India lives in its far flung, nearly six lakh, villages. Agriculture is our backbone. Villages are our future hope. Urbanization, with its attendant acculturation, would result in deadly diseases, increasing exponentially. It is estimated that in the new millennium Bombay, that is Mumbai, would be getting the dubious distinction of being the first among the most populous cities in the world, snatching that `honour’ from Shanghai. Medically speaking, this would convert Mumbai into one of the biggest mortuaries in the world at any given point in time.



Heart and lung diseases are supposed to go up directly proportionate to the population growth in any congested city. It would be a frightening scenario to visualize. This applies to many of our other cities, including our capital city of Delhi, where pollution levels are prohibitively high, not to speak of the unhygienic conditions in which the less fortunate have to live there, with frequent epidemics of deadly communicable diseases rearing their heads.



Our only hope for the future is our villages, where the real India lives. It is in the villages that the environment is much cleaner than in any industrialized city. But the sad fact is that our villages have the least facilities for human habitation, despite the fact that the father of the Nation, Mahatma Gandhi, dreamed of village development and cottage industries, as our priority after independence. Unfortunately, his followers soon forgot him and his wise counsel, going in for mega- industries and metropolitan development for their own glorification, with their western mind set.



Health care delivery in Indian villages is appalling, to say the least. Most medical help is needed in our villages, where we find hardly any existing; while all our doctors and, the five-star medical facilities, keep mounting in the large metropolitan cities, where their need is minimal. This is the “inverse-care law”, first propounded by a thinking family doctor, that worked for forty-five years in a small coal mining village in Wales, Tudor Edward Hart. Unfortunately this operates in most of our villages in India and also in many other developing countries.













What do we need for total health care in the villages?



Recent UNIDO report (Wemembe) clearly showed that more than 80% of the world population, especially in the far flung villages, do not have any touch with modern medicine. Many of the remote aboriginal tribes still live on conventional folk medicines. There may be a hidden treasure of potentially useful pharmaceuticals in our rain forests still to be tapped. British Medical Journal, writing an editorial about a year ago, felt that more than 750 useful medicinal herbs could be there in the rain forests of the world. One of the pharmacologists, Dr. Chattopadhyaya, recently found out a very potent anti-malarial drug from the bark of a tree in Andaman Islands, being used by the local tribals. The local population there does not bother about malaria, despite the fact that they have the highest population of mosquitoes of all “castes” there! We need to tap all that gold mine some day, for total health care of our teeming millions of poor people in the villages, at an affordable cost.



World Health Organization estimates, that the three most urgent steps to be taken in villages to keep the poor healthy to be:



* Clean drinking water.

* Avoiding contamination of the human food with either human or animal excreta.

* Avoiding cooking (and other) smoke inside the house (this causes most killer respiratory diseases in children).



That said, I must hasten to add that the villagers need nutritional diet, in addition. Interestingly, our villagers have the best foods available to them in their own village. Best healthy foods are not the ones available in departmental stores in the large cities, but the fresh fruits and vegetables in the villages. Vegetarian food is not only healthier; it is also the altruistic diet in the global sense. Whereas a vegetarian consumes about 200 Kg. Of cereals in a year for good nutrition, the non-vegetarian cousin of his ends up consuming 2 tons of the cereals if he is a total meat eater. Does it look ridiculous? Animals used for meat, also get their protein from cereals. However, only 10% of the cereals eaten get converted into meat; the remaining 90% goes waste. That is how a pure non-vegetarian gets to waste 2 tons of cereals per year, while a vegetarian only consumes 200 Kg. per year. What a difference!



The other ingredients of the nutritional healthy diet, the fruits, are available in plenty in our villages, if only the villager is told to harness them. Bananas, papayas, guavas, ordinary berries, grape fruit, cashew fruit and the nut, mangoes, sapotas, water melons, and many other local fruits are available fresh in our villages. They could also grow plenty of leafy vegetables. They should be encouraged to develop organic farming in place of chemicals fertilizers and sprays, which, in the long run, might ruin their health, although in the short-term analysis it may be more profitable.



Mini diary farms in the villages could give them the much-needed milk and milk products, in addition. This, coupled with regular advice on avoiding contamination of their food and water with excreta should enable our villagers to be healthy as long as they live. School health education and, also health surveys, with proper immunization schedules, would prevent most of the communicable diseases. China has been able to eradicate gastrointestinal diseases, because of their strict implementation of the “boiled-water-to- school-policy”.



Other important risk factors for major killers are unemployment and hostility. Everyone in the village would have some employment, either self-employment or, as an agricultural labourer. Hostility is definitely much less in the villages, where people live in harmony, compared to the man-eating-man life in the larger cities. The clean environment of the villages is very good for the health of even babies less than five years. Many Indian cities have been declared unfit for such babies, because of the pollution. Latrines and proper waste disposal should make our villages heaven on earth.



Curative Medicine in our Villages:



“To believe that DOCTORS AND HOSPITALS are needed for keeping the health of the population is PLAIN RUBBISH.”

Denis Burkitt.



The above statement, by one of the best brains in medicine, though looks harsh, is the whole truth. The governmental efforts to improve our Primary Health Centres has not met with much success for the simple reason that the present day medical graduates, trained in the five-star, technology based, education in curative medicine, are a square plug in a round hole, for health care in the remote villages. They are aliens there, waiting to get out at the first opportunity; even if they are pushed there by legislation. Having been trained in cities, they are not at home in these villages. Their families will have none of the “facilities” that a large city could provide. They are too young to have developed the altruistic attitude in life. To cap it, curative medicine does very little for the well being of the villagers, anyway.



The Chinese “bare-foot” doctor scheme, suitably modified, could work wonders in our villages. We have done some experiments on this in our University, with the help of the Ford Foundation. The results have been very impressive. We have been able to get the infant mortality to almost 20 per thousand, which could be compared favorably with the developed countries. The morbidity/mortality ratio, in children, has improved very significantly. We have been able to achieve a significant level of health education, including education regarding family planning methods. Our thrust has been to concentrate on able bodied village youngsters, mainly girls, who were given three months training in recognizing serious medical problems to be attended to by our base hospitals.



Rest of the common ailments, could be handled by these trainees, who are given a box of innocuous medicines, to treat the symptoms. The medicines are chosen in such a way that they could do no harm, at any dose. To make them feel responsible, the medicine kit is sold to them at half the price. They could sell it to the villagers at the normal price to earn a profit, in addition to the stipend they get every month. They could, of course, attend to their work at home as usual. The enormity of the benefit could be gauged if one understands the basic data, that a doctor would see thirty thousand common ailments, while he gets to see one patient with a massive heart attack in any given community. French government has been able to cut their health care budget, even in the city of Paris very significantly, by starting a Chinese medicine hospital of 100 beds, which cut out almost 80% of unnecessary load on modern medical facilities. This could bring down the health care budget drastically there!



The local youth health care team concept works wonders, as the boys and girls employed in this exercise are the sons-of-the- soil and, have their moorings in the village. The question of forcing unwilling young doctors to go to the villages has been counter-productive.



Economic Development of our Villages:



One has to see these working wonders in the remote villages of Kuchchh, where non-governmental organizations are doing God’s work. They have co-operative mini diaries, mini herbal gardens, and local crafts like batik painting and toy making, in addition to their Kuchchhy embroidery designed clothes for direct export to the West. The final price of the dress sold in foreign markets is shared between the tribal women who make these dresses at their spare time at home, and the NGO “Shrujana” for their overheads, there being no middle men to eat into their income in a big way in the larger export organizations!



While Kuchchh gets about 3-4 inches of rain every year they have developed their own indigenous methods of water harvesting and artificial rain, that the desert that Kuchchh was a few years ago, has been transformed into a green belt now. NGO s will be responsible for the common man’s life in the next millennium, the governments becoming almost irrelevant in this field. This kind of innovative economic developmental plans could be drawn up for every village, depending on the local talent and natural resources. It could not be the same for all parts of the country, though. It shall not be imposed from above as of now. Our five-year plans have mainly remained on paper as far as the ultimate beneficiaries are concerned, even after half a century of independence. Let us make a new beginning in micro-economic development. Even the die-hard economists of the West are slowly realizing their mistakes, Scheumaker writing about Small is Beautiful.



Harnessing the local talent, Kuchchhies have organized evening entertainment for the villagers, which could be replicated elsewhere, to give much needed relaxation for our villagers. This could detract them from their other relaxations like sexual intercourse, the latter again adding to the problem of over-population, and alcoholism ruining family life totally. Our greatest curse has been the disproportionately high birth rate that has nullified the reasonably good progress that we have made in the last fifty years of independence!



We have reached a do-or-die stage in our village development. The sooner we think of doing something seriously, the better for All of us both in the villages and the cities, as otherwise all of us would come to grief. We must expect people moving in the opposite direction, from cities to villages, for the total good of mankind. Every citizen has a moral responsibility to contribute his mite in this direction, lest we should perish because of wrong policies! Reverse the inverse care law.