn subsequently as much nutrition in MD as I learnt in this school, in that one month of kitchen. With responsibility but also with science, and when you actually do it, you learn that learning remains with you lifelong. So briefly, this was the Nai Talim method of learning. At the same time we were also exposed to the art of Rabindranath Tagore, we were also exposed to Bhoodan movements. So every year for eight days our school used to be closed and everybody went on Bhoodan movement in villages. 

So we saw Indian villages very closely living in farmers’ houses, moving from village to village. 

Let me just give the last example. When I was in 7th standard I declared that learning English is sign of slavery and India had recently become independent. My father was a freedom fighter and this was in Bapu’s ashram. So naturally actually as a child I thought it’s following the British language so why should I do it? So I declared in the school that I won’t study English. My mother herself was the school principal, so all the teachers sat together, “What to do with this boy?” And being Mahatma Gandhi’s school and Bapu kuti was a hundred feet away… From the window of my school we could see Mahatma Gandhi’s Bapu kuti. So the school decided that we have to give this freedom to the boy, though they thought that it was good to learn English, but they couldn’t force English upon a boy if he was linking it with independence. So I was given freedom not to learn English. So this was a remarkable school, that whole atmosphere in which I grew, I think the whole atmosphere was cool. Not only was the school cool but my whole life was cool. 

SUCHITRA

Yeah. And the values are… It’s not as though you have a class on values or moral science or something like that, right? It’s everywhere in the air around you.

ABHAY

Now I can’t stop giving you examples but you can edit it later on. 

Now how do you understand the reality of a poor person’s life? Eleven September was Vinoba’s birthday. In our school the day used to be celebrated like this – from morning till evening, we all, teachers and all students used to work in the field like laborers. Hungry, no food, nothing, except for water, nothing. And then at the end of the day the amount of work that actually we had done, it used to be calculated and turned into the wages – what agricultural labor would earn. Naturally our work was very inadequate so we used to get a very tiny mazdoori, and our evening food was to be purchased only with that money. So only for one day, but we used to have the experience of life of a landless laborer, his hunger, his economic compulsions, his poverty and that’s how the values were really, I shouldn’t use the word “taught,” but you experience those values.

SUCHITRA

So you have a lovely story of how after growing up I think when you were about 15-16 you decided to become a doctor, right? So how did that come about?

ABHAY

I was a lazy boy and what I liked was to read books and often in the morning I used to start with a bunch of books lying on my side and when the time to go to school used to come I used to suddenly have pain in my abdomen. My mother, who herself was the principal, thought that this child has his own ways of learning so she gave me that freedom. 

So my dream was to become a writer, author. I thought that, “Author kya karta hai, he only reads, what a paradise!” So I thought that I will become an author. But then, once when I was 13, my elder brother Ashok was 16. In May 1964 in the summer in the heat of Vidarbha, we were going on bicycle and then Ashok stopped the bicycle and he said, “Abhay we are grown up so we must decide what we will do in life.” I didn’t understand how serious that question was. I said, “Okay let us decide.” I thought it was something like what we will have for evening food, so similarly we’ll decide what we’ll do in life. 

We were at that time standing beside a village called Pipri. Now this is 1964, India was a very food deficit country. Every day milo, red jowar, used to be brought from the US and used to be distributed through relationships, so actually India survived on milo which was  cattle feed in the US. Pipri was poor, the land was parched, children were sick and malnourished. So both of us thought that something had to be done for the village’s plight. 

So what can be done? We thought that agriculture needs to be improved because people are hungry, and health needs to be improved. So Ashok said I shall improve agriculture, so by default I had no other choice but to say, “Okay then I shall improve the health of villages.” And that’s how at the age of 13 years I found my life mission without really realizing… And that’s how I went to medical college.

SUCHITRA

And that’s where you met Dr. Rani Bang.

ABHAY

On the very first day of my medical college, in the first year they make you dissect dead human bodies? That is of course the worst way of introducing medical science but that’s how it is done. So there is a huge hall, a dissection hall and 50 dead bodies are kept there in a row. Eight students on each table dissecting dead bodies. Boys were on one table, girls were on another table. So we were dissecting, after sometime we got tired and we started looking around. 

So my tablemate in dissection, he said, “Look at that girl.” Of course I keenly looked at the girls. And so he said, “Look at that particular girl.” So I said, “What is special about her?” I looked at a thin tall girl with glasses and very sincerely doing dissection. He said, “She is Rani Chari. She is from my town Chandrapur and she is extremely brilliant, comes from a very rich family. She is the star of Chandrapur.” So I said, “Let her be, how does it matter to me?” He said, “No, no, no, in the entrance test for medical, she was the first in the university but because she was underage she did not get admission last year, so she has come this year.” And in our batch, ‘68 batch I was the first in the merit list. So he said, “Now two of you from two different batches but you top notchers have come together. So you will have tough competition from her, be aware.” That’s how I was first introduced to Rani. 

We studied together for nine years. After MBBS together, I did my medicine MD, she did her gynaecology MD. A very compassionate, transparent, generous, very generous human being, so I fell in love with her qualities. When I proposed to her in my 9th year of education, then I realized, “Oh she’s beautiful also.” But I must say I was fascinated by her qualities, and of course she was brilliant, and we found that our dreams of life, our values matched. So it was not love at first sight, it was a warning at first sight, but then subsequently we really liked each other and decided to marry. 

This was during the Emergency, 1976. So my parents were in jail. They were close associates of Jayaprakash Narayan, so both were jailed during the emergency. I took Rani to jail to show to my parents, so her first muh dikhayi, as it is said in Hindi, happened in Nagpur jail.

HOST 

Here’s Dr. Rani Bang’s sharing her early life, interests and the deep convictions that lead her to choose a life of service with Dr. Abhay Bang.

RANI

Actually, I was born and brought up in Chandrapur. Previously Chandrapur and Gadchiroli were together. And in 1982 Gadchiroli was separated. I belonged to an Iyengar family, and so was very highly educated. All the relatives are very orthodox, and my father was a very senior medical practitioner. He studied in Stanley Medical College in Madras. My grandfather was a Member of Parliament from this area. And I studied in Nagpur Medical College. So since my childhood, my dream was to become a doctor.

Abhay and I both were classmates in medical college. We did our MBBS and MD also together. And I come from a very different background, meaning a typical materialistic type of family and I had a dream that my father and I both, all the family members had a dream that I would do my MBBS MD, then go to the UK or US to pursue my higher studies. My elder brother was in the UK, he is still in the UK, my sister-in-law is also a doctor, both of them are doctors. So the family tradition was to study in India, do further studies in either US and UK and work abroad. But I was not interested in materialistic things since my childhood, maybe I was a different person in the family, maybe I was destined to marry Abhay.

I had great opposition in my marriage because, the first thing is about the caste, because they thought that… The caste hierarchy, my family members could not accept it. And also because Abhay’s family had adopted voluntary poverty and my family members thought that I would not be able to adjust to this new way of life, but ultimately they gave up for my sake and agreed to my marriage. 

Another problem started later on because we both had very fixed ideas about how to perform the marriage. Abhay and I wanted to go for a registered marriage but my family members thought that no registered… Because my father was a supreme court lawyer, he thought that maybe if I get separated after my marriage… The divorce is not that easy in vedic type of marriage. So they were opposed to registered marriage. Mine and Abhay’s conditions were very different, we wanted to perform the marriage in a very simple way and my parents wanted to perform the marriage in very different type of way.

I was the youngest in the family, so marriage would be performed with all pomp and show. And my conditions about marriage were different. We decided that I won’t go for kanyadaan because I said that I am not an object to be donated to someone. So my parents were opposed to that. Then there was no len den, no dowry or nothing. Then we opposed tying the sacred thread, mangalsutra. Because when a woman wears mangalsutra, it is removed if she becomes a widow – that type of sacred thread or toe rings are there for any woman. But what about the man? Suppose the wife dies earlier, then will he remove any objects like mangalsutra or sacred thread or toe rings? So we were opposed to that and both of us had similar views.

My parents were very much opposed to that. They said, “What is the sanctity of marriage if you don’t use this type of mangalsutra and all that?” Then we said that there will be only 20 guests from either side because so much money is spent on all those things. So there was no akshata because there was so much wastage of grains, food grains. So our marriage was performed in a very simple way and only 20 guests from either side. My parents were very much opposed to this type of marriage but ultimately they agreed to that. 

I mean, now retrospectively, when I think about it, I think that we were very obstinate, very stubborn and parents that we are very mature and very understanding. That time they agreed to everything, whatever we said. Now after marriage, after initial two, three years, my parents agreed to everything and they were very happy about our marriage. Now they are no more but they used to say that mine was a very wise decision and they were very happy with Abhay and all my family members, in-laws and all that.

SUCHITRA

What a remarkable story! And then, like other couples, both of you went from India to Johns Hopkins to study. You could have chosen to just settle there and not come back like many Indians chose to do, but you chose to come back and you chose to come to Gadchiroli. How did both of you decide? 

ABHAY

The real answer is, why did we decide to go? After completing our medical education, when Emergency was lifted, 1977, with Jayaprakash Narayan’s appeal, I think hundreds of young people at that time of my generation decided to go to villages and serve the people – we were one of those. 

So we started working in a village called Kanhapur in Wardha district itself. We were young, both of us gold medalists from university, with our MDs and we thought with clinical medicine, by serving patients, we will change the village and the village will improve. Very romantic, but naive kind of dreams. 

We worked in Khanapur village for two years, served every hut and house in that village. And one day, one landless laborer, his name was Ajab Rao, while working on the thresher machine of a farmer, his arm got chopped. We had to take him to hospital, amputation was done, he returned after 15 days with right hand lost. So we thought this is the time for establishing social justice and we appealed to the villages of Kanhapur, that this man should be compensated by a piece of land from the owner for whom he worked. Nobody responded. So we organized a night meeting. 

Now, usually for our meetings, 200-300 people used to assemble. This day nobody came except for Ajab Rao and his one friend who was drunk. So, with the audience of two people we started talking in loud speakers making appeals for social justice. People from every household threw stones on us. We were stunned and our dreams were shattered. Village where you served everybody medically for two years, and here on the first instance for a call for social justice, what you receive is stones. 

We wound up our meeting. We had a scooter, two wheeler at that time. So, in the month of December, we came back home completely cold from inside, outside. After 15 days we summoned courage to go back to that village. People behaved as if nothing had happened. So we asked them, “Why did you throw stones on us that day?” They said, “When you came you said that you wanted to do medical service so we thought you were doctors. But you started behaving like political leaders, you cheated us, so we threw stones on you. Quits!” We realized that they had a point. Our implicit dream was that if you provide Seva, medical service, people will be willing to change. We realized that our dream of changing people, sampoorna kranti , was too lofty and our method of medical service to people was too inadequate. So we had to learn and change our approach. 

We then decided that instead of having very lofty dreams of changing everything in the society, we need to improve the health of the people. And mere patient care is inadequate for that, you need public health. And to study public health, that’s why we decided to go to the US. We got Ford Foundation International Fellowship which chose to study at Johns Hopkins, and we primarily studied public health research, how to do public health research in developing countries. 

Another reason for taking up this approach was that we looked at the history of development of medical science in India. Malaria was India’s problem, but who did research on that? Ronald Ross. He came from the UK, a British army officer doctor. Cholera was a problem of India but Robert Koch from Europe, he came all the way and discovered cholera organisms in India. They were great, but what were the doctors of this country doing at that time, and even when we worked in Kanhapur? Most of the medical doctors in India worked in urban areas and research was done on the problems of the west. So we realized that Indians actually need to do research on India’s health problems. And research could be a very powerful way of solving health problems, and that’s why we went to Johns Hopkins, that’s why we came back. 

SUCHITRA

So let’s get to the heart of the work of SEARCH, which is really the community based approach to research and healthcare. I think anybody who’s in public health, anybody who’s doing research of any kind, would really learn a lot from your decades of thinking, listening, testing, so can you talk about at the beginning the work that you did and how taking a research based approach really made a difference there. 

ABHAY

I used to work with landless labourers, trying to organize them for better wages. The precursor of the current MNREGA was called EGS in Maharashtra, Employment Guarantee Scheme. So in 1979 I used to work with a laborers group trying to organize them, get their wages raised… And the wages wouldn’t go beyond ₹4 per day. 

So I realized that this was the minimum wage set by a minimum wage committee of state governments. This minimum wage work we did while we were in Wardha, not in Gadchiroli, but it was sort of the beginning of our research experience. 

So I went to Mantralaya, at that time there was no RTI facility. So I had to literally get very secretive access to the minutes of the minimum wage committee. And I found that they had made enormous errors, blunders. 

They said that the minimum wage should be adequate for the nutritional requirement of a labourer but they had assumed very, very meager and inadequate requirements. So I took their framework and corrected it with the ICMR’s recommendations of nutrition and several other errors that they had made, corrected it without adding anything of my own that they should have scooter or housing etcetera, only the nutritional based minimum wages came to ₹12 while their recommendation was ₹4. 

This was published by practically every magazine, newspaper in Maharashtra. Volunteer organizations picked it up, Sharad Joshi picked it up, and within one year after I published this small essay, minimum wages in Maharashtra were raised from ₹4 to ₹12 – exactly what I had calculated. One must give credit to the government’s sensitivity at that time. 

This was an amazing experience. I was organizing landless labourers and nearly 2000 labourers in Wardha district and their wages I could raise from ₹3 to ₹4. And with this piece of investigative work and within three months I produced this particular essay and that resulted in raising minimum wages of six million labourers in Maharashtra from ₹4 to ₹12. That was the first realization that knowledge can be a powerful change lever. 

We did not know the research methodology enough and that is how we decided to learn it. Even in the health field it is basically new knowledge which changes the health scenario. Now just to take an example, leprosy was such a horrible problem of public health in India and several very eminent people from Baba Amte to Mother Teresa have worked to serve the patients of leprosy, but I can humbly say that it hardly solved the problem of leprosy. What solved the problem of leprosy in India to a large extent, not entirely, but to a large extent, was the new knowledge, new drugs and drug combination and the multidrug therapy. So knowledge really plays an enormous role in changing health scenarios. This realization was really the foundation of SEARCH’s strategy of working – serve the local people through healthcare but by way of research, produce new methods and new knowledge so that it serves the entire country.

SUCHITRA

So when we are talking about SEARCH and research, here’s a very basic question, research for whom?

ABHAY

When we came here in ‘86, maybe within two months after we started working, an eight year old tribal girl was sent to me – a suspected case of heart disease, and because I am a trained physician the case was referred to me. And she was a girl, little stunted, bloated abdomen, pale and mild jaundice. So I suspect that maybe she has sickle cell disease. Till then no case of sickle had ever been reported from Gadchiroli district. 

So I established a test and she turned out to be really a case of sickle cell disease. Now that was the first diagnosed case of sickle in the district. So we decided to organize a sample survey and we conducted a district survey in which we found that 15% of the population had this gene but the actual symptomatics – only the sickle homozygous. They are relatively rare, less than 1% of these findings. 

Maharashtra government was very impressed. It was published as a research paper. Maharashtra government lauded it, they gave me my first award – Adivasi Sevak Puraskar. But nothing happened to sickle. So we went back to the tribal village chief saying, “Look at this problem we found, your government is not doing anything, only giving us an award, so can you raise your voice?” So tribal, old people, they looked at us very coldly and with a masked face they said, “Doctor this is your problem, we have nothing to do with this problem. You called sickle, did we ever tell you that this is our problem? You found it. When you came, we thought accha young doctor couple, why should we disappoint them? So we gave you a drop of blood. We have nothing more to do with this problem, this is your problem, you solve it.” 

So we realized that we had made a blunder. We had picked up a problem for research out of our intellectual curiosity, rarity, but that was not a common experience of the people so they were least bothered about it. And from that we really decided for ourselves, for SEARCH, the ethics, that hereafter we will not conduct any research which directly or indirectly does not help the people on whom this research is done. 

So from that actually subsequently I developed a framework that medical or public health research, could be research on the people. Where researchers practically use people as guinea pigs – he does his research and goes away. And I am ashamed to say that sickle cell research was something of that sort. It was our curiosity. Research on the people. 

Second is research for the people where the purpose is to help the people. But then people still remain only beneficiaries, passive beneficiaries. So the third stage is research with the people. So far we have been trying to follow either research for the people and research with the people. 

My final dream is research by the people, when people will start doing research. But that is how our research ethics emerged. I am a physician so I am always looking for heart disease but at that time heart disease was not a problem. So we should really choose a problem to solve which is people’s problem and not my mind’s problem. That’s what we learn through this sickle cell experience.

SUCHITRA

So this idea, to build on the word “ethics,” how do you weave ethics into any medical work or any research work that you do, how did you get engagement with the community? Especially when you’re talking about cultures that are quite different, the Gond tribe for example…

ABHAY

One problem with most of the health policy making is that policy makers usually come from a very elite class, whether doctors or bureaucrats, and they sit in air conditioned rooms in the state capital or global capital. With good intentions, but they often tend to choose priorities which may not be people’s priorities as our sickle cell showed. So after the sickle cell lesson we decided that we should have humility enough to ask people as to what are your problems? So we organized the first meeting in 1990 and subsequently in ‘93 and then started organizing annually collecting representatives of people from 50 villages. People’s Health Assembly or Tribal Health Assembly. First assembly was the Rural People’s Health Assembly, the second was the Tribal Health Assembly. And after discussion among them, we asked them, “You tell us which are the health problems which bother you, on which SEARCH should conduct research.” I am not aware anywhere where researchers have asked people to tell them research priorities. But we learnt it from the sickle cell experience. So after a lot of deliberations we conducted voting. 

So every representative was given three leaves as ballot papers and told to select three health problems which you think are the high priority problem for you and SEARCH should conduct research or programme on that, and that’s how six health problems were selected by people.

SUCHITRA

What were they?

ABHAY

One was malaria, second was backache, third was alcohol and alcoholism, fourth was women’s white discharge, fifth was diarrheal disease and sixth was, “Our children die, can you do something about it?” 

And actually this provided us with a research agenda for the next 30 years. Some of these health priorities were well known in the field of public health, like malaria, diarrheal disease, these were not new, but alcohol and alcoholism. Alcoholism, yes, but alcohol? People saying that alcohol is a major problem, do something about it… Subsequently women in every village used to tell us, “Keep your stethoscope and medicine aside, first do something for this alcohol.” Now women of Gadchiroli told us alcohol was a problem 35 years ago. Now, 35 years later, Global Burden of Disease study, which is the largest ever study on global health has identified alcohol and tobacco as one of the two of the top seven causes of death, disease and disability world over. So what public health scientists are realizing now, people of Gadchiroli knew 30 years ago because it was their life experience. 

Low backache – nobody had even thought of low backache as a public health problem in the nineties, but Gadchiroli people were complaining. Now in Global Burden of Disease study – back pain and neck pain are one of the top two morbidities. So listening to people is a very important way of choosing your priorities. 

Fortunately, sickle cell taught us that humility, that you need to listen to people rather than imposing your priorities on them and that gave us a very rich dividend in the sense we got priorities on which to work, these people’s priorities, so we got huge cooperation on that. Some of these became global first priorities. 

Subsequently, later on, the Time Magazine New York had chosen us as Global Health Heroes. So their Asia bureau Chief came here to write a story on us. He wrote the story and he gave the title to the story as ‘The Listeners,’ I was not very happy. I said, “You could have thought of some better title.” He said, “Dr. Bang, you don’t know, your uniqueness lies in your listening. Doctors or public health experts, they don’t listen to people and your specialty is that you listen to people.” In hindsight now I realize that, yes… And so listening to people was a very good way of beginning to identify priorities which need solutions.

SUCHITRA

And your listening to people also led to the changes you made in your hospital. Can you talk us through that?

ABHAY

Yes, when we moved and started living at Shodharam, we didn’t have any hospital, but people in tribal areas did need hospital care. Unfortunately Rani and I had that clinical expertise. So we assembled people – people from 50 villages and asked them, “What kind of hospital do you need?” So people told us their difficulties. 

Apart from distance and money, they said “These hospitals have very huge multistory buildings and we are lost in them, we are scared.” Second, they said, “The patient is admitted in the ward and relatives are told to come between three to six for a meeting. But we have gone 50-100 kilometers, where do we go for the rest of the hours? If we can’t stay in that hospital we say patient and we all come back, so there is no space for relatives in the hospital.” Third, they said “Doctors and nurses talk some gitpit language, English, we don’t understand and they laugh at our language and our clothes.” “And Doctors,” they said, “wrap themselves in some white cloth.” So we said, “What objection do you have?” They said, “No, in our Gond tradition dead bodies are wrapped in white cloth. If these doctors are already wrapped in white cloth, how are they going to save lives?” And then finally they said, “Look doctor, there is no God in these hospitals. Doctors consider themselves to be gods but if there is no God in the hospital there cannot be healing. And because there is no God in hospitals we don’t go to them.” 

Now keeping all these in mind, when we designed the hospital here in Shodharam, we said that it will not be a hospital with a multi storey building, it will be a hospital of huts – it should look like a tribal village so that tribal people should not feel intimidated. They should feel as if they are coming to their own village. So we constructed a hospital of huts. 

Our OPD had a waiting room which was like a ghotul. Ghotul is a place in every Gond village, there is a common place – new visitors and guests are usually welcomed there. So our OPD waiting room was constructed like a ghotul. Indoor was constructed of huts. So the tribal people liked that idea so much. When it came to constructing hospital tribals from two villages, they came before we had put in our first brick, they came and constructed their huts for they said these are huts for patients from our village. 

And finally when the hospital was constructed, we brought and constructed a temple of tribal goddess. Their goddess is Danteshwari, the temple is in Dantewada, in Bastar, but for Gond tribals, Danteshwari is the highest Devi. She is a reincarnation of Parvati. So when it came, “What name should be given to this hospital?” Tribal women stood up and they said, “Look doctor, this hospital now doesn’t belong to Abhay Bang, it doesn’t belong to Rani Bang. It is our hospital and we have named it as Maa Danteshwari Dawakhana.” And that’s how it remained as Maa Danteshwari Dawakhana.

And the most beautiful part was that they felt that it was their hospital. So this is how our tribal friendly hospital emerged. 

SUCHITRA

Okay Dr. Abhay can you tell us a little bit about Shodhgram, life at Shodhgram here and the culture that you’ve built over time and how having most of your employees live in the campus and work together – how you set up that kind of culture?

ABHAY

Culture begins with yourself. We social workers often are trying to address problems outside – systems need to be changed, this evil, that evil. But we often forget to look inside or forget to see the way we live. 

Now, taking you to a very different… Once Ram Manohar Lohia asked, and this is a story which my father has told me, Ram Manohar Lohia was a great socialist leader, very firebrand orator. He once asked Gandhi, “Bapu, Nehru, Subhash Bose, Jayaprakash Narayan and I, Lohia, we are firebrand orators and we talk fiery language and very erudite speech. And while when you talk, your pronunciation is not clear, you use very bland words, no exaggeration, no superlatives, and still these stupid people of India follow you, not us. So what is your magic?” So Bapu said, “Beta Ram Manohar, I can see only one difference, and that is I never asked people of India to do something which I have not first lived in my own life,” and he said, “my power lies in this.” 

And so in Shodhgram, we truly believe that you cannot live only for external projects and goals etc. Your own day to day living is also equally important, as much as possible you ought to live what you believe in. And so Shodgram’s buildings are constructed to at least look like a tribal village, they look like huts. Usually we have avoided multistorey buildings. 

There are abundance of trees here around, every building is usually named after a tree. So we have tried to preserve the environment as much as possible. We have created a rural, but ashram environment. 

Our own day to day living, that is culture. Peter Drucker once very famously said that culture eats strategy for breakfast. People in the corporate sector often talk about strategy, strategy, but the global guru of management is saying culture is far more important. We don’t follow it because Drucker said it, but basically it is Mahatma Gandhi’s influence. What I saw and lived in his ashram, it has continued to stay with me. So we practice some of those things here. 

ARCHIVAL AUDIO – Dr. Bang leads communal prayer at SEARCH
https://www.youtube.com/watch?v=h99ydMi7xA0&t=24s

Evening prayer – every day when you work for the whole day, there is a need for some time when you come together and reflect together, inspect, introspect and then finally pray. Pray to whom? Not necessarily any particular God, but pray to forces larger than you. It’s required that at least for a few moments in the evening you break out of your own. And so we have community prayer together in the evening. It is a religious prayer, but it is a multi religious prayer. So we have prayers from Buddhism, from Upanishad, from Quran, from Bible.Twice a week we have common shramadaan here. We used to call it shramadaan but I am trying to change it to shramayog. Daan is you giving it to somebody, but there is no daan here. We are trying to maintain the environment healthy and clean and green, so twice a week shramayog. 

We professional class, especially in India have forgotten manual labor, and this usually looked down upon. And unfortunately in Indian society, which is so not only class based but also varna-based, doing manual labor is a work of shudras. We professional elites are Brahmins or Kshatriyas, higher varna, we don’t do manual labor. And so through shramdaan all of us come to the same level of equality and contribute to cleaning the environment and nurturing the environment. 

So shramayog really helps in several ways. It breaks down barriers, it breaks down elitism. And during some shramadhan, especially during the rainy season, we even do rice transplants. We do few acts which the tribals also do in their field, it is very important. When you do rice transplants for one hour, your back aches for seven days and then you know why people complained of backache, what does it mean? So it’s good to experience what people live. 

We often have joint functions together. Several cultural festivals we have together so that the whole community can come together. Hospital and the Shodharam community, we do not, of course, alcohol and tobacco are not permitted here. And at the entrance itself, you might see there is a board, Humara Ghar. So we have constructed this Shodharam… It is a poem really written by a woman poet called Nandini Mehta, it’s a beautiful poem. I liked it, so we have put it there that we have built this house not to limit, but to welcome you, it welcomes everybody. 

Fortunately, people from all over the world come here, mostly from India and Maharashtra, but sometimes from all over the world. So we get the opportunity to interact with the people, welcome, and understand their culture. Several young professionals keep coming here for living and learning from the experience of SEARCH and Shodharam. So in a way, it has become a living university. We are not a formal university, nor do we intend to do that, but it is a living university – by living and working on the issues of health and healthcare, many professionals tend to learn here. 

SUCHITRA

One of the remarkable things that you and Dr. Rani and SEARCH have really worked on issues that are important, locally, but then taken the research, taken the data, published it at a very global level. And then had effects on global policy. You’ve done this again and again and again. What happened here, what did the data say and then how did it change global policy?

ABHAY

Most often it begins with an encounter with reality. In the 80s and 90s, pneumonia was the number one cause of global childhood mortality. Nearly five million child deaths used to occur globally because of pneumonia. Now antibiotics had been discovered nearly 50 years ago, but they didn’t reach where antibiotics were required. We, the professionals and the middle class consume antibiotics even for sore throats. But here in villages, children with pneumonia, panting for breath and often dying, did not receive antibiotics. 

My first experience outside the hospital was very pathetic. In Kanhapur, there was a widow called Rai Bai Dabole and she had three children. Once she brought her one year old child, which was her last child before her husband died, and the child had bronchopneumonia. Child was too serious so I told her that it cannot be managed here in the clinic, the child needs to be admitted to hospital. So I wrote a referral letter. 

In the evening we got an emergency call – the child is very sick. So Rani and I went there, and saw that the child was already dead. She had not taken the child to the hospital. When she came, my first reaction was anger. I scolded her, “What kind of mother are you? The child was so serious and you didn’t take the baby to hospital and happily went to the field to work.” So she brought her two other children, made them stand before me and said, “Look, Doctor, I had three children and every evening I am able to feed them based on what I earned during that day. If I had gone with this younger one to the hospital, these other two would have been starved and died. So I had to choose which child to save and which child to let die.” 

Now, this was a very cruel choice for any mother, but she had real compulsion and she had to make a choice. So we doctors very happily give referral letters, “Go to the hospital.” But where is the hospital? Can that mother or can any daily wage earner go there? So the pneumonia treatment, that child… Subsequently in Gadchiroli, this question was before us, the children die with pneumonia, they cannot go to hospitals, there are no doctors, no stethoscopes, no x-rays in villages, can we develop a method by which without doctors, without stethoscopes, without x-ray, pneumonia in children, in villages can be diagnosed? And can somebody not only diagnose but give antibiotics there and see that the child is safe? 

It means really we wanted to develop a community based method of childhood pneumonia management. Fortunately for us, one Australian paediatrician called Frank Shan, he had gone to work amongst tribes in Papua New Guinea and he did a wonderful piece of research. He compared the respiratory rate in children with cough, he compared their respiratory rate with the x-ray finding and he came up with very interesting conclusion – that if a child has cough and you count respiratory rate, if respiratory rate is more than 50, most likely it is pneumonia. X-ray shows pneumonia. 

Now this was a very important piece. As I said earlier, knowledge is an important thing in changing global health, so this was the important piece. So we took that research study and then built that into a method by which community health workers could be taught, ordinary village women could be taught how to diagnose pneumonia in a child with cough. Because children often have cough, which is simple cough and cold, you have to distinguish. 

Then I developed a small instrument called a breath counter because some of our dayis were illiterate, so how could they count up to 50? This breath counter has got really a sand timer and rows of beads. And for every counted ten breaths she moves one bead. Dayis could not count more than ten or twelve, but without being able to count more than ten or twelve, but they could correctly diagnose, if the respiratory rate was more than 50 or 60, and diagnose pneumonia. Using this method, I compared 50 children with cough, I diagnosed using stethoscope and these dayis diagnosed using this breath counter. Third diagnosis matched with my diagnosis in 82% instances. So good. They were 82% doctors.

SUCHITRA

It’s a simple tool that without knowing how to read or write, you could use to detect this. No x-rays, no electricity, nothing needed.

ABHAY

Counting respiratory rate and if you can’t count more than ten, breath counter. Those who could count more than ten, more literate community health workers, they didn’t need a breath counter. We conducted a field trial in 102 villages. 58 villages, this was introduced through community health workers and dayis, and remaining villages remain government programme villages. And it showed that the childhood pneumonia mortality could be remarkably brought down, the infant mortality could be remarkably brought down with this one intervention only – and it became very popular. 

Within two years, almost hundred percent of all children with pneumonia episodes received care through this approach. A hospital or doctor-based approach would not have been able to reach more than 10%. So this was very successful.

It was published in the Lancet and it became the world’s first trial which showed that you can reduce pneumonia mortality and infant mortality by way of community health workers in this approach. 

Subsequently, in 1993, when Global, they call it ARI – acute respiratory infection. So Global ARI control programme was designed… Gadchiroli study was an important evidence that with this approach you can provide pneumonia management in the village itself and it became part of the global policies. Currently, 77 countries use this method for diagnosing and treating childhood pneumonia. 

So from that one realization of Rai Bai Dabole’s child and her compulsion of not being able to go to the village, this simplified method in which power could be transferred to the community… It not only reduced child mortality in Gadchiroli, but because it was conducted as a research field trial, it contributed to the global knowledge and contributed to shaping global policy. So from Gadchiroli to global – that’s the power of knowledge.

SUCHITRA

There are also other threads… Continuous medical knowledge of the SEARCH team and knowing the Papua New Guinea work that was done, being able to then translate it on the ground to what was needed here and then to be able to take that research to Lancet and WHO and these 77 countries… 

ABHAY

There is a very well known saying in the field of environment that, ‘think globally, act locally.’ It’s a very empowering slogan. So we thought about global problems… But actually that people’s health assembly had given us that issue – “our children die” — and pneumonia was the number one cause. So actually Gadchiroli’s priority and global priority coincided. But then there is another way also, that if you think locally, it has a global effect. 

When you solve a local problem, if you solve it thoughtfully with research design or ideas, sometimes, not always, but sometimes it has the potential that it can produce global action. 

So think globally, act locally, but think locally, and it has got global action – it is a two way kind of relationship. When we began in Gurchurli, in nearly 100 villages, we developed something which can be called a population laboratory. 

The census was conducted of the whole population, nearly one lakh population and every child birth and every child death was recorded and the cause of child death was determined. This population laboratory, or in scientific terms, it is called ‘demographic surveillance system,’ we have continued from 1988 till today. So it is one of the longest population laboratories in India. So we found that the infant mortality rate in 1988 at the beginning was 121. What does it mean? It means that if a thousand babies were born alive within one year, 121 of them died. Just for comparison, to give people some sense, infant mortality rate is currently lowest in Kerala, about ten. And in the US it is six. In Gadchiroli, it was 121. And why were children dying? We developed a method because nobody, no doctor used to see those children before death, so how do you know what is the cause of death? So we developed a method called verbal autopsy, by which even if you were not present when the child died, but subsequently a field supervisor visits, he makes detailed inquiry about the symptoms, signs, circumstances of death and from that you can surmise as to the most likely cause of child death. Verbal autopsy. 

So pneumonia was the number one cause. Now, with this field trial, fortunately, it was solved. But our infant mortality rate got stuck at around 75. So we found that most of the now remaining child deaths were occurring amongst the newborn babies. Out of 75 infant deaths, nearly 60 were amongst the newborn babies. Now, newborn was a difficult challenge to solve. At that time, one other instance happened. 

We were living in Shodhgram, and once in the month of August in 1993, on a very rainy day, I completed my daily OPD and in the evening went back home and just relaxed on my bed. Suddenly, two women knocked on my door and then stormed inside the house. One was an old woman and another was her young daughter, and that daughter was carrying a baby at her bosom. Baby was very shrunken and malnourished, it was very sick, so I put that baby on my bed itself and I was examining it. While I was examining… We doctors have this habit that we do self talk. So I said, “Severely malnourished, dehydrated, pneumonia.” Baby was panting and had a stethoscope, I could hear bubbling chest sounds. I said, “Pneumonia,” and the baby stopped breathing and died. 

Now I must have seen hundreds of deaths in the hospital, but this was the first and thankfully the last child death on my bed itself. I was very frustrated and I couldn’t do anything to this child. So I vented my anger on those women, “Why did you come so late? Why didn’t you come earlier? I might have been able to do something.” 

Sobbingly they told the whole story – they came from a village called Khursa, three kilometers from Shodhara. This mother was illiterate, her husband was alcoholic. I am not telling the entire story, but when the child became sick, they went to a mantric, magic healer, who took money, did some rituals, and the child did not improve… So finally when they wanted to come to our hospital, there was a river called Kathani and Kathani river was fully flowing so they could not cross. There was a bridge which was broken because of corruption in the construction. So they had to wait till evening on the other bank of the river, and by the time they came, the child was too sick. 

Now I could list 18 causes contributing to this child’s death, from illiteracy to poverty, alcoholism of husband, not having enough nutrition during pregnancy, delayed breastfeeding, and so on and so forth. I was very frustrated. If 18 causes conspire together to kill this neonate, it’s a hopeless case, what can you do? And you can’t really solve problems like poverty and corruption, etcetera. I was very despaired. Then suddenly in the same reality I saw light. 

If there are 18 causes, each cause offers me an opportunity to intervene. So the list of 18 causes, I was thinking that this is impossible case, there are 18 enemies fighting together, but no. There is a very famous strategic saying that the strength of the chain is equal to the strength of the weakest link in the chain. 

So I did not have to break these 18 links in the chain. Even if I could break one link, the chain of child death will be broken. So in this case, what could be done? I couldn’t build bridges, I couldn’t remove poverty, I couldn’t remove illiteracy. So if the baby couldn’t reach here, if newborn care could reach their village, then this chain could be broken. How can that be done? At that time, this was the early 90s, global guidelines including WHO guidelines were that a sick newborn is in a very serious condition, you can’t do anything, immediately hospitalize. But where were the hospitals? This mother and the baby couldn’t cross even three kilometers and come to our hospital. And actually our hospital did not have newborn care, intensive care, so the nearest hospital was 200 kilometers away. So then if babies cannot go to hospitals, hospital knowledge must go where the babies were. And that’s how I designed home-based newborn care. So necessity is the mother of discovery or invention.

SUCHITRA

So what was that like? The design, and what were the changes that moved that 75 number down?

ABHAY

This home-based newborn care is a package of medical sciences, but simplified together into a package which can be delivered in a village at the home itself. So the baby doesn’t have to be brought out, and you can train a literate village woman to become a village neonatologist and provide that care at home. It contains (A) giving health education to mothers during pregnancy so a large number of problems can be prevented. 

Secondly, at that time most of the deliveries were home deliveries, so this community health worker, trained worker, we used to call her Aarogya doot, she could attend home delivery and conduct it safely. When the baby is born, 10% of babies don’t breathe, they need resuscitation, so she could do resuscitation, then weigh the baby. If the baby is a low birth weight preterm, provide special care, keep babies warm, encourage immediate breastfeeding and monitor the sign symptoms. If a baby develops sign symptoms of newborn infection, that’s called neonatal sepsis – very serious, potentially fatal condition. Then ask parents to go to hospital but if they are not willing, take the written signature and give antibiotics to newborn babies. 

So managing birth asphyxia, babies not breathing at birth, to low birth weight preterm babies, to breastfeeding problems and to newborn sepsis – all this was included in this home-based newborn care package and we selected one woman from each village, literate woman, trained her and she delivered this package. 

Three year field trial was conducted – how do you know that this is effective? In your enthusiasm you might think that my interventions are effective. So to test that, we conducted a controlled field trial. By the end of the third year, 93% of neonates born in those villages had received home-based newborn care, so coverage was outstanding. And the newborn mortality was reduced by 62% as compared to the control area – control area was a government programme area.

SUCHITRA

Incredible.

ABHAY

WHO was saying that you can’t do anything and so refer to the hospital… In the US, if any new drug or any new invention reduces newborn mortality by 5% that would become a national headline. And here it was reduced by 62% and infant mortality reduced from 75 to 30. So this was a remarkable intervention. And if we put this two simple interventions together – infant mortality rate at 121, childhood pneumonia management brought it to around 75 to 80 and home based newborn care brought it to 30. So from 121 to 30 – this is practically revolution. And who did it? Four women – mother, grandmother, this dayi and the trained community health worker we call Aarogyadoot. Four together women could really bring this child survival revolution in the village. And these are the kind of women, every village has this kind of four women, they are not very unique. So this can happen in any village, every village. 

What it requires is that you select a village woman, train her for 36 days, and set of equipments which can be carried on her shoulder bag. But more important than equipments on shoulder bag that is home-based newborn care kit, is the knowledge and the skills in her hands and most important, compassion, love in their heart. 

So these community health workers can convert any village, home or hut into a newborn care unit. When we conducted this field trial it was published in the Lancet in the year 1999. It becomes it became world’s first field trial to reduce neonatal mortality by this approach, this approach itself was new. 

Subsequently Landset included this as the vintage papers in the Lancet published over 180 years of history.

 So here was Gadchiroli village neonates dying, and with this piece of research finally Government of India included that. The ASHA programme is partly shaped on this model. One is Gadchiroli model of community health worker and Mitanin programme in Chhattisgarh – these were the two major pillars of evidence for ASHA programme. We were given responsibility of training ASHAS in the entire country in this home based newborn care. 

So we designed methods of training training material, we trained 500 national and state level trainers. They went back and they trained 5000 district trainers and they trained nine lakh ASHAs. So today home based newborn care is delivered through nine lakh ASHAs in the entire country. Last year one and half crore neonates, 15 million neonates in rural areas received HBNC home-based newborn care. This principle has been now picked up by Unicef, WHO and is used under different names. But it is used globally. 

The current director general of World Health Organisation, Dr. Ted Ross, earlier when he was health minister of Ethiopia, he heard about this. He sent a special delegation from Ethiopia to first see – actually has it really happened? Then he sent a second team of trainers to be trained in SEARCH, and that method was replicated in Ethiopia, then in several countries. Bangladesh, Nepal, Pakistan, Bolivia. Currently nearly 80 countries practice this. 

So this is the power of knowledge. You have a real life problem, often you meet that problem by chance, but you meet it because the problem is commonly there. It’s not a rare problem, it’s an accident that you meet it. That problem was already there, you were not there. You choose to go there and the problem becomes visible to you. 

It is almost like Newton’s apple falling. Apples were always falling, only Newton has to go and ask this question, “Why did it fall down and didn’t go up?” So similarly when you ask this question that, “Why did this child have to die? Can there be a way?” And you turn the traditional medical science that everything needs to be done in the hospital. You develop a simple solution and then it’s the power of knowledge actually that makes this kind of global policy impact.

SUCHITRA

It’s remarkable and very, very powerful. Just the numbers, the story, the lives saved… We’ve talked about various aspects of the work that SEARCH does, is there any area that you would like to talk about that’s not been covered so far?

ABHAY

I’m deliberately leaving out women’s health, which you will be talking with Rani…

MUSIC

HOST

Dr. Abhay and Rani Bang’s work on maternal and women’s health in Gadchiroli has been instrumental in improving healthcare access and services for its underprivileged communities. In the early years, Dr. Rani Bang encountered first hand the devastating consequences of reproductive policies did not prioritise the health of women –  there were extremely high levels of gynacological morbidity, and most women in the area were suffering from some form of gynecological problem, many of which went untreated due to social taboos, lack of medical resources, and cultural stigma.  Her work is hugely significant to the broader movement toward improving rural healthcare in India, particularly for women who have historically been marginalized in healthcare access and decision-making. Here she speaks of her experiences and how she came to work for the women of Gadchiroli.

RANI

As a gynecologist, I always thought that at that time there was maternal and child health in India, MCH, but the M component was totally neglected. MCH was equated to only antenatal care, postnatal care … And family planning. 

Family planning had become the bhasmasura of women’s health programmes. Nearly 75% time of the health workers who are ANMs, Auxiliary Nurse Midwives, who are the backbones of the primary healthcare, that was all spent in the family planning programme, and MCH component was very less. And all other components of maternal health like gynecological problems of women, adolescent sexual health problems, then abortion… Because abortion was legalized in India since 1972, but for women, legal and illegal abortions are useless terms. What matters to them is availability or non availability of the services. 

So abortion has been legalized since 1972 but if we look at the figures, illegal abortions were hundred times more than legal abortions. I do legal abortions and in the whole district there were only two people at that time who could do legal abortions. 

I remember when I started training the traditional birth attendants, one of the very old tribal traditional birth attendants, she came to me and she said, “Madam, I want to tell you something and please, it’s my request that please do something about this problem of illegal abortion.” And she said that because there are no services available, women have to go to these quacks or the abortionists who are quack abortionists, and she told that this quack abortionist in the villages they go either by cycle or by motorcycle and the fee they demand is… Not only the money but also if they are conducting the abortion, the part, the fee is they indulge in sexual intercourse with the lady who is undergoing the abortion before and undergoing the abortion.

I was aghast. In a country where abortion has been legal since 1972 and Indian abortion law is very lax, I mean anything can fit into that, legally we can do abortion up to 20 weeks and now up to 24 weeks in some special cases, and here the situation of women is so bad. All these missing links in reproductive health are… Of course family planning should be a part of reproductive health, but family planning for whom? Just for population control? The Indian family planning program was a target-based population control programme. Actually, family planning should be for the better health of women and children, but that whole thing was absolutely lost and it was a target-based population control program.

Because I was interested in women’s health in my experience I found that gynecological problems were totally neglected and maternal health gynec problems were not included.

So we did the first community based study in Gadchiroli. This study is supposed to be the first study in the whole world, and in that study we selected two villages and all the eligible women including the unmarried girls from the age of 13 years, up to menopause and thereafter. Women with symptoms or without symptoms, everybody was included because we wanted to do the community based study so we can’t just take the symptomatic patients. 

And we found that 92% of the women had gynecological problems and on an average each woman had about four types of gynecological problems. And we also found that only 8% of the women had ever sought any care for their gynac problems. So the need was there but the gap was so much.

 

 

 

 

We published this study later on in Lancet. But before the study was published, we took out a health awareness jatra in the villages or carnival, we can say, and we went to about eight big villages, talukas, and the program was full one day programme. In the morning we showed slideshows on gynecological problems, menstrual problems, sexual problems, STDs, sexually transmitted diseases. We drew the men and women volunteers from different villages and we trained them to explain the findings of the gynac study. We prepared the posters not only about the findings from gynac study but on various issues of women’s health. In the evening there was a kirtan on poverty in the villages, a village round was taken and we selected three families, three houses with best and good clean surroundings – that was done to focus the attention of the villages on cleanliness and sanitation.

In the night there was a small drama, written by me and directed by me. The name of the drama was When the Husband gets Pregnant. The story was in one village the husband accidentally detects that he is pregnant, then the mother-in-law of the pregnant husband comes into the picture and she comes to know about the son in law’s pregnancy. So like in normal cases, she comes and she puts a lot of restrictions on him about the food restrictions – this is what we find in the villages normally. Then she asks him to do a lot of heavy work because in villages they believe that doing heavy household work in pregnancy leads to easy delivery. And this husband is really… I mean he is so fed up with all the restrictions, food restrictions and heavy work he has to undergo. Ultimately he lands up in a cesarean section and he needs blood transfusion and nobody is ready to give him blood. So ultimately his wife comes forward and she donates the blood. 

We did it deliberately because while I used to do cesarean-section in the district hospital, the husbands or relatives flatly refused to give blood. I remember one husband, he said to me, “Let my wife die, but I am not ready to give a drop of blood.”

So when the husband needs blood, the wife comes forward and she gives blood, and in the end, ultimately he ends up giving birth to a baby girl. So again the mother-in-law is very annoyed. After three days at least she comes and sees the baby, baby girl is born. So she says that, “Okay, this time it’s okay that the baby girl is born but later on in your life you should again become pregnant, pray to God and you should be blessed with a son.” This drama became so popular in the villages that when we moved from village to village, we found that the women would literally drag their husbands to come and see the play. And in the end, two members of the legislative assembly, they came to us and they used to be with us during this cultural fair…

So they came to me and they said, “Madam, please let us enact the role of pregnant husband.” And they said that they calculated that they would make the mass hoods of women if they enacted this role of pregnant husband. So all this was done before we published this study because we thought that instead of publishing the study we should go back to the people of the villages on whose life this study was done. 

Then after this study was published, what to do about these findings? We thought that we should train… Because there were no village health workers, there were no gynecologists, so what to do? So we came up with the idea that we should train the traditional birth attendants. I trained nearly 125 traditional birth attendants who were illiterate women, old women and I trained them as a gynecologist in the village. They could do pelvic examination, treat infections… Because our findings in gynac study was nearly 50% of the women had reproductive tract infections, so treatment of infections was very important. Treatment of urinary tract infection, because that is also very common in women. 

Also I trained women about ethno-anatomy and ethnophysiology because their whole perceptions of the village people and also traditional birth attendants about what is normal and what is abnormal are absolutely different. I will tell you some examples, like our perceptions about the body, anatomy and physiology are very different. When we conduct the delivery, we think that we know that there are three factors – power, passage and passenger. Power is uterine contractions, passage is uterus and the bony canal and the passenger is the fetus.

In the villages there is no perception about power. They feel that the baby comes out with its own bodily movements. So in villages they feel that healthy baby should be very, lean and thin. And when we give iron tablets or folic acid tablets during pregnancy and we tell the women that you eat these tablets and your baby will be healthy, they just throw away all these iron tablets in the dustbin because for them a healthy baby means lean and thin baby. They said that if we eat these tablets the baby would put on weight and the labour would be very difficult. And instead of saying that these tablets would lead to a healthy baby with good body weight, you do not mention the name of the healthy baby, you just tell that the baby would be very active. And they said that with these iron, folic acid tablets and calcium tablets, you tell the women that if you eat these iron, folic acid tablets, your blood would be healthy. 

There is no perception about stillbirth and women. And I used to tell them, “I am a gynecologist and I have seen in my experience that some babies are dead at the time of birth.” There are stillbirths, but the TBAs would flatly refuse about delivering a dead baby. Initially I thought that they were trying to protect their reputation but then I realized that these are perceptions about the power passage and passenger. They said, “If the baby is dead inside the uterus, how can it come out?” So their whole perceptions about body, anatomy, physiology are different. 

There is no perception about the diaphragm. They feel that all the vital organs are there in the abdominal cavity. They told me that the scanty menses are not good and heavy menses should be there because if there are scanty menses that menstrual blood it would not come out and it would all gather inside the uterus. And they never knew that the uterus was closed from above, they thought the uterus was open. So if the scanty menses are there, the menstrual blood will accumulate inside the uterus, it will accumulate inside the abdomen and it would impinge on the vital organs and the mother would die because of that. So I had to retrain these women on what is normal and what is abnormal.

So we identified that reproductive health programs should include gynecological care for women. Then, sexual health is a neglected branch of reproductive health, so that should be another aspect. Services for safe and legal abortion care. Of course family planning is a part… 

Adolescent sexual health education for both boys and girls, because in my experience as a gynaecologist I always found that 50% of the unmarried girls had premarital sex that time. And when I talked to the villagers they said that this is an underestimate, the figures are much more. But nobody talked about adolescent sexual health and whatever little services were available that was only for the girls, talking about menstrual health but not the whole range of adolescent sexual health programmes. So I thought that this should be a complete service which should be available. 

ARCHIVAL AUDIO  

Promo video for Arunyabhan, the sex education program by Dr. Rani
https://www.youtube.com/watch?v=yRWJ7XKY9eM 

ABHAY

Women of Gadchiroli were insistent that we do something for alcohol. And this was in the late 80s. 

There was a village meeting in a village called Purlah and Rani and I wanted to tell them about women’s health and health problems. They said, “You keep your medicine aside, alcohol is our main problem.” And in that meeting, one woman stood up and she told a story about how her father used to drink and used to beat her mother and how her husband really beat her throughout life, then she said, “But now my son in law is beating my daughter.” Another woman stood up, talked about how her husband died of alcohol – she was crying. So the other woman said, “You are crying because your husband is dead. I am waiting, when will my husband die?” 

Now this was unthinkable. An Indian woman saying that I want my husband to be dead… But that’s what alcohol does. One can’t blame those women but the alcohol needs to be blamed. So women forced us to take up this issue. I first thought that it is my Gandhian ethics etc. which is making me see a problem, but no, women were very insistent. 

We conducted some studies in Gadchiroli and realized that it was really a very major public health issue, also economic issue, because men were spending and wasting money on that. And then one day men from one village, a village called Wasa, came and they said “Yes, alcohol is a problem in our village also. So what can we do?” I didn’t know what they could do. 

There was no simple solution. But as a social worker I was expected to give them some solutions, so I just blurted out, “You hold a village meeting and if you together decide then you can shut down all the alcohol in your village.” Then another from another village called Amirza. I also told them this and then I forgot. I had just, sort of, to do something. I had said this but I was not serious about it. 

15 days later they came and they said, “Doctor, we did it.” I said, “What did you do?” They said, “We stopped alcohol in our village.” “How?” “You told us to organize a village meeting, we organized a village meeting and we decided as a whole village that nobody would drink alcohol and there will be no illicit alcohol produced and sold. And we have started imposing a ban, a fine on that. And we patrol our village borders in the evening so that nobody can bring alcohol inside. And it has stopped.” 

This was fascinating. I had never thought that this could be a reality, but they made that into a reality. We started disseminating information about this and 150 villages stopped alcohol in their village.

RANI

When we are involved in the anti-alcohol movement, the alcohol lobby was so strong and they had all organized. I remember that in the night around 12 o’clock in the night, one fellow, they had set up their own organization, this anti-alcohol lobby. So the vice president of the anti-alcohol lobby came to our house in the night around 12 o’clock and I was really shocked when I saw him. At that time these two children and myself were only at home. And in Gadchiroli, in that small town, everybody knows when Abhay is out of station. 

So this fellow, he knocked the door. I opened the door and I saw that person. On the same evening they had conducted the meeting in Gadchiroli and threatened us that we should not get involved in the anti-alcohol movement and all that. We are doctors and we should focus on healthcare and not get involved in anti alcohol campaigns. So they said that if we get involved in an anti-alcohol campaign, they would cut our heads and kill us. So the same person who had given the lecture the previous day, the same person was in our house at night. I was shocked to see him initially. He said, “One of my workers in our liquor shop, his daughter, is very sick. His wife has given birth and the daughter, a very small child, is very sick. So you come to the village to see the baby.” I actually refused, but he was insisting, so I went with him. 

He had a scooter. I said, “I won’t come one scooter, I will go walking,” and I was all the time thinking that now he’s going to do some wrong to me. Either he would kill me or he might do something to me. I was not talking to him. At the same time I was thinking in my mind that I had learnt karate and I was all the time thinking that if he does some mischief, how can I use my karate skill? I was carrying my stethoscope and torch. How I could use my stethoscope and torch? 

But ultimately we reached home and the story was true – there was a small baby. So I gave instructions about the treatment and about admission in the hospital. From the next day he started telling everybody in the town and his alcohol lobby people also that Madam and Dr. Abhay, they are very good people. Our vested interests are different, but basically they are good people. So from today we should stop opposing them.

That was a good lesson for me, because from my childhood, the way I was brought up in the Iyengar family, everything is in black and white – this is good, this is bad. But from this experience I learnt that there are no good people or bad people, there is always good and bad. 

SUCHITRA

To talk a little bit again about SEARCH and all your collaborations and partnerships, can you talk about how you’ve used various streams of partnerships to extend the reach of the work that you do?

ABHAY

Even though geographically Gadchiroli is a relatively isolated place, fortunately, through various streams we have been able to keep connection. 

One is the knowledge stream and we very avidly follow what is coming every week. So the Lancet, New England Journal of Medicine and the New York Times and the Economist and Economic and Political Weekly, we keep in touch with everything which is coming. 

In SEARCH we have a weekly knowledge club and another data club. In the knowledge club, something appears in the literature, and that literature is not always only formal scientific research journals, but even social sciences and political… So Knowledge club and Data Club, where we share our own data being generated in SEARCH so that we can collectively look at data, learn from it, criticize it, design new things. So one connection is knowledge. We receive knowledge and little bit contribute too. And we have often used these formal journals. We have often mentioned that we have published so much in the Lancet… Sometimes I have heard people saying that SEARCH has published in the Lancet more than any institution in India. That may or may not be true, I do not know. But I am happy, in hindsight, I am happy that we did it because that provided legitimacy to what we did here. Otherwise, an NGO doing something, unfortunately, it is not always considered very credible. So one is this knowledge stream. 

Second is I do come from the social reform movement, so we do carry that streak and that connection with social reformers in Maharashtra, in India. The anti-alcohol stream, the movement against alcohol, women’s movement and Rani has been a pioneer in women’s movement…

Now, of course, there have been programme or theme-based partnerships like for child mortality or newborn care, we had formed a collaborative group in Maharashtra called Child Death Study Action Group, in which we studied what is the true child mortality in Maharashtra. So several such theme-based collaborations. 

We have been very lucky, actually, that we received funding support. Generous, but generous not so much in the sense of amount, but generous in the sense of freedom. Our donors never impose their ideas on us. I must say that we were fortunate to have such donors, but they always thought that probably, “SEARCH knows what is required, so let them try, something new might come out.” So they never imposed conditions on us. 

Initially, our major donor partners were research donors, foreign funding agencies and ICMR. Gradually, over the years, the donor base has moved to CSR – that is the changing scenario in India. So similarly, CSR and private philanthropic foundations, these have become the major donors. 

We deliberately constructed links with the policy makers, because, as I said, think globally, act locally, so our dream always was that what we see in Gadchiroli, what we do in Gadchiroli, should influence, make larger policy impact, because original commitment was to improve the health of rural India. Gadchiroli is not the whole of India. Though we try, we believe and we try to see, to use William Blake’s words, “To be able to see Earth in a grain of sand.” 

Gadchiroli is a microcosm, but probably it represents what is there in the world globally, so we don’t have to run after the whole world, but what we see here, or what we do here, we have with efforts, we have constructed policy linkages. So we have dialogue with the former Planning Commission, NITI Aayog, Health Ministry, or Government of Maharashtra. So if sometimes we can contribute to their policies, shape their policies, the impact becomes larger. 

In addition to that, you always have your own friend circle, people of my generation – either social reformers. As I said, because of Vinoba’s movement and Jayaprakash Narayan’s movement, there are a large number of people of my generation who have similar values, many of whom have gone to rural tribal areas and have worked – so we have our own community also. So we have been lucky to have several such communities. But it’s a strength because nobody can live in isolation. It’s always good to join hands and become a group and say we shall overcome.

SUCHITRA

So this whole notion of the jargon or the words that have come in, right, like systemic change or a lot of management words that have come into how things are run or how things are viewed, what are your thoughts?

ABHAY

Look, every era has got its own jargon. So keeping jargon aside, there are some new ideas, new strategies, new methods, so we need to learn and use them. For example, in the case of health and healthcare, it is well known in the field of public health that there is something called epidemiologic transition. 

50 years ago, malaria, malnutrition, infectious disease – these were the main health problems. Now gradually these problems are being replaced by non communicable diseases – hypertension, diabetes, obesity, heart disease, stroke, cancer and mental health problems. So this epidemiologic transition is happening. 

But our vision, our dream is that not only we need to develop solutions for this, but these solutions should ultimately empower the people. So we need to use newer technology, but empowering technology. So I think mobile phones are a very empowering technology. It may have its ill effects, but it is a very empowering technology. Because of the apps, the ordinary man or woman has got enormous power of knowledge and at some point of time, probably later on, mobile phones would come with apps which will be able to measure your BP and count your pulse rate and oxygen saturation and your blood sugar also, and maybe even take your ECG if required! So mobile phones are a very useful technology. 

Similarly, I don’t not know right now, but artificial intelligence might be helpful. It could be disempowering also, but it could be empowering also. I have coined a term, our dream is Aarogya Swaraj. People should be healthy, but people should be able to take care of their own health. 

SUCHITRA

You talked about the changing nature of diseases and therefore various programmes that have come. Can you talk a little bit about the mental health work that SEARCH is doing?

ABHAY

Our first intervention was really to addiction because you cannot institutionalize everybody, so we developed a community based approach to de-addiction. Now our daughter-in-law, Aarti, Amruth’s wife, is a psychiatrist. So she looks after the mental health programme and it’s growing in several directions because mental health is a major part of now non-communicable disease – so addiction is one. Common mental health disorders like anxiety and depression are common. She and her team they have conducted mental health problems in tribal population study and they found huge amount of depression, even suicidal ideation. So even tribal people need mental health. So we are trying to develop a mental health programme which addresses local needs but in a way that it can be decentralized. There are few psychiatrists in India, very few in number so it should not be psychiatrist dependent but it should be given in the hands of paraprofessionals and ultimately community health workers addressing issues of addiction, depression, anxiety and common mental health problems.

SUCHITRA

One of the things that a lot of founders of NGOs in particular struggle with is what happens after me? So both of you have two sons who you raised really locally, and then like you, they went to study elsewhere and have come back. So can you talk a little about what they’ve brought? Their childhood?

ABHAY

When we came to Gadchiroli in 1986, Anand, our eldest son, was six years old and the younger one, Amrut, was six months old. So we literally carried Amrit in our lap to bring him here. They grew up in Gadchiroli. We thought that they should really receive same education like any ordinary child or tribal child in Gadchiroli, so we put them in regular zilla parishad primary and secondary schools. 

Anand followed that stream, then he got admission in the medical college, he did his graduation MBBS and then subsequently went to Johns Hopkins exactly 25 years later. Because when we were studying there, he was three year old, he was with us. So 25 years later he went there, studied public health and came back. 

Amrut was a rebellious child, he didn’t like to go to school. So he used to come back and he finally rebelled, he said, “I don’t want to go to school.” We had to accept it. Most of his schooling was homeschooling that helped him learn to do self learning. I often used Nai Talim methods in helping him complete his education but finally he joined formal school. Then he did his engineering in India and then he did his masters in Pennsylvania University. So both of them studied both in Gadchiroli, then in the cities of India and abroad. 

In my experience, you can very well educate your children in remote areas also. After all, most of the learning of the child occurs at home and in the environment. Formal schools really contribute much less and you can easily compensate it, if parents are willing to give little more time to child. 

For example, for Amrut, every day I used to teach him – I shouldn’t use word teaching, – but I used to help him learn for one hour. Everyday I used to set his curriculum for today and then he would decide when he wanted to complete that, he would study. So using formal and informal ways of learning… And children more learn more through the environment. 

Both of them used to come with us to village meetings. They used to help us in our clinics and OPDs, community health worker training and dayi training. And hearing and absorbing all those things are very important. I remember they used to come with us in anti-alcohol protests also, so they once came with us in the protest that we had organized against alcohol shops. 

Incidentally, my father also had come. So he said, “Okay, I’ll also join.” He was the senior most Gandhian at that time in India, so he also came. Police arrested all of us, so we three generations were in police custody at any given day. 

Anand and Amrut enjoyed that experience, they were not frightened at all. Anand at that time was maybe twelve years old and Amrut was eight years old. They went back to school and very proudly said we were arrested. So the next day all their classmates came to us and said, “We also want to get arrested.” 

It’s a political education and all this exposure to villages, exposure to health work, the life in Shodhgram and the values that we try to live here, plus their own formal education, I think that has created the commitment they have shown for the people of Gadchiroli. 

So, “go to the villages of India,” that’s the message Mahatma Gandhi gave to my father, even in the third generation, is still echoing. Anand and Amrut made their own choices, we never really influenced or compelled them that they should come to Gadchiroli. But it’s purely out of their own love for the people of Gadchiroli and their own commitment, they think this is a much more meaningful life rather than pursuing a formal career and making money. 

So Anand and Amrut started leading individual teams. Eventually, with their capabilities, their vision and commitment, they have been able to take more and more responsibilities, so there is a sort of collective leadership. Rani and I are still here, but I hope that eventually the institution can run without us, and I am sure about it that it can run without us as well.

SUCHITRA

You’ve put in the pillars to keep it going.

ABHAY

People have imbibed it, that’s the beauty of life.

SUCHITRA

Now, 30-40 years into all the remarkable work, looking back, would you have done anything differently in the early years or in the middle years of all this work?

ABHAY

Probably one thing we should have done, we didn’t do anything about formal education of tribal people and I realize its importance now. We should have started something on education also for tribal people but we didn’t know much about education except my beautiful Nai Talim experiences. We didn’t start with that, but if I would do today, probably, I may. I think, rest of the things we didn’t really deliberately design. The priorities were given by the people, or sometimes life brought something as a priority before us and that’s the beauty of following people and following life, rather than you having your own preconceived priorities and imposing those on the people.

SUCHITRA

Yeah, that ties beautifully into one of my last questions, which is looking forward, what advice would you have to young people in India, whether they are in public health, whether they are in the social sector, regardless. What hopes and thoughts and advice?

ABHAY

My suggestion or advice to young people usually is that you have only one life, there is no one more. You have come on this earth only once, so this life is very precious. Don’t waste it only for earning money. Money is abundant, there are trillions of dollars in the world economy and you have only one life. So it will be a stupid barter to exchange your one life for the sake of money alone. 

Secondly in Viktor Frankl’s book ‘Man’s Search for Meaning,’ he says something very beautiful.

To quote him, “Those who know the why of living have no problems about the how of living.” Most often we are bothered about what food will I get, my housing, my car, my TV, my bank balance etc. These are all questions about the ‘how’ of living. 

He says if you know the purpose of life, the why of living, these problems become trivial – that’s very true. So find out the why of your living. 

And what we learned from our life is to go where the problems are and not where the facilities are. The places with facilities don’t need you, there you become a problem. Better go where the problems are and nobody wants to go, you become the pioneer. Once Vinoba said something which is a master stroke, he said, “If you are standing in a long queue you are in the end.” 

In the MPSC and UPSC service examinations, you stand hardly any chance. He didn’t say anything about UPSC MPSC, I am just applying it… But he said, “Turn your back to the world and the whole world will be behind you, turn your direction 180 degrees and you become the first in the queue.” It’s a strategic master stroke. 

And become the first not for the sake of your CV or career, but that provides you really the ‘why’ of living. So go where the problems are, where people need you. Rather than following a socially accepted career. This is much more beautiful, much more rewarding, very fulfilling and I hope it helps people also. Even the most difficult challenges can be solved. Just do it and that’s it.

SUCHITRA

Thank you so much, Dr. Bang.

ABHAY

Well, thank you.

Grassroots Nation is a podcast from Rohini Nilekani Philanthropies. For more information go to rohininilekaniphilanthropies.org or join the conversation on social media at – rnp_foundation.  

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