Time to Unite

That paediatrician and health activist Dr Binayak Sen has spent more than a year now in a Chhattisgarh prison, on charges of being a Naxalite, is a sad reflection of the abject plight of healthcare activists who dare to display courage. It is a matter of national shame that even after a petition was signed by over thousands of doctors, intellectuals and activists for release of Dr Sen, and there was international clamour for his release from prominent American writer Noam Chomsky and 22 noble laureates, and Global Health Council announcing the Jonathan Mann award for Dr Sen, there has been no ray of hope for his release.

It is beyond our imagination as to why is the central Government turning a blind eye to the sufferings of a man who has dedicated his life for improving healthcare of the poor in the tribal regions of central India by running free clinics, setting up a rural hospital, and reducing Infant Mortality Rate (IMR) and deaths caused by diarrhoea and dehydration. Dr Sen's fault lies in raising his voice against the atrocities committed by the Chhattisgarh Government in trying to tackle the Maoists in the State by backing civil militia of local tribals called Salwa Judum. He was penalised for his courage and accused of being a Naxalite, just because he enquired about the health of an incarcerated CPI (Maoist) leader and tried to get him medical attention.

Dr Sen may be a one-off case of imprisonment of an activist on such charges, but many healthcare activists in terrorists-ridden pockets suffer similar harassment. The healthcare activists fight to gain confidence of people whose faith in establishment has been eroded and who live in the grip of fear because of the constant clashes between terrorists and the police. Fear also stalks the activists. While terrorists seek healthcare treatment from them mostly at the gun point, they are harassed by the police for attending to the terrorists.

Do healthcare activists, who have renounced the comforts of a city life to stay in far-flung villages, leading a Gandhian life and work for a cause selflessly, deserve this kind of abysmal treatment? The Indian healthcare industry would have been a rudderless ship without the contributions of these activists. Think about it— in recent times, healthcare activists have been instrumental in the amendment of PNDT Act, helped the Government nab gynaecologists indulging in sex determination tests and female foeticide, campaigned to bring in Clinical Establishment Act, hauled up trust hospitals which fail to do charity, fought for affordable medications, etc. Various health programmes of the Government would not be a success story without the suggestions and active participation of the activists.

Who would not salute the courage and compassion shown by the legendary late Baba Amte who gave a dignified life to leprosy patients ostracised by society? Who does not appreciate the relentless battle waged by Dr Abhay and Dr Rani Bang of Society for Research and Action and Community Health (SEARCH) from Gadchiroli district of Maharashtra to make the State Government accept their path-breaking methods to reduce IMR? Who does not remember how the late Dr HN Antia (the founder of Foundation for Research into Community Health) and Dr Rajanikant Arole propagated the concept of training illiterate villagers to give primary care, much against the resistance from the Government.

Some may not have been full-time fire-brand activists, but have championed causes in their own manner. Take the case of Mumbai-based diabetes surgeon Dr Arun Bal who founded Association for Consumer Action on Safety and Health (ACASH) to support aggrieved patients of medical negligence or Mumbai-based paediatrician Dr RK Anand who fought against the artificial baby food lobby to propagate the importance of feeding breast milk to newborns.

Some healthcare NGOs, however, have created a bad name for themselves mainly because of the method that they adopt— when they believe sloganeering is synonymous with activism. History bears witness that by just shouting slogans and creating pandemonium one does not achieve much. It is only when activism is evidence-based advocacy or has an active research component that the voices of protests have been heard by the Government. The reason the pioneering work of the Bang couple had to be finally accepted by the Government was because they have shown how IMR can be reduced by training Trained Birth Attendants to conduct deliveries and reduce pneumonia, the leading cause of infant mortality. Same with Dr Antia who proved his claims at Parinche valley near Pune and Dr Arole in Jamkhed of Maharashtra. Dr Antia later went on to become a member of steering committee of the National Rural Health Mission. Besides the resistance from Government, another stumbling block for the activists has been the dubious existence of some NGOs, flush with international funding. They demean the good work done by the honest activists. The lack of unity among healthcare activists also dilutes their cause. Often, I have heard them levy allegations against each other for being a fraud or bicker regarding the methods each adopts to reach their goals. I have also been warned against health activists who started on an honest mission, but somewhere down the lane have sold their souls.

It's time that the Government acknowledges the outstanding work done by the activists by roping them in more responsible posts, the way Karnataka Government has done by recruiting idealist and activist Dr H Sudarshan to probe into corruption charges in healthcare delivery. Let us also fight a united battle to not only release Dr Sen, but to rid health activism of fears of harassment. Or as Dr Sen's wife Ilina, has pointed out, "We are part of a much larger fight. We are struggling for the right to dissent peacefully." The failure to release Dr Sen would be the darkest chapter in the annals of Indian healthcare industry.

Rita Dutta
rita.dutta@expressindia.com