Work at Pratichi gives me ample opportunity to come out of this glittering and dazzling metro city-life and get a deeper impression of the so-called ‘peripheral’ areas – which although we generally prefer to ignore, are also very much a part of our state West Bengal. At present, I am working on a health project, which seeks to identify and determine the patterns of health-seeking behaviour prevalent for various ailments, all across the 19 districts of the state. It was on one of the field-trips connected with this project wherein I visited Goshanibagh – one of the largest para or locality in Mishipur.

Goshanibagh (District: Malda; Block: Gazole; Village: Mishipur) is primarily inhabited by people who work as daily wage labourers and bidi-binders. In addition, small-scale vegetable-sellers, rickshaw & van drivers were also found here. Very few families have their own land. The percentage of agricultural labourers were also very less. Most of the families have settled here after fleeing from Bangladesh (some have even fled from there while it was still a part of Pakistan) and one old lady even reported to have left behind 16 bighas of land out there. Agriculture not being the prime source of income has its link with the fact that the water table of the village is extremely low. So practicing agriculture does become a problem here, especially when most of the families depend on well (idara in Bengali) as their main source of drinking water. Further on, the quality of water is extremely poor- being quite yellowish and muddy. At a particular household, it took nearly 5-7 minutes for me to raise one bucket of water from the well and this was not because I was inexperienced but due to the fact that the water level was so very low that it took a while for me to even “see” the water. Most of the households do not do anything for purifying the water. However, some reported that they keep this water in a pot for some time and once the dirt settles down, they filter the water out and use it both for drinking and other household purposes. They also reported that the ASHA (Accredited Social Health Activists) workers distribute bleaching powder once a month for purification of water.
Health awareness seemed quite low in this area despite the local quack reporting the trend to be on an increase. While some families have never even heard about health insurance, one or two does have a Medicliam policy done.

The ‘Push & Pull’ phenomenon of public and private health facilities
Reliance and dependence on public health facilities seemed to be non-existent. General experience regarding public health facilities being poor, people do avail treatment from the doctor who is available at the primary Health Centre (PHC) but only when s/he renders service from her/his own private chamber – which in most of the circumstances happens to be the government quarter allotted for the doctor! So, whether it is the charm of private facilities that is “pulling” them or the commonly prevalent dissatisfaction about government health facilities “pushing” them away remains questionable.

Victims of this ‘Push & Pull’ phenomenon: The Common People
Lakshmi & Nitai Das (names changed): A family of five mouths to feed with irregular flow of income. Nitai is a daily-wage labourer with no surety of income. Back at home, Lakshmi rolls bidis or cheap Indian hand-rolled cigarettes to earn a living. However she has to roll about 2000 bidis daily for a mere pittance of Rs.100 per day. Even with such financial condition, in case of need both Nitai & Lakshmi Das desire to avail the services of a private practitioner. Their (and that of people at large) perception about government health service delivery system is so very poor that they prefer to spend Rs. 80 (as doctor’s fee in comparison to free treatment at PHC, commuting expenses extra) for each visit to a doctor, together with additional expenses for medicines and other essential tests but still will not go to the same doctor while he/she is giving out treatment from a government facility. This goes a long way in telling that people do not disapprove the doctors but they possess an utter disregard for the system itself. Quoting her “Ote kokhono kaj hoy kokhono hoy na – bhorsha nei. Tachara sarkari haspatale gele sokal 6ta theke line e darale, tobe 10tai daktar dekhate pari. Private e gele tokhoni hoye jai.Oi somoy tate amar rojgar o hoye jai. 10 takar bidi bedhe nite pari totokhone”. Long waiting at government OPDs and subsequent loss of income seems to be the major reason for not availing public health facilities.

This particular family (and for this village in general) also reported that behaviour of the health workers of their village sub-centre is extremely rude. The ANMs themselves only ask the patients to attend the doctor’s private chamber! In addition, neither do they distribute the required medicines regularly nor do they explain the purpose for consuming them or the side-effects associated with their regular intake. Thereby, most of the villagers prefer not to consume the medicines distributed by the health workers of the sub-centres. They keep the medicines back at their home and continue to give assertive responses when enquired about medicine-consumption. This particular feature is not an attribute of this particular village or the district, but by and large a general phenomenon, massively observable in other districts too. According to an old person’s verbatim “Nobody is really bothered about whether we live or die. It’s as if we are destined to be deprived. But we too deserve to be respected and we do not desire to compromise on that. Sub centre er didira eshe koyekta bodi diye geche. Bole geche roj khete. Ami khai na. Keno khabo, kijonno khabo na bolle keno khabo? Ke jane ki sob diyeche tai khai na. Jigesh korle boli ha kheyeci”.

Satisfied, but still...
One couple, whose six month old daughter was hospitalised in the district hospital in Malda for 5 days, reported that they were highly satisfied with the service provided to them. All the concerned people-doctor, nurse, matrons and other personnel were very well-behaved and the doctor patiently met all their queries and explained to them everything about the treatment. However the irony is, even after this pleasant experience at a public hospital, when they are enquired about their preference, without a moment’s thinking they confidently stated that whenever possible they will always opt for a better service provider – which, unquestionably according to them, is a “private health facility”. Therefore despite it being extremely expensive, rather unjustifiably pocket-unfriendly, a private clinic is always perceived as “better and of possessing high standards” – a characteristic which according to them is a rare phenomenon in case of public hospitals.

Seems like an unending vicious cycle
Nevertheless, we always come across extremely crowded public hospitals, especially the medical college hospitals, district hospitals and the sub-division hospitals. If we go on to do a root-cause analysis, a picture of bypassing the lower-level public facilities becomes grossly apparent. This again reveals a lack of confidence on the lower rung and a sheer desperation to receive better and quality treatment, leading to massive patient-load on these hospitals, while the lower ones continues to remain comparatively unasked. The hospitals fail to provide quality treatment under the immense work load, thereby playing a role to increase public discontent towards government facilities and eventually, the lure of private concerns. In the midst of all this what results is unused lower level public health centres, their man-power practicing individually leading to completely unused, sometimes even locked health centres, pressure building upon the district and medical college hospitals and them breaking down owing to this enormous patient load – thereby, transforming us all into victims of this vicious cycle.

A quack and his expectation
The village has an allopathic quack and also a homeopathic quack. The allopathic quack is also a teacher at a private school in the village. His father was also a quack and he had his baby steps in this ‘profession’ following his father’s way of rendering treatment to the villagers. He generally gives out treatment for typhoid, diarrhoea, dysentery and other common ailments and also has in store quite a good stock of medicines. When enquired about his expectations from the government, financial assistance for opening a diagnostic laboratory in the village was his spontaneous answer! However although this man does not perform any surgeries or delivery cases, his attitude revealed that if asked, he does not mind performing deliveries! His regret was clearly observable while he commented that the homeopathic quack being experienced regularly gets called for performing home-deliveries. However, one also needs to remember here that West Bengal’s performance in institutional delivery has been on an increasing trend in the last few years (from 39 per cent in 2003-04 and 46 per cent in 2005-06 to 49 per cent in 2007-08 (Source: DLHS 3, 2007-08, West Bengal 2010). The Janani Suraksha Yojna (JSY) scheme has also been quite a success with an increase of around 8 per cent from 2008-09 to 2010-11(Source: Health on the March, 2010-2011, West Bengal 2012.)

Varied places but with similar stories
A round of the area showed that it has very few (probably 1 or 2) pukka houses (while one is tiled, the other one is a tin shed). Most of the families reside in mud huts, with their children playing around in the dirt – bare-bodied. The condition of the roads forces us to redefine the word “terrible” and a dust storm is raised every time motor-van rickshaws pass through the road. With no clean drinking water, no electricity (although the poles exist, but without any connection!), no modern means of communication –this village is still very much a “land of nothings” with the people accepting their fate of being eternally exploited and deprived. And, this is not just the condition of this particular village. Field visits revealed the fact that the condition of a good number of areas in Bengal portrays this similar fate.

The local villagers prefer to send their children to a private school, which charges them hundred rupees a month, in addition to which they have to purchase books and other stationeries, despite a government secondary school being present in the locality. They are aware of all the facilities which are being offered at a government school and neither do they have any complaints about it but even in the face of all their hardships, they foremost choice is always a private school because they have a fascination towards it and it is their whole-hearted belief that these are the best for their children. It’s nothing but simply a lack of trust and dependence towards the government at large, whose only probable explanation can be the failure of the entire state machinery.

And the satire is
Even after six decades of independence and three decades of Left-front rule in our state – the central government had to declare 14 districts (out of the 19, which covers very much about 80 per cent of our state) as “backward” while allotting the Backward Region Grant Fund (BRGF) for our state. Hasn’t our patience being tested enough? Don’t we owe answers from our very own representatives? For how long are we expected to remain satisfied with the “bare-nothings” that are disrespectfully thrown towards us?

First published on this site on 17/04/2012