My Tryst in Rural India

Dr Araveeti Ramayogaiah

In 1968 when I joined medical school, 80 per cent of MBBS students aspired to settle down as practitioners in their native villages. But I had different plans. I wanted to be medical officer (MO), a gazetted officer of the government and a very glamorous post. It is a prestigious position in the society.

I gave Andhra Pradesh Public Service Commission (APPSC) in 1977 with eight senior batches while I was a PG student in paediatrics. I completed my PG in January 1978, got APPSC selection in April 1978 and a posting order in September 1978.

After eight months’ stint as a MO of ESI dispensary at Hindupur, Anantapur district, I was transferred as MO, PHC Kallur in Kadapa district due to the separation of ESI wing from the main Directorate of Medical and Health Services. I was told that Kullur is a remote place and many refuse to go there. May 24, 1979 was a red letter day in my life. I was 29 years old, full of energy and enthusiasm. A day when I started my work in the country side of my nation. I was quite euphoric. From that day, I was the custodian of health of 70,000 and odd people and the team leader of 60 plus nursing and paramedical personnel. I had to work with several formal and informal leaders across 50 and odd villages. I still remember the day I took a crowded private bus from Proddutur, a town near by Kallur to start my stint as MO PHC. Many people in the bus looked at me curiously as I was a stranger. After knowing that I was their next MO, they vacated a front seat for me immediately. The bus conductor refused to take the bus fare as I was their MO. By the time the bus reached Kallur, two elders of the village invited me for lunch. Through I declined their offer politely they did not budge. I reported at the PHC and started my work. The news about the new MO spread like wildfire in the village and a crowd thronged the PHC to see me! As I was born and brought up in a rural agricultural family, it was not embarrassing for me and I could easily mingle with them. At 1.00 pm exactly, a person came to take me for lunch to one of those two hosts. I had my lunch, relaxed, conversed with some inmates of the house, had a cup of tea and returned to the PHC by 4.00 pm. That is the kind of love and affection that a medical officer of a PHC receives!

After two years’ stint there, and four years of working at a 30-bed urban hospital, I went to the PHC at Rajupalem as a MO. Rajupalem covers 1,20,000 population with hundred and odd staff. Several people used to take me to their houses for lunch. They are all very good to me! I worked there for four years before starting a PHC at Mylavaram as Additional Incharge MO.

My entire PHC service was in the Kadapa district. I visited villages regularly, visited schools and hostels, conducted several village leaders training programmes and implemented National Health programmes etc as part of my work. Rajupalem PHC stood first in the district twice during my stint there. During my visits to villages, I never returned to headquarters without dining in these villages. I covered these places on cycle, tractors, bullock carts, PHC vehicles and public transport. I was part of the village games, festivals, cultural activities, folklore and customs.

In 1990, I went to Guntur district from Kadapa to work in cyclone ravaged villages. PHC Visweswaram was my area of operation. I was ‘dropped along with food and milk pockets’ in a marooned village by an army helicopter! The protocols of the day didn’t allow even legislators to board the helicopter. I lived in the Visweswaram PHC without power supply, in the midst of water snakes, lying and sleeping on benches. There was no regular MO at that time. It used to be a Herculean task to secure food and drinking water! I can’t forget covering Lankavanidibba on the tractor provided by the neighbouring village people as my vehicle could not navigate in the slush lands there. Even a Sarpanch (Pradhan) could not take care of us! Such was the calamity. It was a great learning experience and I will never not forget the resilience of the people in the midst of calamity. What more can a MBBS doctor expect from this country than opportunities like this?

To my great luck, I became the district officer of Guntur in 2003. I took the earliest opportunity to visit Visweswaram and I shared my experience of the days there with the staff and people present. Some senior paramedical staff could recognise me.

As Additional District Medical and Health Officer (DM & HO), I visited 70 and odd PHCs several times. It was a great opportunity to lead a team of 3500 and odd people. I implemented celebrations of all health days, promoted donation of mosquito nets, visited many government schools along with PHC staff without the directions from the state headquarters and without any additional budget! I had the opportunity of organising the launch of state level ‘Vande Mataram’ programme as DM & HO, a great responsibility was thrust on me by my state administration. Guntur is a big district in Andhra Pradesh and a district officer is a crucial person in the rural healthcare system. What more does an MBBS doctor expect than opportunities to provide healthcare services to a district from this nation?

In 2005-06, I visited hundreds of PHCs across the state of Andhra Pradesh as a Joint Director of Commissionerate of Family Welfare. I played a major role in designing the NRHM interventions. The The then Chief Minister of Andhra Pradesh, Late Dr YS Rajasekhara Reddy launched two subjects handled by me. None of the other officers had this privilege where the CM launched their subjects. For launch of free RTC bus passes to pregnant women, I went to PHC Kanthi in Medak District to look after the arrangements. I used to sleep on benches of the PHC at Kanthi.

My MBBS and DCH belong to this nation. If anybody asks me which is the best part of my service, my reply would be – my PHC service. PHCs make a leader out of a MBBS doctor. These days many are voicing the view that there is a need to include personality development in the MBBS curriculum! Working in a PHC for three years is enough to mould your personlity and enhance it. The people and experiences at the PHCs in rural villages would mould the doctors’ attitudes and personalities for the better. Villagers are the best teachers and personality developers!

PHCs and MBBS now

The public sector rural medical care is ailing from vacancies of MO posts, absenteeism of health functionaries, disfunctionality and physical non-availability of staff. How can we implement any programme when functionaries are not physically staying at the place of posting?

A MBBS is the best leader to lead a PHC however they do not want to go the rural areas. In India, a MBBS doctor is privileged, across all castes, religions and regions. He gets sympathy from all quarters of society. Whenever we talk about posting of an MBBS at a PHC, everybody talks about the facilities there! However, these considerations are not given to revenue staff, panchayat raj staff, power supply staff, teachers, women and child development officers and even the nursing and paramedical staff. MBBS doctors are the only ones getting incentive money for working in rural and tribal areas. In India, MBBS doctors expect all the facilities at a PHC like those in the tertiary hospital where he/she received his/her training. MBBS is the only cadre to get preference in PG if they work in rural areas. MBBS doctors are mightier than state in India. State prostrates before a MBBS. Indian State is MBBS centric, but not people centric. An Indian MBBS is a very discontented person and always broods that he is the subject of lot of injustice.

He always seeks sympathy from every quarter – rightists, leftists and centrists and all stands by them in every genuine or perceived crisis. He compares his life with all haves in the world. Every MBBS aspiring plus two student’s goal is super specialisation. Towns, cities and foreign countries are their dream destinations when there is dire need for doctors in rural areas. However, this situation has not been created by MBBS graduates, they are not the culprit. He/she is a victim of circumstances. The economic model is the real culprit. If my daughter or a grandson would be a MBBS doctor, they would be no different from others. I predicted this in 1970 itself. Indeed, a paradigm shift happened. A set of professionals earlier to 1980 have been completely replaced by post 1980 professionals who possess a diagonally opposite value system. History alone will decide which is the best.

(The author was also Former Medical Consultant – Indian Institute of Health and Family Welfare- Hyderabad and Former State Coordinator, Breastfeeding-Promotion Network of India, Andhra Pradesh)