My excitement knew no bounds that day. As the place I was going to serve in neared, my anticipation reached its zenith. After all, I was visiting a borderland, a place of unique scenic escapades, the countryside seemed luring and there were mountains all around. Mountains where lay my calling.
As per the rules under the Government of Assam, we, the young medical graduates, are required to serve for a year under the NHM-Rural Posting. Having completed my internship early this year, the tenure of my one-year long contract started with I being posted in the remote district of Baksa in Assam, an area in BTAD (Bodoland Territorial Area Districts) under the jurisdiction of BTC (Bodoland Territorial Council) of Assam. The health centre, Subankhata State Dispensary, is situated at the strategic intersection of Indo-Bhutan border with forest land and wildlife flourishing near the edges; people here pay Rs 5 (INR) or 5 Ngultrum (currency of Bhutan) to the hospital to avail its services. It is a foothill area that had severe malaria prevalence in the past; actually, it was a malaria endemic zone until a couple of years back.
The first few days here were spent surveying the area around and the condition of the beneficiaries of the health services. I observed that the people here had limited access to safe drinking water and for the household chores, river water was being drained to the homes. Ambulance services provided by the government, like the 108 (GVK-EMRI) and 102 (NAS) services were availed by a limited section of the society, the rest either due to lack of knowledge or resources to avail such facilities, preferred to carry their patients to and fro on handcarts — a visual that still pesters me.
During the first week, I could hardly stay back after the OPD hours as my accommodation was yet to be managed, but once I was settled, my understanding of the place and the people, despite the language barriers, increased manifold. Many a sleepless nights were spent handling different emergencies. From the nights of tremendous satisfaction derived from delivering a new born baby to the awaiting parents to the nights when there would be cases of assault due to domestic violence, when I, along with the assisting staff, had to work with our headlamps and mobile flashlights, suturing wounds and monitoring the patient, sometimes until he/she was referred to higher centre for the required investigations and treatment, I learned and grew both as a human being as well as a doctor.
A particular incident which deeply hurt me was when a 1.5 years old baby was brought to the hospital. She had sustained injuries to the head after drowning and the people claimed to have found her body some 30 minutes after she drowned in her own backyard, playing in the stream water. We did our best but we could not resuscitate the baby. At that moment I could feel the urgent need of trained staff, of proper oxygen supply device and awareness among the local people, out of many other things which are missing there.
With time, I began realizing the various loopholes in the functioning of my health centre. For e.g., there is a serious shortage of nursing staff and together with it the other non-permanent staff who were present seemed to be persistently disturbed by the financial doldrums that they were facing. The reason being that all sweepers and cleaners are meagrely paid. The infrastructure too seemed in need of urgent mending and the electricity supply had ‘mood swings’ just like the weather out there. There were days of incessant rains where we had to wait for an entire OPD session without a single patient turning up and there were so many days of harsh summer, without the fans working, but we had to extend our duty hours to cater to the needs of the patients.
My existence and functioning as a human being and a doctor was engulfed by a dominant lack of basic facilities and gross mismanagement of the available ones. To name a few, a digital generator installed by the authorities a few years back was in need of repair, the water supply to the hospital and the quarters was highly inefficient and lacking, patient records was in an archaic state and computerization of the patient records was yet to be done. A central issue was that the accountant of the hospital never took his job seriously, and was suspended, which left all the hospital funds being untouched for two long years in succession. We hope that our repeated appeals to the authority shall bring some good news for the hospital soon.
Patients here frequently visit the dispensary with complaints of fever, cough, weakness, acute episodes of diarrhoea, dog-bites, cases of domestic violence, skin and soft tissue infections and a few Road Traffic Accident (RTA) cases. The antenatal check-ups here are scheduled by the Accredited Social Health Activists (ASHAs). Immunisation is another aspect that I would love to cover, as the centre caters to almost 15,000 people, and supervises the functioning of sub-centres located at further places. Regular immunisation is being done at all the centres by the nursing staff, aided by ASHAs and Community Health Officers (CHOs).
The food habits of the Bodo community are extravagant and exotic as they use several different herbs and various kinds of meat but they prefer very little oil for cooking. They also consume a lot of homemade rice based liquor, it is ingrained in their culture, but the interesting fact I observed is that hardly do I find patients presenting with features of Cirrhosis and other ailments. Perhaps, this can be attributed to the hard work and physical labour in the fields by these people as they toil hard to produce both cash crops and other vegetables. The Nepali people in the region are the cattle rearers and seemed to have their income from dairy products. Not as hardworking, in my view, as the Bodos, they came with more Respiratory Tract Infections (RTIs) than any other community, which could be attributed to the overcrowding in their homes. The patients all come from different communities like Chaotals, Rabhas, Assamese, Christians, Hindus and Muslims alike visit our hospital and avail the health services and the benefit of the government schemes.
Despite the issues of extremism and the political situation, which from time to time threatens our daily life, the scenario is way better now than during the previous years. Overall, the working atmosphere is quite pleasant because people here are really down to earth, which is a refreshing change from the materialistic ways of our cities. They share their misfortune of not being able to bring their ailing family members or friends to the hospital on time or sometimes going down to the Ojha (traditional healer) before approaching the medical centre. But with all the experiences that I have gathered in the past few months, I would like to conclude that the rural population in this part of the country deserves a little more from the state and nevertheless the people here are still happy with what they have and that is the true beauty of life here.
Dr Uddipta Talukdar is currently serving as a Medical Officer in a government health centre, situated in a remote Indo-Bhutanese border village, under the National Rural Health Mission (NRHM). He is the only doctor serving in the village.
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