TWO INDIAS EXIST IN HEALTHCARE

The Guardian website now features a short film I made about a health project in rural India called Jan Swasthya Sayhog (JSS).

I have photographed the JSS several times before and always felt that their ceaseless commitment to the rural community they serve together with their understanding of healthcare in India would warrant the making of a film. In producing this film, I also hope to provide some insight into the systemic deficiencies of healthcare in India.

Dr. Yogesh Jain with 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 fo (Tom Pietrasik, Tom Pietrasik)

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

Any honest discussion on the subject of medical care in India must acknowledge the government’s failure to properly resource the public healthcare system. India’s Economy grew almost 50% between 2001-2006 yet in the same period the malnutrition rate for under 3’s dropped just a single percentage point to 46%. When they entered power in 2004, the Congress-Party-led government promised to increase public health spending from 1% of GDP to 2-3% of GDP by 2012. Today, public spending on health stands at just 1.2% of GDP (the global average is 6.5%) and the Indian government, still led by the Congress Party, appears to have abandoned any notion of universal healthcare.

Without a properly-funded public healthcare system, those who have the resources to pay out of pocket or who are fortunate enough to possess health insurance, look to private hospitals for care. These hospitals in-turn attract the most able health professionals, drawing them away from and so further undermining the public system on which the majority of the population depend.
The husband (2nd left) of a 30-year old woman who had attempted suicide looks on anxiously as she is transported by ambulance from the JSS hospital in Ganiyari to the ICU at the large government hospital in Bilaspur, 25km away. The woman is one of many such cases of attempted suicide by the ingestion of insecticide. She was brought to the JSS hospital on a motorbike where doctors spent two hours stabilising her. The woman survived thanks to the efforts of the JSS and was discharged from hospital one week later. ..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 t (Tom Pietrasik)

The husband (2nd left) of a 30-year old woman who had attempted suicide looks on anxiously as she is transported by ambulance from the JSS hospital in Ganiyari to the ICU at the large government hospital in Bilaspur, 25km away. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

While working for UNICEF in October, this phenomenon was illustrated to me by a doctor whom I was photographing as he and his medical team responded to an outbreak of measles in eastern Bihar. He told me that the remote district in which he was posted was unable to attract the doctors required to run local government health services. The problem was so bad that 70% of positions were left unfilled.

Doctors simply don’t want to be posted in a poor, far-off district that offers little opportunity to supplement a government wage with a private practice. The result is that the ordinary people in these areas must either forgo care or turn to unqualified quacks when they fall ill. The need is so great that the first-class service offered by a relatively small rural hospital like the JSS serves a catchment area comprising a population of almost 1 million people.

India’s failure to properly invest in a decent universal healthcare service compounds the widespread poverty and hunger that afflicts much of the population, 40% of whom are underweight. The World Health Organisation (WHO) describes public health spending in India as,

“abysmally low in a country where about 26% of people living below poverty line are critically dependent on public health services and the range and complexities of health issues are substantial with the equal presence of both communicable and non-communicable diseases.”
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

Poverty, in all its manifestations, affects just about everyone who accesses the service provided by the JSS. When I visited the JSS hospital in Chhattisgarh in November, a young man, only recently married, was rushed to the emergency room with 40% burns. Like nine out of ten Indian workers, he was employed in what is called the un-organised sector where exploitation is routine and many workers undertake hazardous tasks with little or no regard to health and safety standards. On this occassion the young man had been casually employed to fix wires on top of an electricity pole even though he was not qualified to do so. While working, he received an electric shock and fell 8 meters unconscious to the ground. By the time he arrived at the JSS hospital, the doctors could detect widespread internal burning by the smell of the poor man’s body. He died the following day.

When the determinants of health, whether nutrition, clean water, adequate shelter or safe working conditions are compromised, it is surely even more incumbent on the Indian government to provide a properly resourced universal healthcare service.

You can find out more about the JSS on their website and read more about my experiences photographing them and their work here.

Empty syringes lie beside the foot of a 30-year old woman experiencing seizures after attempting suicide by drinking insecticide. The woman is one of many such suicide cases treated at the JSS hospital in Ganiyari. She was brought to the hospital on a motorbike. After stabalising her, the JSS doctors admitted her to the ICU at the large government hospital in Bilaspur, 25km away. The woman survived thanks to the efforts of the JSS and was discharged from hospital one week later. ..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 und (Tom Pietrasik)

Empty syringes lie beside the foot of a 30-year old woman experiencing seizures after attempting suicide by drinking insecticide. The woman is one of many such suicide cases treated at the JSS hospital in Ganiyari. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

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