[ Note - Due to lack of time, instead of posting at relevant lines, I am posting all images and videos in the end of this post. I will reformat and correct grammatical mistakes, if and when I could get time. ]
Hello, I am Dr. Atul Tiwari, Medical Officer at Pratapgarh (Rajasthan). I was originally posted at PHC Avleshwar of Pratapgarh district. On July 25th 2012, I attended State level training and thereby became one of the district trainer (and The Youngest one) for Measles Immunization. It is a govt. program to vaccinate and/or re-vaccinate all children of age range 9 months – 10 yrs. And we were asked to achieve target 100% strictly, else we will have to complete this task without any extra financial help.
On 8th August 2012, I was (relieved from PHC Avleshwar and) ordered to join PHC Devgarh, which was said to be one of the toughest place where achieving a target of even 50% was a challenging thing. Now I had 2 PHCs to take care of, one officially (PHC Devgarh) and one unofficially (PHC Avleshwar, as there was no acting Medical Officer for the task). I relieved and joined from respective places on the same day. I don’t want to describe the PHC building / infrastructure at this point, as it will divert my original topic. But it should be pictured some other time. I just want to highlight that at that time I was completely unaware of geography of that PHC and its 34 villages.
Now my mission was to vaccinate 7985 children of PHC Devgarh and 5210 children of PHC Avleshwar within the working days limit of 17th September to 6th October 2012. And believe me, it was never like that I knew where these children live or even who these children really are or they will themselves come directly to me to get vaccinated. I along with my staff of both PHCs had to work hard to count, enlist and trace all the children of age range 9 months – 10 yrs. Then we had to design the Micro-plan when and where we will vaccinate. Also, I want you to know some important issues about measles vaccine –
1. It should always be stored at a temp of 2 – 8 degree Celsius.
2. It shouldn’t be exposed to direct sun-light.
3. Once reconstituted (prepared) it should have to be used within 4 hrs, else even injection to the child can cause Toxic shock syndrome and thereby leading to Death of otherwise healthy child.
So providing all the logistics an appropriate environment was another big challenge because this is not Delhi – Mumbai, where you have power sources. Here we hardly get 6-8 hrs of power supply, and that too after begging.
I worked almost 16-18 hours a day to plan all this from Aug 8th to Sept 16th, with many sleepless nights too. From Sept. 17th my real exam started. Although I never took this program lightly, but on the very 1st day I got hard realisation that it won’t be an ordinary task in any means. I made 10 teams in PHC Devgarh and 9 in PHC Avleshwar. Each team consists of 1 Vaccinator (ANM or GNM), 1 ASHA / Aanganwadi (of respective village) Worker and 1 Teacher (of respective village’s school). To be truthful I didn’t get much support from Teachers and Anganwadi workers. There were 6 supervisors to monitor at least 3 Vaccinators each. I and my staff had to wake up at 4:30 AM every day, so that we can do pre-vaccination work, and can start Vaccination program by 8:00 AM.
As I was never in a mood of describing my life in front of the world, also I never want to recall any of these in my life again (because if one health program finishes, another starts) so never took any photo or videos. But something happened on 22nd Sept 2012 that forced me to make a complete post on this task. Those few hours of ours can show the world, how medical officer and their staff work, rather struggle in their day-to-day life. On 22nd Sept, we were to vaccinate in a remote and hard to reach area named Pal.
One day before, we had our vaccination program in Jamabuwela situated at the border of Pal. My bike and the Pick-up van (carrying the whole team with vaccines and other logistics) got stuck into Mud. Yes into mud. What do you think? We don’t usually get roads to do our work, and neither can we wait for the govt to make the way/roads for us. Anyways that day all the staff had to reach the destination by feet only. And believe it’s not just walking freely. Each vaccinator has to carry 2-3 vaccine carrier (where there are vaccines + diluents for about 200 children, which is strictly to be maintained at 2-8 degree temp), one dustbin, two banners, one hub cutter, 250 syringes, one kit for emergency meds, 3 types of different reporting formats etc. And after that if you have some space in your hand, then only you can carry your lunch box (also if you got enough time in the morning to make it).
My bike fell vertically 90 degree into a pit there, and my clutch wire got damaged, along with some other minor damages to the other part. Thankfully, I didn’t get any injury (except for one minor abrasion at right knee) and was fully able to work.
It took 6 hrs to get the van out of that Mud. I reported this instance to my superiors, because it was impossible to go on such HIGHWAYS again, to go to PAL. One of my superior said “Doc, you don’t want to work, that’s why you are excusing”. One other commented “My bike was damaged already and now i am just making excuse”. Anyways, they didn’t aborted the program, but at least they agreed to give me a Govt. Gamma Jeep for my Team. Like I said earlier, till that day I was not in a mood to record/take photo of any of this.
On 22nd we again started the job. But like I knew the Jeep couldn’t cross that Mud. I with my team members tried hard to rescue the jeep, but we couldn’t. In such cases what should one do? We should call for help. But there is no mobile network coverage. One of our staff walked for 2 kms to get the mobile signal to call for help. Meanwhile we continued our efforts. When I got tired I did two things –
1. Clicked pics and took video of few mins, of that situation.
2. Went into the village, for help. While I was walking, I realised world should know that what highway govt is providing me and my ANM for the ease of work.
It took again 4-5 hrs to rescue it. And this time the plan was aborted for the day.
But, later I was asked “When I knew that roads are severely compromised, then why didn’t I use the Tractor.”
So, I filmed one special scene too. Also, not to mention how many of you are ready to go into tractor 20 kms on such roads. And then can work continuously for 15 hrs.
Have a look at these, and judge yourself –
1. Vaccinator gets Rs. 75/- day for this work [I needed money for at least 110 sites, I got money for 100 vaccination sites]
2. Asha/Anganwadi worker gets Rs. 50/- day
3. Supervisors get Rs. 75/- day + Rs. 100/- day for the vehicle/petrol [I had 3 supervisors/phc and I got money for two]
4. I get 1000/- per day for the vehicle to drive on these so-called roads [I asked for 16 days transport facility, and I got it for 10 days only. ]
5. Medical Officer gets nothing – So practically he is supposed to do some scam to save money for himself.
How am I supposed to pay the rest of the amount?
Since 17th Sept to 5th Oct., I have driven 837 kms Bike for the measles vaccination program. (and charged rs. 950/- for the damage caused by it) I could have done Rajasthan tour in that much of kms. And I know, I won’t get a single rupee for it.
So, far I have successfully vaccinated about 89% of children. Rest are left into Pal, where we are trying our 2nd attempt, to vaccinate on 9th and 10th Sept. Wish us luck.
While I got tired, my staff was still working hard to rescue the jeep.
My ANM told me there is only one person in the village who has tractor, I along with the ANM started another journey. One little boy of the village, guided us the shortest and most convenient pathway. It was about 2.5 – 3 kms. Just a few glimpses of pathway. believe me it was much more terrific in the starting, before I got the idea to record it.
Where vehicles can’t go, we have to go, and we do go; Not because we want to be hero or something, just because we know, if today we failed, no one will ever try to vaccinate these children.
The tractor which came to rescue us, itself got stuck and blocked our way. People tried to rescue it, but couldn’t get success, then later our team joined to help them. I didn’t get time to edit these videos and mark, that 2 of the persons are Medical Officers helping that tractor.
It’s easy to speak on TVs that Doctors are Looting patients and other Blah, Blah, Blah, but live our lives first and only after that, you can say something about us. What do you think, at the end of the day, I could get a sound sleep after this body-breaking work. NO. Measles is not the only responsibility for the doctor. Sickness of the people doesn’t check my schedule. I had to manage and treat others too. And now I can’t sleep, because I am having a nightmare (since last 3 days) of the newborn (6-7 months premature delivery) whom I couldn’t save just because I was completely broken in this program and I couldn’t reach to him in time.
Govt. asks doctors why don’t they come and join PHCs. I openly want to say to all the Doctors that “If you want to be honest with your life and duty NEVER join state medical services (as its very hard to stay honest in this system, and one or the day you will have to be part of its corruption… I am also waiting for that day); and if you are good with speaking lies and know how to forge reports, also don’t care if someone lives or die.. You are the most eligible candidate for this job.”
Story doesn’t end here.. it’s just one day of my life…