Kashijora is a quaint village spread like a thick vine around sporadic clusters of sal trees. Though administratively part of the Salboni block in West Medinipur district, the village is a world in itself. Nestled into an expanse of green, it is a curious mix of huts as well as both adobe and pucca houses. The village has 158 households and a population of 847. Professionally, the villagers till land, mostly their own and in cases also others’: they grow paddy, mustard and potato. 
    
Quite close to the panchayat office which roughly forms the centre of the village, in a mud house lives eight years old Puja Mahato. Her father is a farm labourer like many others in the village while her mother is a housewife. Today Puja got up from her bed with a bad earache. Before she could wake up properly and figure out the area of her pain, her father like any other day had left for his work. She knows her mother will not get free from her share of domestic chores before afternoon. So when her pain becomes excruciating, she leaves on her own for the health sub-centre in the village. Luckily, it is merely a stone’s throw from her mud house.

Villagers’ first point of contact in cases of medical emergencies, the Kashijora sub-centre has on any given day two auxiliary nurse and midwives (ANMs) and an unfixed number of accredited social health activists (ASHAs). In case of a doctor’s help, the first point of contact is the block hospital. One of the ANMs in Kashijora sub-centre, Monideepa Chakraborty, is known to the Mahato family and it is this acquaintance that has allowed Puja’s mother to send her alone to the sub-centre. But today, it is a different scene here.

Puja arrives at the sub-centre to find quite a crowd of patients there. There are equipment, a pathology technician, a pharmacist, an x-ray technician and above all a doctor here. Puja is confused and keeps loitering here and there unless she is helped by someone and taken before the doctor.
What Puja witnessed at the sub-centre is a mobile medical camp, which operates in the remote areas of Paschimanchal under the Jangalmahal project of the national rural health mission (NRHM). Under this project, a mobile medical camp consisting of a qualified doctor, an ANM, a pathology technician, a pharmacist and an x-ray technician visits six different sub-centres in Salboni block of the district six days a week to give health services to the villagers free of cost. The programme has been outsourced to an NGO, Child Support and We, which runs it in the block. The team visits six sub centres – Madhupur, Satpati, Kashijora, Dakhinsole, Sarashbedia and Jara – one each day. Health services, check-ups, blood tests, x-rays and medicines are provided to the people for free.

The camps are operational in 18 blocks of the region so far, since the middle of January. Camps are going to be started in two other blocks from March. Besides West Medinipur, mobile medical camps are operational in Bankura, Jalpaiguri, Purulia, North and South 24 Parganas. In West Medinipur district, five NGOs conduct the mobile medical camps in 11 blocks.

Here is an account of a week spent with the mobile medical camps, one each in a different village.

People
Dulal Chalak coughs repeatedly as he awaits blood tests and an x-ray in the porch of Jara sub-centre. His son Buddheshwar tells Governance Now that the doctor suspects he has tuberculosis. Even a year ago, people like Chalak would have to go to the Salboni bock hospital for a check-up. But now, help arrives right at his doorsteps, even if once a week.  

The working conditions are not always conducive to run a health camp. In Sarashbedia, the medical camp is run in an under-construction sub-centre. The floor is littered with iron rods; there is no electricity or running water. “We were shifted to this place from the original sub-centre as there was no space,” says ANM Sunaini Pal. Due to absence of electricity largely, x-rays cannot be performed. The doctor is examining patients by the light streaming in from the windows. Only in Kashijora sub-centre, there is adequate space to set up medical equipment properly. Even then, frequent power cuts play spoilsport.
Sambhu Mahato, 10, has cycled from his village in Baikanthapur all alone. When asked why no one is accompanying him, he says that his mother is busy with the household work. He hurt his ankle a few days ago and is awaiting an x-ray. Luckily for him, the power came back and he got his x-ray done.
Not everyone is lucky though. At Jara sub-centre, Srimanta Mandal waits for his x-ray report. A few days ago a heavy paddy sack fell on his leg. “It has been aching ever since. The doctor advised me to get an x-ray done,” he says. A few moments later Biswajit Jana, the x-ray technician comes out with his undeveloped plate and asks him to come back the next week. “The chemical is very old and needs to be changed,” says Jana when asked what went wrong. Chalak meets with the same fate. Chalak, who was coughing badly all along, was positioned with great difficulty under the x-ray machine by Jana and his son. He waited almost twenty minutes to get his results. “If his condition deteriorates, I will have to take him to Salboni,” his son says.

Problems
“Illiteracy is the biggest challenge,” says Dr Sivananda Acharya, the doctor associated with the team.  “Breastfeeding is advised till six months from the time of birth. I have women coming and telling me that they have been breastfeeding kids till four years. They are unaware of the nutrition deficit being caused due to this,” he rues.

Dhanonjoy Mahato, 70, is suffering from an acute stomach ache. He had stopped taking medicines sometime ago and has come back for a check-up. “He won’t listen to us. He stopped taking medicines as soon as the pain was relieved. If we try to make him finish the course, he would accuse us of trying to kill him,” his son says.

Jagannath Bishnoi is suffering from acute diarrhoea. He had been referred to the Salboni block hospital by the doctor but still he comes back every week. “The OPD was closed when I went to Salboni hospital. My farming activities don’t allow me time to go there. So I come here,” he says.
Bijoy Bhandari, 68, has been suffering from stiff arms and legs for the past 20 years. “I cannot afford the medicines prescribed at Salboni hospital. So I come here. The free medicines given here provide me at least some relief,” he says.

“Absence of awareness, prevalence of customs combined with the reluctance to know what has really happened make our task very difficult,” says Acharya. “The biggest challenge is not to get frustrated,” he adds.

On Monday, the team arrived late at Madhupur sub-centre. Mamoni Tudu, who is cradling a baby in her arms, says that she will go to the local quack if the team doesn’t show up. When told that quacks are not really doctors, she looks a bit confused but walks away nevertheless. Soon after this, the team arrives and the patients queue up in front of the doctor’s room.

Patients mostly are not aware what their problems are. Some of them come without cards or have lost their cards. At times like these, the doctor is clueless about the nature of their ailments and their medical history.

Dr Trideep Das, deputy chief medical officer of health 1 (CMOH1), West Medinipur, says, “These 65 gram panchayats, where the medical mobile camps are being held, have no primary health centres. So there is no facility for clinical services. The micro plan for fixing dates of camps is made in consultation with the block health and family welfare samiti. For every block, an NGO handles the entire operation starting from manpower, logistics, and equipment. It is their responsibility to make people aware of the existence of the camp.”

In Salboni, the camp so far has catered to 10,438 patients. The medical camp has to quite an extent been able to wean away people from the quacks.  Fudon Pathor, a resident of Sarashbedia, says that previously they used to go to the quack who charged them Rs 150 per visit besides the cost of medicines. “Now we have a fully qualified doctor at our doorstep and it is for free,” she says.

However, the mobile camp staff members complain of inadequate pay and manpower constraint. “Our salary is always late. We get paid every three months or so,” says Bhurishrestha. Dilip Das who ferries the team to and from Salboni gets Rs 440 per day. “When I cannot come, I have to arrange for another car. Nobody agrees for such a meagre amount. Then I have to pay them out of my own pocket,” he says.

Monitoring
The monitoring of the camps is done by a GPS-based tracking system. An SMS-based information collection has been started since the beginning of each camp. After each camp, the organising agency has to send one SMS to a dedicated number informing about their performance for the date. The information is ported in the database as well as for public viewing on the website www.wbnrhm.org/jangalmahal. Locations are ported automatically in the Google map.
On instructions of the state government to check whether the mobile medical camps are fulfilling their duties, now a district-level team comprising prime minister’s rural development fellows, West Bengal civil services executive probationers and IAS probationers will be closely monitoring the progress of the project. Inside sources say that the need for monitoring has been felt following some negative feedback about the camps.

A source also says the present monitoring system is not foolproof. “NGOs can hire someone to login from the site of the camp and hence mislead us,” he says. “There have been complaints that the doctors hired by the NGOs are not qualified and that the camps are irregular,” he adds.
But deputy CMOH1 Dr Das rules out such a possibility. “The camps are monitored regularly. Many NGOs have been back-listed as they failed to adhere to the guidelines,” he says.