THE SAD STORY OF DHANGA BAIGA

Photo above: Dhanga Baiga, attended to by Dr Yogesh Jain of the Jan Swasthya Sahyog at a weekly clinic held in Bamhni village. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

My good friend and fellow-journalist Dilip D’Souza wrote to me a few days ago with the sad news that a man called Dhanga Baiga, whom we both met a year ago, died last Monday.

I was introduced to Dhanga while photographing the work of a group of doctors called the JSS who run a hospital in the small, dusty town of Ganiyari in Chhattisgarh, central India. The JSS stands for Jan Swasthya Sahyog which means People’s Health Support Group.

It was while photographing Dr Yogesh Jain as he ran an outreach clinic in the village of Bamhni that the wizened figure of Dhanga Baiga entered the consultation room.

Moving with a caution that was in keeping with his fragile state, Dhanga, a member of India’s indigenous Baiga community, eased himself onto a plastic stool in front of Yogesh. It was clear that Dhanga knew and trusted Yogesh. Indeed, he owed his life to the intervention of the JSS medical team who had temporarily slowed the advancing tuberculosis that was gripping his hunger-ravaged body.

Dhanga Baiga, a TB patient during a weekly out-patient clinic at the JSS outreach medical centre in Bamhni village. ..The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access to essential services has been undermined by the Chhattisgarh government's decision to completely disinvest in public transport. ..Continually exposed to illnesses associated with malnutrition and poverty including tuberculosis and rheumatic heart disease, the doctors at JSS are tireless advocates for universal healthcare and the need to introduce measures to reduce society's inequities and focus re (Tom Pietrasik)

Dhanga Baiga photographed twelve months ago while being treated for the hunger-related tuberculosis that led to his death on March 21st 2011. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

As Dhanga recounted his most recent ailments, Yogesh examined him, gently prodding and squeezing in a manner intended to reassure his patient as much as facilitate a diagnosis. Weighing just 29 kilos, Dhanga was certainly not doing very well and Yogesh concluded by asking him stay overnight for observation before venturing home on foot the next day.

The tuberculoses that had all but destroyed one of Dhanga’s lungs had undoubtedly reduced his chances of survival. But when I enquired, Yogesh had been reasonably optimistic about the sick man’s prognosis so long as he could raise his calorie intake and avoid the kind of opportunistic infection that so frequently claims the lives of those weakened by hunger.

A TB patient's weight is recorded at 28.9 kg (64 pounds) during a weekly out-patient clinic at the JSS outreach medical centre in Bamhni village. All patients accessing care from the JSS are weighed as a matter of course. Documenting the weight of a patient has obvious benefits for individual diagnosis and care. But trends can also be extrapolated from the data and this has helped the JSS focus resources toward confronting malnutrition which is widespread in rural Chhattisgarh...The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access to essential services has been under (Tom Pietrasik) Patients attending JSS clinics are all weighed. Dhanga Baiga’s weight is recorded at 28.9kg (64 lb). Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

By the time he died, Dhanga had been able to increase his weight by only two kilos. And, as Yogesh had feared, a fever did eventually strike, confining Dhanga to his bed and leaving him unable to eat. Dhanga died last Monday evening, too late for the intervention of JSS field staff who were informed the following day. Though no one knew his exact age, Dhanga was probably in his early 50s.

Dhanga’s is not an isolated case. Thirty-three percent of Indians are underweight with a BMI (Body Mass Index) below 18.5 which, Dr Binayak Sen says amounts to a “genocide without bullets”. Sen, a public-health activist and advisor to the JSS, currently resides in prison, serving a life sentence on false charges of sedition. Sen’s real crime has been to expose the Chhattisgarh state government’s appalling failure to represent the interests of those to whom it was elected to serve: ordinary people like Dhanga Baiga.

A village health worker inspects blood samples at a monthly JSS antinatal clinic in Semariya village....The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access to essential services has been undermined by the Chhattisgarh government's decision to completely disinvest in public transport. ..Continually exposed to illnesses associated with malnutrition and poverty including tuberculosis and rheumatic heart disease, the doctors at JSS are tireless advocates for universal healthcare and the need to introduce measures to reduce society's inequities and focus resources upon t (Tom Pietrasik)A village health worker inspects blood samples at a monthly JSS antinatal clinic in Semariya village. Bilaspur District , Chhattisgarh. India ©Tom Pietrasik 2010

Continually exposed to illnesses associated with malnutrition and poverty including tuberculosis and rheumatic heart disease, Yogesh Jain, Binayak Sen and others at the JSS argue that any serious challenge to hunger necessitates that we also confront India’s vast and growing inequities.

I was privileged to spend some more time with Yogesh and his colleagues last month while on assignment for Oxfam and will return to them again here in my blog. In the meantime, a gallery of my photographs of the JSS working with the people of rural Chhattisgarh, including the unfortunate Dhanga Baiga, can be seen here. And, for a revealing insight into the experiences of working as a doctor in rural north India, I’d certainly recommend the Fieldnotes blog written by the JSS’s, Dr Ramani Atkuri.

Dr. Raman Kataria reviews an x-ray on the ward of the JSS hospital in Ganiyari. Kataria is a specialist in pediatric surgery...The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access to essential services has been undermined by the Chhattisgarh government's decision to completely disinvest in public transport. ..Continually exposed to illnesses associated with malnutrition and poverty including tuberculosis and rheumatic heart disease, the doctors at JSS are tireless advocates for universal healthcare and the need to introduce measures to reduce society's inequities and (Tom Pietrasik)Pediatric surgeon Dr. Raman Kataria reviews the x-ray of a child on the ward of the JSS hospital in Ganiyari. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010