Thursday, November 20, 2008

Becoming a 'jhola chhaap' doctor

'Jhola chhaap' is a colloquial term used to describe informal medical practitioners in some parts of India. These are usually people with some experience with medicines and health care – they may have worked as a compounder with a doctor somewhere or received some formal/informal training or just picked up medical knowledge along the way. But health services are so scanty in rural areas that these people can get elevated to doctor-like status. At CHC, we've had a few discussions about such practitioners – are they just quacks who should be discredited and banned? Or are they providing a valuable resource in the absence of trained professionals? Some groups have been working with such practitioners to improve their techniques – a powerful example is the trainings provided to traditional dais (midwives) to promote safe deliveries, prenatal and antenatal care etc.

The ease at which one can become a medical authority was brought home to me in Sitapur district this August. Malaria seems to be quite prevalent here – exact numbers are hard to come by. In Mishrikh block, only the town of Mishrikh has government and private labs that can test for malaria. The time and expense (including travel expenses and loss of daily wages) involved in the testing process discourage many people from going through with it. We were discussing this issue in the Sangtin Kisaan Mazdoor Sangathan's (SKMS) regional meeting at Qutubnagar and I asked what people did instead. One or two replied that they go to a 'doctor' in Qutubnagar who injects them with some medicine that makes them better.

Many situations have come up in Sitapur where people have taken decisions or acted in ways that I am sure are wrong for them. But I have often kept quiet due to the lack of alternative options for them and because I did not want to get into an indefinite 'lecturing' mode. Even with friends and family in one's socioeconomic strata, we choose to keep quiet during difficult discussions to keep the peace. But here, I decided to speak up and told the group that that was not the right way to treat malaria.

'Then what is the right way, didi?' asked someone. I mentioned chloroquine, the most commonly used drug for treatment or prevention of malaria. The group talked among themselves and more people joined the conversation. A little while later, another SKMS member came up to me and confirmed the name of the drug. By that evening, a number of people had bought chloroquine tablets to stock at home and had told their fellow villagers to come to them if they had 'jaada bukhaar' (cold and fever, the colloquial term for malaria)!

Was this the right thing to do? What if they used the wrong dosage? What if....? I was quite worried at this outcome and wondered if I should have instead pushed these folks to get tested and get proper medical advice from trained professionals. I called Sukanya at CHC Bangalore and the feedback she gave provided some comfort. She suggested that I talk to doctors in the area and the PHC and government staff to get an idea of the malaria situation in the area. Also, CHC would send me pamphlets on malaria, its diagnosis and treatment (written in Hindi) that I could distribute to the group and use for further discussions. 'You gave them the right information,' she added. 'The need for good health services in these communities is so acute that any good information they get can only be beneficial. So don't hesitate to share complete and accurate information – we all have a role to play.'

So this is how, for a short time, I became a 'jhola chhaap' doctor! I expect to fulfill that role again in the future and hope that I will be able to respond in a sensitive and useful manner. After all, when campaigning for 'Our health in our hands' (a message of the People's Health Movement), each of us have to step up to the challenge as best as we can.

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