“Kaise bhi chalao abhi, baat kar rakhi hai,” (‘Run it anyhow right now, we have talked about it’) is the answer the head of the village gave Lalit when he questioned the absence of doctors in the government hospital in Dhamas in Almora district of Uttarakhand.
The government hospital in Dhamas, a settlement area in the foothills of the Himalayas with around 250 houses, does not just function in the absence of electricity and water, but doctors too.
The only medical consultant at the hospital is Lalit Mohan Joshi, a ward boy. Lalit has been working in the hospital for 20 years now and has shouldered the responsibilities of the hospital all by himself since Deep Pathak, a compounder who would advise patients was transferred out in August 2017.
“Someone has to do it, otherwise people will abuse and ask ‘Why have you simply opened a hospital if you cannot give medicines?” says the ward boy with a sigh.
The hospital shares its campus with an Auxiliary Nursing Midwife (ANM) centre which treats cases of pregnancies but the staff at the ANM centre share Lalit’s helplessness. “We have not done a single delivery in months. How do we do it without electricity?” says Dhaneshwari Shah, an ANM worker who travels to the centre from Almora, around 35 kms away from Dhamas.
Lacking medical care, villagers in Dhamas have increasingly turned to jholachhaaps (quacks). Jholachhaaps are unqualified people who claim to have medical knowledge. “That jholachhaap doctor’s shop is running very well,” says Lalit disapprovingly, referring to Biplab Majunder, an infamous quack in Dhamas. On the other hand, Majunder refuses to identify himself as a doctor. “We just keep a few light medicines, just like first aid. Hardly any patients come here,” he says with nonchalance.
However, due to the unavailability of doctors at the government-run hospital, many in the village end up at Biplab’s doors giving him a steady turnover of business. He has however incurred the wrath of doctors in nearby villages for his unconventional treatment. “The patients get immediate relief from his medicines and do not understand the long-term effect of these medicines,” says Dr Deepika Dharmshaktu, a doctor in the Government Ayurvedic hospital in Shitlakhet, a neighbouring village.
Deepika has held camps in Dhamas to spread awareness about Ayurveda and feels like she is competing with the jholachhaaps around. This isn’t helped by the fact that the Ayurvedic hospital has its fair share of troubles. It faces water shortage and Deepika complains about the poorly maintained staff quarters.
“I want to live in Shitlakhet. Who would like to travel from Almora on daily basis?” she says. (Shitlakhet and Almora happen to be 35.5 kilometres apart.)
She also draws attention to how women have suffered due to lack of hygienic practices, and reproductive healthcare education, something Prema Mehra, an Accredited Social Health Activist (ASHA) worker in Salla Rautela area of Shitlakhet corroborates.
Prema usually takes expecting mothers to Hawalbagh, 25 kilometres of winding roads away from Shitlakhet, for deliveries but when the Intensive Care Unit in Hawalbagh began experiencing blood shortage, she decided to take expecting mothers to Almora, where there are ample facilities but not enough doctors. “Hawalbagh has good facilities and the doctors look at each patient properly. Almora, either because of the excess of patients or lack of doctors, does not pay much attention to those coming from villages,” says Prema.
Menstrual hygiene is another issue plaguing women in the village. While most women in the village use sanitary napkins, there are still several who continue to use and reuse cloth during menstruation. Many couples are unaware of family planning and do not use contraceptive tools like condoms, cervical caps, Intra Uterine Devices (IUDs) to prevent pregnancy.
Expecting mothers in Shitlakhet are sometimes even taken on a doli (palanquin) as there are no roads in some parts of the village. A few instances of women giving birth while on the way to the hospital have also occurred on the dangerous winding roads to the hospital.
Civic officials including those in the Block Development Committee (BDC) have been apprised of the situation but repeated requests to address the issues have fallen on deaf ears according to Geeta Devi, Gram Pradhan of the village. “There is no one to listen to us,” she says with a sense of helplessness.
The only ray of hope to improve the situation comes from the efforts of the Health Ministry and the graduating medical students of Government Medical College, Haldwani and Doon Medical College in Dehradun, who signed a five-year bond to work in the rural areas of Uttarakhand.
“Uttarakhand will get more doctors in 2-3 years,” says Mohan Ram Arya, former Zila Panchayat Head of Almora but for now, it remains just that – a ray of hope in an otherwise grim situation.
All Photographs Courtesy: Purva Pathak
With inputs from Bhaumi Pathak