A Gandhian aiding tribals

A few of us forget all the positive values taught to us. Some like Dr Ashish Satav these forward in many different ways. His story as told to Jamuna Rangachari 

I was influenced by my grandfather Mr. Vasantrao Bombatkar (Sarvodaya leader) since my childhood. Under his guidance, I read literature written by Mahatma Gandhi and great saint Vinoba Bhave. I was touched by Gandhian teaching that “youths should go to the villages to serve as real India is in villages” and after 12th standard, I decided to become doctor and serve the rural part of India. After admission to Government medical college Nagpur, I started visiting various rural and tribal health projects run by Drs. Prakash and Manda Amte, Drs. Abhay & Rani Bang, etc.  After visiting tribal areas, I realized that tribal areas need medical facilities to a great extent as compared to rural area. So, during my M.D. training, I decided to start work in very difficult area of Melghat where medical facilities were very scarce. I attended “Shram Sanskar Shibir” organised by great social worker Baba Amte during 9th standard which was a real experience for future social life. Ultimately, Mahatma Gandhi & Swami Vivekananda are my rieal driving force (Preranasthan-Source of inspiration) for all my endeavours. 

 I was supported by his wife Dr. Kavita Satav (M.S. eye surgeon) and my parents, brothers.  Due to very active, parental and good financial  support from Caring friends , Mumbai (especially Ramesh uncle Kacholia, Prakash Apte), Kasturba Health Society, Sevagram (Late Dr. Sushila Nair),  Dr. Vibhawari Dani, Dr. Dilip Gahankari, etc. our activities got momentum and we could achieve success in  most of our program .  The other pillars are Stichting Geron, The Netherlands, Mastek foundation. (Mr. Sudhakar Ram and Sanjay Mundane) and Bajaj Auto Limited. 

There are lot of obstacles while working in Melghat since beginning. But now I think, these obstacles are not hurdles in the road but a challenge to test and prove ourselves. The life is like a river. The river is more beautiful when it flows through mountains, valleys, falls, etc. But danger of end is always there. 

In 1998, I resigned from the post of lecturer in the department of Medicine  AT Sevagram and registered a voluntary organization. This was named MAHAN and we started a hospital in Melghat. In the beginning, there was no financial support from anybody. While during post-graduation and lecturer ship in medical college, I was living a simple life due to which I saved some money I used that money for running hospital in Melghat. After 4 months, honourable Dr. Sushila Nayar who was the great supporter of the project provided financial support and since then MAHAN &Kasturba Health Society, Sevagram were running these projects up to 2016. 

From 1998 to 2015, not a single new M.B.B.S. doctor started non-governmental hospital in Dharni. So, most of the people could not believe that I can be a M.B.B.S., M.D. doctor. 

We started our OPD in a hut at Kolupur and then hospital in a small (four rooms) rented house in Dharni. It was used for outpatient department and for indoor patients. In the same house, patients use to vomit etc.  and just nearby to it, was my dining room and bed room. When I was in Government Medical College, Nagpur, I was habitual of working in a big hospital. But in Melghat, while treating the serious patients of brain haemorrhage, heart attack, etc., we faced lot of problems in the same small hospital. But I could manage successfully lot of serious patients even many times in the absence of electricity & other facilities. 

Once  at around 12 midnight a patient of serious heart attack i.e. acute myocardial infarction with pulmonary edema was admitted in government hospital. As there was not a single physician, I was called to treat that patient. I was assisted by unqualified attendant and I carried one E.C.G. machine and injection Streptokinase along with me. There was no cardiac monitor or defibrillator. There was not a single hospital for management of serious patients in Dharni and critical care hospital was 100 k. m. from Dharni. When I was in Government Medical college, Nagpur, and in M.G.I.M.S., Sevagram, there used to be a team of 3-4 doctors and trained nurses and well-equipped intensive care unit and well-furnished library to refresh your knowledge. But it was my first experience to treat such patient in Dharni with minimum facilities. If I treat the patient and if he succumbs, then people will not believe me and I might have to leave Dharni. But then I realized that, if I treat that patient, there is 90% chance that he will be saved. But if not treated, there is 100% chance of death.  So, my strong will power forced me to start the treatment.  I was treating that patient until 4 a.m. The patient was out of danger at around 4 a.m. and I was relaxed. But after then, till now, I have successfully treated more than 3000 serious patients with no fear in mind. Till July 2007, our indoor hospital was in 20* 50 square feet hut. 

Once a fifty years old male patient of brain haemorrhage (7cm in parietal lobe and 1cm in Thalamus) was admitted in comatose condition in our small hospital. He was advised by doctors from Amaravati & Indore that he could not be saved and hence it is not practical to hospitalize. I did not cross the boundary of the hospital for 7 days as I was busy in treating that serious patient. I was assisted by one 9th standard passed boy. There was mental pressure of 30 to 40 people daily for that patient.  On 8th day, that patient started walking and I was relaxed. From that day, people realized that I am a good qualified doctor and I got acceptance & publicity in Melghat. 

I do remember a story of 5 years young girl patient suffering from cerebral malaria with coma with decerebrate posture with convulsions. Not being a paediatrician, I thought a lot, whether to treat her or not.  But if I won’t treat, she will not be saved (it was 100% sure), as there was no paediatric critical care hospital for 100 km.  Hence, I decided to use my all knowledge and courage to treat the child and could successfully save her. It increased my confidence that I can manage serious children also though I am not a paediatrician. 

Sometimes I am also surprised that, I could have successfully managed serious patients in such difficult circumstances. 

After 2 years, my wife Dr. Kavita (M.B.B.S., M.S.) started her eye hospital in Dharni. For first year, there was no financial support for her work. There used to be very few patients for initial one to two years. As most of the tribal patients in Melghat are very poor, they cannot afford charges of operation for cataract. So many times, Kavita got depressed. Probably I will have to operate cataract of a tiger, sarcastically she used to say sometimes. We used to live very simple life so that we could save a substantial amount of money and after few months we purchased operating microscope worth Rs.2,00,000. Mr. Prabhakar Palaskar (retired engineer, P.W.D.), one of our closed well-wishers from Nagpur donated some moneg. Kavita operated upon  cataract patients from that donation. And there after gradually we received more financial support for our eye hospital from Kasturba Health Society (Patron respected Dhirubhai Mehta), Sight Savers International, Caring friends, Mumbai, Rotary club Amaravati, etc. Till now, Kavita had operated more that 3000 eye patients successfully (including cataract patients i.e. Intra-ocular lens implantation free of cost). Due to poor socioeconomic conditions & superstitions, it was very difficult to convince patients for cataract surgery in Melghat. 

Kavita visited more than 400 villages in Melghat and tribal villages of Madhya Pradesh and conducted door to door screening and treatment of patients. Our son, Athang was 4 months old. She used to keep him in cradle(zoli) under some tree in those villages and she used to manage the patients. She used to bring patients for surgery in her own vehicle. Many times, she used to come at night from villages and prepare food for the blind patients and feed them. It reminded me “Patient is God and to worship the patient is real worship to god” . In such difficult circumstances, she operated upon many cataract patients. Her surgical results in such difficult conditions were admired by many doctors. 

Due to her amicable and loving nature, we could extend our friend circle to very great extent and many of them are now good supporters of the project. 

In Melghat, I have to shoulder many responsibilities other than physician and the day become so busy that I cannot spare enough time for my wife and son. For initial years, Kavita and Athang used to get irritated but now they have become habitual of the situation.  Athang asks me baba; will you get time for me? For what you work so much? 

For first couple of years, I used to go to interior villages through forest either by two-wheeler or by bullock cart or walking for treatment of patients and health education. Melghat is famous for wild life like tiger, leopard, wild bear, etc. So, Kavita was afraid of my life. My elder brother Avinash gave his tempo trax jeep free of cost for 7 years, due to which we could extend our medical relief work to most interior part of Melghat. Now due to strong support from Caring Friends, Mumbai especially ambulance, we are able to extend our activities to a great extent. 

Once one pregnant lady was delivering the baby. Her relatives were persistently asking Kavita to conduct the delivery. When Kavita went, the condition was critical. Somehow, she could deliver and save the mother but the baby had birth asphyxia. She treated the baby and saved her life. But the mother could not secrete breast milk for her baby. At that time, Athang was six months young. Kavita used to send half of her milk to that newborn baby and keep half for Athang. Today that milk brother of Athang is living normal life. Now our team of village health workers & supervisors have motivated many tribal females from self-examples to breast feed other babies whose mother had lactation problem. Many children were saved similarly. 

Once I was in Gadchiroli, Athang developed severe Asthma at 3.00 a.m.  He was then hospitalized in M.G.I.M.S. Sevagram. He developed similar attacks many times in Dharni. Once, Athang developed high grade fever. I started medicine but he developed abdominal pain at 2 a.m. in night. How to shift to Amaravati (which is 140    k. m. away and road is through dense forest and mountains,) at odd hours was a great challenge for us. Then I preferred to rely on my own clinical judgment and started other medicine. In the morning, he felt better and we were relaxed. Two years young Athang developed pneumonia. I treated him with antibiotics for 5-6 days. As there was no significant improvement and as there was no paediatrician in Melghat, I consulted paediatricians in Nagpur and M.G.I.M.S., Sevagram and started new medicines. After 10 days, he became normal. Once Athang developed acute otitis media leading to rupture of tympanic membrane and severe ear pain during night hours. As there was no Ear, Nose & Throat surgeon in Melghat, I treated him at home. In the morning, he felt better. 

We thought, we both are highly qualified doctors and we cannot provide expert paediatric facilities to our son. But then we realized that we have to come out of our own personnel comfort zone to serve the nation. 

In Melghat, I have to shoulder many responsibilities other than physician and the day become so busy that I cannot spare enough time for my wife and son. For initial years, Kavita and Athang used to get irritated but now they have become habitual of the situation.  Athang asks me baba; will you get time for me? For what you work so much? 

For first couple of years, I used to go to interior villages through forest either by two-wheeler or by bullock cart or walking for treatment of patients and health education. Melghat is famous for wild life like tiger, leopard, wild bear, etc. So, Kavita was afraid of my life. My elder brother Avinash gave his tempo trax jeep free of cost for 7 years, due to which we could extend our medical relief work to most interior part of Melghat. Now due to strong support from Caring Friends, Mumbai especially ambulance, we are able to extend our activities to a great extent. 

Once one pregnant lady was delivering the baby. Her relatives were persistently asking Kavita to conduct the delivery. When Kavita went, the condition was critical. Somehow, she could deliver and save the mother but the baby had birth asphyxia. She treated the baby and saved her life. But the mother could not secrete breast milk for her baby. At that time, Athang was six months young. Kavita used to send half of her milk to that newborn baby and keep half for Athang. Today that milk brother of Athang is living normal life. Now our team of village health workers & supervisors have motivated many tribal females from self-examples to breast feed other babies whose mother had lactation problem. Many children were saved similarly. 

Once I was in Gadchiroli, Athang developed severe Asthma at 3.00 a.m.  He was then hospitalized in M.G.I.M.S. Sevagram. He developed similar attacks many times in Dharni. Once, Athang developed high grade fever. I started medicine but he developed abdominal pain at 2 a.m. in night. How to shift to Amaravati (which is 140    k. m. away and road is through dense forest and mountains,) at odd hours was a great challenge for us. Then I preferred to rely on my own clinical judgment and started other medicine. In the morning, he felt better and we were relaxed. Two years young Athang developed pneumonia. I treated him with antibiotics for 5-6 days. As there was no significant improvement and as there was no paediatrician in Melghat, I consulted paediatricians in Nagpur and M.G.I.M.S., Sevagram and started new medicines. After 10 days, he became normal. Once Athang developed acute otitis media leading to rupture of tympanic membrane and severe ear pain during night hours. As there was no Ear, Nose & Throat surgeon in Melghat, I treated him at home. In the morning, he felt better. 

We thought, we both are highly qualified doctors and we cannot provide expert paediatric facilities to our son. But then we realized that we have to come out of our own personnel comfort zone to serve the nation. 

In Melghat, as there were no expert doctors other than us, one has to move at least 100 km to reach to expert doctors and the road is through difficult forest and mountains and during night hours, especially during rainy season it is very frightening experience. 

Once Kavita went to a village for supervision of field activities. As there was no return bus from the village she preferred to stay in the village in night. She slept outside the hut of a tribal. Few days back a tiger had attacked that village. At around 5 a.m., Kavita realized that somebody had put leg on her abdomen(belly) and she frightened to think that probably it is the tiger and she shouted. And when she open her eyes she saw a calf had kept his one leg over Kavita and was ready to put other leg. But due to shouting, that calf ran away and Kavita was saved. 

The next morning, Kavita went to the forest for defecation as there is no latrine in most of the villages. Within fraction of seconds, she listened rustling sound of leaves and when she saw, she was horrified to see a black cobra snake nearby to her. She was not injured and saved. 

MAHAN trust had no money for purchase of land. My parents donated money and we purchased one hector of land nearby to village Utavali and gave it on lease basis for 25 years to MAHAN trust without any rent. Today KARMAGRAM is slowly developing there. There are lot of snakes including poisonous snakes like Cobra, Krait and Vipers, etc. Once Kavita was shortly saved from a snake who was on her cloths & I was surprised by black cobra in my hut cum bedroom nearby to head end of my bed. Nearly 5-6 times snakes (including poisonous verity) entered our house.  We being Sarpamitra-friend of snakes, we usually don’t kill snakes but catch them and release them in forest. Once a black scorpion was sleeping quietly on bed of Athang throughout night.   Hence, Kavita is always worried about myself and Athang.  For initial few years, Panther, bear and other wild lives used to pass nearby to our land for drinking water to Sipana river. It further increased her stress. 

In 2004-2005, we raised the issue of malnutrition and children mortality via newspaper, television, etc. Due to which government health and I.C.D.S. department have to work hard today & their negligence was exposed. So, the government staff in those departments became angry and created lot of problems for me and our organization. We were threatened by many social ill elements instigated by such people. Few people tried to put fake police and court cases against me and our organization. Many of our village health workers were pressurized by those ill elements to leave the work. But we did not bow in front of such pressure tactics and faced all such obstacles with great success at last. Dr. Gite, director, Rajmata Jijau mother and children health and nutrition mission of government of Maharashtra along with Raji Nair, UNICEF, personally visited our project area in Melghat, verified our findings of malnutrition and children mortality. They were satisfied with our survey report and realized the false, under reporting of these issues by government health and I.C.D.S. departments. They started measures to improve the situation as per our recommendations.  We also suggested RJMCHN Mission to conduct independent enquiry in other tribal part of Maharashtra which exposed the reality of malnutrition status in Maharashtra. Lakhs of children are benefitted due to it. 

From 2006-2007, we are getting cooperation from government system. But as we got success, the local political leaders and other ill elements of society instigated by local govt. employees started creating problems from 2008. 

Tribal consider malnutrition to be curse on them. As we exposed the problem of malnutrition and children mortality in Melghat, the disturbed government system and few social ill elements started creating nuisance for us. Many times, it disturbed my mental piece so that I use to think to lodge a police complaint against such people. But our friend and supporter Dr. Avinash Saoji advised to follow teaching of great Vinoba Bhave “Fight the sword with shield not with sword itself”. Then we changed our strategy and started increasing our rapport building in the community itself and tried to increase the community participation in the project. And the community itself answered to those ill elements and supported us. Then I thought, Gandhiji went to jail for freedom. Cow dung was thrown on Savitribai Fuley by ill elements for educating girl and Yeshu Krishtha was put to death on cross by goons. So those who want to uplift the society and swim against the flow, has to bear opposition from ill elements. Stones are thrown only on trees full of Mangos. So, I will have to tolerate it, fight for right and not leave right path. 

Lack of water, electricity, etc. is now routine for us. Very high temperature up to 48 degrees during summer (lack of electricity and so no cooler for many times), cold waves with temperature reaching to 3 degrees during winter and incessant heavy rains during rainy season leading to floods in rivers, isolating villages from Dharni & cities leading to stagnation of staff in villages is now routine for us. Many times, we saved very critical patients of heart attack, brain haemorrhage etc. in absence of electricity in light of candles, etc. Once I saved a serious case of heart attack by not sleeping throughout night in absence of electricity. Next day a dog of our neighbourer barked at son of that patient. He rewarded me by threatening to lodge a police complaint instead of thanking me. 

Once a person lodged a false Atrocity case against me and Kavita. Actually, we did not abuse him. Police tried to pressurise us for settlement saying that we will be arrested. At that time Athang was small and exam going. In next month, I was supposed to go to Germany for presenting paper in international medical conference.   We thought a lot and decided we will not bow Infront of such wrong allegations and bear whatever will be the consequence. But at last police could not arrest us as it was fake case. We realised Mahatma Gandhiji’s sentence “Truth can be troubled but cannot be defeated.” 

In 2007-08, Kavita developed heart problem-neurocardiac syncope leading to ventricular bigeminy, but she never thought of running away from her work or Melghat. 

Sach Pareshan ho sakta hai, Parajit Nahi:    Khayra tembhru experience:   Due to negligence of one government nurse in Kharyatembhru village, one child died. So we investigated the case and realised that due to her attitude the health status of Kharya Tembhru is bad. IMR was very high. But due to fear, she and some ill elements of the villages defamed us and stopped our work in the village. Once as per government request, our team visited Kharya Tembhru village for third party evaluation of health and ICDS system. The same nurse quarrelled with our staff and false case of conspiracy of murder and molestation was filed against me and our staff in police station. All political parties, government officers who were unhappy because of exposure of malnutrition and child death reality, tried to remove me from Melghat.   A PIL was filed by us in Mumbai High court against negligence of the ANM and hon. Chief justice asked govt. to take action against the nurse. 

After 4 years, hon. Court declared us innocent. So, we learn a lesson that if you are true but working against the corrupt system, you have to face loss of obstacles. 

Road traffic accident: Once a truck carrying more than 50 passengers fallen down in river near Bihali village. More than 10 people died on spot and more than 12 were serious. No vehicle was ready to stop there and remove the serious patients from the river. We 3 got down into the river and removed all 12 serious patients from the river and could sent them to hospitals. Out of them only one died. So we could save 11 lives. Later on our team saved >30 accident victims by rescuing from the accident site and proper referral. 

Though there are lot of obstacles like this in our path, we both never felt frustrated so as to leave Melghat. This is the greatest achievement of our life. 

We had many fights with corruption in government system like: 

1. Funds for Health camps. 

2. Forest wood for house. 

3. Atrocity case. 

4. Tribal hospital funding. 

 But we never paid bribe nor bowed Infront of corrupt personnel. We suffered a lot for truth. 

In 2004, while shifting the luggage to new home during rainy season, myself and my mother received severe electric shock injury. We were unconscious for few seconds. Vitthal Pande saved us by pulling the wire with wood.

We were saved. I think, due to our good work we were saved by his messenger.  After the incidence, I could continue my work with full strength.  

Reduction in under 5 children mortality rate, severe malnutrition, age specific mortality rate (16-60 years) and case fatality rate of serious patients in our ICU is less than 9 percenr, and felicitation by World Health Organisation with Public Health Champion Award, are the most special moments for us. 

Self-Sustainable Healthy Human Being. MAHAN wanted to become the best health institution for tribal areas of India with an aim to improve the health and reduce deaths of tribal of Melghat & India. 

Their future plans are: 

1) Replication of HBCC, SAMMAN, MCPEPAG, Counsellor program. 

2) Tribal Health Research Centre of Excellence. 

3) Tribal Medical College. 

4) Research:  Yoga, meditation: Deaddiction. 

5) One health. 

6) Childhood blindness management. 

Great aim, hard work, perseverance, stop not till the goal is achieved.   Service to society, research and activism should be the way of life of youths. 

Serving the poorest of the poor is the real worship of god, he concludes. 

Kudos to him and his team for such selfless services. 

By Jamuna Rangachari