Modern medical science has made immense strides throughout Asia during the past two generations. These advances were facilitated by the widespread availability of “miracle drugs” that began with sulfa derivatives and antibiotics. Yet in practice only a minority of South and Southeast Asians benefit adequately.
Physicians, clinics and well-equipped hospitals almost invariably cluster in or near urban centers, serving chiefly the articulate, educated and more prosperous citizens. Patients’ ability to pay continues to promote a concentration
of medical skills and facilities. Where village-based health services have been organized, they tend to flounder and disappear when the innovators move on. Critical is the poverty that still is the lot in life of the majority of rural families for whom population pressure has made malnutrition the most prevalent and rapidly growing illness.
When Drs. RAJANIKANT and MABELLE AROLE chose to practice in Jamkhed taluka (sub-district) in Ahmednagar district of Maharashtra in 1970, they had prepared themselves meticulously and thoroughly researched the community. Both products of an Indian Christian education’ they had chosen each other in marriage with a pledge to share in serving rural India First joining a small voluntary hospital in Maharashtra, they refined their ideas for service; graduate medical studies in America followed.
Deliberately the AROLES selected a region where the villager’s existence was grim and seemingly hopeless. Two consecutive monsoon failures compounded chronic drought. Much topsoil had washed away after forests were cut for firewood. Villages were split into factions by caste and clan. Leprosy and tuberculosis were prevalent, although often unreported. Infant mortality ranged from 80 to 150 per 1,000 live births. Malnutrition, especially among children under five years of age, was made worse by gastrointestinal diseases carried in the often contaminated water taken from streams and ponds. Everywhere want produced despair among a people denied the means and lacking the will to achieve better.
The simple curative medical practice begun by the AROLES in a small lent cowshed in Jamkhed won them acceptance by community leaders and the voluntary construction of a small hospital. But they found permanent answers demanded a changed environment. To make preventive medicine a reality they utilized the semiskilled personnel and unsophisticated equipment at hand. To ensure that villagers acted for themselves, the doctors subordinated their work to local leadership, and as outsiders were only catalysts. Village Health Workers, often illiterate older women nominated by their neighbors, were trained to give simple treatment and bring serious cases to a mobile weekly medical team. Wells were drilled for potable water, located in the village section inhabited by Harijans, or untouchables. Young Farmers Clubs reclaimed idle land, built dams and roads, planted trees and otherwise utilized the food-for-work program to grow added crops, partly for children’s feeding programs.
Changes wrought by this Comprehensive Rural Health Project above all cemented a new sense of community, erasing many caste barriers among the 40,000 inhabitants of 30 villages. At an annual per capita cost of 70 U.S. cents—excluding the cost of special treatment for tuberculosis and leprosy patients—this scheme is being extended to another 30 villages in neighboring Karjat taluka. Now in their mid-40s, the AROLES are refining their movement for mobilizing rural initiative and leadership, and sustaining their commitment to continue learning from the villagers whose cause they share.
In electing Dr. RAJANIKANT SHANKARRAO AROLE and his wife, Dr. MABELLE RAJANIKANT AROLE, to receive the 1979 Ramon Magsaysay Award for Community Leadership, the Board of Trustees recognizes their creating a self-sustaining rural health and economic betterment movement in one of the poorer regions of West-Central India.
My wife and I wish to express our warmest and humblest thanks for honoring us with this eminent Ramon Magsaysay Award. We hope we will be able to bring further distinction to such recognition.
In Asia and the rest of the world, positive strides have been made in the fields of medicine and science. We witness the magnificent feat of men living in environments alien to us in yesteryears. It is commonplace for us to hear of man conducting experiments in the far-reaching dimensions of space and in the depths of our oceans. We have developed technology of such sophistication that now it is possible to replace diseased body organs. There appears to be no limit to making all our imaginings realities (given enough of that precious commodity—time). But as we slowly lower our eyes from the dazzling heights of man’s achievements, our sight will fall on the ugliest of scars of mankind’s workmanship—poverty and disease. Statisticians enjoy playing the numbers game with lives in our Asian villages. It throws up the frequency of births, deaths and diseases, but hides the stark reality of suffering and deprivation.
Optimum health is the right of every individual and we possess more than enough knowledge to make this right a reality. Knowledge is the total accumulation of all the efforts of mankind over the past decades. No single profession or group can claim a monopoly on this market. It should be available to all, but in the very name of protecting the people, this trust of knowledge is withheld from them. Presently in Asia large sections of the population are deprived of the benefits acquired from this common pool of knowledge, which leads us to pose painful questions. What hinders the available medical care from reaching these people? Is it the monetary cost involved? If this is so, what causes the high cost? If this care is so far removed from the common people, are we failing in our responsibility? We must search into these questions objectively and try to answer them in a dispassionate manner. We know that morbidity and mortality in rural areas are closely related to basic health problems caused by inadequate food, a polluted water supply, poor sanitation and man’s inability to equalize distribution. Today we commit the great crime of allowing malnourished children and adults to succumb to diarrhea and tuberculosis, major killers. Why should a mother lose her life due to tetanus or sepsis? We possess enough knowledge and machinery to prevent such wastage of lives, and we can be certain that there is no dearth of village people to help in this task. So why do these tragedies continue? There appear to be certain cliques that monopolize knowledge, technology and remedies that are vital to the very survival of human life. If the common man is allowed access to these resources, the predictions of a doomed future would rapidly change.
Poor, illiterate people are like rough diamonds hidden under dirt and stone. Given the opportunity, they can reach their full potential—a potential as great as is possible for you and me. Just because facilities of schools and universities are inaccessible to them we are mistaken in labeling them unintelligent. “Ignorant” is the word to use here as this denotes deprivation of knowledge. The villagers are capable of learning and utilizing skills for the betterment of life. All that is necessary on our part is sharing our “trust of knowledge” with them. They have the potential to be responsible, sensitive human beings, possessing the qualities for self-reliance, and able to shed old customs and traditions that impede forward development. We just need to exercise patience and care in working with them.
Why are people still imprisoned in the shackles of bondage? They should be able to decide who controls knowledge and how it should be utilized for the positive progression of mankind. We must make available to them the means to gain access to, and control over, their own health care. I must ask myself if I am consciously or unconsciously involved in this obstruction and how I can facilitate the services reaching those in most need. I believe, both as a humanitarian and as a physician, that qualities of independence and self-reliance should be encouraged and nurtured in regard to people’s health care, and to this end my wife and I are channeling our efforts.
At this point Arnold Toynbee’s words echo through my mind: “The twentieth century will be remembered chiefly, not as an age of political conflicts and technical inventions, but as an age in which human society dared to think of the health of the whole human race as a practical objective.”