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Hospital on wheels for Uttarakhand villages

Sep 29, 2010

In the rural hinterland of Uttarakhand, India, a mobile hospital van is making a huge difference to the health and well being of the locals who earlier had limited access to health facilities. The Arogya Rath not only provides medical services but also spreads awareness regarding health and reproductive issues.

Pithoragarh, Uttarakhand: As the 'Arogya Rath' (no-illness van) makes its way into the remote Chirmiya village of Uttarakhand, there is a collective cheer from the villagers. After all, this van is their only access to a competent doctor and basic health services. 

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In the far-flung mountain areas of the hill state of Uttarakhand, basic health services were almost non-existent until the National Rural Health Mission (NRHM) decided to introduce the mobile health van, or Arogya Rath, service last year. Earlier, with medical facilities accessible only in big towns and cities, for those living in small villages and hamlets the journey to a proper health care facility was often long and arduous. This led many to continue suffering without seeking medical care or to delay treatment for so long that some would even succumb to their condition before they could reach a hospital. 

The Arogya Rath service has helped to change all that. Now, Godavari Devi of Chirmiya does not panic when one of her family members falls ill; she knows she can reach a Arogya Rath that can provide timely medical care. The mobile health vans tour through all the 13 districts of the state - which has been divided into two divisions, Kumaon and Garhwal - crossing some extremely difficult terrain. There were two categories of vans, imaginatively conceived to correspond to a hospital scenario - one caters to medical emergencies, and functions more like a casualty ward; the other takes care of the routine ailments, akin to an OPD or Out Patients Department in a public hospital.

This service may be entirely government funded, but the operational part is in the hands of some specially identified non-governmental organisations (NGOs) working in the various districts. In all there are nine 'mother' NGOs implementing this service - some work exclusively within one district, while others take care of two. For instance, there's the Himalayan Adhyan Kendra that takes care of Champawat and Pithoragarh districts, while Ambuja Cement Foundation operates in Haridwar district, and Almora district is serviced by In Heer. 

Every month, the Chief Medical Officer of the health department of each district maps a carefully planned route, which is then intimated to the concerned NGOs. Camps are set up in all the places where the vans halt. On board each Arogya Rath are qualified doctors and nurses/ANM, a lab technician, and an attendant. Each van is equipped with an X-ray machine, microscope, weighing machine and examination table.

While families Below the Poverty Line (BPL) are given checkups and provided X-ray facilities free of cost, a nominal charge of Rs 5 per month (US$1=Rs 45.7) is charged for this doorstep facility to those who are better off. This is a one-time charge for the whole month, and people can visit the van as many times as they wish. 

Besides offering medical care, this service also aims at gradually building health awareness among the local population. Health volunteers are trained to take the message of healthy living into the most remote of rural areas. Simple lifestyle changes are suggested with tips on hygiene - for example, the washing of hands before eating or keeping food covered - being shared. Information on how people can protect themselves against diseases is also made available, including why building toilets to prevent open defecation is essential.

For those associated with these Arogya Raths, there have been many learnings along the way. Dr Rampukar Tiwari, a doctor from Benaras, who decided to join the team of doctors selected for this service, talks about some common health problems that afflict people here. "We have noticed a calcium deficiency in children; there are symptoms of night blindness also. It has also been observed that women mainly suffer from osteoporosis, joint pains and itching," he says. Those cases that need specialised treatment are referred to the local hospitals; the rest is tackled at the camp itself. It is this kind of attention to the specific needs on the ground that has made this health service a hit with the people. Incidentally, these vans do not stop only at established points; they often halt when there are crowds around, like at a local fair or festivals. 

Says Godavari Devi of Chirmiya village, "Yeh swasthya sewa hamare liye behetareen sewa hai. Jab yeh gaon tak pahoonchi to gaon ka sudhar ho gaya. (This health service is indeed a boon for us. Its introduction has transformed the village.)" And Laxmi Devi of Champawat district couldn't agree more. Not just the beneficiaries, even local activists have a good word about the service. Says Manish Pandey, a prominent social worker in Kumaon region, "Thanks to this 'sewa' (service) that has also managed to build up health awareness among rural folk, the number of people falling ill has come down. People are spending less time running to hospitals and can now concentrate on other aspects of their lives like education, proper nutrition, and so on. Quality of life in these parts has definitely improved."  

The mobile health vans are on the move for 23 days in a month. They do not ply for the other seven days so that personnel can get a break, recharge their supplies, and check their equipment. 

Dr Bharti Dangwal, State Coordinator, NGO Cell, Health and Family Welfare Department, is happy with the feedback: "We are getting good reports from different areas." Only a year into the service and 97,163 people have been treated, 1,531 X-rays have been taken, 10,454 lab tests have been done. And, in a move to provide reproductive health services, 14,115 condoms have been distributed in rural areas.

The response from local communities also indicates a growing awareness and appreciation for the service. There is now a demand for more specialised health care, which Dr Dangwal takes as a positive sign, "Seeing the benefits of this state-of-art van, the rural population is demanding an ultrasound and operation facilities in the van." There is also a demand that the problem of shortage of medicines on these vans be addressed. Each mobile van is allotted a sum of Rs 14,000 for medicines, a sum that many here believe is inadequate and should be increased. As Vinod Karki, local activist, observed, "The medicine quota should be increased so that rural people are not forced to go to the towns and cities for their medicines."

Clearly, the Arogya Rath has become a local institution, especially in Uttarakhand's rural hinterland, with panchayat members lending support to health activists associated with it. But it is the hill women who are the happiest. Given their hard lives in this rugged terrain, they can now breathe a little easier in the knowledge that there is a doctor for any health emergency - right there at their doorstep.

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