Our experience with Ramshastri Prabhune
Today when we see the outer world, running round the clock and hardly have any time for social inclination, being a social animal, one can easily frustrate by this. There are many social minded people who are working for the up liftment of the society and want a little push for the same. It works nicely when we get the desired support from the system which is the rare thing! The same has been happened with the counsellors program in Melghat.
MAHAN and KHOJ which are serving the people of Melghat since many years have started counsellor program in all government hospitals of Melghat from 2007 with the support of honourable collector Dr. Bhapkar, CEO Mutthuswamy and Div. Commissioner Dr. Goyal. It brought significant changes in Govt. hospitals of Melghat, saved many critical lives, many severely malnourished babies were hospitalised and a significant proportion of patients were improved, Hospital deliveries increased. Hospitals are catering care round o’ clock to patients.
But suddenly due to the ill intentions of one corrupt Govt. Officer, the program had been stopped from February 2010 . We tried at our best at all Govt. level from district administration to state secretary level to start the program but all went in vain. The counsellors even went on fasting for few days but there was no success.
At last we took a decision to appear in high court. Then Purnima Upadhyaya as petitioner filed a public interest litigation. We three (Purnima, Bandya and Dr. Ashish Satav) appeared in the high court (Mumbai) and our arguments were given very keen attention by Honourable chief justice JN Patel, Honourable chief justice Mohit Shah and Honorable addl. Chief Justice Mr. Chandrachud. Advocate Gayatrising (Amicus Curiae) helped us free of cost to plead our case. Their approach towards the case showed the concerned for the poor tribal people of Melghat which was the missing part from the Govt. System. It was enough to build a faith of a common man over the Indian Judiciary System. They gave motivating decision about the counsellors program that this program should continue and even recommended that Govt. of Maharashtra should replicate this model.
The counsellor program was restarted. It was proved to be the real victory of a common tribal man. No doubt that the kind consideration and positive approach of honourable justices played an important role to see the things in real context.
Later on, Hon. Chief justice Mohit Shah and Hon. ACJ, Mr. Chandrachud asked us to give suggestions to improve the health system and overall condition of tribal. The suggestions and the recommendations submitted by the
petitioner are taken on record. The respondents will consider the same
and give their response at the next hearing. In the mean time, it is open
for the respondents to consider all such suggestions and those
suggestions which are accepted may be implemented immediately
without waiting for any further orders of this Court. The suggestions and
the recommendations given today as well as the various other
suggestions made by the Non Government Organizations which have
been discussed today shall be considered by the Respondents.
Following significant policy changes were done due to court order.
1. Court ordered that instead of take home ration (prepared by industries), with the consent of gramsabha fresh hot cooked food (prepared by self help group of tribal) should be given to children below the age of 3 years to prevent malnutrition. Due to it, thousands of tribal will get employment and children will get good food.
2. Counsellor program will continue and will be implemented via coordination committee made up of voluntary organizations and government. Extension of counsellors program in district hospital Amravati and sub district hospital Achalpur.
3. Severe Acute Malnutrition (SAM) as well as old method of grading (I to IV) will be used for classification of malnutrition. It will benefit lakhs of children of Maharashtra.
4. Rajmata Jijau Mother and Child Health and Nutrition Mission should be restarted. This will save lakhs of children and pregnant mothers of Maharashtra.
5. Increment in the funds, number as well as rejuvenation of Village Child Developmental Centres & Child development centres in Maharashtra. It will save thousands of children.
6. The public distribution system (ration shops) should be handed over to the self help groups of tribal instead of commercial private people.
7. Appointment of IAS officer as Integrated Tribal Development Project Officer for eight tribal blocks of four districts, Amravati, Yavatmal, Akola and Nanded, who will be overall incharge (Additional Collector) of tribal areas.
8. Appointment of special nodal officer for coordination of all government schemes of tribal area of Melghat.
9. Formation of district coordination committee of Govt. and voluntary organization for Melghat improvement.
10. MAHAN developed home based child care model to reduce child deaths and malnutrition in Melghat. Due to it the child deaths and malnutrition in 17 villages of Melghat was reduced by more than 50%. Hon. High court asked govt. why not to try this model for whole Melghat. Also the HBNC model of SEARCH should be accepted for whole Melghat.
11. Action against Kharyatembru nurse for her irresponsible negligence leading to death of a severely malnourished child.
12.
Hon. Chief justice of High court have also leave it open to the petitioners to approach the
Taluka Legal Service Committee, Dharni and also the Taluka Legal
Service Committee, Achalpur for generating public awareness about
various welfare Schemes and also for rendering any further assistance
1. which N.G.O.s in the area may require.
These types of recommendations and the implementation over it will really work to improve the health facet of the people of the tribal areas of the state. Thanks to the Indian Judiciary System which is still binding the faith of people for the justice. It reminds us that Ramshastri Prabhune is still existing in India in the form of Honorable Chief Justice Mohit Shah, Honorable Associate Chief Justice Chandrachud and Honorable Chief Justice J. N. Patel.
Thanks to Caring friends for the financial support.
1/26/2009
MELGHAT HEALTH PROJECT
Tribal Health Research Project , Melghat
Organizers: MAHAN, Melghat & Kasturba Health Society, Sevagram
FACULTY
Name Qualification
Dr. Ashish Satav M.B.B.S., M.D.
Dr. Kavita Satav M.B.B.S., M.S.
INTRODUCTION
Melghat is the hilly forest area in the beautiful Satpuda mountain ranges. Population is 2,80,000 & 75% of them are tribal . Korku is the major tribe of Melghat .Most of the tribal (>90 %) are farmers or labourers, living below poverty line(>75%) & very hard life in kaccha houses without electricity (>90%) & illiterate (>50%). Medical facilities are worst in Melghat as compared to rest of Maharashtra . This area is known for highest under 5 children mortality (>100 per live births) especially Malnutrition related deaths and highest mortality in age group (16-60years) in Maharashtra.
BRIEF REPORT (Nov.1997- 31st March 2011)
Our base hospital is at Karmagram, Tahsil Dharni (Mahatma Gandhi Tribal Hospital) which is 140 Km from Amravati (nearest city). We are working in more than 36 villages of Melghat.
A) Curative Activities
More than 50808 patients have been treated till now. Ours is only hospital in Melghat for treatment of serious patients & we managed many (>800) serious patients (e.g. Myocardial infarction, brain haemorrhage, cerebral malaria , meningitis, tetanus etc.) and saved precious lives at our hospital
SURGICAL CAMPS
a) Operated more than 749 cases with ophthalmic problems like cataract (free of cost -intra-ocular lens implantation), eye injuries, minor surgeries etc.
b) Plastic surgery camp: 215 cases of post burn contractures, cleft lip, cleft palate, etc. were operated free of cost in our hospital.
c) 15 cases of Rheumatic volvular heart diseases detected in our camp were operated free of cost at Mumbai with the help of G-66 Heart Foundation Atchut Maharaj Heart Foundation, Amravati.
d) More than 20 other general surgical cases have been operated in various hospitals due to our efforts.
MORTALITY CONTROL PROGRAM
We trained 19 village health workers for treatment of under 5 children. More than 81425 individuals were treated free of cost in the villages itself from May 1, 2005. Due to it, we could reduce under 5 children mortality by more than 50% over a period of 5 years, which is a cost effective and easily replicable model. This project received first best oral presentation award in national symposium on tribal health by Indian Counsel of Medical Research in 2006.
This project has been accepted for 7 international symposia organised by Medical School of U.K., Indian Counsel of medical research, The Netherlands Symposium and European Society of Paediatric Research, Germany and Denmark.
Effect of our work on community health:
Our data collection during last 6 years revealed the actual mortality status of Melghat. It indicates that the government data is far from reality. The infant and under five children mortality rate & prevalence of malnutrition in Melghat is very high as compared to most of the Maharashtra. The exposure of real status in newspaper and television etc. created lot of awareness amongst the various section of the society. Rajmata Jijau mother and children nutrition mission of the Maharashtra government along with UNICEF confirmed our findings, accepted the realities and started work to improve the situation. The government was mobilized to announce some welfare schemes for the poor tribal. Various N.G.O. and social minded people are helping the poor people due to massive campaigning of the issue. Due to our efforts most of the severely malnourished babies are getting supplementary nutrition in 17 villages and many deaths due to malnutrition were prevented. The prevalence of severe malnutrition was reduced by around 60%. The prevalence of anemia was decreased in Intervention village.
Mortality control program for economically productive age group (16-60 years)
Many patients are dying prematurely due to illness like Tuberculosis, Hypertension, Heart Attack, Pneumonia, Diarrhea, Malaria , Chronic Obstructive Airway diseases, Jaundice, Addiction , Suicide, maternal deaths, etc. Most of the deaths are due to wrong life style like unhygienic practices, addiction and lack of doctors. Hence MAHAN has trained tribal female village health workers for early identification and treatment of illness in village or in hospital. Due to their intervention, MAHAN could reduce death rate by more than 35% in above age group from 16 -17 villages of Melghat. This is most probably the first sort of innovation in world.
Maternal mortality reduced by more than 60%.
SPECIALITY CAMPS
We arranged various speciality diagnostic & treatment camps in Melghat like Gynaecology & Obstetrics, Ultra Sonography, Paediatrics , eye, ENT, pathology , etc. and treated >15942 patients. Detection of Malaria parasite positive patients in the camps activated the government system to start malaria prevention program on massive scale in Melghat.
SCHOOL HEALTH CHECKUP
Around 17914 students from more than 102 schools were examined & the needy were treated free of cost (especially for eye problems).
ANGANWADI CHILDREN HEALTH CHECK UP
More than 9000 pre-school children from 37 villages in Melghat were screened & needy were treated. Around 3-10% of children are severely malnourished. With the help of other charitable trusts, we provided nutritious food to more than 300 malnourished babies and mothers for 3 months. Due to our efforts many deaths due to malnutrition were prevented.
BLINDNESS CONTROL PROGRAM
Only our hospital has full time ophthalmic surgeon. More than 330 cataract cases have been operated upon (free of cost). More than 3248 students & villagers were given spectacles (free of cost for students).
ROAD TRAFFIC ACCIDENT:
We saved lives of around 29 seriously injured persons in road traffic accidents by rescuing them from accident site in Melghat.
DOOR TO DOOR SCREENING & TREATMENT OF PATIENTS:
More than 14289 cases were screened and needy were treated.
B ) Preventive Activities
HEALTH EDUCATION PROGRAMME
More than 3732 health education programs were organized for more than 73576 people. We prepared one C.D. on Nutrition Health Education in local Korku dialect, which has been highly accepted & appreciated by the villagers. We also prepared one flip chart on nutrition highly appreciated & recommended for government health education program by Dr. Mishra (IAS) , Special Reporter, National Human Rights Commission & Ex-secretary, Union Labor, Ministry, Govt. of India, New -Delhi. Also highly appreciated by Dr. Fernandez, neonatologist and ex dean of SION Medical College.
YOUTH DIALOGUE & HEALTH TRAINING PROGRAM
Due to our continued efforts, government was forced to conduct Mutation (i.e. change of title of land to the existing progeny of the tribal) on massive scale & many poor tribal became legal landowners.
POLICY LEVEL ACTIVITIES
Participation in Policy level activities:
1. Member of Bhavishya Alliance ,an international alliance for reducing malnutrition in Maharashtra.
2. Member of state level Village Child Development Committee of Rajmata Jijau Mission of Govt. of Maharashtra.
3. Member of European Society of Pediatric research.
4. Member of national child health policy committee by Lifebuoy company.
5. Member of Special study group for Tribal health improvement of Vidarbha Statutory Development Board appointed by Governor of Maharashtra .
6. Participation in state level policy meeting about use of antibiotics in childhood illness by village health workers and ASHA. (Arranged by additional chief secretary, health)
7. Hon. Chief justice of Maharashtra asked govt. to implement recommendation of MAHAN for Melghat health improvement.
8. MAHAN model of HBCC has been accepted by Govt. for whole Melghat.
9. Member of district Navsanjeevan committee for monitoring child health and nutrition activities.
10. Member of mentoring committee of district National Rural Health Mission.
11. Secretary of Coordination committee of counselor program for govt. hospitals in Melghat.
PROGRAMS OF MAHAN TRUST ACCEPTED OR ON WAY FOR ACCEPTANCE AS STATE LEVEL POLICIES:
1. Village feeding centers for severely malnourished babies-or VCDC.
2. Counselor program for govt. hospitals in rural and tribal areas.
3. Acceptance of real status of severe malnutrition in all tribal blocks of Maharashtra by RJMCHN Mission . Govt. policies were changed.
4. Hot cooked food to children in the age group of 6 months to 3 years prepared by local tribal female Self Help Group.
5. Three criteria for selection of severe acute malnutrition children for supplementary nutrition.
HEALTH TRAINING PROGRAMS
Health training programs for Doctors, Nurses, CDPO, Anganwadi supervisors, Teachers, N.G.O., Counselors, yuva doots & village health workers. Topic :Treatment of under 5 children, Mother & children care. Nutrition & Malnutrition, counseling skills, heart attack, sustainable agriculture Immunization, adolescent and maternal health including hygiene and sanitation, pregnancy cycle, importance of skilled birth, 5safes, administrative structure in health and ICDS, important government schemes, addiction, yoga, meditation, de-addiction, etc.
COUNSELORS PROGRAM
Trained local Korku tribal youths are appointed as counselors in government health institutions of Melghat and Amravati. Due to this innovative program the following positive effects can be observed in government health institutions:
a. The OPD and IPD (hospitalization of severely malnourished babies and pregnant ladies ) were improved due to hospitals remaining open for 24 hours.
b. Significant improvement in hospitalized severely malnourished babies.
c. Significant increase in no. of hospitalization of severely malnourished children and hospital deliveries.
d. Quality of food served to patients improved.
e. Sanitary, lighting and other facilities in hospitals improved.
f. Drug availability improved.
g. Referral transportation of patients improved.
h. Staff became patient friendly. Communication with patients improved.
i. Confidence of people in hospitals improved. They stayed in hospital for reasonable time, unlike going back home immediately or in a day’s time.
The Counselors Program is proving to be a successful initiative for such tribal and remote areas with distinct hurdles of reach, language, lack of facility level supervision and poor community response. Till now more than 64000 tribal are benefited through the program. The project will be replicated across all such remote tribal areas of Maharashtra with local specific modification.
PROJECT UMANG (DE-ADDICTION PROGRAM)
One of the areas MAHAN had decided in the beginning was ‘De-addiction’. In Melghat every year, hundreds of people die because of various addictions. People are addicted mainly to Tobacco & local Alcohol. Addiction is prevalent in ladies & youngsters also. ‘Mohaful’ used for making alcohol is available in ample quantity in jungle of Melghat. Like urban lifestyle, alcohol is used in almost all functions & celebrations. Root causes found out of addiction are cultural practices, lack of awareness, peer group pressure etc. As it was wide spread across the Melghat & related to behavioral change, it was challenging task to achieve de-addiction with available resources.
Following are the results:-
• Around 100 volunteers & patients trained & treated by us stopped alcohol drinking & smoking. Ghota villagers celebrated Holi festival without social drinking for consecutive 5 years.
• Innovative way of celebration of new year : Instead of celebrating new year by traditional way of drinking alcohol, villagers celebrated it by way of:-
1. Shramdan- 200 villagers made a drainage channel of two kilometer and a footpath of 700 meter in village.
2. 30 youths and 50 children took an oath of development of village and making Ghota village as a model village,
3. Five youths gave up addiction
4. various government officers made villagers aware about various government policies & schemes available
• Yoga : More than 400 villagers started regular yoga for de-addiction.
• Sports:-Around 500 people attended the ‘Holley ball matches’ without consuming alcohol & smoking, in Tarubanda village, which is the 1st time happening in Melghat.
KITCHEN GARDEN AND NUTRITION FARM PROGRAM
Kitchen garden through waste water channelization is the innovative concept to deal with the lack of nutrition. By establishment of kitchen gardens in the backyard of the houses of tribal, production of green leafy vegetables and fruits has been taken by the tribal. Intake of these nutritious food helps to combat the malnutrition among the tribal. Till now we produced more than 1000 kitchen gardens in 17 villages of Melghat. We are also planning to establish the nutrition farms in 320 acres of land in 17 villages so that the annual production for a family can be drown by cultivating variety of food in one acre. This helped to reduce malnutrition in Melghat.
PAPER/POSTER PRESENTATION IN CONFERENCES
A. Presentation and acceptance of the Home Based Child Care Program in many international symposia over following issues.
1. Child health -at Hamburg Germany organized by European Society of Pediatric Research.
2. “From Research to Improved Practice & Policy in International Health” by NVTG and Uniting Streams, Utrecht, Netherland , The Netherlands.
3. Tribal health by Indian Counsel of Medical Research.
4. Home based child care for reducing child malnutrition in Melghat- 3rd Congress of the European Academy of Paediatric Societies, EAPS 2010, Denmark.
5. Effect of Home based child care on child mortality in tribal population: Result of field trial - 3rd Congress of the European Academy of Paediatric Societies, EAPS 2010, Denmark.
6. Infectious diseases of children at Hague, The Netherland organized by European Society of Pediatric Infectious Diseases-2011.
7. “European Society of Paediatric Research (ESPR) 2011 : 52nd Annual Meeting”,. in Newcastle, UK -2011.
8. Health and Wellbeing-the 21st Century Agenda: Royal Society of Pediatric Health , London, UK-2011
9. Tribal health by medical school of UK.
A. Paper Presentation in International Journals
1. Post graduate journal of Medicine, England. (Topics; Skeletal abnormalities, hypocalcaemia and intracranial calcification) vol. 73, 1997.
B. Presentation and acceptance of work in many national symposia/conferences/workshop/ journals :
1. National symposium on tribal health by Indian Counsel of Medical Research, Jabalpur.
2. National symposium on Infectious diseases by All India Institute of Medical Sciences , Delhi and Infectious diseases society of India.
3. Association of Physicians of India – Calcutta national conference.
4. APICON 98 - Association of Physicians of India – Bangalore national conferences.
5. Neurological manifestations associated with HIV/AIDS in JAPI 1999, Vol. 47, No. 1
6. Tetanus after Electric shock Injury –published in national journal- JAMS-96.
7. Effect of Yoga on Bronchial Asthma in JAPI1999, Vol. 47, No. 1.
8. National seminar on role of Ayurveda in management of malnutrition in mother and child of tribal area in Gramin Ayurved mahavidyalaya Patur, Distt. Akola, Maharashtra.
9. National conference of infectious diseases organized by AIIMS in association with Infectious Diseases Society of India.
10. Community Ophthalmology Conference Eye India 04 organized by PBMA’s H. V. Desai Eye Hospital, Pune.
11. Microbial study of seasonal variation in acute gastroenteritis in adults in JAPI 1996, Vol. 44, No. 12.
12. Clinical profile of HIV infection in high risk group (Hospital Based Study) in JAPI, Vol. 46, January 1998
13. Demographic study of HIV infection in high risk group (Hospital Based Study) in JAPI 1998, Vol. 46, No. 1
PRINT AND ELECTRONIC MEDIA
Dr. Ashish Satav was invited as an expert on Mumbai Doordarshan for a program “Malnutrition problem” under the program Sapat Mahacharcha. The project activities were presented by ETV Samvad, SAAM TV, NDTV, etc. The work was published in the form of more than 100 news in various news papers like Times of India, The Hindu, DNA, Asian Ages, Lokmat, etc.
STRENGTHENING OF GOVT. HEALTH & ICDS SYSTEM
1. We won the PIL in Mumbai High court and court has given order to restart the counselor program in all govt. hospitals of Melghat. So our counselors have started their work.
2. Impact of Government -NGOs coordination : Due to our counselors, there is qualitative and quantitative improvement in all of the Govt. hospitals of Melghat. This is the first such type of innovative program of monitoring of government hospitals by NGOs in India .
3. Due to our regular pressure , there is improvement in services provided in ICDS centers (anganwadi centers ) of 17villages of Melghat. Govt. has accepted our proposal of starting nutritious feeding in villages to severely malnourished children in the form of VCDC.
OTHER COMMUNITY DEVELOPMENT ACTIVITIES
Various socio-economic status up-liftment activities like Employment guarantee scheme , Water supply schemes, repairing of road of few villages and S.T. Bus facilities have been started in many villages of Melghat by government due to our regular follow up. Admission of many students to schools was facilitated by us. Providing financial support to poor student for studies. 200 bicycles were distributed to the needy poor tribal people . It made them self sustainable and got easy means of transport for education and earning. We distributed cloths to more than 2000 tribals.
9. DE-ADDICTION PROGRAMME: Around 100 volunteers & patients trained & treated by us stopped alcohol drinking & smoking . Ghota villagers celebrated Holi festival without social drinking for consecutive 5 years due to our efforts. But as we stopped this activity since 3 years , there is relapse in above village.
REPUTATION OF THE INSTITUTION
Awards
i. The project was awarded “Best Tribal Research Project Award & Young Scientist Award” by Indian Counsel of Medical Research, selected by eminent epidemiologist and doctors from World health organization , USA, UK and India.
ii. Felicitation by Jagtik Marathi Academy and Shivaji University, Kolhapur.
iii. Americares Foundation’s ‘Spirit of Humanity Award 2011 –National Award ’ for child nutrition.
iv. National Child Health Award for Nutrition by Lifebuoy.
v. Karmveer Social Citizen National Award.
vi. Dr. Vankar award by Indian Medical Assoication, Nagpur.
vii. Dr. Dwarkanath Kotnis National Award and Savitribai Fuley state award .
viii. Spirit of Mastek Award from Mastek Foundation, Mumbai
ix. Uvaunmosh Puraskar from Indradhanu, STAR Mazha and Maharashtra Times.
x. Godatai Parulekar state award.
xi. M.B. Gandhi award .
xii. Samajseva Bhushan Puraskar.
xiii. Jamshetji Tata National Rural virtual fellowship.
xiv. Felicitation by chief minister of Maharashtra.
xv. Swatyantravir Savarkar Samajik Samarasta award .
xvi. Dr. V.N. Vankar award for “Health & Hygiene” by Indian Medical Assoication.
xvii. Comred Godavari Parulekar Smruti Award .
xviii. Felicitation by Rashtrasant Tukadoji Maharaj Samiti wardha .
xix. Karyanishtha Gaurav Puraskar to Dr. Ashish Satav.
xx. Vocational award by Rotary club of Gandhi city.
xxi. Vocational Excellence award(Scroll of honour) by Rotary club of Pune.
xxii. Sevankur Idol.
xxiii. Vishesh Karyagaurav Sanstha Puraskar.
xxiv. Felicitation by LIONS club, Nagpur .
xxv. Dada Chandiramji Wadhwani Memorial Award (from Vidarbah Vaibhav.org.) to Dr. Ashish Satav.
xxvi. Felicitation by SAAM TV and Sakal news paper.
xxvii. Felicitation by Vivekanand Medical Mission, Khapari.
xxviii. Felicitation by VidyaNiketan School, Amaravati by Ex. minister of central govt. Mr. Anand Adasule.
xxix. Felicitation by Center point college, Nagpur .
Comments by famous person about the work
i. News published in Delhi edition of Indian Express December 5, 2006 -Dr Naresh Geete, director (Monitoring), Rajmata Jijau Mission for Mother and Child Nutrition, the government body appointed to monitor health reporting and coordinate among the various agencies working for child and mother care, admits to under-reporting: “Satav is 100 per cent correct. We have asked our officers to improve reporting. Unless we report correctly, we won’t be able to solve the problem.” Government reporting has since improved in Satav’s 19 intervention villages of Melghat.
ii. ‘I had remarkable experience seeing the hospital and then visiting the research personnel (of MAHAN Trust) in their home in the village. This maternal infant project demonstrates the power of low tech investigations to decrease infant mortality. Our discussion with the research team here have informed me how to think about the project for the US National Institute of Health – Maternal Infant Research Network working with Dr. Archana Patel from Nagpur, we will get great value and stimulation from the brief visit. Thank you very much!’ – Alan H. Jobe, MD, PhD, Professor of Pediatrics and researcher, Cincinnati Children’s Hospital , Cincinnati, Ohio, USA.
iii. ‘The dedication and involvement of the MAHAN staff under Dr. Satav’s leadership and that of the community workers was truly impressive. The need to serve and in turn gain the respect of the community members is mutually beneficial and therefore sustainable. The measurable improvement in the health indicators, knowledge of the community members and their trust in MAHAN’s workers indicates that MAHAN is making a big difference in their lives. May they have the strength and conviction to continue this excellent work.’ – Dr. Archana Patel, HOD, Pediatrics, IGMC and VP, Lata Medical Research Foundation, Nagpur.
iv. Your life and work inspire me greatly. Dr. Ashish is my indian teacher.- Mr. Adam Kahane, Canada-International expert in problem solving.
v. Your work of home based child care program should be propagated all over India, said Dr. Katoch, Director General, ICMR and Secretary , Health Research, Govt. of India.
vi. Dr. Satav taught us the real status of Malnutrition in Melghat admits Rajlakhmi Nayar (Program officer of UNICEF on nutrition for Maharashtra ).
vii. Dr. Satav family is doing excellent work in Melghat. Their work reminds us Dr. Albert Shwaitzer. Their work will be helpful for overall development of Melghat. Said by Dr. Prashant Gangal (M.D.- Chief trainer of Malnutrition reduction program of Maharashtra Government and UNICEF training program ), Dr. Sanjay Prabhu (M.D.-Maharashtra state Secretary of Breastfeeding Promotion Network of India, ), Dr. Shakuntala Prabhu- Professor of Pediatrics- Wadia children Hospital, Mumbai.
viii. The flipchart on Malnutrition , prepared by you is of an excellent quality and I recommend that govt. of Maharashtra should use it for their health education program. – Dr. L.P. Mishra, IAS , special rapporteur, National Human Rights Commission of India. He was impressed by our way of monitoring govt . Health & ICDS program in Melghat and scolded many govt. officers after reading our report.
ix. Dr. Satav is an great asset for Melghat and district administration, said Dr. Shanta Sinha , Chairperson, National Child-right Protection Commission of India.
x. You are doing very good work at Melghat said Mr. Dhirubhai Mehta, President, Kasturba Health Society, Sevagram and director of Mahatma Gandhi Institute of Medical Sciences, Sevagram.
xi. I would like to take this opportunity to express my personal gratitude to you and your team of workers for leaving no stone unturned in order to ensure the complete success on the occasion – Dr. Mrs. P. Narang , Dean, Mahatma Gandhi Institute of Medical Sciences, Sevagram.
xii. Dr. Satav’s hard work , sincerity and dedication is praise worthy. He has travelled a lot in interior of villages by scooter and walked a long distances. He commands good respect with local leaders, Govt. officers and villagers of the area.- Dr. Prakash Behere, Prof. & Head of the department , Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram.
xiii. We are very much happy and satisfied after seeing the good project of Dr. Satav . During such a young age, it is not easy to avoid lot of attractions in life and live in such small village. Drs. P.R. Mhaskar & Kamal Mhaskar, Mhaskar trust, Amalner.
xiv. I was very happy to visit your camps. The subjects you are discussing are very critical to the future of the people of India. Mr. Boffalme-USA.
xv. We are really inspired by the good work done by Drs. Ashish & Kavita Satav. Very few people like them realises their responsibility to serve for the motherland. To dream such work and to do it actually is really praiseworthy. - Dr. Kanak Nagale , Heart Surgeon from Nair hospital , Mumbai.
xvi. The work they are doing is highly laudable. Selfless service given to people of tribal area seeing to all round development of an individual and also making them participate in the activity is a real great thing. Wishing them all success in their endevour - Dr. C.J. Hemantkumar, Heart Surgeon (Cardiovasular surgeon )from Jaslok hospital and Hinduja hospital , Mumbai.
xvii. "Shailesh nisal" shailesh.nisal@gmail.com something I wrote........
Utavali, Dharni, INDIA.
Utavali means 'eager' in Hindi. Eager to work are the Satav couple, Eager to go there are people who have visited the place once. It is an example of what the human spirit can make happen. What the will of 2 persons can bring up from nowhere, from nothing. And where it is most needed. One can't but wonder why they do it? What takes a highly educated couple to a god-forsaken forest to deliver health care to people who live on nothing. It's a mission that is difficult to comprehend. Even more the fact that they put their life at stake, when there were so many comforts that could have been easily theirs. They are a creed apart; they come to this world to give, at the cost of time, comforts, family and their life. I salute them, the spirit that drives them. I salute their courage to do what they want to, and the guts to keep going.
Dr. Shailesh Nisal, (M.B.B.S., M.S., M.Ch.) plastic surgeon, Nagpur.
xviii. I impressed upon the trustees of Love trust U.K. , the planned and systematic nature of your work with the tribals and my expectations that it will yield good results in the health of tribals and in particular in reducing mortality among young children up to the age of six. My wife and I were especially impressed by the concept of training village health workers. The lady village health worker to whom you introduce us in the village, and who spoke so clearly of her work diagnosing pneumonia and malaria is an excellent ambassador for your work. –Mr. Stephen Love, England.
xix. We were convinced with your capacities to lead the project of children mortality control program. You definitely convinced me that the results of your work and your scientific research will have an important impact on the future of many people in the Melghat area. Now you have won this national price, and your research work is appreciated by national and international experts in community health, it will even have impact on many more people. Congratulations to you and Kavita also. She has also played such an important role! May be in future your results can even be used in Sierra Leone! - Dr. Annekoos Wiersinga(M.D.) , Stitchting Geron, Netherlands.
xx. I congratulate you with the award that you received at the symposium at Jabalpur. You certainly deserved it. Your work has been of great importance for the destitute tribal people of Melghat and I am happy and proud that we have sponsored this work. I vividly remember that meeting in the garden of the heart hospital near Amravati. I am very happy that you convinced me there about the necessity of this work. The result has proved that you were right. Annekoos, Batiaan and Taco told me about their visit to Dharni and they told me they were very much impressed by the wonderful and dedicated work you are doing there by Nico Nobel, Netherlands.
xxi. Meeting you made me realize that “role models are neither historical nor in books- they are in ‘action’ in ‘here & now’ . I guess its just a beginning – Mr. Manish Shrivastava– National training manager –Hindustan Lever Limited , Mumbai.
xxii. Dr. Ashish & Dr. Kavita Satav- you are simply great. I want to do lot of work for the tribal community. Your work will inspire me. Really envy you both. Mr. Sunil Limaye (IFS)- Additional Tribal Commissioner, Amaravati division.
xxiii. Your work is like a temple said Dr. Taori, Neurophysician and Director, CIIMS hospital, Nagpur.
xxiv. Awareness generation amongst tribal women & men of Melghat by your trust is praiseworthy. The efforts of Dr. Satav & team will be certainly useful for Melghat . Such training camps will produce Master trainers for social welfare department of Maharashtra government. Mr. Raghunath Kulkarni- Divisional Social Welfare Officer, Amaravati division.
xxv. The various camps organized by the trust is praiseworthy. The various health related activities done by the trust is useful for Melghat. Mr. Kapase , Project officer , Integrated Tribal Development Project, Dharni.
Dr. ASHISH SATAV (M.B.B.S., M.D.)
Mahatma Gandhi Tribal Hospital, Karmagram, Utavali, Dharni , Dist: Amaravati.-444 702,
Phone: 07226-202793, 202291, 9325094780, Email : drsatav@rediffmail.com
Organizers: MAHAN, Melghat & Kasturba Health Society, Sevagram
FACULTY
Name Qualification
Dr. Ashish Satav M.B.B.S., M.D.
Dr. Kavita Satav M.B.B.S., M.S.
INTRODUCTION
Melghat is the hilly forest area in the beautiful Satpuda mountain ranges. Population is 2,80,000 & 75% of them are tribal . Korku is the major tribe of Melghat .Most of the tribal (>90 %) are farmers or labourers, living below poverty line(>75%) & very hard life in kaccha houses without electricity (>90%) & illiterate (>50%). Medical facilities are worst in Melghat as compared to rest of Maharashtra . This area is known for highest under 5 children mortality (>100 per live births) especially Malnutrition related deaths and highest mortality in age group (16-60years) in Maharashtra.
BRIEF REPORT (Nov.1997- 31st March 2011)
Our base hospital is at Karmagram, Tahsil Dharni (Mahatma Gandhi Tribal Hospital) which is 140 Km from Amravati (nearest city). We are working in more than 36 villages of Melghat.
A) Curative Activities
More than 50808 patients have been treated till now. Ours is only hospital in Melghat for treatment of serious patients & we managed many (>800) serious patients (e.g. Myocardial infarction, brain haemorrhage, cerebral malaria , meningitis, tetanus etc.) and saved precious lives at our hospital
SURGICAL CAMPS
a) Operated more than 749 cases with ophthalmic problems like cataract (free of cost -intra-ocular lens implantation), eye injuries, minor surgeries etc.
b) Plastic surgery camp: 215 cases of post burn contractures, cleft lip, cleft palate, etc. were operated free of cost in our hospital.
c) 15 cases of Rheumatic volvular heart diseases detected in our camp were operated free of cost at Mumbai with the help of G-66 Heart Foundation Atchut Maharaj Heart Foundation, Amravati.
d) More than 20 other general surgical cases have been operated in various hospitals due to our efforts.
MORTALITY CONTROL PROGRAM
We trained 19 village health workers for treatment of under 5 children. More than 81425 individuals were treated free of cost in the villages itself from May 1, 2005. Due to it, we could reduce under 5 children mortality by more than 50% over a period of 5 years, which is a cost effective and easily replicable model. This project received first best oral presentation award in national symposium on tribal health by Indian Counsel of Medical Research in 2006.
This project has been accepted for 7 international symposia organised by Medical School of U.K., Indian Counsel of medical research, The Netherlands Symposium and European Society of Paediatric Research, Germany and Denmark.
Effect of our work on community health:
Our data collection during last 6 years revealed the actual mortality status of Melghat. It indicates that the government data is far from reality. The infant and under five children mortality rate & prevalence of malnutrition in Melghat is very high as compared to most of the Maharashtra. The exposure of real status in newspaper and television etc. created lot of awareness amongst the various section of the society. Rajmata Jijau mother and children nutrition mission of the Maharashtra government along with UNICEF confirmed our findings, accepted the realities and started work to improve the situation. The government was mobilized to announce some welfare schemes for the poor tribal. Various N.G.O. and social minded people are helping the poor people due to massive campaigning of the issue. Due to our efforts most of the severely malnourished babies are getting supplementary nutrition in 17 villages and many deaths due to malnutrition were prevented. The prevalence of severe malnutrition was reduced by around 60%. The prevalence of anemia was decreased in Intervention village.
Mortality control program for economically productive age group (16-60 years)
Many patients are dying prematurely due to illness like Tuberculosis, Hypertension, Heart Attack, Pneumonia, Diarrhea, Malaria , Chronic Obstructive Airway diseases, Jaundice, Addiction , Suicide, maternal deaths, etc. Most of the deaths are due to wrong life style like unhygienic practices, addiction and lack of doctors. Hence MAHAN has trained tribal female village health workers for early identification and treatment of illness in village or in hospital. Due to their intervention, MAHAN could reduce death rate by more than 35% in above age group from 16 -17 villages of Melghat. This is most probably the first sort of innovation in world.
Maternal mortality reduced by more than 60%.
SPECIALITY CAMPS
We arranged various speciality diagnostic & treatment camps in Melghat like Gynaecology & Obstetrics, Ultra Sonography, Paediatrics , eye, ENT, pathology , etc. and treated >15942 patients. Detection of Malaria parasite positive patients in the camps activated the government system to start malaria prevention program on massive scale in Melghat.
SCHOOL HEALTH CHECKUP
Around 17914 students from more than 102 schools were examined & the needy were treated free of cost (especially for eye problems).
ANGANWADI CHILDREN HEALTH CHECK UP
More than 9000 pre-school children from 37 villages in Melghat were screened & needy were treated. Around 3-10% of children are severely malnourished. With the help of other charitable trusts, we provided nutritious food to more than 300 malnourished babies and mothers for 3 months. Due to our efforts many deaths due to malnutrition were prevented.
BLINDNESS CONTROL PROGRAM
Only our hospital has full time ophthalmic surgeon. More than 330 cataract cases have been operated upon (free of cost). More than 3248 students & villagers were given spectacles (free of cost for students).
ROAD TRAFFIC ACCIDENT:
We saved lives of around 29 seriously injured persons in road traffic accidents by rescuing them from accident site in Melghat.
DOOR TO DOOR SCREENING & TREATMENT OF PATIENTS:
More than 14289 cases were screened and needy were treated.
B ) Preventive Activities
HEALTH EDUCATION PROGRAMME
More than 3732 health education programs were organized for more than 73576 people. We prepared one C.D. on Nutrition Health Education in local Korku dialect, which has been highly accepted & appreciated by the villagers. We also prepared one flip chart on nutrition highly appreciated & recommended for government health education program by Dr. Mishra (IAS) , Special Reporter, National Human Rights Commission & Ex-secretary, Union Labor, Ministry, Govt. of India, New -Delhi. Also highly appreciated by Dr. Fernandez, neonatologist and ex dean of SION Medical College.
YOUTH DIALOGUE & HEALTH TRAINING PROGRAM
Due to our continued efforts, government was forced to conduct Mutation (i.e. change of title of land to the existing progeny of the tribal) on massive scale & many poor tribal became legal landowners.
POLICY LEVEL ACTIVITIES
Participation in Policy level activities:
1. Member of Bhavishya Alliance ,an international alliance for reducing malnutrition in Maharashtra.
2. Member of state level Village Child Development Committee of Rajmata Jijau Mission of Govt. of Maharashtra.
3. Member of European Society of Pediatric research.
4. Member of national child health policy committee by Lifebuoy company.
5. Member of Special study group for Tribal health improvement of Vidarbha Statutory Development Board appointed by Governor of Maharashtra .
6. Participation in state level policy meeting about use of antibiotics in childhood illness by village health workers and ASHA. (Arranged by additional chief secretary, health)
7. Hon. Chief justice of Maharashtra asked govt. to implement recommendation of MAHAN for Melghat health improvement.
8. MAHAN model of HBCC has been accepted by Govt. for whole Melghat.
9. Member of district Navsanjeevan committee for monitoring child health and nutrition activities.
10. Member of mentoring committee of district National Rural Health Mission.
11. Secretary of Coordination committee of counselor program for govt. hospitals in Melghat.
PROGRAMS OF MAHAN TRUST ACCEPTED OR ON WAY FOR ACCEPTANCE AS STATE LEVEL POLICIES:
1. Village feeding centers for severely malnourished babies-or VCDC.
2. Counselor program for govt. hospitals in rural and tribal areas.
3. Acceptance of real status of severe malnutrition in all tribal blocks of Maharashtra by RJMCHN Mission . Govt. policies were changed.
4. Hot cooked food to children in the age group of 6 months to 3 years prepared by local tribal female Self Help Group.
5. Three criteria for selection of severe acute malnutrition children for supplementary nutrition.
HEALTH TRAINING PROGRAMS
Health training programs for Doctors, Nurses, CDPO, Anganwadi supervisors, Teachers, N.G.O., Counselors, yuva doots & village health workers. Topic :Treatment of under 5 children, Mother & children care. Nutrition & Malnutrition, counseling skills, heart attack, sustainable agriculture Immunization, adolescent and maternal health including hygiene and sanitation, pregnancy cycle, importance of skilled birth, 5safes, administrative structure in health and ICDS, important government schemes, addiction, yoga, meditation, de-addiction, etc.
COUNSELORS PROGRAM
Trained local Korku tribal youths are appointed as counselors in government health institutions of Melghat and Amravati. Due to this innovative program the following positive effects can be observed in government health institutions:
a. The OPD and IPD (hospitalization of severely malnourished babies and pregnant ladies ) were improved due to hospitals remaining open for 24 hours.
b. Significant improvement in hospitalized severely malnourished babies.
c. Significant increase in no. of hospitalization of severely malnourished children and hospital deliveries.
d. Quality of food served to patients improved.
e. Sanitary, lighting and other facilities in hospitals improved.
f. Drug availability improved.
g. Referral transportation of patients improved.
h. Staff became patient friendly. Communication with patients improved.
i. Confidence of people in hospitals improved. They stayed in hospital for reasonable time, unlike going back home immediately or in a day’s time.
The Counselors Program is proving to be a successful initiative for such tribal and remote areas with distinct hurdles of reach, language, lack of facility level supervision and poor community response. Till now more than 64000 tribal are benefited through the program. The project will be replicated across all such remote tribal areas of Maharashtra with local specific modification.
PROJECT UMANG (DE-ADDICTION PROGRAM)
One of the areas MAHAN had decided in the beginning was ‘De-addiction’. In Melghat every year, hundreds of people die because of various addictions. People are addicted mainly to Tobacco & local Alcohol. Addiction is prevalent in ladies & youngsters also. ‘Mohaful’ used for making alcohol is available in ample quantity in jungle of Melghat. Like urban lifestyle, alcohol is used in almost all functions & celebrations. Root causes found out of addiction are cultural practices, lack of awareness, peer group pressure etc. As it was wide spread across the Melghat & related to behavioral change, it was challenging task to achieve de-addiction with available resources.
Following are the results:-
• Around 100 volunteers & patients trained & treated by us stopped alcohol drinking & smoking. Ghota villagers celebrated Holi festival without social drinking for consecutive 5 years.
• Innovative way of celebration of new year : Instead of celebrating new year by traditional way of drinking alcohol, villagers celebrated it by way of:-
1. Shramdan- 200 villagers made a drainage channel of two kilometer and a footpath of 700 meter in village.
2. 30 youths and 50 children took an oath of development of village and making Ghota village as a model village,
3. Five youths gave up addiction
4. various government officers made villagers aware about various government policies & schemes available
• Yoga : More than 400 villagers started regular yoga for de-addiction.
• Sports:-Around 500 people attended the ‘Holley ball matches’ without consuming alcohol & smoking, in Tarubanda village, which is the 1st time happening in Melghat.
KITCHEN GARDEN AND NUTRITION FARM PROGRAM
Kitchen garden through waste water channelization is the innovative concept to deal with the lack of nutrition. By establishment of kitchen gardens in the backyard of the houses of tribal, production of green leafy vegetables and fruits has been taken by the tribal. Intake of these nutritious food helps to combat the malnutrition among the tribal. Till now we produced more than 1000 kitchen gardens in 17 villages of Melghat. We are also planning to establish the nutrition farms in 320 acres of land in 17 villages so that the annual production for a family can be drown by cultivating variety of food in one acre. This helped to reduce malnutrition in Melghat.
PAPER/POSTER PRESENTATION IN CONFERENCES
A. Presentation and acceptance of the Home Based Child Care Program in many international symposia over following issues.
1. Child health -at Hamburg Germany organized by European Society of Pediatric Research.
2. “From Research to Improved Practice & Policy in International Health” by NVTG and Uniting Streams, Utrecht, Netherland , The Netherlands.
3. Tribal health by Indian Counsel of Medical Research.
4. Home based child care for reducing child malnutrition in Melghat- 3rd Congress of the European Academy of Paediatric Societies, EAPS 2010, Denmark.
5. Effect of Home based child care on child mortality in tribal population: Result of field trial - 3rd Congress of the European Academy of Paediatric Societies, EAPS 2010, Denmark.
6. Infectious diseases of children at Hague, The Netherland organized by European Society of Pediatric Infectious Diseases-2011.
7. “European Society of Paediatric Research (ESPR) 2011 : 52nd Annual Meeting”,. in Newcastle, UK -2011.
8. Health and Wellbeing-the 21st Century Agenda: Royal Society of Pediatric Health , London, UK-2011
9. Tribal health by medical school of UK.
A. Paper Presentation in International Journals
1. Post graduate journal of Medicine, England. (Topics; Skeletal abnormalities, hypocalcaemia and intracranial calcification) vol. 73, 1997.
B. Presentation and acceptance of work in many national symposia/conferences/workshop/ journals :
1. National symposium on tribal health by Indian Counsel of Medical Research, Jabalpur.
2. National symposium on Infectious diseases by All India Institute of Medical Sciences , Delhi and Infectious diseases society of India.
3. Association of Physicians of India – Calcutta national conference.
4. APICON 98 - Association of Physicians of India – Bangalore national conferences.
5. Neurological manifestations associated with HIV/AIDS in JAPI 1999, Vol. 47, No. 1
6. Tetanus after Electric shock Injury –published in national journal- JAMS-96.
7. Effect of Yoga on Bronchial Asthma in JAPI1999, Vol. 47, No. 1.
8. National seminar on role of Ayurveda in management of malnutrition in mother and child of tribal area in Gramin Ayurved mahavidyalaya Patur, Distt. Akola, Maharashtra.
9. National conference of infectious diseases organized by AIIMS in association with Infectious Diseases Society of India.
10. Community Ophthalmology Conference Eye India 04 organized by PBMA’s H. V. Desai Eye Hospital, Pune.
11. Microbial study of seasonal variation in acute gastroenteritis in adults in JAPI 1996, Vol. 44, No. 12.
12. Clinical profile of HIV infection in high risk group (Hospital Based Study) in JAPI, Vol. 46, January 1998
13. Demographic study of HIV infection in high risk group (Hospital Based Study) in JAPI 1998, Vol. 46, No. 1
PRINT AND ELECTRONIC MEDIA
Dr. Ashish Satav was invited as an expert on Mumbai Doordarshan for a program “Malnutrition problem” under the program Sapat Mahacharcha. The project activities were presented by ETV Samvad, SAAM TV, NDTV, etc. The work was published in the form of more than 100 news in various news papers like Times of India, The Hindu, DNA, Asian Ages, Lokmat, etc.
STRENGTHENING OF GOVT. HEALTH & ICDS SYSTEM
1. We won the PIL in Mumbai High court and court has given order to restart the counselor program in all govt. hospitals of Melghat. So our counselors have started their work.
2. Impact of Government -NGOs coordination : Due to our counselors, there is qualitative and quantitative improvement in all of the Govt. hospitals of Melghat. This is the first such type of innovative program of monitoring of government hospitals by NGOs in India .
3. Due to our regular pressure , there is improvement in services provided in ICDS centers (anganwadi centers ) of 17villages of Melghat. Govt. has accepted our proposal of starting nutritious feeding in villages to severely malnourished children in the form of VCDC.
OTHER COMMUNITY DEVELOPMENT ACTIVITIES
Various socio-economic status up-liftment activities like Employment guarantee scheme , Water supply schemes, repairing of road of few villages and S.T. Bus facilities have been started in many villages of Melghat by government due to our regular follow up. Admission of many students to schools was facilitated by us. Providing financial support to poor student for studies. 200 bicycles were distributed to the needy poor tribal people . It made them self sustainable and got easy means of transport for education and earning. We distributed cloths to more than 2000 tribals.
9. DE-ADDICTION PROGRAMME: Around 100 volunteers & patients trained & treated by us stopped alcohol drinking & smoking . Ghota villagers celebrated Holi festival without social drinking for consecutive 5 years due to our efforts. But as we stopped this activity since 3 years , there is relapse in above village.
REPUTATION OF THE INSTITUTION
Awards
i. The project was awarded “Best Tribal Research Project Award & Young Scientist Award” by Indian Counsel of Medical Research, selected by eminent epidemiologist and doctors from World health organization , USA, UK and India.
ii. Felicitation by Jagtik Marathi Academy and Shivaji University, Kolhapur.
iii. Americares Foundation’s ‘Spirit of Humanity Award 2011 –National Award ’ for child nutrition.
iv. National Child Health Award for Nutrition by Lifebuoy.
v. Karmveer Social Citizen National Award.
vi. Dr. Vankar award by Indian Medical Assoication, Nagpur.
vii. Dr. Dwarkanath Kotnis National Award and Savitribai Fuley state award .
viii. Spirit of Mastek Award from Mastek Foundation, Mumbai
ix. Uvaunmosh Puraskar from Indradhanu, STAR Mazha and Maharashtra Times.
x. Godatai Parulekar state award.
xi. M.B. Gandhi award .
xii. Samajseva Bhushan Puraskar.
xiii. Jamshetji Tata National Rural virtual fellowship.
xiv. Felicitation by chief minister of Maharashtra.
xv. Swatyantravir Savarkar Samajik Samarasta award .
xvi. Dr. V.N. Vankar award for “Health & Hygiene” by Indian Medical Assoication.
xvii. Comred Godavari Parulekar Smruti Award .
xviii. Felicitation by Rashtrasant Tukadoji Maharaj Samiti wardha .
xix. Karyanishtha Gaurav Puraskar to Dr. Ashish Satav.
xx. Vocational award by Rotary club of Gandhi city.
xxi. Vocational Excellence award(Scroll of honour) by Rotary club of Pune.
xxii. Sevankur Idol.
xxiii. Vishesh Karyagaurav Sanstha Puraskar.
xxiv. Felicitation by LIONS club, Nagpur .
xxv. Dada Chandiramji Wadhwani Memorial Award (from Vidarbah Vaibhav.org.) to Dr. Ashish Satav.
xxvi. Felicitation by SAAM TV and Sakal news paper.
xxvii. Felicitation by Vivekanand Medical Mission, Khapari.
xxviii. Felicitation by VidyaNiketan School, Amaravati by Ex. minister of central govt. Mr. Anand Adasule.
xxix. Felicitation by Center point college, Nagpur .
Comments by famous person about the work
i. News published in Delhi edition of Indian Express December 5, 2006 -Dr Naresh Geete, director (Monitoring), Rajmata Jijau Mission for Mother and Child Nutrition, the government body appointed to monitor health reporting and coordinate among the various agencies working for child and mother care, admits to under-reporting: “Satav is 100 per cent correct. We have asked our officers to improve reporting. Unless we report correctly, we won’t be able to solve the problem.” Government reporting has since improved in Satav’s 19 intervention villages of Melghat.
ii. ‘I had remarkable experience seeing the hospital and then visiting the research personnel (of MAHAN Trust) in their home in the village. This maternal infant project demonstrates the power of low tech investigations to decrease infant mortality. Our discussion with the research team here have informed me how to think about the project for the US National Institute of Health – Maternal Infant Research Network working with Dr. Archana Patel from Nagpur, we will get great value and stimulation from the brief visit. Thank you very much!’ – Alan H. Jobe, MD, PhD, Professor of Pediatrics and researcher, Cincinnati Children’s Hospital , Cincinnati, Ohio, USA.
iii. ‘The dedication and involvement of the MAHAN staff under Dr. Satav’s leadership and that of the community workers was truly impressive. The need to serve and in turn gain the respect of the community members is mutually beneficial and therefore sustainable. The measurable improvement in the health indicators, knowledge of the community members and their trust in MAHAN’s workers indicates that MAHAN is making a big difference in their lives. May they have the strength and conviction to continue this excellent work.’ – Dr. Archana Patel, HOD, Pediatrics, IGMC and VP, Lata Medical Research Foundation, Nagpur.
iv. Your life and work inspire me greatly. Dr. Ashish is my indian teacher.- Mr. Adam Kahane, Canada-International expert in problem solving.
v. Your work of home based child care program should be propagated all over India, said Dr. Katoch, Director General, ICMR and Secretary , Health Research, Govt. of India.
vi. Dr. Satav taught us the real status of Malnutrition in Melghat admits Rajlakhmi Nayar (Program officer of UNICEF on nutrition for Maharashtra ).
vii. Dr. Satav family is doing excellent work in Melghat. Their work reminds us Dr. Albert Shwaitzer. Their work will be helpful for overall development of Melghat. Said by Dr. Prashant Gangal (M.D.- Chief trainer of Malnutrition reduction program of Maharashtra Government and UNICEF training program ), Dr. Sanjay Prabhu (M.D.-Maharashtra state Secretary of Breastfeeding Promotion Network of India, ), Dr. Shakuntala Prabhu- Professor of Pediatrics- Wadia children Hospital, Mumbai.
viii. The flipchart on Malnutrition , prepared by you is of an excellent quality and I recommend that govt. of Maharashtra should use it for their health education program. – Dr. L.P. Mishra, IAS , special rapporteur, National Human Rights Commission of India. He was impressed by our way of monitoring govt . Health & ICDS program in Melghat and scolded many govt. officers after reading our report.
ix. Dr. Satav is an great asset for Melghat and district administration, said Dr. Shanta Sinha , Chairperson, National Child-right Protection Commission of India.
x. You are doing very good work at Melghat said Mr. Dhirubhai Mehta, President, Kasturba Health Society, Sevagram and director of Mahatma Gandhi Institute of Medical Sciences, Sevagram.
xi. I would like to take this opportunity to express my personal gratitude to you and your team of workers for leaving no stone unturned in order to ensure the complete success on the occasion – Dr. Mrs. P. Narang , Dean, Mahatma Gandhi Institute of Medical Sciences, Sevagram.
xii. Dr. Satav’s hard work , sincerity and dedication is praise worthy. He has travelled a lot in interior of villages by scooter and walked a long distances. He commands good respect with local leaders, Govt. officers and villagers of the area.- Dr. Prakash Behere, Prof. & Head of the department , Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram.
xiii. We are very much happy and satisfied after seeing the good project of Dr. Satav . During such a young age, it is not easy to avoid lot of attractions in life and live in such small village. Drs. P.R. Mhaskar & Kamal Mhaskar, Mhaskar trust, Amalner.
xiv. I was very happy to visit your camps. The subjects you are discussing are very critical to the future of the people of India. Mr. Boffalme-USA.
xv. We are really inspired by the good work done by Drs. Ashish & Kavita Satav. Very few people like them realises their responsibility to serve for the motherland. To dream such work and to do it actually is really praiseworthy. - Dr. Kanak Nagale , Heart Surgeon from Nair hospital , Mumbai.
xvi. The work they are doing is highly laudable. Selfless service given to people of tribal area seeing to all round development of an individual and also making them participate in the activity is a real great thing. Wishing them all success in their endevour - Dr. C.J. Hemantkumar, Heart Surgeon (Cardiovasular surgeon )from Jaslok hospital and Hinduja hospital , Mumbai.
xvii. "Shailesh nisal" shailesh.nisal@gmail.com something I wrote........
Utavali, Dharni, INDIA.
Utavali means 'eager' in Hindi. Eager to work are the Satav couple, Eager to go there are people who have visited the place once. It is an example of what the human spirit can make happen. What the will of 2 persons can bring up from nowhere, from nothing. And where it is most needed. One can't but wonder why they do it? What takes a highly educated couple to a god-forsaken forest to deliver health care to people who live on nothing. It's a mission that is difficult to comprehend. Even more the fact that they put their life at stake, when there were so many comforts that could have been easily theirs. They are a creed apart; they come to this world to give, at the cost of time, comforts, family and their life. I salute them, the spirit that drives them. I salute their courage to do what they want to, and the guts to keep going.
Dr. Shailesh Nisal, (M.B.B.S., M.S., M.Ch.) plastic surgeon, Nagpur.
xviii. I impressed upon the trustees of Love trust U.K. , the planned and systematic nature of your work with the tribals and my expectations that it will yield good results in the health of tribals and in particular in reducing mortality among young children up to the age of six. My wife and I were especially impressed by the concept of training village health workers. The lady village health worker to whom you introduce us in the village, and who spoke so clearly of her work diagnosing pneumonia and malaria is an excellent ambassador for your work. –Mr. Stephen Love, England.
xix. We were convinced with your capacities to lead the project of children mortality control program. You definitely convinced me that the results of your work and your scientific research will have an important impact on the future of many people in the Melghat area. Now you have won this national price, and your research work is appreciated by national and international experts in community health, it will even have impact on many more people. Congratulations to you and Kavita also. She has also played such an important role! May be in future your results can even be used in Sierra Leone! - Dr. Annekoos Wiersinga(M.D.) , Stitchting Geron, Netherlands.
xx. I congratulate you with the award that you received at the symposium at Jabalpur. You certainly deserved it. Your work has been of great importance for the destitute tribal people of Melghat and I am happy and proud that we have sponsored this work. I vividly remember that meeting in the garden of the heart hospital near Amravati. I am very happy that you convinced me there about the necessity of this work. The result has proved that you were right. Annekoos, Batiaan and Taco told me about their visit to Dharni and they told me they were very much impressed by the wonderful and dedicated work you are doing there by Nico Nobel, Netherlands.
xxi. Meeting you made me realize that “role models are neither historical nor in books- they are in ‘action’ in ‘here & now’ . I guess its just a beginning – Mr. Manish Shrivastava– National training manager –Hindustan Lever Limited , Mumbai.
xxii. Dr. Ashish & Dr. Kavita Satav- you are simply great. I want to do lot of work for the tribal community. Your work will inspire me. Really envy you both. Mr. Sunil Limaye (IFS)- Additional Tribal Commissioner, Amaravati division.
xxiii. Your work is like a temple said Dr. Taori, Neurophysician and Director, CIIMS hospital, Nagpur.
xxiv. Awareness generation amongst tribal women & men of Melghat by your trust is praiseworthy. The efforts of Dr. Satav & team will be certainly useful for Melghat . Such training camps will produce Master trainers for social welfare department of Maharashtra government. Mr. Raghunath Kulkarni- Divisional Social Welfare Officer, Amaravati division.
xxv. The various camps organized by the trust is praiseworthy. The various health related activities done by the trust is useful for Melghat. Mr. Kapase , Project officer , Integrated Tribal Development Project, Dharni.
Dr. ASHISH SATAV (M.B.B.S., M.D.)
Mahatma Gandhi Tribal Hospital, Karmagram, Utavali, Dharni , Dist: Amaravati.-444 702,
Phone: 07226-202793, 202291, 9325094780, Email : drsatav@rediffmail.com
our experinces in Melghat
<
My self Dr. Ashish Satav (M.B.B.S., M.D.) & my wife Dr. Kavita Satav (M.B.B.S., M.S.-Eye surgeon) are providing curative and preventive medical facilities to poor tribal people of Melghat. Our life has been enlightened by 9 years son, Athang.
Motivation for the work / source of inspiration
I was influenced by my grandfather Mr. Vasantrao Bombatkar (Sarvodaya leader) since my childhood. Under his guidance, I read literature written by Mahatma Gandhi and great saint Vinoba Bhave. I was touched by Gandhian teaching that “ youths should go to the villages to serve as real India is in villages” and after 12th standard, I decided to become doctor and serve the rural part of India. After admission to Government medical college Nagpur, I started visiting various rural and tribal health projects run by Drs. Prakash and Manda Amte, Drs. Abhay & Rani Bang, ( main guide), Dr. Ravindra Kolhe, Dr. Sudarshan, etc. After visiting tribal areas, I realized that tribal areas need medical facilities to a great extent as compared to rural area. So during my M.D. training, I decided to start work in very difficult area of Melghat where medical facilities were very scarce.
I stood first in Wardha district (city area) in 7th class scholarship examination due to guidance of Miss Joshi (now Mrs. Deshpande). It increased my interest in study. Attending “Shram Sanskar Shibir” organised by great social worker Baba Amte during 9th standard was a real experience for future social life. I stood first in Sanskrit in 12th class in Maharashtra due to sincere guidance by Mr. Bhagwat sir.
The guidance by Dr. Ulhas Jaju, Dr. Avinash Saoji , Dr. Kalantri, Dr. Jalgaonkar and Dr. Mrs. Holey is always helpful to me.
Mahatma Gandhi & Swami Vivekananda are my real driving force (Preranasthan-Source of inspiration) for all my endeavors.
Due to very active parental and heavy financial support from Caring friends , Mumbai (especially Rameshuncle Kacholiya and Nimeshbhai Sumati), Kasturba Health Society, Sevagram (Late Dr. Sushila Nair & Dhirubhai Mehta ), our activities got momentum and we could acheive sucess in most of our program .
Preparation for future life:
I decided to start hospital in tribal or rural area while doing M.B.B.S. So during M.B.B.S. course in Government Medical College, Nagpur, I followed simple living. During summer (45-46 degree), I used to live without cooler or fan, during winter, I used to take bath by cold water intermittently. Such type of experiences were going on to test myself.
Due to regular yoga and meditation, study of Geetai written by Vinoba Bhave(especially Sthithpradhnyachi Laxane-symptoms of stable mind), “Experience with truth” written by Mahatma Gandhi, books written by Swami Vivekanand , my mental strength is increased to a significant extent. I can control the innate desire of human being like sex, gride, anger, luster, egoistic attitude, envy ,etc. due to regular meditation. It increased my mental piece and physical and mental capacity for my social work. Due to regular visits and discussion with idealistic social minded people, I could develop those values & qualities necessary for future life.
Reading the book “Seven Habits of Highly Effective People” helped me for social work. Due to use of “Ahimsa (Non-violence), Satya (Truth), Asteya (Non-stealing), Bramhacharya (control of sex with other female and other desire), Sharirshram (hard work), Aswad (no attachment to taste), Sarvatra Bhayavarjan (courage), Sarvadharma Samanatva (equal behavior with all religions), Swadeshi (use of material made in own country) , Sparshabhavana (avoid untouchable behavior) ” in personnel life, the life in Melghat become palatable and tolerable.
During MBBS, I attended Movad river flood relief camp and distributed lot of cloths to those who lost everything in the flood.
Pillars of project:
• Caring friends, Mumbai especially Rameshbhai Kacholiya, Nimeshbhai Sumati, etc.
• Kasturba health society sevagram and MGIMS esp. Late Dr. Sushila Nayar, Mr. Dhirubhai Mehta.
• Nico Nobel & Stichting Geron , the Netherlands.
• Dr. Avinash Saoji, Dr. Abhijit Bharadwaj, Dr. Gahukar.
• Mrs. Jayashri Pendharkar, Vijay Kaore.
• Palaskar, Varangaonkar & Kashikar families.
• Satav, Renge & Manekar families.
• Dr. Dilip Gahankari, Dr. Mrudula Bapat.
• Dr. Vibhavari Dani.
In the whole journey my mother(Kamal Satav) and father (Rambhau Satav) , brothers (Avinash & Ajay) and wife stood very firmly behind me and supported when needed.
Some important events in life:
Second life: In 2004, while shifting the luggage to new home during rainy season, myself and my mother received severe electric shock injury. We were unconscious for few seconds. Vitthal Pande saved us by pulling the wire with wood. We were saved. I think, due to our good work we were saved by his messenger. After the incidence , I could continue my work with full strength.
Obstacles converted to opportunity :
There are lot of obstacles while working in Melghat since beginning. But now I think, these obstacles are not hurdles in the road but a challenge to test and prove ourselves. The life is like a river. The river is more beautiful when it flows through mountains, valleys, falls, etc.
In 1998, I resigned from the post of lecturer in the department of Medicine of M.G.I.M.S. Sevagram and registered a voluntary organization named MAHAN and started hospital in Melghat. In the beginning, there was no financial support from anybody. While during post-graduation and lecturer ship in Medical college, I was living a simple life due to which I could save around Rs.1,00,000 . I used those money for running hospital in Melghat. After 4 months, honorable Dr. Sushila Nayar who was the great supporter of the project provided financial support and since then Kasturba Health Society, Sevagram and MAHAN are running this project.
Since last 20 years (in 1998) not a single new M.B.B.S. doctor started non governmental hospital in Dharni. So most of the people could not believe that I can be a M.B.B.S., M.D. doctor.
We started our OPD in a hut at Kolupur and then hospital in a small (four rooms) rented house in Dharni. It was used for out patient department and for indoor patients. In the same house, patients use to vomit etc. and just nearby to it, was my dinning room and bed room. When I was in Government Medical College, Nagpur, I was habitual of working in a big hospital. But in Melghat, while treating the serious patients of brain hemorrhage, heart attack, etc., we faced lot of problems in the same small hospital. But I could manage successfully lot of serious patients.
Once upon a time, at around 12 midnight a patient of serious heart attack i.e. acute myocardial infarction with pulmonary edema was admitted in government hospital. As there was not a single physician, I was called to treat that patient. I was assisted by unqualified attendant and I carried one E.C.G. machine and injection Streptokinase along with me. There was no cardiac monitor or defibrillator. There was not a single hospital for management of serious patients in Dharni and critical care hospital was 150 k. m. from Dharni. When I was in Government Medical college, Nagpur, and in M.G.I.M.S., Sevagram, there used to be a team of 3-4 doctors and trained nurses and well equipped intensive care unit and well furnished library to refresh your knowledge. But it was my first experience to treat such patient in Dharni with minimum facilities. If I treat the patient and if he succumbs, then people will not believe me and I might have to leave Dharni. But then I realized that, if I treat that patient, there is 90% chance that he will be saved. But if not treated, there is 100% chance of death. So my strong will power forced me to start the treatment . I was treating that patient until 4 a.m. . The patient was out of danger at around 4 a.m. and I was relaxed. But after then, till now, I have successfully treated more than 800 serious patients with no fear in mind. Till July 2007, our indoor hospital was in 20* 50 square feet hut .
Once a fifty years old male patient of brain hemorrhage (7cm in parietal lobe and 1cm in Thalamus) was admitted in comatose condition in our small hospital. He was advised by doctors from Amaravati & Indore that he could not be saved and hence should not be hospitalized. I did not cross the boundary of the hospital for 7 days as I was busy in treating that serious patient. I was assisted by one 9th standard passed boy. There was mental pressure of 30 to 40 people daily for that patient. On 8th day, that patient started walking and I was relaxed. From that day, people realized that I am a good qualified doctor and I got acceptance & publicity in Melghat.
I do remember a story of 5 years young girl patient suffering from cerebral malaria with coma with decerebrate posture with convulsions. Not being a pediatrician I thought a lot, whether to treat her or not. But if I won’t treat she will not be saved , it was very 100% sure as there was no pediatric critical care hospital. Hence , I decided to use my all knowledge and courage to treat the child and could successfully save her. It increased my confidence that I can manage serious children also though I am not a pediatrician.
Sometimes I am also surprised that, I could have successfully managed serious patients in such difficult circumstances.
After 2 years, my wife Dr. Kavita (M.B.B.S., M.S.) started her eye hospital in Dharni. For first year, there was no financial support for her work. There used to be very few patients for initial one to two years. As most of the tribal patients in Melghat are very poor, they can not afford charges of operation for cataract. So many times, Kavita got depressed. Probably I will have to operate cataract of a tiger, sarcastically she used to say sometimes. We used to live very simple life so that we could save a substantial amount of money and after few months we purchased operating microscope worth Rs.2,00,000. Mr. Prabhakar Palaskar (retired engineer, P.W.D.),one of our closed well wisher from Nagpur donated Rs.10,000 . Kavita operated upon 10 cataract patients from that donation. And there after gradually we received more financial support for our eye hospital from Kasturba Health Society(Patron respected Dhirubhai Mehta), Sight Savers International, , Mumbai group of friends, etc. Till now, Kavita had operated more that 700 eye patients including cataract patients successfully including Intra-ocular lens implantation free of cost. Due to superstitions, it was very difficult to convince patients for cataract surgery in Melghat.
For one year, Kavita visited more than 50 villages in Melghat and conducted door to door screening and treatment of patients. Our son, Athang was 4 months old. She used to keep him in cradle( zoli) under some tree in those villages and she used to manage the patients. She used to bring patients for surgery in her own vehicle. Many times she used to come at night from villages and prepare food for the blind patients and feed them. It reminded me “ Patient is God and to worship the patient is real worship to god” . In such difficult circumstances, she operated upon many cataract patients. Her surgical results in such difficult conditions were admired by many doctors.
Due to her amicable and loving nature, we could extend our friend circle to very great extent and many of them are now good supporter of the project.
In Melghat, I have to shoulder many responsibilities other than physician and the day become so busy that I cannot spare enough time for my wife and son. For initial years, Kavita and Athang used to get irritated but now they have become habitual of the situation. Athang asks me baba, will you get time for me? For what you work so much?
For first couple of years, I used to go to interior villages through forest either by two wheeler or by bullock cart or walking for treatment of patients and health education. Melghat is famous for wild life like tiger, leopard, wild bear, etc. So Kavita was afraid of my life. My elder brother Avinash gave his tempo trax jeep free of cost for 7 years, due to which we could extend our medical relief work to most interior part of Melghat. Now due to strong support from Mumbai group of friends especially ambulance , we are able to extend our activities to a great extent.
Once upon a time one pregnant lady was delivering the baby. Her relatives were persistently asking Kavita to conduct the delivery. When Kavita went, the condition was critical. Some how she could delivere and save the mother but the baby had birth ashphyxia . She treated the baby and saved her life . But the mother could not secrete breast milk for her baby. At that time, Athang was six months young. Kavita used to send half of her milk to that newborn baby and keep half for Athang. Today that milk brother of Athang is living normal life. Now many of our village health workers & team of supervisors have motivated many tribal female from self examples to breast feedother babies whose mother had lactation problem. Many children were saved similarly.
Once I was in Gadchiroli, Athang developed severe Asthma at 3.00 a.m. He was then hospitalized in M.G.I.M.S. Sevagram. He developed similar attacks many times in Dharni. Once, Athang developed high grade fever. I started medicine but he developed abdominal pain at 2 a.m. in night. How to shift to Amaravati (which is 140 k. m. away and road is through dense forest and mountains,) at odd hours was a great challenge for us. Then I preferred to rely on my own clinical judgment and started other medicine. In the morning he felt better and we were relaxed-a sigh of relief. Three years back Athang developed pneumonia. I treated him with antibiotics for 5-6 days. As there was no significant improvement and as there was no pediatrician in Melghat , I consulted pediatricians in Nagpur and M.G.I.M.S., Sevagram and started new medicines. After 10 days, he became normal. Once Athang developed acute otitis media leading to rupture of tympanic membrane and severe ear pain during night hours. As there was no Ear, Nose & Throat surgeon in Melghat, I treated him at home. In the morning, he felt better.
Once there was important meeting of Bhavishya Alliance in Mumbai for deciding policies of malnutrition control in Maharashtra . Athang had severe attack of Bronchial Asthma . I was very much confused whether to go to Mumbai or not . But then Kavita assured me that you don’t worry , I will manage Athang , you go and attend the meeting . I attended that meeting and opposed the policy of Bhavishya Alliance to use social marketing skills for sale of products. Then Bhavishya Alliance made the policy of no business in social work.
We thought, we both are highly qualified doctor, and we cannot provide expert pediatric facilities to our son. But then we realized that we have to come out of our own personnel comfort zone to serve the nation.
In Melghat, as there was no expert doctors other than us, one has to move at least 100 km to reach to expert doctors and the road is through difficult forest and mountains and during night hours, especially during rainy season it is very frightening experience.
Once Kavita went to a village for supervision of field activities. As there was no return bus from the village she preferred to stay in the village in night. She slept outside the hut of a tribal. Few days back a tiger had attacked that village. At around 5 a.m. , Kavita realized that somebody had put leg on her abdomen(belly) and she frightened to think that probably it is the tiger and she shouted. And when she open her eyes she saw a calf had kept his one leg over Kavita and was ready to put other leg. But due to shouting, that calf ran away and Kavita was saved.
In the next morning, Kavita went to the forest for defecation as there is no latrine in most of the villages. She sat underneath a tree. Within fraction of seconds, she listened rustling sound of leaves and when she saw, she was horrified to see a black cobra snake near by to her. She was not injured and saved.
There was no money with our trust for purchase of land. We purchased one hector of land nearby to village Utavali and gave it on lease basis for 25 years to MAHAN trust without any rent. Today KARMAGRAM is slowly developing there. For initial few days, there were lot of snakes including poisonous snakes like Cobra, Krait and Vipers, etc. Once Kavita was shortly saved from a snake who was on the cloths & I was surprised by black cobra in my hut cum bedroom nearby to head end of my bed. We being Sarpamitra-friend of snakes, we usually don’t kill snakes but catch them and release them in forest. Once a black scorpion was sleeping quietly on bed of Athang throughout night. Hence, Kavita is always worried about myself and Athang. For initial few years, Panther, bear and other wild lives used to pass nearby to our land for drinking water to Sipana river. It further increased her stress.
In 2004-2005, we raised the issue of malnutrition and children mortality via newspaper , television ,etc. Due to which government health and I.C.D.S. department have to work hard today & exposed their negligence. So the government staff in those departments became angry and created lot of problems for me and our organization. We were threatened by many social ill elements instigated by such people. Few people tried to put fake police and court cases against me and our organization. Many of our village health workers were pressurized by those ill elements to leave the work. But we did not bow in front of such pressure tactics and faced all such obstacles with great success at last. Dr. Gite, director, Rajmata Jijau mother and children health and nutrition mission of government of Maharashtra along with Raji Nair, UNICEF , personally visited our project area in Melghat , verified our findings of malnutrition and children mortality . They were satisfied with our survey report and realized the false, under reporting of these issues by government health and I.C.D.S. departments. They started measures to improve the situation as per our recommendations. We also suggested RJMCHN Mission to conduct independent enquiry in other tribal part of Maharashtra which exposed the reality of malnutrition status in Maharashtra. Lakhs of children are benefitted due to it.
Now from 2006-2007, we are getting cooperation from government system.
But as we got success , the local political leaders and other ill elements of society instignated by local govt. employees started creating problems from 2008.
Tribal consider malnutrition to be curse on them. As we exposed the problem of malnutrition and children mortality in Melghat, the disturbed government system and few social ill elements started creating nuisance for us. Many times, it disturbed my mental piece so that I use to think to lodge a police complaint against such people. But our friend and well wisher Dr. Avinash Saoji advised to follow teaching of great Vinoba Bhave
“Fight the sword with shield not with sword itself”. Then we changed our strategy and started increasing our rapport building in the community itself and tried to increase the community participation in the project. And the community itself answered to those ill elements and supported us. Then I thought , Gandhiji went to jail for freedom. Cowdung was thrown on Savitribai Fuley by ill elements for educating girl and Yeshu Krishtha was put to death on cross by goons. So those who want to uplift the society has to bear opposition from ill elements. So I will have to tolerate it, fight for right and not leave right path.
Lack of water, electricity, etc. is now routine for us. Very high temperature up to 48 degree during summer (lack of electricity and so no cooler for many times), cold waves with temperature reaching to 3 degree during winter and incessant heavy rains during rainy season leading to floods in rivers , isolating villages from Dharni & cities leading to stagnation of staff in villages is now routine for us. Many times we saved very critical patients of heart attack, brain heamorrhage etc. in absence of electricity in light of candles, etc. Once I saved a serious case of heart attack by not sleeping throughout night in absence of electricity. Next day a dog of our neighbourer barked at son of that patient. He rewarded me by threatening to lodge a police complaint instead of thanking me.
Once a person lodged a false Atrocity case agianst me and Kavita. Actually we did not commit any mistake. Police tried to pressurise us for settlement saying that we will be arrested. At that time Athang was exam going. In next month , I was supposed to go to foreign for presenting papers in international medical conferences. We thought a lot and decided we will not bow infront of such wrong allegations and bear whatever will be the consequence. But at last police could not arrest us as it was fake case. We realised Mahatma Gandhiji’s sentence “ Truth can be troubled but cannot be defeated.”
In 2007-08, Kavita developed heart problem-neurocardiac syncope leading to ventricualar bigeminny , but she nevere thought of running away from her work or Melghat.
Kharya tembhru experience: Due to negligence of one government nurse in Kharyatembhru village, one child died. So we investigated the case and realised that due to her attitude the health status of Kharya Tembhru is bad. But due to fear, she and some ill elements of the villages defamed us and stopped our work in the village. A PIL has been filed by us in Mumbai High court and hon. Chief justice asked govt. to take action agaisnt the nurse.
Though there are lot of obstacles like this in our path , we both never felt frustrated so as to leave Melghat. This is the greatest achievement of our life.
We had many fights with corruption in government system like:
1. Health camps.
2. Forest wood for house.
3. Atrocity case.
But we never paid bribe nor bowed infront of corrupt personnel .
Development of new horizon:
1. While starting hospital in Melghat in 1998, it was decided by me not to do any other work than medical care especially treatment of medicine subject related illnesses. But after one and half years, I realized that, without health education, most of the tribal health problems cannot be solved. Hence we started health education programs in the form of slide show, group discussion, etc. in various villages. I used to advice them to eat high protein, calories rich diet and fruits and vegetables to prevent malnutrition. After listening it, poor tribal used to say, doctor we will get such diet on the day of bazaar (once a week) only. Being poor, we cannot afford to purchase it regularly. I used to advice regarding Kitchen garden. People said, we fetch drinking water from river at 2 km., go to forest for defecation and for bathing we go to river, then how to develop kitchen garden with limited sources of water? So we realized the limitations of routine methods of health education. Then we started youth training program where we used to create awareness among youths regarding health problems, sustainable agriculture, kitchen garden, de-addiction, government schemes, etc. Now we started experiment of kithcen garden in 17 villages of Melghat under guidance of Agriculture expert Manohar Khake. We could develop around 450 kitchen gardens in Melghat. It is proving to be sustainable long term solution for malnutrition.
2. In 2001, Dr. Kavita started her ophthalmic hospital in Melghat. But at that time, most of the tribal could not even imagine existence of separate doctor for eye care. Most of the tribal were not aware of benefits of cataract surgery and spectacles. There used to be less patients in her hospital. Then Dr. Kavita started Community Based Blindness Control Program in the form of door to door eye care, health education program, diagnostic and therapeutic camps, school eye checkup, etc. in more than 100 villages of Melghat.
3. Children mortality control program:
Melghat is known for malnutrition and children mortality. As I am not pediatrician, I decided not to touch this issue. Once I was in my OPD, a widow tribal female brought 2 years old child who was severely malnourished and suffering from bilateral pneumonia. His chest wall was studded with rice, geru (red liquid), feathers of hen and Damma(skin burnt with red hot iron rod) and garlic mala around neck. He was very serious and I advised the mother to admit that baby. But the mother was reluctant to admit and asked for injection. After repeated request, she denied admission. Then I used my ultimate weapon that if she won’t admit him, he will die. She coolly responded, let him die, I have four more children at home, goats and chicken and who will take care of them and any how he is going to die. She went back with the child. After 3 days, I got the message that the baby died. I realized rule of survival of fittest and thought if I would have been at her place, I might have thought similarly, thanks to the poor situation. But after listening repeated news of children deaths, myself and Kavita used to get depressed. In 2003, 5 children from 2 families of 2 different villages died due to diarrhea. For two nights, Kavita did not allow me to sleep properly. She demanded to arrange camps in different villages to stop children deaths at cost of routine O.P.D. In Melghat , there are 317 villages, our capacity is limited , government could not control the situation in last 10 years by mobile camp approach and whenever there is a disease in villages , timely proper medical care cannot be made available . So I could convince Kavita that mobile clinic is not solution for reducing childhood mortality in Melghat. I was thinking of training bare foot doctors.
During that time, I came across the Home Based Neonatal Care approach developed by respected Dr. Abhay Bang, SEARCH Gadchiroli. I discussed it with Dr. Bang and realized its replicability and acceptability in Melghat.
Our trust adopted 38 villages for this experiment(Randomised clinical trial) . We trained illiterate to semi-literate tribal female as village health workers for treatment of childhood illness. From January 2004, our village health workers started recording vital events i.e. death and birth record, weight record of children in the 37 villages. From May 2005, village health workers from 19 villages of intervention area, started treatment of childhood illness while in remaining 19 villages of control area, only data collection is going on. Today we are getting good result of it. We could reduce the under 5 children mortality & Malnutrition by more than 60 % in those 17 villages which is cost effective and easily replicable model. Dr. Ashish Satav received Young Scientist Award and first best oral presentation in National Symposium on Tribal Health by Indian Counsel of Medical Research. It was presented in 6 international medical conferences.
Sukrai Jambekar, 7th std. pass, our tribal village health worker saved a baby suffering from birth ashphyxia by 60min artificial respiration showing her will power and dedicaion to save the newborn.
Kantabai Wankhede, totally uneducated village health worker saved a baby of birth ashphyxia by artificial respiration in govt. primary health center when govt. doctors expressed their inability to save the baby.
Sumantara Dhande, 6th std. VHW saved a baby of neonatal sepsis in village who was referred by doctors from subdistrict hospital , Dharni.
Shamim Bashir saved a baby of 800 gram by proper newborn baby care in village it self.
Sheela (Keli) and Urmila (Berdaballa) saved babies by breast feeding children of other females.
Now this program will be replicated by government in all villages of Melghat.
4. Counselor program:
Tarubanda story in Sub District Hospital , Dharni (SDH )
Collector of Amravati requested voluntary organizations to admit severely malnourished babies in hospital. MAHAN trust admitted 4 severely malnourished babies in SDH Dharni in 2006. On 4th day the mothers left the hospitals with children and told to us that they were not cared by doctors and nurses. So MAHAN investigated the case and found many lacunaes in the govt. hospitals especially communication gap and lack of facilities.
• MAHAN and KHOJ approached Dr. Mishra (National Human Rights Commission , special reporter), Divisional Commissioner Dr Goyal and District Collector Dr. Bhapkar.
• On our request local tribal youths were appointed as counselors in all government hospitals of Melghat under government and voluntary agencies paretnership, under our leadership . The benefits of the program are:
• Communication development between doctors and community.
• Increased quantitative and qualitative improvements in Melghat government hospitals and patients hospitalisations.
• It saved thousands of precious lives.
This is the first innovative program of monitoring of government hospitals by voluntary organisations in India. Due to this, many social ill elements who were corrupt and robbing govt. hospitals were diturbed and tried to threaten us. One of the corrupt district health officer suddenly stopped this program. We tried at all level to restart it but in vain. Then we filed a PIL in Mumbai High court. Honorable chief justice JN Patel, Mohit Shah and justice VY Chandrachud restarted this program and has advised govt. of Maharashtra to replicate the model all over Maharashtra. They also advised government to implement other suggestions of voluntary organisations for reducing child deaths and malnutrition in Melghat. This episode proved that Justice is till exist in India. If you are true, work for the people, scientific and ready to fight selflessly then one can win the almighty government also. This increased our own faith on ourselves.
Success story:
Everybody has his own concept of success.
1. In the beginning, people were suspicious whether a M.D. doctor can stay in Melghat or he will run away within months. Will tribal patient accept me (because tribal patients don’t go to doctors was a prevalent concept at that time) was itself a great challenge. In the beginning, very few tribal patients used to come to me for treatment. Many of them used to go to other unqualified doctors as I avoid unnecessary injections. But I continued my medical care without becoming depressed. People used to suspect whether a doctor living in hut, using bicycle and running hospital in hut is a really educated doctor or not. But when I treated and saved many serious cases of brain hemorrhage, heart attack, cerebral malaria and meningitis, people got confidence in me and I got recognition. Now those tribal who come to me usually become my permanent patient and I become their family doctor. Today the number of tribal patients attending our hospital for treatment is gradually increasing. My increasing confidence and my decision to stay for ever in Melghat indicates my success.
2. Initially patients were very reluctant for cataract surgery. But with great efforts, Dr. Kavita could operate upon more than 300 patients free of cost. Recently one poor patient even purchased preoperative medicines. It is great achievement for us that the family realised the importance.Now patients themselves are coming for surgery. This indicates some success to our efforts.
3. Since last 10 years, children and infant mortality rate could not be reduced by government efforts. But we could reduce the under 5 children mortality rate by more than 56% over a period of 1 year by home based child care approach (treatment by village health workers in 19 villages). This cost effective approach is the great success of our project. During last 5 years, the village health workers treated more than 75000 patients. The concept of bare foot doctors is now gaining good result. Our project received Young Scientist Award and first best oral presentation in National Symposium on Tribal Health by Indian Counsil of Medical Research – selected by chief of WHO- South East Asia Dr. Krongthorm. Our research work has been accepted in many international conferences. Now govt. has decided to replicate our home based child care program in whole Melghat.
4. Due to our advocacy over malnutrition and children mortality, Rajmata Jijau Mother and children Health & Nutrition mission(RJMCHNM) of government of Maharashtra along with UNICEF verified our survey reports, accepted the findings and started measures to control the situation. After our confirmation, RJMCHNM conducted similar survey in other tribal areas of Maharashtra and found very high prevalance of severe malnutrition. So our study exposed the situation of severe malnutrition in all tribal areas of Maharashtra.
Our NGO has been included in Bhavishya Alliance (international trisectorial partnership) for deciding policies for malnutrition reduction in Maharashtra. This is our great success.
5. In 2004, during winter season, we supplied nutritious food to 300 severely malnourished children from 38 villages of Melghat for 100 days and saved many lives. Most of the severely malnourished babies are getting food from AWW due to our monitoring. We analysed around 20 locally available food and found that many are nutrtionaly good. We prepared many dishes during the nutrition demonstration and trained many tribals from 17 villages for home based feeding & hygeiene . Due to our this experience , we mobilised local govt. health department to start village based feeding centers in 39 villages of Melghat. They got good result and then from this lesson, (RJMCHNM) conducted similar experiment in other part of Maharasthra. Now it is state level policy of VCDC. The root lies in our experiment of 38 villages.
6. During camps we exposed problem of Malaria. D.M.O. pressurised us not to expose. We did not bow . Collector accepted the fact and ordered the government machinery to start malaria control program on massive scale.
7. Road traffic accident: Once a truck carrying more than 50 passenger fallen down in river near Bihali village. More than 10 people died on spot and more than 12 were serious. No vehicle was ready to stop there and remove the serious patients from the river. We 3 got down into the river and removed all 12 serious patients from the river and could sent them to hosptials. Out of them only one died. So we could save 11 lives. Later on our team saved many accident cases by rescuing from the accident site and proper referral.
8. Socioeconomic development especially public Satbara reading. Initially in Melghat most of the tribals were working on the fields given by government to their ancestors. But the were not legal heir of the lands and hence were not getting benefits of government schemes. We with the help of villagers could pressurise government to start mutation and open satbara reading on mass scale. Due to which many tribals are benefitted to great extent.
9. We prepared one flipchart for malnutrition. Many experts expressed that , it is excellent flipchart. Now it is being used in all government hospitals of Melghat and Amaravati.
10. Story of community awakening :
Village Kokmar- 1. Motivation of people for accepting facts of malnutrition : Due to exposure of reality of malnutrition in Melghat, the grass root govt. workers along with some notorious people presurrised Kokmar village health worker (VHW) to stop work. It was a great blow to me , as it was my dream to reduce deaths in very interior village like Kokmar. Then myself with my friends esp. Alhad Kashikar and our staff went to the village in rainy season thorough very dense forest on bikes. The villagers were reluctant to speak as they were told that we are defaming their village by publishing name of the severely malnourished babies. After 30 minutes, we saw a thin boy walking with a roti in hand. He was severely malnourished 3 months back and bed ridden & was not getting proper nutrition from anganwadi. Due to exposure of his name in news paper by us, he was getting benefit of special diet and health care from govt. So now he is able to walk. We explained it to the villagers. They were convinced with the example and started supporting like anything to us since then. We have now full support in the village. The VHW restarted her work.
There is lot to write but to I am finishing it here. At last, I must be thankful to many of our friends, supporters, financers and our parents, family members , staff and especially patients who by heart, supported us to full extent in our endeavor.
Address for correspondence:
Dr. Ashish Satav
Mahatma Gandhi Tribal Hospital,
Karmagram, Utavali
Tah: Dharni, Dist : Amaravati
Maharashtra-444 702
Phone: 9325094780, 07226-202793, 202291
Email: drsatav@rediffmail.com
Add PBC neck 20 yrs female unmarried, operated-, blind suicide prevented.
Our experiences of Melghat.
My self Dr. Ashish Satav (M.B.B.S., M.D.) & my wife Dr. Kavita Satav (M.B.B.S., M.S.-Eye surgeon) are providing curative and preventive medical facilities to poor tribal people of Melghat. Our life has been enlightened by 9 years son, Athang.
Motivation for the work / source of inspiration
I was influenced by my grandfather Mr. Vasantrao Bombatkar (Sarvodaya leader) since my childhood. Under his guidance, I read literature written by Mahatma Gandhi and great saint Vinoba Bhave. I was touched by Gandhian teaching that “ youths should go to the villages to serve as real India is in villages” and after 12th standard, I decided to become doctor and serve the rural part of India. After admission to Government medical college Nagpur, I started visiting various rural and tribal health projects run by Drs. Prakash and Manda Amte, Drs. Abhay & Rani Bang, ( main guide), Dr. Ravindra Kolhe, Dr. Sudarshan, etc. After visiting tribal areas, I realized that tribal areas need medical facilities to a great extent as compared to rural area. So during my M.D. training, I decided to start work in very difficult area of Melghat where medical facilities were very scarce.
I stood first in Wardha district (city area) in 7th class scholarship examination due to guidance of Miss Joshi (now Mrs. Deshpande). It increased my interest in study. Attending “Shram Sanskar Shibir” organised by great social worker Baba Amte during 9th standard was a real experience for future social life. I stood first in Sanskrit in 12th class in Maharashtra due to sincere guidance by Mr. Bhagwat sir.
The guidance by Dr. Ulhas Jaju, Dr. Avinash Saoji , Dr. Kalantri, Dr. Jalgaonkar and Dr. Mrs. Holey is always helpful to me.
Mahatma Gandhi & Swami Vivekananda are my real driving force (Preranasthan-Source of inspiration) for all my endeavors.
Due to very active parental and heavy financial support from Caring friends , Mumbai (especially Rameshuncle Kacholiya and Nimeshbhai Sumati), Kasturba Health Society, Sevagram (Late Dr. Sushila Nair & Dhirubhai Mehta ), our activities got momentum and we could acheive sucess in most of our program .
Preparation for future life:
I decided to start hospital in tribal or rural area while doing M.B.B.S. So during M.B.B.S. course in Government Medical College, Nagpur, I followed simple living. During summer (45-46 degree), I used to live without cooler or fan, during winter, I used to take bath by cold water intermittently. Such type of experiences were going on to test myself.
Due to regular yoga and meditation, study of Geetai written by Vinoba Bhave(especially Sthithpradhnyachi Laxane-symptoms of stable mind), “Experience with truth” written by Mahatma Gandhi, books written by Swami Vivekanand , my mental strength is increased to a significant extent. I can control the innate desire of human being like sex, gride, anger, luster, egoistic attitude, envy ,etc. due to regular meditation. It increased my mental piece and physical and mental capacity for my social work. Due to regular visits and discussion with idealistic social minded people, I could develop those values & qualities necessary for future life.
Reading the book “Seven Habits of Highly Effective People” helped me for social work. Due to use of “Ahimsa (Non-violence), Satya (Truth), Asteya (Non-stealing), Bramhacharya (control of sex with other female and other desire), Sharirshram (hard work), Aswad (no attachment to taste), Sarvatra Bhayavarjan (courage), Sarvadharma Samanatva (equal behavior with all religions), Swadeshi (use of material made in own country) , Sparshabhavana (avoid untouchable behavior) ” in personnel life, the life in Melghat become palatable and tolerable.
During MBBS, I attended Movad river flood relief camp and distributed lot of cloths to those who lost everything in the flood.
Pillars of project:
• Caring friends, Mumbai especially Rameshbhai Kacholiya, Nimeshbhai Sumati, etc.
• Kasturba health society sevagram and MGIMS esp. Late Dr. Sushila Nayar, Mr. Dhirubhai Mehta.
• Nico Nobel & Stichting Geron , the Netherlands.
• Dr. Avinash Saoji, Dr. Abhijit Bharadwaj, Dr. Gahukar.
• Mrs. Jayashri Pendharkar, Vijay Kaore.
• Palaskar, Varangaonkar & Kashikar families.
• Satav, Renge & Manekar families.
• Dr. Dilip Gahankari, Dr. Mrudula Bapat.
• Dr. Vibhavari Dani.
In the whole journey my mother(Kamal Satav) and father (Rambhau Satav) , brothers (Avinash & Ajay) and wife stood very firmly behind me and supported when needed.
Some important events in life:
Second life: In 2004, while shifting the luggage to new home during rainy season, myself and my mother received severe electric shock injury. We were unconscious for few seconds. Vitthal Pande saved us by pulling the wire with wood. We were saved. I think, due to our good work we were saved by his messenger. After the incidence , I could continue my work with full strength.
Obstacles converted to opportunity :
There are lot of obstacles while working in Melghat since beginning. But now I think, these obstacles are not hurdles in the road but a challenge to test and prove ourselves. The life is like a river. The river is more beautiful when it flows through mountains, valleys, falls, etc.
In 1998, I resigned from the post of lecturer in the department of Medicine of M.G.I.M.S. Sevagram and registered a voluntary organization named MAHAN and started hospital in Melghat. In the beginning, there was no financial support from anybody. While during post-graduation and lecturer ship in Medical college, I was living a simple life due to which I could save around Rs.1,00,000 . I used those money for running hospital in Melghat. After 4 months, honorable Dr. Sushila Nayar who was the great supporter of the project provided financial support and since then Kasturba Health Society, Sevagram and MAHAN are running this project.
Since last 20 years (in 1998) not a single new M.B.B.S. doctor started non governmental hospital in Dharni. So most of the people could not believe that I can be a M.B.B.S., M.D. doctor.
We started our OPD in a hut at Kolupur and then hospital in a small (four rooms) rented house in Dharni. It was used for out patient department and for indoor patients. In the same house, patients use to vomit etc. and just nearby to it, was my dinning room and bed room. When I was in Government Medical College, Nagpur, I was habitual of working in a big hospital. But in Melghat, while treating the serious patients of brain hemorrhage, heart attack, etc., we faced lot of problems in the same small hospital. But I could manage successfully lot of serious patients.
Once upon a time, at around 12 midnight a patient of serious heart attack i.e. acute myocardial infarction with pulmonary edema was admitted in government hospital. As there was not a single physician, I was called to treat that patient. I was assisted by unqualified attendant and I carried one E.C.G. machine and injection Streptokinase along with me. There was no cardiac monitor or defibrillator. There was not a single hospital for management of serious patients in Dharni and critical care hospital was 150 k. m. from Dharni. When I was in Government Medical college, Nagpur, and in M.G.I.M.S., Sevagram, there used to be a team of 3-4 doctors and trained nurses and well equipped intensive care unit and well furnished library to refresh your knowledge. But it was my first experience to treat such patient in Dharni with minimum facilities. If I treat the patient and if he succumbs, then people will not believe me and I might have to leave Dharni. But then I realized that, if I treat that patient, there is 90% chance that he will be saved. But if not treated, there is 100% chance of death. So my strong will power forced me to start the treatment . I was treating that patient until 4 a.m. . The patient was out of danger at around 4 a.m. and I was relaxed. But after then, till now, I have successfully treated more than 800 serious patients with no fear in mind. Till July 2007, our indoor hospital was in 20* 50 square feet hut .
Once a fifty years old male patient of brain hemorrhage (7cm in parietal lobe and 1cm in Thalamus) was admitted in comatose condition in our small hospital. He was advised by doctors from Amaravati & Indore that he could not be saved and hence should not be hospitalized. I did not cross the boundary of the hospital for 7 days as I was busy in treating that serious patient. I was assisted by one 9th standard passed boy. There was mental pressure of 30 to 40 people daily for that patient. On 8th day, that patient started walking and I was relaxed. From that day, people realized that I am a good qualified doctor and I got acceptance & publicity in Melghat.
I do remember a story of 5 years young girl patient suffering from cerebral malaria with coma with decerebrate posture with convulsions. Not being a pediatrician I thought a lot, whether to treat her or not. But if I won’t treat she will not be saved , it was very 100% sure as there was no pediatric critical care hospital. Hence , I decided to use my all knowledge and courage to treat the child and could successfully save her. It increased my confidence that I can manage serious children also though I am not a pediatrician.
Sometimes I am also surprised that, I could have successfully managed serious patients in such difficult circumstances.
After 2 years, my wife Dr. Kavita (M.B.B.S., M.S.) started her eye hospital in Dharni. For first year, there was no financial support for her work. There used to be very few patients for initial one to two years. As most of the tribal patients in Melghat are very poor, they can not afford charges of operation for cataract. So many times, Kavita got depressed. Probably I will have to operate cataract of a tiger, sarcastically she used to say sometimes. We used to live very simple life so that we could save a substantial amount of money and after few months we purchased operating microscope worth Rs.2,00,000. Mr. Prabhakar Palaskar (retired engineer, P.W.D.),one of our closed well wisher from Nagpur donated Rs.10,000 . Kavita operated upon 10 cataract patients from that donation. And there after gradually we received more financial support for our eye hospital from Kasturba Health Society(Patron respected Dhirubhai Mehta), Sight Savers International, , Mumbai group of friends, etc. Till now, Kavita had operated more that 700 eye patients including cataract patients successfully including Intra-ocular lens implantation free of cost. Due to superstitions, it was very difficult to convince patients for cataract surgery in Melghat.
For one year, Kavita visited more than 50 villages in Melghat and conducted door to door screening and treatment of patients. Our son, Athang was 4 months old. She used to keep him in cradle( zoli) under some tree in those villages and she used to manage the patients. She used to bring patients for surgery in her own vehicle. Many times she used to come at night from villages and prepare food for the blind patients and feed them. It reminded me “ Patient is God and to worship the patient is real worship to god” . In such difficult circumstances, she operated upon many cataract patients. Her surgical results in such difficult conditions were admired by many doctors.
Due to her amicable and loving nature, we could extend our friend circle to very great extent and many of them are now good supporter of the project.
In Melghat, I have to shoulder many responsibilities other than physician and the day become so busy that I cannot spare enough time for my wife and son. For initial years, Kavita and Athang used to get irritated but now they have become habitual of the situation. Athang asks me baba, will you get time for me? For what you work so much?
For first couple of years, I used to go to interior villages through forest either by two wheeler or by bullock cart or walking for treatment of patients and health education. Melghat is famous for wild life like tiger, leopard, wild bear, etc. So Kavita was afraid of my life. My elder brother Avinash gave his tempo trax jeep free of cost for 7 years, due to which we could extend our medical relief work to most interior part of Melghat. Now due to strong support from Mumbai group of friends especially ambulance , we are able to extend our activities to a great extent.
Once upon a time one pregnant lady was delivering the baby. Her relatives were persistently asking Kavita to conduct the delivery. When Kavita went, the condition was critical. Some how she could delivere and save the mother but the baby had birth ashphyxia . She treated the baby and saved her life . But the mother could not secrete breast milk for her baby. At that time, Athang was six months young. Kavita used to send half of her milk to that newborn baby and keep half for Athang. Today that milk brother of Athang is living normal life. Now many of our village health workers & team of supervisors have motivated many tribal female from self examples to breast feedother babies whose mother had lactation problem. Many children were saved similarly.
Once I was in Gadchiroli, Athang developed severe Asthma at 3.00 a.m. He was then hospitalized in M.G.I.M.S. Sevagram. He developed similar attacks many times in Dharni. Once, Athang developed high grade fever. I started medicine but he developed abdominal pain at 2 a.m. in night. How to shift to Amaravati (which is 140 k. m. away and road is through dense forest and mountains,) at odd hours was a great challenge for us. Then I preferred to rely on my own clinical judgment and started other medicine. In the morning he felt better and we were relaxed-a sigh of relief. Three years back Athang developed pneumonia. I treated him with antibiotics for 5-6 days. As there was no significant improvement and as there was no pediatrician in Melghat , I consulted pediatricians in Nagpur and M.G.I.M.S., Sevagram and started new medicines. After 10 days, he became normal. Once Athang developed acute otitis media leading to rupture of tympanic membrane and severe ear pain during night hours. As there was no Ear, Nose & Throat surgeon in Melghat, I treated him at home. In the morning, he felt better.
Once there was important meeting of Bhavishya Alliance in Mumbai for deciding policies of malnutrition control in Maharashtra . Athang had severe attack of Bronchial Asthma . I was very much confused whether to go to Mumbai or not . But then Kavita assured me that you don’t worry , I will manage Athang , you go and attend the meeting . I attended that meeting and opposed the policy of Bhavishya Alliance to use social marketing skills for sale of products. Then Bhavishya Alliance made the policy of no business in social work.
We thought, we both are highly qualified doctor, and we cannot provide expert pediatric facilities to our son. But then we realized that we have to come out of our own personnel comfort zone to serve the nation.
In Melghat, as there was no expert doctors other than us, one has to move at least 100 km to reach to expert doctors and the road is through difficult forest and mountains and during night hours, especially during rainy season it is very frightening experience.
Once Kavita went to a village for supervision of field activities. As there was no return bus from the village she preferred to stay in the village in night. She slept outside the hut of a tribal. Few days back a tiger had attacked that village. At around 5 a.m. , Kavita realized that somebody had put leg on her abdomen(belly) and she frightened to think that probably it is the tiger and she shouted. And when she open her eyes she saw a calf had kept his one leg over Kavita and was ready to put other leg. But due to shouting, that calf ran away and Kavita was saved.
In the next morning, Kavita went to the forest for defecation as there is no latrine in most of the villages. She sat underneath a tree. Within fraction of seconds, she listened rustling sound of leaves and when she saw, she was horrified to see a black cobra snake near by to her. She was not injured and saved.
There was no money with our trust for purchase of land. We purchased one hector of land nearby to village Utavali and gave it on lease basis for 25 years to MAHAN trust without any rent. Today KARMAGRAM is slowly developing there. For initial few days, there were lot of snakes including poisonous snakes like Cobra, Krait and Vipers, etc. Once Kavita was shortly saved from a snake who was on the cloths & I was surprised by black cobra in my hut cum bedroom nearby to head end of my bed. We being Sarpamitra-friend of snakes, we usually don’t kill snakes but catch them and release them in forest. Once a black scorpion was sleeping quietly on bed of Athang throughout night. Hence, Kavita is always worried about myself and Athang. For initial few years, Panther, bear and other wild lives used to pass nearby to our land for drinking water to Sipana river. It further increased her stress.
In 2004-2005, we raised the issue of malnutrition and children mortality via newspaper , television ,etc. Due to which government health and I.C.D.S. department have to work hard today & exposed their negligence. So the government staff in those departments became angry and created lot of problems for me and our organization. We were threatened by many social ill elements instigated by such people. Few people tried to put fake police and court cases against me and our organization. Many of our village health workers were pressurized by those ill elements to leave the work. But we did not bow in front of such pressure tactics and faced all such obstacles with great success at last. Dr. Gite, director, Rajmata Jijau mother and children health and nutrition mission of government of Maharashtra along with Raji Nair, UNICEF , personally visited our project area in Melghat , verified our findings of malnutrition and children mortality . They were satisfied with our survey report and realized the false, under reporting of these issues by government health and I.C.D.S. departments. They started measures to improve the situation as per our recommendations. We also suggested RJMCHN Mission to conduct independent enquiry in other tribal part of Maharashtra which exposed the reality of malnutrition status in Maharashtra. Lakhs of children are benefitted due to it.
Now from 2006-2007, we are getting cooperation from government system.
But as we got success , the local political leaders and other ill elements of society instignated by local govt. employees started creating problems from 2008.
Tribal consider malnutrition to be curse on them. As we exposed the problem of malnutrition and children mortality in Melghat, the disturbed government system and few social ill elements started creating nuisance for us. Many times, it disturbed my mental piece so that I use to think to lodge a police complaint against such people. But our friend and well wisher Dr. Avinash Saoji advised to follow teaching of great Vinoba Bhave
“Fight the sword with shield not with sword itself”. Then we changed our strategy and started increasing our rapport building in the community itself and tried to increase the community participation in the project. And the community itself answered to those ill elements and supported us. Then I thought , Gandhiji went to jail for freedom. Cowdung was thrown on Savitribai Fuley by ill elements for educating girl and Yeshu Krishtha was put to death on cross by goons. So those who want to uplift the society has to bear opposition from ill elements. So I will have to tolerate it, fight for right and not leave right path.
Lack of water, electricity, etc. is now routine for us. Very high temperature up to 48 degree during summer (lack of electricity and so no cooler for many times), cold waves with temperature reaching to 3 degree during winter and incessant heavy rains during rainy season leading to floods in rivers , isolating villages from Dharni & cities leading to stagnation of staff in villages is now routine for us. Many times we saved very critical patients of heart attack, brain heamorrhage etc. in absence of electricity in light of candles, etc. Once I saved a serious case of heart attack by not sleeping throughout night in absence of electricity. Next day a dog of our neighbourer barked at son of that patient. He rewarded me by threatening to lodge a police complaint instead of thanking me.
Once a person lodged a false Atrocity case agianst me and Kavita. Actually we did not commit any mistake. Police tried to pressurise us for settlement saying that we will be arrested. At that time Athang was exam going. In next month , I was supposed to go to foreign for presenting papers in international medical conferences. We thought a lot and decided we will not bow infront of such wrong allegations and bear whatever will be the consequence. But at last police could not arrest us as it was fake case. We realised Mahatma Gandhiji’s sentence “ Truth can be troubled but cannot be defeated.”
In 2007-08, Kavita developed heart problem-neurocardiac syncope leading to ventricualar bigeminny , but she nevere thought of running away from her work or Melghat.
Kharya tembhru experience: Due to negligence of one government nurse in Kharyatembhru village, one child died. So we investigated the case and realised that due to her attitude the health status of Kharya Tembhru is bad. But due to fear, she and some ill elements of the villages defamed us and stopped our work in the village. A PIL has been filed by us in Mumbai High court and hon. Chief justice asked govt. to take action agaisnt the nurse.
Though there are lot of obstacles like this in our path , we both never felt frustrated so as to leave Melghat. This is the greatest achievement of our life.
We had many fights with corruption in government system like:
1. Health camps.
2. Forest wood for house.
3. Atrocity case.
But we never paid bribe nor bowed infront of corrupt personnel .
Development of new horizon:
1. While starting hospital in Melghat in 1998, it was decided by me not to do any other work than medical care especially treatment of medicine subject related illnesses. But after one and half years, I realized that, without health education, most of the tribal health problems cannot be solved. Hence we started health education programs in the form of slide show, group discussion, etc. in various villages. I used to advice them to eat high protein, calories rich diet and fruits and vegetables to prevent malnutrition. After listening it, poor tribal used to say, doctor we will get such diet on the day of bazaar (once a week) only. Being poor, we cannot afford to purchase it regularly. I used to advice regarding Kitchen garden. People said, we fetch drinking water from river at 2 km., go to forest for defecation and for bathing we go to river, then how to develop kitchen garden with limited sources of water? So we realized the limitations of routine methods of health education. Then we started youth training program where we used to create awareness among youths regarding health problems, sustainable agriculture, kitchen garden, de-addiction, government schemes, etc. Now we started experiment of kithcen garden in 17 villages of Melghat under guidance of Agriculture expert Manohar Khake. We could develop around 450 kitchen gardens in Melghat. It is proving to be sustainable long term solution for malnutrition.
2. In 2001, Dr. Kavita started her ophthalmic hospital in Melghat. But at that time, most of the tribal could not even imagine existence of separate doctor for eye care. Most of the tribal were not aware of benefits of cataract surgery and spectacles. There used to be less patients in her hospital. Then Dr. Kavita started Community Based Blindness Control Program in the form of door to door eye care, health education program, diagnostic and therapeutic camps, school eye checkup, etc. in more than 100 villages of Melghat.
3. Children mortality control program:
Melghat is known for malnutrition and children mortality. As I am not pediatrician, I decided not to touch this issue. Once I was in my OPD, a widow tribal female brought 2 years old child who was severely malnourished and suffering from bilateral pneumonia. His chest wall was studded with rice, geru (red liquid), feathers of hen and Damma(skin burnt with red hot iron rod) and garlic mala around neck. He was very serious and I advised the mother to admit that baby. But the mother was reluctant to admit and asked for injection. After repeated request, she denied admission. Then I used my ultimate weapon that if she won’t admit him, he will die. She coolly responded, let him die, I have four more children at home, goats and chicken and who will take care of them and any how he is going to die. She went back with the child. After 3 days, I got the message that the baby died. I realized rule of survival of fittest and thought if I would have been at her place, I might have thought similarly, thanks to the poor situation. But after listening repeated news of children deaths, myself and Kavita used to get depressed. In 2003, 5 children from 2 families of 2 different villages died due to diarrhea. For two nights, Kavita did not allow me to sleep properly. She demanded to arrange camps in different villages to stop children deaths at cost of routine O.P.D. In Melghat , there are 317 villages, our capacity is limited , government could not control the situation in last 10 years by mobile camp approach and whenever there is a disease in villages , timely proper medical care cannot be made available . So I could convince Kavita that mobile clinic is not solution for reducing childhood mortality in Melghat. I was thinking of training bare foot doctors.
During that time, I came across the Home Based Neonatal Care approach developed by respected Dr. Abhay Bang, SEARCH Gadchiroli. I discussed it with Dr. Bang and realized its replicability and acceptability in Melghat.
Our trust adopted 38 villages for this experiment(Randomised clinical trial) . We trained illiterate to semi-literate tribal female as village health workers for treatment of childhood illness. From January 2004, our village health workers started recording vital events i.e. death and birth record, weight record of children in the 37 villages. From May 2005, village health workers from 19 villages of intervention area, started treatment of childhood illness while in remaining 19 villages of control area, only data collection is going on. Today we are getting good result of it. We could reduce the under 5 children mortality & Malnutrition by more than 60 % in those 17 villages which is cost effective and easily replicable model. Dr. Ashish Satav received Young Scientist Award and first best oral presentation in National Symposium on Tribal Health by Indian Counsel of Medical Research. It was presented in 6 international medical conferences.
Sukrai Jambekar, 7th std. pass, our tribal village health worker saved a baby suffering from birth ashphyxia by 60min artificial respiration showing her will power and dedicaion to save the newborn.
Kantabai Wankhede, totally uneducated village health worker saved a baby of birth ashphyxia by artificial respiration in govt. primary health center when govt. doctors expressed their inability to save the baby.
Sumantara Dhande, 6th std. VHW saved a baby of neonatal sepsis in village who was referred by doctors from subdistrict hospital , Dharni.
Shamim Bashir saved a baby of 800 gram by proper newborn baby care in village it self.
Sheela (Keli) and Urmila (Berdaballa) saved babies by breast feeding children of other females.
Now this program will be replicated by government in all villages of Melghat.
4. Counselor program:
Tarubanda story in Sub District Hospital , Dharni (SDH )
Collector of Amravati requested voluntary organizations to admit severely malnourished babies in hospital. MAHAN trust admitted 4 severely malnourished babies in SDH Dharni in 2006. On 4th day the mothers left the hospitals with children and told to us that they were not cared by doctors and nurses. So MAHAN investigated the case and found many lacunaes in the govt. hospitals especially communication gap and lack of facilities.
• MAHAN and KHOJ approached Dr. Mishra (National Human Rights Commission , special reporter), Divisional Commissioner Dr Goyal and District Collector Dr. Bhapkar.
• On our request local tribal youths were appointed as counselors in all government hospitals of Melghat under government and voluntary agencies paretnership, under our leadership . The benefits of the program are:
• Communication development between doctors and community.
• Increased quantitative and qualitative improvements in Melghat government hospitals and patients hospitalisations.
• It saved thousands of precious lives.
This is the first innovative program of monitoring of government hospitals by voluntary organisations in India. Due to this, many social ill elements who were corrupt and robbing govt. hospitals were diturbed and tried to threaten us. One of the corrupt district health officer suddenly stopped this program. We tried at all level to restart it but in vain. Then we filed a PIL in Mumbai High court. Honorable chief justice JN Patel, Mohit Shah and justice VY Chandrachud restarted this program and has advised govt. of Maharashtra to replicate the model all over Maharashtra. They also advised government to implement other suggestions of voluntary organisations for reducing child deaths and malnutrition in Melghat. This episode proved that Justice is till exist in India. If you are true, work for the people, scientific and ready to fight selflessly then one can win the almighty government also. This increased our own faith on ourselves.
Success story:
Everybody has his own concept of success.
1. In the beginning, people were suspicious whether a M.D. doctor can stay in Melghat or he will run away within months. Will tribal patient accept me (because tribal patients don’t go to doctors was a prevalent concept at that time) was itself a great challenge. In the beginning, very few tribal patients used to come to me for treatment. Many of them used to go to other unqualified doctors as I avoid unnecessary injections. But I continued my medical care without becoming depressed. People used to suspect whether a doctor living in hut, using bicycle and running hospital in hut is a really educated doctor or not. But when I treated and saved many serious cases of brain hemorrhage, heart attack, cerebral malaria and meningitis, people got confidence in me and I got recognition. Now those tribal who come to me usually become my permanent patient and I become their family doctor. Today the number of tribal patients attending our hospital for treatment is gradually increasing. My increasing confidence and my decision to stay for ever in Melghat indicates my success.
2. Initially patients were very reluctant for cataract surgery. But with great efforts, Dr. Kavita could operate upon more than 300 patients free of cost. Recently one poor patient even purchased preoperative medicines. It is great achievement for us that the family realised the importance.Now patients themselves are coming for surgery. This indicates some success to our efforts.
3. Since last 10 years, children and infant mortality rate could not be reduced by government efforts. But we could reduce the under 5 children mortality rate by more than 56% over a period of 1 year by home based child care approach (treatment by village health workers in 19 villages). This cost effective approach is the great success of our project. During last 5 years, the village health workers treated more than 75000 patients. The concept of bare foot doctors is now gaining good result. Our project received Young Scientist Award and first best oral presentation in National Symposium on Tribal Health by Indian Counsil of Medical Research – selected by chief of WHO- South East Asia Dr. Krongthorm. Our research work has been accepted in many international conferences. Now govt. has decided to replicate our home based child care program in whole Melghat.
4. Due to our advocacy over malnutrition and children mortality, Rajmata Jijau Mother and children Health & Nutrition mission(RJMCHNM) of government of Maharashtra along with UNICEF verified our survey reports, accepted the findings and started measures to control the situation. After our confirmation, RJMCHNM conducted similar survey in other tribal areas of Maharashtra and found very high prevalance of severe malnutrition. So our study exposed the situation of severe malnutrition in all tribal areas of Maharashtra.
Our NGO has been included in Bhavishya Alliance (international trisectorial partnership) for deciding policies for malnutrition reduction in Maharashtra. This is our great success.
5. In 2004, during winter season, we supplied nutritious food to 300 severely malnourished children from 38 villages of Melghat for 100 days and saved many lives. Most of the severely malnourished babies are getting food from AWW due to our monitoring. We analysed around 20 locally available food and found that many are nutrtionaly good. We prepared many dishes during the nutrition demonstration and trained many tribals from 17 villages for home based feeding & hygeiene . Due to our this experience , we mobilised local govt. health department to start village based feeding centers in 39 villages of Melghat. They got good result and then from this lesson, (RJMCHNM) conducted similar experiment in other part of Maharasthra. Now it is state level policy of VCDC. The root lies in our experiment of 38 villages.
6. During camps we exposed problem of Malaria. D.M.O. pressurised us not to expose. We did not bow . Collector accepted the fact and ordered the government machinery to start malaria control program on massive scale.
7. Road traffic accident: Once a truck carrying more than 50 passenger fallen down in river near Bihali village. More than 10 people died on spot and more than 12 were serious. No vehicle was ready to stop there and remove the serious patients from the river. We 3 got down into the river and removed all 12 serious patients from the river and could sent them to hosptials. Out of them only one died. So we could save 11 lives. Later on our team saved many accident cases by rescuing from the accident site and proper referral.
8. Socioeconomic development especially public Satbara reading. Initially in Melghat most of the tribals were working on the fields given by government to their ancestors. But the were not legal heir of the lands and hence were not getting benefits of government schemes. We with the help of villagers could pressurise government to start mutation and open satbara reading on mass scale. Due to which many tribals are benefitted to great extent.
9. We prepared one flipchart for malnutrition. Many experts expressed that , it is excellent flipchart. Now it is being used in all government hospitals of Melghat and Amaravati.
10. Story of community awakening :
Village Kokmar- 1. Motivation of people for accepting facts of malnutrition : Due to exposure of reality of malnutrition in Melghat, the grass root govt. workers along with some notorious people presurrised Kokmar village health worker (VHW) to stop work. It was a great blow to me , as it was my dream to reduce deaths in very interior village like Kokmar. Then myself with my friends esp. Alhad Kashikar and our staff went to the village in rainy season thorough very dense forest on bikes. The villagers were reluctant to speak as they were told that we are defaming their village by publishing name of the severely malnourished babies. After 30 minutes, we saw a thin boy walking with a roti in hand. He was severely malnourished 3 months back and bed ridden & was not getting proper nutrition from anganwadi. Due to exposure of his name in news paper by us, he was getting benefit of special diet and health care from govt. So now he is able to walk. We explained it to the villagers. They were convinced with the example and started supporting like anything to us since then. We have now full support in the village. The VHW restarted her work.
There is lot to write but to I am finishing it here. At last, I must be thankful to many of our friends, supporters, financers and our parents, family members , staff and especially patients who by heart, supported us to full extent in our endeavor.
Address for correspondence:
Dr. Ashish Satav
Mahatma Gandhi Tribal Hospital,
Karmagram, Utavali
Tah: Dharni, Dist : Amaravati
Maharashtra-444 702
Phone: 9325094780, 07226-202793, 202291
Email: drsatav@rediffmail.com
Add PBC neck 20 yrs female unmarried, operated-, blind suicide prevented.
Our experiences of Melghat.
Subscribe to:
Posts (Atom)