A hospital of tribals, for tribals, by tribals.

Deep in the misty Nilgiri hills, an inspiring revolution has been taking place since 1985. A revolution that’s truly inspiring but not many people are aware of. That revolution is ACCORD or Action for Community Organisation, Rehabilitation and Development – an organisation that helps the adivasi community of the Gudalur Valley in the Nilgiris to take control of their own lives.

Gudalur, a lush green valley nestled at the confluence of the southern states of Karnataka, Kerala and Tamil Nadu, is home to adivasis — the original inhabitants for several centuries. When it looked like they were going to disappear, because of great exploitation, ACCORD was born. The team behind ACCORD, Stan and Mari Thekaekara’s objective was to organise the adivasis and help them fight their alienation, speak for their rights, fend off land grabbers and preserve their identity. Thus was born the Adivasi Munnetra Sangam (AMS), a representative organisation of the adivasis of Gudalur.

What began as a political struggle soon started moving into other areas of the adivasis’ existence, especially health. “Tribals used to come to ACCORD meetings unwell. It was quite difficult to educate them about land rights then. All attention used to get diverted to one of them who was lying down in pain, groaning,” recalls Dr. Shylaja Devi. She goes on to explain, “The adivasis did not have a health-seeking behaviour. There was no concept of antenatal care, of immunisation or of seeking medical help when sick. They called their gods or lay down to die.” It was, therefore, common for women to die at childbirth and for their children to suffer from illnesses like diarrhoea. There was a clearly a pressing need for some kind of intervention!

But, it was not only the problem of land. The village sangams again and again brought up the issue of health care. Women were dying during childbirth. Children were suffering from easily preventable diseases. Some intervention was urgently required. But, Stan and Marie were not doctors. They started looking out for some doctors through their contacts.

Fortunately, they met two young doctors, Dr.Devadasan and his wife, Dr. Roopa, quite eager to take up the challenge. The young doctor couple joined ACCORD in 1987 and launched a community health programme for the adivasis. The aim was to train village-level health workers selected from the community to prevent illnesses, provide immunisation and nutrition to pregnant women and young children, and improve general health awareness.

This effort grew into ASHWINI, an acronym for “Association for Health Welfare in the Nilgiris” as well as the “God of Healing” in Hindu mythology. Since 1990, ASHWINI has been running a comprehensive health programme for the tribals. This also includes the successful running of the Gudalur Adivasi Hospital. Though it was another young doctor couple, Dr Shylaja Devi and Dr Nandakumar Menon, who took up the challenge of setting up the hospital and training young adivasi girls as nurses.

It was no easy challenge but they were determined. “There was initially a lot of resistance to modern day health care. They were afraid of us. It was an uphill task to gain their confidence,” recalls Dr Shylaja Devi. She went on to explain how they were only able to earn their trust once their understood their way of life. She says, “Tribals think very differently from city folk. They neither understand the cash economy nor plan for the future. They can only think uptil their next meal.” This also makes them very “giving” people as they are not accustomed to saving for the future, or even for a rainy day for that matter. It’s no surprise then that catch from a hunt is shared with one and all – irrespective if they contributed to that particular hunt or not.

So, ASHWINI’s efforts began with outreach and educational camps. Health checkups through further camps came much later. As a few folk benefitted from medicines and diagnosis, more were began to seek medical help when sick. That’s how health-seeking behavior was encouraged.

The hospital today serves around 300 hamlets spread over two talukas. With 40 beds, it is capable of administering secondary-level health care. It has facilities for obstetrics and surgery, in addition to medical, paediatric and general services. It is staffed by a surgeon, gynaecologist, physician and a junior doctor. The nurses, lab technicians and administration staff are all tribals trained on the job – an intentional move to further encourage health-seeking behavior; as this makes the tribals more comfortable in the hospital environment.

For this same reason, training becomes a key component. Except for a few professionals, the entire programme is staffed by tribals trained over the last 20 years. ASHWINI has also affiliated itself with BSS, a central government initiative for open schooling, to ensure that its training courses are government-recognised.

Since 1996, the hospital has brought maternal and infant mortality down by 75%, doubled the number of deliveries happening at the hospital, and boasts of indicators better than the national average. But it’s clearly more than healthcare. It’s a social revolution. Running the hospital themselves has given the tribals great confidence. By doing so, they have sent out the message to non-tribal communities that they are a “capable” lot – a big step to be accepted within society.

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Aadeep