A quiet movement in health care has been unfolding in the rural interiors of West Bengal, improving the lives of thousands of people in villages where no doctor has ever been before. It is an effort defined by vision and commitment and is far removed from the CPI(M)-led Left Front, which has spent 30 years in power in the state.
The epicentre of this endeavour is the Shramik Krishak Maitri Swastha Kendra (Worker- Peasant Friendship Hospital) in Chengail in Howrah district, about 25 km from Kolkata. It is a simple two-storied building enveloped by huge trees in a quiet bylane. Outside the hospital there is a bench made from bricks, a small tea shop and a pond.
The Worker-Peasant Friendship Hospital is clean and basic. Its doctors and health workers provide high quality health care without any fuss and bother. Patients turn up assured of attention. Initially, the hospital was meant only for the poorest of the poor. Now, however, all are welcome.
HEALING HANDS
It’s about 6.30 in the morning as we wait for Dr Punyabrata Gun. There is something languid and unhurried about the wait. No one is jostling and jumping queues as might be the case in most hospitals run by the government. You won’t find patients lying around in extreme distress either. Systems are in place and working.
Dr Gun is a general physician in his fifties whose experience and commitment show in his manner. He wears rubber slippers and is bearded. As is evident from the patients waiting to see him, his day always begins early. We are told it invariably ends late because he does not turn anyone away. It could be evening or even night by the time he has examined 100 or 150 patients. It is then that he heads back to his home in Kolkata.
This morning he is a bit behind schedule because he was on a train all night from Pakur and Gumani in Jharkhand, locations which are on the border with Bengal . He attended medical camps there for people afflicted with Kala Azar, tuberculosis and silicosis. Camps of the kind Dr Gun has attended are reaching out to extremely poor people who have received no attention from the government health system.
As he arrives at the Worker-Peasant Friendship Hospital , Dr Gun first heads for a quick bath. His trained health workers, most of them women from families of unemployed jute workers, are already on the job. They are recording case histories, providing physiotherapy, conducting ECGs and organising the dispensary. Lunch is being prepared in the canteen: a basic meal of rice, dal and aloo bhaja. Sometimes eggs are cooked.
These women are the backbone of the hospital. They care for it because they have known Dr Gun from the time he set up his first camp at the Kanoria Jute Mills when it went defunct and the workers were in dire straits. The women have their own stories to tell of a trade union movement that failed. One of them joined Dr Gun when her husband committed suicide. She is transparent: “He was in the forefront of the struggle. Suddenly he lost his mind.” Her daughter is now a member of the kitchen team and has her hands full trying to meet the demands of the youngsters: give us some more curry, bhaja, how can we eat such dry food?
Every patient knows the doctor. More importantly, the doctor knows every patient. Some of the bonds are old and even personal. For instance, there is the ageing school master who seems to be losing his memory and hangs out at the hospital as though it were his second home.
But key to the doctor-patient relationship is the system of records. Medical histories are meticulously preserved on computers and when that is not possible, in handwritten files. “Case histories are crucial,” says Dr Gun. “How can you treat a patient without knowing the complete biographical details of their ailments, their social and economic condition, the mental backdrop, earlier treatments, nourishment levels, family conditions, if he or she can buy a certain medicine or afford a hospital bed?”
Registering at the hospital costs just Rs 5. The registration fee was Rs 1 in 1994 and rose to Rs 2 in 1996 and Rs 4 in 1999. It was raised to Rs 5 in 2002. There are those who cannot even pay this small amount and they are allowed to register free. No one is turned away.
“It’s not that we are only giving dignity to every poor patient. We are also creating a new discourse of alternative and mainstream allopathic medicine and professional health care,” says Dr Gun. “This knowledge is their political right.”
Part of providing access is to make tests available cheaply. An ECG for Rs 50, an ultrasound for Rs 150 or an X-ray for Rs 65 are very reasonable for those who can pay. And those who can’t, use the hospitals diagnostic facilities anyway.
Says Dr Pradeep Saha, radiologist, “The hospitals and clinics in Kolkata charge Rs 20 for what can be done for Rs 1. Okay, we don’t have the best equipment, but our results are on the dot. In India we just don’t have a policy of national health care, everyone is fleecing the patient.”
QUALITY CARE
Doctors easily rally around Dr Gun and his mission. They are drawn to his idealism as well as the practical efficiencies that he has inculcated. Both are needed for building a health care system that is inclusive in spirit and yet representative of the best professional standards.
Dr Gun is, of course, the mainstay, the one man who does it all day after day, from administration to basic health care to arranging for super specialty treatment. The best of doctors from Kolkata and elsewhere, including veterans from medical colleges, visit Worker- Peasant Friendship Hospital to provide free treatment and consultation to poor patients, who would otherwise be ruined trying to get private care in the clinics of Kolkata.
The hospital attracts specialists in various disciplines: ENT, skin, reproductive health, dentistry, eye care, physiotherapy. There is a need for psychologists as well because of the trauma that jobless workers and their families experience. High levels of distress lead to psychological problems.
When surgeries need to be performed, a network of doctors in Kolkata helps out. They arrange for beds and operations at subsidised rates. Or they succeed in getting the surgery done free in Kolkata Medical College and other such institutions.
Dr Chanchala Samajar, a gynaecologist five years senior to Dr Gun, explains: “It's a drop in the ocean, but we still try to give our best.” Her husband, Dr Ashok Kundu, who is a general practitioner and runs a private clinic, is equally committed.
For these doctors providing equal access to health care is necessary for the transformation of society. It is part of the larger politics of workers and peasants asking for their rights.
Says young Kakoli Bhuiya in a cotton saree with a big bindi and a generous smile, “I have been cured by Dr Gun many times. Now I have brought my mother. Where else can you get such extraordinary treatment, tests, cheap medicine? For my baby too, I came here. Dr Gun arranged everything in a hospital for us. We had no trouble. He is like god to us, but he is also like a friend. And he knows us, like he knows everybody, their entire life, like family.”
It has taken just about one hour for Kakoli to get her mother a good session with the doctor. So off she goes to her village half-an-hour away, riding her cycle, her mother perched at the back, on a familiar journey of hope.
LEGENDARY HEROES
On the walls of this Worker-Peasant Friendship Hospital are black and white pictures of the heroes who inspire the kind of work done here. There is the Canadian physician and medical innovator Dr Henry Norman Bethune, born 3 March, 1890, who painstakingly built up medical units during the Spanish Civil War. He developed the first mobile blood-transfusion service in Spain in 1936. Later, he worked with the People’s Liberation Army of China during the Second World War, and sacrificed his entire life in support of the politics of radical struggles for a just society.
Then there is Dr Dwarkanath Kotnis, made famous in India by V Shantaram’s Dr Amar Kotnis ki Amar Kahani penned by Leftist writer Khwaja Ahmed Abbas, who lived and died during the Chinese epidemic in the Second World War, married a Chinese girl, and finally, succumbed to plague himself. There is also a picture of Dhiranjan Sen, Calcutta Medical College student, shot during a protest on ‘Vietnam Day’ in 1984, in Calcutta.
Among other legends on the hospital’s walls is the trade union and mass leader Shankar Guha Niyogi, who was murdered on 21 September, 1991, by contract killers because he was seen as a threat to industries in Bhillai.
Niyogi’s vision is what the hospital has been built on. Niyogi entered Madhya Pradesh’s rural and industrial areas and created a completely new, non-violent discourse among mine and textile workers, peasants and adivasis. His message and influence spread like wildfire in Dalli Rajhara, Durg, Rajnandgaon, Bhillai and Raipur.
His original vision broke through conventional trade unionism and conformist communist politics and created strong, often highly paid mine workers’ unions, schools, cooperatives, peasant networks, anti-prohibition campaigns, women’s empowerment struggles and a political language rarely seen in the annals of Indian grassroots politics. One of the great experiments was called the ‘Shaheed Hospital’ at Dalli Rajhara, dedicated to the fallen comrades of the movement.
Dr Gun, as Dr Kundu, Dr Binayak Sen and others, worked for years in this alternative model of revolutionary health care, where the health of the workers and peasants and poor and locals became a political challenge of total transformation through militant, creative and non-violent mass struggles for an alternative people’s movement and a new society.
Dr Gun and other doctors have tried to show that the Shaheed Hospial model can work without external funds and dubious donations. “If health care can’t radically change the world, then what is the use of being a doctor?” says a stoic Dr Gun. “And if we can’t change the world, what’s the point in talking about it?” Dr Gun and Dr Swarup Jana, who teaches pharmacology at the Calcutta Medical College, have set up a formidable network of thousands of non-professional doctors in the hinterland who gave life when there was no medical system or doctor at hand and all of them set up medical camps staking their lives against the CPI(M) Guns at Nandigram and Singrur, also at Sunderbans when the typhoon struck.
In village after village they are working, sleepless, with no basic equipment. Even now the Chengail chapter is entering Bauria and Bagnan in Howrah , Beliatore in Bankura, Kumar Nati, Barasat, Sarberia in North 24 Paraganas, Jamespur in South Paraganas, Babdowan in Purulia and areas in West Midnapore
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