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Gagari defies official statistics

Sourish Bhattacharyya

It takes a real village to make an editorial-page fixture make sense out of statistics. Figures dished out by the Health Ministry in New Delhi say that out of 4.09 lakh village health guides, who are given just enough hands-on training to provide immediate relief to their neighbours, not more than 3.20 lakh report for work. At Gagari, a dusty village which is a two-hour bumpy jeep ride into the desert from Jodhpur, you wonder whether even this not-so-flattering attendance figure is remotely proximate to the truth.

And Gagari is fortunate, for its health is being looked after by the Gramin Vigyan Vikas Samiti (GVVS), an NGO founded by Laxmi Chand Tyagi, an old acolyte of Vinoba Bhave and Acharya J. B. Kripalani. There was a time when Gagari, too, had its regulation village-level health worker and traditional birth attendant, who looked good in official figures, but meant little to the people they were meant to serve.

For Gagari, like the other villages scattered across arid Rajasthan, is a collection ofclusters of dhanis -- cone-shaped hovels, which in the homes of the chaudhuris house goats and sheep -- physically separated from each other by unlit sand tracks stretching across kilometres.

A village of 5,000 people, Gagari's one end is separated from the other by 10 km, which means one cluster of dhanis could be a good 2-2.5 km away from another. Not surprisingly, no village-level health worker, or traditional birth attendant, could be motivated to attend to a delivery or a nasty bruise it involved an avoidable trudge, especially in the dark.

The GVVS got around the problem by volunteering to ferry these village health functionaries from one cluster of dhanis to another, but then, Gagari is special. Less fortunate villages never get to see their health providers, and the nearest primary health centre could well be on the other side of the moon. Even in Gagari, a medical emergency at night may still go unattended. Just imagine life without the many amenities we take forgranted 24-hour emergency services, a car or a cab on call, a doctor just six or seven taps on the phone away and you'll figure out why even a normal delivery can be a risky proposition in well-cared-for Gagari.

Try to visualise a would-be mother in the throes of labour pains late in the night. Chances are it'll only be next morning before her family can reach the nearest health worker on foot (a dehydrating experience in the summer) and then organise some transport to induce her to attend to the childbirth (and, maybe, possible complications) -- in a village whose only contact with the outside world is the daytime bus that tos and fros from the stone quarries where most of its males between 15 and 40 go to earn their daily pittance, I didn't come across any family, barring that of the sarpanch and his predecessor, with any form of transport.

Gagari at least has a guardian angel. Spare a thought for the villages that don't. The Health Ministry may declare from the top of Nirman Bhawan that everyinhabited village in the country has an accessible health worker, but the truth is that each of these cogs in the gargantuan primary health-care wheel must have at least a bicycle to make a real difference to people's health. And even the statistics are riddled with flaws.

As the Report of the Independent Commission on Health in India points out, the December 1995 Bulletin of Rural Health Statistics omits to account for 7,607 primary health centres. It is this smugness of our babudom that is responsible for more and more of the rural poor sinking into the ranks of the poorest as they queue up in city hospitals for ailments that require only basic care. It is the reason why a premier basic research and tertiary-care facility like New Delhi's All India Institute of Medical Sciences (AIIMS) has been reduced to a primary health centre.

As I returned from Gagari admiring the sunset, the peacocks, the neelgais looking incredulously at our breathless Sumo, I was reminded of these bits of statisticsfrom the National Family Health Survey: