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Love & Loneliness: Getting on with the job in the Nilgiri Hills

Love & Loneliness ACCORD, Action for Community Rehabilitation and Development, is an Indian NGO which was started in 1986 by Stan Thekaekara, Mari Thekaekara and K T Subramani. The aim of the organisation was to enable the indigenous tribal peoples of the Nilgiri Hills in the south of India to fend for themselves in twentieth century society. The need for a cohesive force to represent the tribals was acute. By nature they are a gentle and self-effacing people who, over time, had retreated deeper into the Nilgiri forests to avoid confrontation with colonialists and various other entrepreneurs who grabbed lands to claim as their own. Since the early 1980's the tribals have had nowhere left to retreat to. They were forced to interact with the people who had invaded their forests and taken their lands. They have their own culture preserved by an insular lifestyle; they are not part of the Hindu caste system and have a different set of values. They were seen as being ignorant and incapable. An oral tradition meant that many were illiterate; in their own society they had no need to read and write. Each tribe has its own language so children did badly at the government schools where they had to adopt a new non-tribal name and to be educated in a language foreign to them. Their history of sharing everything they have with their fellow villagers, their innate trust in man made them easy prey for unscrupulous racketeers. They were shunned at government hospitals, loss of their lands made gathering of their traditional medicines difficult, economic oppression lead to starvation and the incomers carried new diseases which their immune systems had not been exposed to. The tribals, the first people to inhabit India, were being wiped out. ACCORD planned to empower them through education and support, eventually aiming to become redundant and leave them to run their own affairs. In the beginning the people were mobilised to stand together in defence of their land and homes. The core group of ACCORD gradually expanded, allowing health, education, building, cultural and business systems to be developed. Now the tribal people run a hospital, a community health programme, a school, a housing scheme, a tea estate and other business ventures.

I ended up here after answering a small, curiously worded advertisement in the International Health Exchange magazine. I had been planning to work abroad for some time and had survived the years as a junior doctor in the UK. The process of finding the right post was time-consuming and exhausting, and I was slowly beginning to despair. However this suddenly turned around after an extraordinary interview in London with a friend of ACCORD's who had no medical knowledge at all, but whose enthusiasm for the project and lack of bureaucratic tendencies filled me with good vibes. I arrived here in April '99 with no clear idea of what my role would be.

There are two permanent doctors here, a surgeon and, to my relief, an obstetrician. There is an ongoing problem of finding doctors to work with ACCORD. The rigorous training programme for junior doctors in India coupled with the low pay and relative geographical isolation does not make it a feasible option for many. I have now been here for nearly five months and feel that I am still on the steep part of the learning curve in several areas. The hospital is led by the nurses and i t really is a multi-disciplinary team. Some of the nurses have been here since the hospital opened and are knowledgeable, responsible and highly skilled. All of them are helpful and friendly, putting up with my pathetic attempts at Tamil. At home as a junior doctor I often felt frustrated at the competitive nature of the medical field. The NHS (National Health Service), nurses, doctors, pharmacists, etc frequently engage in posturing shows of knowledge. That doesn't happen here which is incredibly refreshing; we can share our respective knowledge and skills and get on with the job.

The patients also actively participate in the day to day running of the ward; many of them were instrumental in setting up the hospital. Often they tell me they are coming for admission and even more frequently tell me when they will leave. Last week I couldn't understand why, overnight, every single patient became symptom free. I watched with trepidation as they coughed and limped their way home. I finally asked one old man, who had complained of abdominal pain every day for weeks, what had happened. 'Doctor, it's Onam (a local Kerala festival) tomorrow. I'll come back if I'm not better next week.' Neither staff nor patients have that freedom at home for many reasons, not least being the ever present threat of litigation.

I have been alone for a while as the other two doctors, a married couple, are away. I have never worked alone at home so it has been a nervous existence, especially as obstetrics has always scared me away. Nevertheless it has been a positive experience, allowing me to get to know the staff and patients on my own terms and to develop a little confidence in areas of medicine I have never forayed into. Here one has to be a true generalist and it has been a humbling experience to witness the proficiency of the doctors in so many different fields. I am here for a year in total; after that I am not sure what to do. I enjoyed most of my time working in the UK but always had a sense of unease at the inequality in healthcare systems around the world and wondered if I was putting what little knowledge and skills I have to their most appropriate use. Human rights and health problems of the developing world do not figure high on most medical school curriculae and still, as doctors, we are not encouraged to take breaks from our UK career paths. Given the state of health of the poor and the oppressed it seems strange to me that the medical profession in 'developed' countries devotes so little time to global health issues. While we discuss rationing of Viagra in order to improve the sex lives of mainly older people in the affluent West, children are dying by the second from diseases we know how to treat. How do you justify that as an individual, a doctor, a nation?

Emma Woolfenden, Scotland

Last update: 2000-02-06 16:12:47 (EEST).
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