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4E 7/t f ?.+tt , : . , i :r r ; : . : . . ; t t, . ; ; ,7r; ; ; i , , ;.. i

srrff"r.rJ v,ith no other option but to borrow morrey at high rates of interest. SX/eshall discuss this at greater length in section 7.)

Tn rss ' , wF, * ?Eh ,4A l t4 rnN{"A. ' t 'L **F .

Although the prevalence of ailments $/as pervasive and people were found to

resort to various health care services,n some of the cases atients remaineduntreat-

ed. \fhile a large majodtv of the suffering people availed of one or other kind of

health services in both the districts, yet 1,2percent in Birbhum and eight perceflt in

Dumka reported not to have taken any kind of medical treatment. (Seeappendix

table 8.6 for details.) Here, we shall briefly discuss the main reasons for not taking

medical treatrneflt.

Reasons for not taking tfeatment: Most of the respondents of both districts

expressed theit helplessness n terms of ftnancial affordability of the cost of treat-

ment. Thirty seven percent of such patients in Birbhum said that financial handicap

was the main reason for not taking treatment. The figure was much higher in Dumka

(64 percent). Accessibility to health services, t seems,was a big problem in Dumka.

Nineteen percent of such patients said that the reason for not taking treaffnent was

the difficulty in accessing health services. It was negligibly two percent in Birbhum.

Fifty six percent of such respondents (those who did not take medical treatment) felt

that it was not necessary o take medical treatment since the ailments were perceived

to be milder in kind, which could be cured natura\ In contrast, such responses

(treatment not felt necessary)were 14 percent in Dumka.2 (SeeAppendix table B.7)'Paisa

nei dekhabo i kore? We have no money, how can we avail of health set-

vices?"was a generalcomplaint of the poor villagers of'Birbhum. Dumka was also

no exception. Forthese people, as their experience went, the public health delivery

system has ceased o be free, and the fear of monetary involvement in many cases

left the patients out of the realm of health services.

The ordinary villagers of both the districts, saving a few exceptions, u'ere visi-

bly upset with the public health delivery systems.Most of them complained "haspatale

geledartarpauajai na, osudh o baire thekekinte hoi tahaleki labh okhanegi,e7(Doctors are

not availabie n hospitals, we have to buy medicines from private salescounte{s, what

is the point of going to hospital?)" In Dumka the complaints were more serious in

nature - m^ny of the respondents complained that doctors and health w-orkers did

not speak to them (ro"ge banro?ak') even afrer the suffering people queued up for a

long time to meet them. To our utter astonishment, we were told by some respo{r-dents that some doctors and health workers in Dumka charged money at the PHCs!

Poor functionality of the public health delivery system has created a sort of skepti-

cism about the PHCs and hospitals. This could v'ell be a reason for many people for

not taking treatment for some ailments, vzhich were perceived to be less serious in

nature.However we haveseen n many cases hat such negligence. ven n very minor

ailments, could take a fatal turn. One of the villagers in Dumka disttict neglected a

chronic headache. It was thought that the simple headache would be cured in due

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course and it was not worth spending money on. Later on, the patient had to pay ahear,yprice - he simply collapsed and died after he was raken to hospital following adeterioration in his condition. Doctors at Mohulpahari Mission hospital told the rel-ativesthat it was some kind of infection in the brain.

Doctors on the other hand, particulady in Dumka, criticised the adivasis for notrisiting the health centres.They held the

adivasis' "superstitious belief " in evil spir-irs (bongas)andheir dependence on witch doctors (Qhas,janguruqetc.)esponsible for

rheir not trsing the public health services.Not only the doctors but also many other

oeople including some academics subscribe to this belief in the adivasis' "supersti-

rious beliefs".3 However, our study found that very few of our respondeflts resort-ed to ojhasor the likes. It is probably the inadequacy and ineffectiveness of the pub-lic health delivery system that serves to develop an inhibition towards the govern-ment doctors and makes people depend

upon private providers. In some cases, hey:re forced to live with their illnesses untreated. There were however, some remark--rbleexceptions. Some of the government doctors were very dedicated and in such

olacespeople were seen to re\ heavily upon them. Interestingly in such places, nci-dence of "no tfeatrnent received" was neady zero,

Incidence of "no treatment received" has another dimension as well. of the:otal number of patients who did not receive any treatment at ail,,62 percent inBirbhum and75 percent in Dumka consisted of females.

Again nine percent of the;nale patients in Birbhum and four percent in Dumka remained untreated, but

rmong female patients the percentageof those who remained uncared for was much

:ugher 14 percent riBirbhum and l l percenr n Dumka.

Table 5.4 No treatmerit and gender inequality

Total number

of patients no ttaking

ffeatrnent

Proportion of

male patientsnot taking

t{eatn€fit

Proportion of r

female patients

not taking

treatment : Maie ' Fe-sral$.

Biiblrlrrrr.,.: 2.0 38.5) 32 (61.5) R . O '

Durnka:, 36 9: 25l: 27 Q5\ 4 1

! ;gurct in parm/fuxs iilicate percnlage

Underteporting illnesses and the neglect of aiiing females by their male coun-

ie{parts are the two phenomena.thatwe observed throughout our study (more on

rhis ptesendy),,Underreporting of ilinesses by women is probably causedby a com-

bination of factots. \)/omen are chiefly responsible for running the household, hence

rhe fear of expenses for fteatment and subsequeflt silence. Moreover, the inherited

knowledge about males.'neglectful response towards the suffering of women might

have caused the underreporting. AccessibiJiq' \n/asanother big problem, particularly

in Dulnka. In some villages people have to walk tor four-five hours to catch a bus.

In such casesvisiting a health setvice centre not only involves a strenuous journey

but also creates.various domestic probiems concerning childcare, c ttfe care, ̂ nd

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othefs. \7hi1e for male patients, "tfeatment not feceived" occutred only in casesof

perceived mild ailments, women were neglected even in casesof serious illness. For

.*r-pI., in Durnka five female patients suffering from malaria remained unattend-

ed by any health service provider, while no man was thus neglected. (For details see

appendix table B.6b).

D r r r r R r f i - i t l l r l l c A t s E R V i C rP R O V i D I R 5

$7e found two main kinds of health services in our study: (1) Public Health

Services, ncluding government doctors and health workers at different levels - from

hospital to the sub-centres, and,Q) Private Health Services. Private health services

can further be divided into: (a) Private Qualified Allopathic Practitioners - private

clinics, nursing homes, etc. (b) Private Unqualified Allopathic Medical Practitioners

cMP)- populafly known as "quacks"; (c) Homeopathic Practitioners; (d) Herbal

Medical Practitioners and others including witch doctors. (fhe herbal medical prac-

titioners, in the study ^rea afegenerally cilIed kabiraj, and the witch or magic doctors

are identified by many different names, viz. ojha,janguruand deasl'

euacks: Private unqualified medical practitioners or quacks (technically UMPs) per-

haps need some clarification. In our study we have considered those UMPs or quacks

who are (i) practising medicine without having registered with any of the recognised

medical councils in India (Allopathic, Homoeopathic, Ayurvedic, Unani, etc'), or (ii)

practising a certain kind of medicine but being registered with a different kind of

medical association (for example practising allopathic medicine with a homoeopath-

ic diploma or degree).

The term'quack' has come from a 16th century Dutch word

'quacksalver' that

combined two vrords'quack'and 'salve', implying one who quacks of boasts about

his salves.a

Quacks, howeveq afe not unique to any particular area. In fact, as a TV pro-

gfamme on the style of functioning of the quacks (most of whom had no basic

knowledge either of the diseasesor of their tfeatments) showed, quacks arc fast

emerging to run a paralTel ystem of health c^r..5 Con.erned at their uncontrolled

(mal)practices and plundering, the Government of Delhi tabled an'Anti Quackery

Bill" in the stateAssembly in1997, but for feasonsbest known to the law makers'

the bill's fate was consigned to oblivion.

The widespread prevalence of quacks in Dumka district has also been acknowl-

edged in public and other documents6 and their prevalence and alleged incompe-

tence were frequently mentioned by the pubJic health officers in Birbhum district'

As mentioned in the methodology part of this report, the study team with the

experr help of two qualified allopathic doctors made an assessmentof UMPs with a

sample of 10 quacks in the study areas.The initiation of the assessmentwas felt to

be important because of the widespread prevalence of UMPs who, in many afeas'

are the only source of medical treatment.The assessingdoctors used some simple criteria for measuring the knowledge