How it began at ASHWINI

“It does not matter if you save a life by giving Intravenous fluids or by doing a complicated surgery. The bottom line is that you have saved a life.”

These are the words of Dr. Nandakumar Menon, founder member of ASHWINI and director of the Gudalur Adivasi Hospital. It was in the mid-1980s that he first came to Gudulur – with a jhola on his shoulder, sporting dusty, rubber bathroom chappals, having bus-hopped from Kerala to Gudalur (Tamil Nadu). It was his search for their i.e. he and his wife Shylaja Devi Menon’s dream village that had brought him there. He had heard through connections with his alma mater that they were looking for doctors to run a hospital here.

Both doctors, he a surgeon and his wife a gynaecologist, they had recently returned from America to India then; having decided long ago that they would return home after saving up $100,000 from their medical practices.

At that time, ACCORD was running a community health programme in the nearby adivasi villages. The programme trained village level Health Workers (HW) from the community itself, to identify and prevent illnesses like diarrhoea, to provide immunisation and nutrition to pregnant women and young children, and generally to improve health awareness among the adivasi community. The ACCORD team used to go village to village, house to house, to ensure healthcare was reaching the people.

And it certainly was – as the team had more-or-less eliminated preventable deaths among the adivasis (like due to diarrhoea or during childbirth), the immunisation status of children & pregnant mothers had dramatically improved and more. But despite its success, there were inevitable cases needing hospitalization – high-risk pregnancies, acute cases of diarrhoea and fever among children, amongst others. While the doctors used to refer such patients to the local Government hospital or to the private clinics, the experience with these alternatives was not very encouraging. At the private clinics, the costs of treatment posed a problem (though ACCORD subsidised these costs). The care and treatment given to patients at the Government hospitals was not satisfactory. Many times, the doctors themselves weren’t around. Dr. Shyla recalls that the Adivasis used to refer to the Government hospitals as “Diarrohea Wards” where one went and returned “feet first” – meaning you’d be wheeled out on a bed as you were dead!

The need for an efficient hospital was increasing by the day. After much deliberation, a search for suitable people to run the same had begun. It was against this background that Dr. Nandakumar arrived at their door – with rubber chappals and jhola on his shoulder.

The couple looks back today and laughs. How naïve they were! $100,000 was quite a small amount to run a hospital. But coupled with donations and government funding for tribals, they have managed just fine. From a one-bed facility in 1986, the Hospital has grown to forty-beds today. Complete with a delivery room, operating room, outpatient rooms, lab (to run samples for diabetes, anemia, sickle cell, and TB), pharmacy, daycare, and classrooms upstairs to train the staff.

But it’s been 14 years of ups and downs! After all, from an emergency trauma center where helicopters flew in accident victims to minimal facilities with erratic electricity and perennial water problems was never going to be an easy ride! And they have so many anecdotes to share about their journey.

From girls they took on to be nurses. They’d made it to high school but their Maths and English were just abysmal. Shyla recalls how they used to cut a cake to explain fractions so that they could calculate drips. Very basic concepts had to be worked on literally from scratch! Or the operating room, which was a tiny narrow ward in which the home-made operating table just about fit. When Nandakumar performed an operation, or Shyla did a Caesarian section, the anesthesiologist had to sit under the table holding the bottle of ether. Forget air-conditioning, there was no room for even a fan. One person mopped brows!

There’s tons of anecdotes about patients too. Once, in 1990, soon after the hospital was opened, a forest-dwelling patient arrived, his face ripped off by a bear. It was a ghastly sight. The government hospital had sutured his face without cleaning the wounds. Unbelievable but typical. Then they’d found him gasping for breath and told him to go 40 kms to Ooty to the district hospital. His family brought him to the Adivasi Hospital instead, where Dr. Nandakumar performed an emergency tracheotomy. He then had to remove all the stitches the government ward aide had put in, clean the dirty wounds and leave them open. He’d barely finished, when in an unbelievably nightmarish coincidence, another bear attack victim walked in from another part of the district. Days later, the first patient ran away without removing his tracheostomy. The emergency was over, he could not stand life outside his village surrounded by strange people. He never ever came back and the team speculated about the fugitive patient for years to come.

But things that have gone right more often than wrong. And records reflect the same. Maternal mortality and infant deaths are lower than the national average, diarrhoea deaths have almost ceased, and most importantly, Adivasis come voluntarily to the hospital rather than running away or preferring to die unnecessary deaths in the security of their own little verandahs.

There’s no stopping this doctor couple. During my visit in May 2014, a new ward thanks to funding from the TATA Trust had just been completed. And they were awaiting all approvals for their much-needed blood bank to come through.

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Aadeep