A balloonist's view of agriculture

For the past month and a half, I have been hard at work trying to put together a report of all I have seen and learnt in the past 6 months. This was a requirement from CHC - a good one, because it forced me to put down on paper a lot of thoughts that were randomly floating through my brain!

Below is the chapter on agriculture. The context to the 'balloonist' is from a question posed to us at CHC: 'Do you want to be a balloonist or a molecular biologist' referring to two approaches of looking at an issue. I consider the past 6-9 months of hectic travel to be in the balloonist mode of learning!

Since 2004, I have been building my understanding and perspective on agricultural issues in India and throughout the world. In the last few months, I have met a number of groups and individuals working on this issue and have had extensive discussions with them. Following is a brief description of each of these visits:

• LEISA project – connecting the dots

In December 2005, Dwiji and I had visited Motaganahalli, a village in Bangalore rural dt., where Prasanna Saligram and others were working as part of AID India with locals on a LEISA (Low External Inputs Sustainable Agriculture) intervention. Back then, their focus was more technical – they were looking at how much biomass was required, what crops to grow together etc. Now, with the implementation of NREGA (National Rural Employment Guarantee Act) in all districts of the country, the social aspect of this program has increased to getting Panchayats involved and using NREGA funds to pay for some of the off-farm activities such as composting and preparing biosolutions. A new field area: Dhanametapalli in Kolar dt. has been added.

The basic model is as follows: a group of 4-6 landless women are selected to work on leased land to improve its fertility and organic content. In the process, they receive a share of the produce and valuable training that can allow them to become resource-persons or workers on organic farms. The philosophy of work is inspired by Dabholkar's ideas and practitioners like Mr. Renke. The current conceptualization with the social components was done by Mr Datye, an expert who passed away recently.

The challenges in this work are immense, the extremely low levels of the water table, shortage of biomass, good quality seeds etc., dependence on the goodwill of the leasing farmer and now cooperation of the Panchayat and so on. But there has been progress – local leaders have been created at the village level and the project has continued due to their commitment. The women of Dhanametapalli, in particular, were enthusiastic and enterprising. At a point when the work was delayed due to non-availability of seeds, they took the initiative to find out who farmed organically in the area. They visited these farms, learnt some farming approaches and procured seeds themselves! Because of the proximity to Bangalore, selling their produce has been relatively easy as well.

In conclusion, this initiative is worth supporting and learning from. It has pitfalls and inconsistencies, but it has also provided valuable capacity-building. Also, from the beginning, importance has been given to replicability and the larger picture, something that is lacking in many agricultural interventions.

• Revathi and TOFARM - where there is no alternative

I first met Revathi in early 2005 in Tamilnadu, while helping her draft a proposal for rejuvenating agricultural land damaged by the tsunami. At that time, agricultural unversity professors were saying that it would take 3-7 years for the land to return to full productivity. Revathi, along with Nammalvar and other people involved in organic farming, wanted to prove them wrong and they did. Of course, whether the farmers involved are continuing these practices is another matter...

Since then, Revathi has continued to work on training trainers and on setting up a model farm near Thiruvarur. More recently, her group has worked with Oxfam in Ampara province in Sri Lanka. The entire province has turned organic, in large part due to the difficulties of supplying fertilizers, pesticides and seeds in this conflict-torn region. A huge challenge from an organic farming standpoint was the lack of domestic animals, again due to conflict. But by using techniques such as green manuring with 15-20 seed varieties, they have been able to make land productive again.

The model farm that Revathi is setting up near Thiruvarur is only a year old, therefore it was an excellent point in time to observe her planning. The land she and her husband purchased is low-lying and often gets waterlogged, therefore it was sold at a cheap rate. Revathi and her team are trying out many innovative techniques to compensate for this. A number of ponds have been dug and the mud from them was used to elevate certain fields. In another place, a zigzag system of trenches has been created with the dug-out soil elevating the space in between them and creepers planted to reduce evaporation in summer. Fish have been introduced into the trenches and ponds – their sale provides income as well.
Revathi's mentor is Nammalvar, one of the pioneers in the Tamilnadu organic movement. He once very beautifully explained to us how it is essential to tailor farming practices to the local conditions. Seeing Revathi's work underscores those principles and provides inspiration for coming up with such approaches wherever we are.

• Farming in Auroville

Around the time we were to visit Auroville, we found that some friends from ReStore, a Chennai collective fostering consumer-producer links, were attending a 10-day workshop at Solitude Farm. We decided to attend part of the workshop while visiting other groups at Auroville. The parts we attended included discussions on Fukuoka's methods, digging a soak pit with banana saplings and other seeds and processing of traditional grains. I also briefly participated in making seeds pellets – encasing them in clay to prevent being eaten by birds and insects when broadcasting (no-tilling sowing).

Solitude farm fits seamlessly into the Auroville ethos of living in harmony with the earth. Also, since Auroville markets and consumes a huge amount of organic produce, the market does not seem to be a problem. The farm, like everything in Auroville, seems quite disconnected from the surrounding population. The cook, who comes in from a nearby village, told us: 'What is the point of going through all this trouble to pound, clean and then cook these grains?' Perhaps, because the farming and food practices are so rooted in spirituality, the residents of Solitude Farm and Auroville are willing to work harder, and pay more, for this lifestyle.

• BAIF Karnataka – tree-based dryland cultivation

BAIF is one of the oldest NGOs in the country, set up during Gandhiji's lifetime by Manibhai Desai. It works in a number of states across the country. BAIF Karnataka works on a number of issues, but we were primarily interested in the agricultural aspects of their work. They have been promoting tree-based farming as the best solution for dryland areas. We saw two types of interventions. One was with individual farmers, where over a 3 year period, they introduced organic practices such as trenches filled with organic matter, biosolutions etc. A lot of their work has been with mulberry growing in this silk-producing area. Through use of biomass, they have cut down on water consumption significantly.

Another effort has been to rejuvenate huge tracts of land, such as a 100 acre barren area that was distributed among landless families. BAIF provided training, support and funding for 3 years, at the end of which the land is productive and covered with trees. This is quite an achievement, given that many such projects are not successfully implemented. The BAIF staff told us that they paid people to water saplings in the summer and extensively monitored to ensure that they were doing so. In the words of their director, 'such work requires commitment over long periods of time'.

The work that BAIF does requires a lot of funding. They have even signed MoUs with the government in order to implement some of this work, and advocate similar styles of functioning for other NGOs. They do not have faith in local government functioning in an honest manner without inspection by NGOs, but NGO can be as susceptible to corruption as a local official, in my opinion.

• Bhaskar Save – the voice of natural farming

In 2007, Bhaskar Save, a famer who has grown using natural methods for decades, wrote an open letter to M.S. Swaminathan about the agricultural crisis in the nation. That letter was an inspiration and we were keen on meeting Bhaskarbhai. We met him a couple of days after Diwali at his farm near Umargaon. A number of pilgrims seem to have found their way here and he now has developed a 2 hour session for visitors! He talked about realizing that he was losing money rather than making a profit through chemical farming because he was spending so much on seeds, fertilizers etc. The understanding that he needed to bring down costs led him to Fukuoka and natural farming. Since then, he has not looked back. His son, Nareshbhai, is also farming organically – the premium these products fetch in the market is also attractive.

Sadly, the area around Umargaon is rapidly getting industrialized. Land prices are shooting up and pollution has shot up. It will be sad if the land that was nurtured carefully for all these decades will be impacted by these new developments.

• Becoming the change – individual experiments in farming

A significant path for people aiming to lead more meaningful lives has been agriculture. I have heard of and met people both in India and the US who have given up professional careers, bought land and begun growing their own food. It is an option we have considered too. In early November, we met Smitaben and Dhirendrabhai, a couple who were professors in Baroda. Through a process of reading, discussions and reflection, they decided to live a more sustainable life and moved to Sakvi, a village near Rajpipla. They learnt traditional farming methods from their Adivasi neighbours, who have now ironically moved to chemical farming.

The couple educated their children at home, allowing them to learn what they were interested in. They grow all they need on one acre of their land. The other acre is devoted to trees and is almost like a forest. They provide mentorship and guidance to others interested in taking up farming. If there is regret, it is that they have not been able to do more work with the villagers. But they feel that such efforts would lead them to neglect the land for which they came here in the first place. It was really nice meeting them and their older son. However, I think I would need a lot more patience and humility than I have to live life as simply and steadily as they have!

• The farmer-labourer connection

In more than one place, we have heard farmers talking about how hard it is to find farm labourers. 'People don't want to work hard','Men are addicted to drink' etc. are some of the comments I have heard. On the other hand, we know that many in rural areas are poor and underemployed. So why does this situation persist? Visiting Subhash Sharma's farm near Yavatmal might provide some of the answers.

The first thing he has done, which is simple yet profound, is provide employment for his labourers all year round. Conventionally, agricultural work has been seasonal, with a lot of demand during the sowing and harvesting times, but little in between. Subhashji has planned his farm so that there is somthing or the other to do. He provides food and accomodation to his employees and even takes them on early vacations! These systems have allowed him to not only farm successfully on his own land, but also lease others' and make them productive and profitable.

Subhashji mainly grows greens, vegetables and pulses. He sells almost all his produce in Yavatmal, with oly a few items bought by dealers in Nagpur. He firmly believes in selling in the open market as close to the farm as possible. I agree with him on this – food that is labeled organic and sold in the export market defeats the goal of sustainability. Subhashji has been able to make good profits by timing the arrival of his produce in the market, for example, the first methi in the market always fetches a good price, so he plants an early crop even though the yield is low. By incorporating natural farming techniques, Subhashji has been able to reduce his costs and his water usage. The tree cover on his land provided a haven for birds, which naturally control pests. He leaves some land fallow every year to let it 'rest'.

After touring Subhashji's farm, I was stuck with the uncomfortable thought that this kind of planning and practices would be possible only on a large landholding. One would need atleast a few acres to allow some of it to remain fallow, to plant trees etc. Would the labourers on this farm follow these practices if they owned the land? I talked to some of them who have land back in their native village – one said that his son, who farms the family land, grows cotton using chemical methods. I was left wondering how to incorporate some of Subhashji's approaches in a collective of marginal farmers.

• 10-gunta farming, rooftop gardening – a model for Indian farmers and cities?

I have been reading 'Plenty for all', a book on how everyone can enjoy a good quality of life with juat half an acre of land. The author, Dabholkar's description of Prayog Parivar, a network of people who learn from and teach each other and collaboratively build on existing knowledge. Dabholkar passed away recently, but many people inspired by him continue to work and refine on the techniques he propounded. Even the aforementioned LEISA project draws on some of these techniques, though one problem with them that the group found was the huge biomass requirements in the first year or two.

Anyway, we heard of a rooftop garden experiment by the manager of a Bombay Port Trust canteen, Preeti Patil. The approach taken by her is inspired by the Prayog Parivar. She has been able to convert all the organic waste produced by her canteen into compost and her team grows a number of vegetables using them. While nowhere near producing the vegetables needed daily in the canteen, this effort effectively manages waste and is a green oasis in the dreary Port area.

We also visited Deepak Suchade in Bajwada, MP. Deepakji is Dabholkar's protege and is working on documenting many of these approaches and providing training and workshops. His farm is on the banks of the Narmada and is a beautiful place. Over the past two years, he has transformed his land and has laid out a model of a 10-gunta (quarter acre) farm that will provide for all the food a family needs. Another model that is called the Gangamaa mandala uses all the household wastewater and provides enough fruits and vegetables for a family.

While these techniques are worth learning, the earlier mentioned drawback of huge amounts of required biomass still exists. Further, the principles that Dabholkarji laid out and which Deepakji advocates seem a bit unrealistic. For example, they say that the Gangamaa mandala would yield atleast 2 kg of vegetables every day. One kg. Can be used for domestic purposes and another kg. can be sold. In my opinion, one cannot sell 1 kg. of vegetables unless one belongs to a cooperative that can take small quantities from a lot of people and sell them collectively. To set up such a cooperative is not a trivial task and may not make business sense, but the Dabholkar school of thought does not seem to give much importance to this problem. From a personal nutrition point of view, this approach is very useful, but I am not convinced that this can provide a livelihood for a marginal farmer, let alone a middle class lifestyle.


All these visits, combined with my learnings in the past have now given me the confidence to begin some work on agriculture in Sitapur dt. The farmer-members of SKMS hold small tracts of land, many under an acre. Most have access to irrigation and therefore grow 3 crops a year. The rabi crop is usually wheat, followed by lentils or vegetables etc. In the monsoon, some grow paddy, others corn, groundnuts etc. A lot of sugarcane is grown, though receiving prompt payment from the sugar mill is a challenge. Monocropping is prevalent and soil erosion is extensive. On the nutrition front, there are high levels of malnutrition and anaemia.

There are many fronts on which I could proceed and I plan to explore them in the future months.

Beyond lectures: new ways of learning

All of us who have gone through the institution of formal education know how easy it is to sit through a lecture, look attentive and not absorb anything! Even with a desire to learn, there is a limit to what can be absorbed and retained in the standard lecture format. In recent years, many innovative methods of learning have been experimented with and implemented in schools and non-formal learning centres, among village-level activists etc. During the orientation and mid-term review at CHC Bangalore, we experienced firsthand the benefits of such approaches.

During the 6+ weeks of sessions in June, July and September 2008, we sang, danced, acted, drew, presented and debated. For me, these interactive sessions often crystallized the content of lectures into valuable insights. One game, in particular, challenged our perceptions of the world we live in and ourselves. This was the monsoon game, led by Ravi Narayan, which we played on the 3^rd day of our orientation. It is a role-play which simulates life in a village. Most participants were divided into 8 upper caste, OBC and Dalit families with varying amounts of land. The huge landholders were all upper or the dominant caste, as is common, while the Dalits were marginal landholders. Other participants were moneylenders, government officials, journalists etc.

The game took us through 7 years of planning what to 'plant' and then 'reaping the harvest' in a good, average or bad monsoon. Those who did not have enough to eat 'starved' and a family that went through 3 years of starvation 'died'. While all this was going on, the moneylender was lending money at exorbitant rates; government officials were announcing relief schemes, very few of which the most needy were eligible for and the journalist was documenting the abuses. Finally, at the end of the game, 3 families were dead and the moneylender had acquired a lot of land!

In the post-game discussion, we realized how easily each of us had fallen into our roles, becoming complacent and often selfish as an upper-caste family and feeling powerless as a Dalit family. We appreciated the difficulty of mobilizing communities that are living a hand-to-mouth existance. We also realized that we had forgotten the activist part of our psyche! We hadn't protested, refused to obey the rules or 'organized'. The game was a powerful tool to make us appreciate the lives of the rural poor.

Dwiji and I traveled through the US in September-October visiting chapters of the Association for India's Development (AID), an organization both of us have volunteered with. While planning sessions on topics as varied as Sustainable Agriculture and Group Dynamics, the games and other activities at CHC provided plenty of inspiration and ideas. We wanted to have more discussions and debates and found that these methods were very effective in getting inputs from participants in these sessions.

While we did not have the time to play something as elaborate as the monsoon game, we tried to come up with a shorter role-play to illustrate group dynamics in the presence of an 'outsider'. The role-play is quite simple – most participants are villagers, while two are the 'change agents', representatives of an NGO. Each person is given a chit that assigns them their role and provides further information that they can choose to share or not share. The background is that the change agents are at the final stage of selecting the village as the site for a new high school which their NGO will manage, but they feel there is something the village is not sharing with them that could impact the success of the project. Their goal is to find out what this 'secret' is. On the other hand, the villagers are vested in seeing the school set up in their village and the resulting benefits. At the beginning, both the change agents and the villagers are allowed time by themselves to strategize – then comes the interaction between the two groups.

We played this game with the volunteers of two chapters and found it was even more successful in illustrating group dynamics and negotiations between groups than we had expected. Hierarchies were formed within the village group and the change agents in both chapters took different approaches – confrontational and friendly - while engaging with the village. We analyzed these interactions later and discussed their pros and cons, comparing them to modes of engagement in the field. Further, a number of issues were raised that were not covered in our initial briefing but are, in reality, important for a school's success. We discussed child and adult education, child labour, migration to cities, public land in a village, mid-day meal schemes and more.

Whether these interactive approaches are more effective than traditional methods remains to be seen. I think they are and we certainly enjoyed planning and participating in them! I hope to benefit from more such games and interactive sessions in the future, whether as just a participant or a co-ordinator and planner as well. In such an interactive process, we all learn and what could be better than that!

At the mercy of Mother Nature

August 2008

Growing up in Bombay, I thought I understood the downsides of monsoon well – the unceasing rain, the flooding, bus and train delays and cancellations... I prided myself on not just coping but also enjoying the season. Of course, things were much worse for the slum dwellers and people living in low-lying areas. But the rains would eventually stop and things would get back to normal, right? It took spending a few weeks in Sitapur in July-August to really appreciate the short-term and long-term impacts of the monsoon.

Most of the SKMS members are agricultural labourers or marginal landholders. They live in 'kuchha' mud houses with thatched roofs. This year, the monsoon was so fierce that it was, in the words of an SKMS supporter, 'Nature's terror'. All the fields were flooded through July and only the paddy seemed to be surviving. But further downpour through August and during the critical period of harvest damaged the paddy crop as well.

In the second week of August, it poured nonstop for 3 days. Houses, already unstable with the water-logging, began collapsing by the dozen – in some cases just one wall, in others the entire structure. These humble homes provided very basic shelter; with their collapse, people were all the more vulnerable to the elements. In one village, entire families spent days under plastic sheets hoisted next to a statue of Ambedkar, the one area in their 'basti' that was not waterlogged. Fevers, diarrhea etc. were rampant. The spring's wheat crop had been a bumper one and many families had stocked up on grain for the entire year. This grain was now wet, spoiled and mostly unusable.

While all this was playing out, we were hearing of the calamity in Bihar where the Kosi changed track and inundated entire districts. The suffering of the people in the affected districts was unprecedented. Even in Sitapur dt., certain blocks such as Rewsa were completely flooded and people were camped out on the roads and highways. Was the suffering of those people worse than that of the people here? After a point, can one quantify suffering?

We were ourselves staying in Surbala's house in the village of Satnapur. Surbala, through sheer determination and some financial strength, had constructed a concrete 2-room house. Unless there was severe waterlogging, her house was safe. But her husband was sick, one of the walls in her in-laws' house had collapsed and she was busy with personal and SKMS work. We were in a quandary – should we leave 10 days from now as we had planned or leave earlier? If we stayed, should we move to a hotel in Sitapur? Our utility to the sangathan was limited – we could help out with the applications for compensation for all those who had lost homes and property, but there were more experienced people already doing that. We could not work on long-term projects in this emergency situation. So we decided to leave early. It did not feel good to leave at such a time...

The rains have now stopped in Sitapur. It is likely that the damage to families' food stocks will have an effect in the coming months, though work through NREGA can mitigate that. It is to be seen how the winter will be. We will be back in Sitapur then and will hopefully contribute in a better manner than we could in the midst of the monsoon fury.

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.

In search of a doctor (and the system)

Again, it's been a long time since I posted - apologies! Also, considering the record length of my posts, I'll try to post shorter, more reflective pieces from now on!

August 2008

The orientation at CHC had given us a thorough introduction to Community Health. But in Sitapur, given that Sangtin Kisaan Mazdoor Sangathan's (SKMS) primary work was in mobilizing for NREGA, I did not plan on sharing my learnings at their meetings. My plan was to discuss these issues with a few people and then see what came through. However Mukesh, who serves in an advisory role with SKMS, suggested that I speak about health at the regional meetings using one or two talking points, thus starting the thought process in this important topic. Other SKMS members concurred, so I raised the issue at the Aug 10th and 11th meetings in Aant and Qutubnagar respectively. We discussed why it is easier, or rather more natural, to work on livelihoods, BPL etc. than on health – we only think about the health system when we are sick, knowledge and power are concentrated in the hands of medical professionals etc.


I asked the assembled people, about 100-150 in each meeting, to think about health-related issues and come up with one or two that they would want to work on. While everyone was mulling over this, a few people raised the issue of malaria. At this, others began speaking up about their own and their village's situation. From there, matters progressed very quickly, and before I knew it, plans were being made to prepare lists of people affected by malaria and to demand action at the block level.


I was not sure what to do with the information being collected, so contacted CHC. Armed with their advice, I went to meet Richa. She was quite concerned with the various illnesses prevalent in SKMS villages this monsoon. She felt that camps should be organized in a few central villages so that all the sick could easily access health services. We decided that I would meet the chief doctor in Mishrikh where a CHC (Community Health Centre) is based.


But first, a brief description of the area: the Mishrikh CHC serves most of Mishrikh block, with some villages as far as 20 km away. The average cost of travel one-way is Rs. 10. If the patient needs to be escorted, travel costs themselves could be as high as Rs. 40. Further, patients need to get to the CHC before noon to get a 'parcha' or token that would allow them to see the doctor, get medicines etc. Transportation in the form of tempos is not very reliable and if one is late, the entire day is wasted. In contrast, Qutubnagar, one of the big villages, is more accessible for the people in that area and has one MBBS doctor who charges ~Rs. 40 / diagnosis and a couple of 'Jhola chhaap' doctors who charge even less. But inspite of this, the Mishrikh CHC is well used as I discovered when I visited it on August 19th.


The chief doctor was not available – he was on leave till the 28th, the day after we were scheduled to leave Sitapur. Further, the situation was dire in many villages – just that morning, we had heard that the entire Dalit 'basti' in Kunwarapur was inundated with both lake and canal water. There and elsewhere, many houses had collapsed and people were exposed to the rains with nothing to protect them but plastic sheets. While I was in Mishrikh, Dwiji had gone to Kunwarapur and was wading through knee-deep water helping to document the damage.


On further enquiry, I found the junior-most doctor on service. He was swamped with patients. While watching him interrogate each patient briefly and jot down a prescription, I was reminded of Adithya recounting his health camp experiences at CHC Bangalore. In such a situation, the doctor can spend at most half a minute on diagnosis. It has got to be dehumanizing to treat patients as if they were parts on an assembly line. I managed to speak briefly to the doctor and ask him what planning the Health department did for malaria and other diseases in the monsoon. He looked at me like I was delirious – 'We are here treating patients – that's what we do!' I then asked what would warrant a personal visit by a team of doctors to a village. 'A serious outbreak of diarrhea or something equally contagious and life-threatening' was his reply before he was engulfed by patients again.


Given the lack of progress at Mishrikh, I went to the District Hospital in Sitapur the next day hoping to get more answers. Here, I was luckier – the additional CMO (Chief Medical Officer) and the Deputy CMO were both in the office and the latter was in a chatty mood. He talked about the staffing problems in the district – there was a shortage of at least 30 doctors. Government service and a rural lifestyle cannot compete with the salaries and career growth possible in urban settings. Currently, even C-sections had to performed in the District Hospital as there was no anesthesiologist at the CHC. They were under-equipped for normal times, let alone catastrophic situations. He then went off on a slight rant about how ignorant and lazy villagers were and how hard it was to treat them. These were comments similar to what I heard the past couple of days from private doctors in Qutubnagar – the path of least resistance in this thankless situation seems to be blaming the victims.


When pushed on health camps, the Deputy CMO said that a team would visit a village only in exceptional circumstances. Usually, there was a good reporting structure in place and news of outbreaks almost always reached them. In fact, in some situations, they had gone to villages and found that the situation there was not as dire as expected. Such visits were detrimental since the team could have spend their time better in the hospital treating the patients who arrived there.


After this discussion, I came to the conclusion that it would be very hard to get a medical team to visit any of the SKMS villages. Other areas in the district were in worse shape – in some blocks, villagers were practically living on the roads as all other areas were flooded. Nevertheless, I communicated this information to the SKMS team and they did try to get a team to visit Kunwarapur.


Two days later, we went to visit Reena and Shammu at Kunwarapur. No medical team had come to assess the situation. But we learnt that, in a nearby village, 7 children had died from diarrheal-related causes the previous day. So much for a good reporting structure...


But given the dire state of the Health system and the realities of rural life here in Sitapur and elsewhere, many such tragedies are in the making...