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.
