By Dr. Raj Arole and Dr. Rajanikant Arole

Two Indian citizens from two different, socially concerned families go to medical school with a dream to serve the poorest members of Indian society who live in rural villages.  Raj Arole and Rajanikant Arole meet eachother in medical school, court, and marry.  After extensive training in India and the US (medical school and public health training), they set in motion a comprehensive rural healthcare project in rural India.  The doctors’ journey to the poor is a long and complicated one because the social structures and cycle of poverty in which the poor are born are difficult to break into.  

The doctors begin by creating a strong medical center or hospital with an operating room, simple lab equipment, etc.  They use this medical center as a base and venture forth from it to small surrounding villages where they do medical camps in order to establish credibility among the villagers.  When there is a terrible drought, the healthcare project drills wells, in the end, creating a clean water supply for the whole region.  Later, the health project begins a Farmer’s Club by inviting men of all Indian classes to play volleyball in the evenings.  Once men of different classes begin to interact, some of the walls of caste prejudice are dropped and the men begin to discuss their everyday problems and complaints about agriculture, etc.  From these meetings, Farmer’s Clubs are created which become forums for men in the villages teach each other about agriculture, land erosion, and social problems.  The Farmer’s Clubs work together to improve the fertility and productivity of the region.  Eventually, the Farmer’s Club in each village elects a single, mature woman to become the village healthcare worker (VHW).  These VHWs travel to the medical center every week to learn about healthcare.  The VHWs are mainly illiterate women who have never been to school, so they are taught by the doctors, nurses, and each other through discussion, drama, illustrations, repetition, song, etc.  The VHWs return to their villages every week to oversee the daily health of the villages: they help deliver babies in uncomplicated pregnancies, administer simple drugs, keep track of vaccination and vaccinate, educate about sexual health, etc.  This whole process (from health center to VHW network) takes over 10 years.  

In the last chapters of the book, health census statistics which were taken throughout the years are published, and I was shocked to see quantitatively how the health of the villages were improved.  This book introduced me to the strategy of establishing a healthcare project among rural peoples.  The most interesting section to me was the chapter where the authors describe teaching the VHWs.  The concept of teaching non-literate people through discussion and other creative means energizes me.  I thought that the most practical section in this book was where the authors detailed methods for taking a health census.  I recommend this book to anyone interested in community health, especially someone who is interested in being involved in a community health project like Jamkhed.  

The Jamkhed rural healthcare project has been among the poor and marginalized for over 37 years now.  When it was first established, it used unprecedented methodology and made many advances in community and public health such as the concept of VHWs.  I think that one of the reasons that the Jamkhed project is so sucesful is because it is built upon the theology that each person is made in the image of God.  This concept has implications that are far reaching.  For example, with this theology, the founders of the Jamkhed project were able to break through the prejudices of the Indian caste system which kept so many people in poverty through their minds and through socio-economical structures.  Also, women were valued as much as men throughout the project; for example, VHWs (mostly women) made the more of an impact in the health of villages than any other component of the healthcare system that was set in motion.  I liked the fact that Jamked medical center was known to the village people as a “river of knowledge” from which knowledge flowed freely to every person who wanted to learn.  Each person in the healthcare system (from the ambulance drivers to the man who made prosthetic legs) was expected to teach another person.  Knowledge should freely flow from each of us who are blessed with formal education so that it can be shared with all.  However, many educated people tend to be like stagnant pools, keeping knowledge to ourselves.  This does not bless the poor.  In the future, I would like to take a few Makonde people with me to stay at the healthcare project in India for a month to learn from the VHWs there.  

The question I am puzzling over now is, how do these concepts relate to the Makonde?  Is a comprehensive healthcare system like Jamkhed needed?  How can I adapt the most helpful parts of the Jamkhed system to serve the marginalized and poor in Makondeland?  Please pray that God will give me wisdom as I continue to read and translate these massive ideas into real health for the poorest of the poor.  Find more information about Jamkhed at http://www.jamkhed.org, read the book Jamkhed, or leave comments for further discussion.  

–Heather Kellis

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