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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
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