September 17, 2012
by Punyabrata Gun
(Translated from Bengali by Debarshi Das)
[Dr. Punyabrata Gun has previously written on "Peoples’ Health Movement in India: Looking Back at Dalli Rajahara - Achievements and Problems". The present article is one of a series on Peoples' Health Movement by the author that will be translated and featured on Sanhati - Ed.]
In 1998 Amitabha, Sumit and I mulled over building an organisation. The organisation got registered as the Shramajibi Swasthya Udyog in December, 1998.
I completed the medical course along with internship and housestaff-ship in 1983. In 1985 I spent few months in Bhopal as part of the health movement for the gas-leak victims. From 1986 to 1998 I worked with the Chhattisgarh Shramik Swasthya Andolan and Shahid Hospital. Since 1995 I have been working in the Shramik-Krishak Moitri Swasthya Kendra in Chengail of Howrah district, this was established at the initiative of the Sangrami Shramik Union of Kanoria Jute Mill.
Amitabha Chakraborty is two years junior to me. He has been my colleague in the Medical College Democratic Students’ Association, All Bengal Junior Doctor Federation, Belur Shramajibi Swasthya Prakalpa. After graduating from Medical College he has been involved in students’ movements as well as workers’ movement in the colliery regions of Pandabeshwar-Ukhra. Since 1997 we have been colleagues in the Moitri Swasthya Kendra.
Sumit Das had graduated from Medical College five years after Amitabha. After MBBS he did DPM in psychiatry and got a government job. He did not take the offer since he would have to work as a general physician instead of treating psychiatric patients. Sumit joined the Moitri Swasthya Kendra in 1998. He was in the same students’ organisation as we were.
Shahid Hospital was a centre for affordable and rational treatment. It was a medium of public education, a tool in the struggle of the working class. In the early 1990s the Kanoria workers’ struggle was at its peak. The workers decided that they would start a health programme in the model of the Shahid Hospital. On 21st March, 1995 the Shramik-Krishak Moitri Kendra started from an abandoned poultry shed in Beltola of Chengail.
At present the government is giving up the responsibility of providing public health facilities on the pretext that it is too expensive. Instead of modern medical science it is promoting AYUSH (ayurved, yunani, siddha, homeopathy). The health sector is being thrown open to private capital. What is to be done the present context?
We wanted to prove that if the works and operations are done in a proper way it is possible to provide modern medical facilities to the people at low expense. A big part of the patient’s expense is the doctor’s fee. Moitri Swasthya Kendra showed that it is possible to run the programme even after charging the patient very little. In the beginning we used to charge one rupee per patient. From 1996 it was raised to two rupees, four rupees from 1998, ten rupees from 2002.
In the medical schools we are taught how to record the health history of the patient, how to conduct medical tests. After we graduate we do not actually follow these lessons. Many a time there is pressure of large number of patients in the outdoor department. Often the incentive is to spend less time per patients so that maximum number of patients can be attended and the earning would be maximised. In Moitri Swasthya Kendra we solved this by training a group of young men and women who work as health workers. They are efficient in recording the medical history. They can check the pulse, breathing, temperature, blood pressure. They record the history and observations in a form. The language of this form is Bengali so that the patient can himself know and understand his health information. From the health worker the patient goes to the doctor. The doctor, after reading the history, questions the patient, conducts more tests. Then he prescribes medicine, or sends the patient for laboratory tests, or to a specialist. It has been found that through this method the detection of the disease is more accurate. Many lab tests are proving redundant. When tests are being conducted, only a few are being done. The expense of the patient therefore declines.
Sometime it’s not the fee of the physician, but the various tests which raise the expenses. Imagine you visit a doctor on a complaint of fever. The doctor gives you a list of tests without enquirying about the history, without testing. The list includes blood and urine tests, test for malaria parasite in the blood, widal test for typhoid, culture sensitivity test of urine, etc. In case of a big doctor there will be further tests of blood culture, malaria antigen, blood test for dengue, and so on. These tests are not always recommended in the interest of the patient. Many of us know that the doctors receive commission for recommending those tests.
In our area of work the doctors get the following sort of commissions: 50% for pathology, 30 rupees per plate for x-ray test, 25% for CT scan, 25% for ultra-sonography, etc. In our Kendra there was no question of taking commission. When we did not have the facility for tests, we used to send patients only to centres where they would deduct our commission from the test charges. At the same time we went on expanding test facilities according to our ability. In 1995 we started with some pathology tests. ECG from 1996, bloodsugar test by glucometre in 1998, biochemistry from 2002, x-ray from 2004, ultra-sonography from 2009.
We were continuing with our experiments with cheap and rational health care. Many doctors were getting involved in this initiative. At this juncture a rift started to appear with the advisers of the Kanoria workers’ unions. These advisers belong to the middle class. The chief adviser suggested that a trust be formed to direct the operations of the Swasthya Kendra. I would be in the trust from the side of the Swasthya Kendra along with an acupuncture specialist, from the side of the union the main adviser and the union president would be there in the trust. Also the editor of a news paper which was close to the ruling party, and a lady editor of a magazine would be there in the trust.
We could not agree to this proposal. The constitution of the trust was such that if someone becomes a trustee, there is no way to remove him, unless he resigns, dies, or turns insane, or goes to jail on criminal charges. We suggested that a society be formed which will include all doctors, health workers, other staff. The society will include representatives of fraternal workers’ unions. The difference in opinion reached such an extent that from 1998 onwards although we had links with the workers of Kanoria, no formal relations remained between the union and the health centre. Two establishments started to operate in the name of Moitri Swasthya Kendra. In the first acupuncture and homeopathy treatment were provided. The doctors here were close to the advisers of the union. In the second we provided modern treatment.
At the Shahid Hospital we used to identify ourselves as Shahid Hospital group. Here we were forced to take a different name for the organisation since there were two health centres with the same name. The Shramajibi Swasthya Udyog started collecting funds for the development of the health centre. New doctors started joining our initiative encouraged by the work of the Moitri Swasthya Kendra. Some of them could be absorbed in the Moitri. Many joined the Arijit Janaswasthya Kendra of Salt Lake (this initiative which was started in 1999 had to close down in 2002 due to lack of enthusiasm of local people). Some of them started the Madan Mukharjee Smriti Janaswasthya Kendra in Beliator of Bankura in 1999. This was a monthly heath camp.
In 2000 the Dr. Bhaskar Rao Janaswasthya Committee joined our organisation. Bauria is an old industrial area of Howrah. Jute industry, textile industry, cable factories are there in the area. Communist organisers built up workers’ movement in this area in the 1930s. Encouraged by the Kanoria workers’ movement workers of Bauria cotton mill formed a workers’ union in 1995. In this region the two organisations of ours started working from the 1st March of 2000 under the name Bauria Shramik-Krishak Moitri Swasthya Kendra.
We hold that ‘external funding means external control’. Therefore we are against funding of health programmes. Our health centre has been self-sufficient since 1998, we can cover the expenses through fees collected from medical consultation, tests, sale of medicine. Before that our salaries were paid by collecting contributions from workers of Kanoria mill. But although daily expenses are met from these sources, it is not possible to expand the facilities, to develop the centre. So, we decided to accept donations from our friends and supporters. We would not accept donations from those who do not agree with us on issue of right to health. Therefore money was slow to flow in, the health centre likewise developed at a slow pace. In 1999 three kathas of land were purchased in Chengail. In 2002 the ground floor of the health centre was constructed. Eight years after the work started, on the May Day of 2002 we shifted from the abandoned poultry shed to the concrete premise. Half of the first floor was built in 2003. This portion started to be used for physiotherapy and new laboratory on 25th May, 2003 (25th May is the day of the Spring Thunder, a memorable day for the Bhilai workers’ movement also). In 2004, on the twentieth anniversary of the Bhopal gas massacre the remaining part the first floor was inaugurated.
We believe providing inexpensive medical treatment is not in itself big work. Through this, pressure can be put on the government, that is all. The number of people whom we serve through inexpensive treatment is only a tiny fraction of the poor people of our country. We are aware from the beginning that our more important task is to sensitise people of the economic and social reasons of health ailments. To this end from the May Day of 2000 a Bengali bi-monthly health newspaper ‘Asukh-Bisukh’ has been published from ‘Foundation for Health Action’. Till January 2011 sixty three issues have been brought out. From September 2011 a newspaper ‘Swasther Britte’ is being published in its place. The purpose is also to demystify the issue of health, to expose the exploitation of capital in health sector.
We know from our experience in the Chhattisgarh health movement that until the health movement and programme are linked to the movement for food-clothing-shelter-education-culture, it cannot succeed. I shall elaborate on the Chhattisgarh health movement on some other occasion. The reason why out of so many places health work was started in Chengail in 1995, was precisely the same: we wanted to link our work with the just workers’ movement which shook West Bengal in the early nineties. Our hopes were not fulfilled. I have described how the link with the workers’ union got severed. In the last decade the Kanoria Jute Sangrami Shramik Union has split into three factions due to personal ego clash between the advisers. Lack of workers’ movement in the work place has pushed us to far off places. We have travelled to Singur, Nandigram, POSCO, Lalgarh in order to be with peoples’ movement. During the time of Nandigram movement at the initiative of Shramajibi Swasthya Udyog forty-two organisations came together to form ‘Nandigram Gana-hatya-birodhi Prochar Udyog’. Under the banner of ‘Nandigram Swasthya Udyog’ more than a hundred doctors and health workers ran weekend health camps in Nandigram from March 2007 to June 2007 and again from November 2007 to January 2008. They provided consultation on every Saturday, gave training to health workers in the evening, provided medical consultation throughout the next day to return back to Kolkata on Sunday night.
From the students’ politics days standing by the victims of natural disasters has been our second nature. During the Malda flood and Orissa super cyclone of 1999, all Bengal flood of 2001, tsunami, Aila of 2009 – we have tried our utmost. We have also got other friends outside the organisation involved in the relief work.
In our discussions social, economic, political, legal problems of doctors, medical students have always figured. To facilitate exchange of opinions among democratic-minded medical practitioners, students we have published tri-monthly bulletin ‘Doctors’ Dialogue’ . We have demanded justice for the murder of doctors such as Dr. Chandan Sen and Dr. Sushil Paul who sacrificed their life to uphold ethical practice in medical profession. Shramajibi Swasthya Udyog also became active in the ‘Free Binayak Sen Campaign’ when human rights activist Dr. Binayak Sen was arrested and sent to life imprisonment. We formed ‘Free Binayak Sen Campaign – Doctors in Solidarity’ with fraternal doctors’ organisations. We also formed ‘Binayak Sen Mukti Mancha’ with many mass organisations.
A few concluding words before I end. The number of doctors with valid degrees is very few in our country. Those who are there are stationed in urban areas mainly. Large sections of our population depend on rural doctors and chemists, or carry on without any treatment at all. Yet, to cure the two most common fatal ailments, diarrhea and respiratory infection (common cold), one does not need a degree-holding doctor. Trained health workers can take care of these to a large extent. This is true for many other common diseases as well. From 2007 onwards Shramajibi Swasthya Udyog has been running a two month residential programme for activists of fraternal organisations to train them as health workers. Besides the remote Bengal villages, we have trained more than hundred activists of mass organisations from the neighbouring states of Bihar-Jharkhand, as well as from states like Tripura, Uttar Pradesh, Madhya Pradesh. The syllabus that we have prepared is in Bengali and Hindi. I shall talk on these matters on some other occasion.