Expanding Health Services to Melghat Region in Amravati

Melghat, a hilly forest area in the Satpura mountain ranges is a habitat for Tiger, Bison, Bear, snakes and many more animals. Melghat stands for its name, which means ‘cluster of Ghats’. A tribal corner in the northeastern fringes of India's richest state-Maharashtra- Melghat is an apt example of almost everything that has gone wrong in India's response to malnutrition and child deaths.

The health related data in Melghat possess the punch of an eye opener: every 14th child dies in Melghat before reaching the age of six, often owing to malnutrition-related causes. These numbers put Melghat almost at par with less-developed sub-Saharan nations such as Senegal and Tanzania.

With an under-five mortality rate of 74, Melghat has twice as many children dying before the age of five as Iraq. A child in Melghat is thrice as likely to be severely malnourished compared with an average child in Maharashtra, according to ICDS data. Melghat comprises of Dharani and Chikhaldara tehsils of Amravati district and has been witnessing 460 child deaths on an average every year in the last five years, of various causes linked to malnutrition

For the population of over 3 lakhs in Melghat, there is only one Sub-District hospital, two rural hospitals and 11 Primary Health Centres (PHC). But for a region which has already witnessed thousands of Child deaths, till recently there was only one paediatrician and no Gynaecologist.

Clearly, Melghat has unacceptably high maternal mortality, infant mortality and malnutrition. With doctors reluctant to serve in resource limited settings, and hesitant to stay in villages in Melghat, the poor and rural people in this region would find it very difficult to access a healthcare that they could afford. Many die prematurely- unsung and unwept.

The villages of Melghat-with treacherous roads, closed schools and mostly without electricity or piped water-appear to be in a time warp, left behind by India's famed engine of economic growth. In several villages, child deaths are more frequent than the visits of public servants.

Beginning 1998, Dr Ashish Satav, a physician and Kavita Satav, an ophthalmologist- both faculty at MGIMS, chose to leave the comforts of teaching at MGIMS and decided to take a path less traveled by- the couple chose to live in a village in Melghat. They were fully supported by MGIMS. Over the last two decades, this couple has invested the best years of their life to care for patients with medical and eye related problems. Mahatma Gandhi Adivasi Dawakhana and Dr. Sushila Nayar Netralaya, at Utavali in Dharni Block, where the couple worked offered much needed respite to tribal, poor and rural people.

An equally important health problem in Melghat is mothers dying during deliveries and parents not being able to celebrate the first birthday of their children:

In January 2012, MGIMS asked Dr. Shakuntala Chhabra, the former Head of the department Gynaecology and the former Dean of MGIMS to supervise all activities related to health care issues related to Melghat. MGIMS decided to go beyond the walls of a medical school and a hospital and planned a community based healthcare facility where its doctors , nurses and paramedics would actually stay and treat patients.

Shri Brihad Bhartiya Samaj, a Mumbai based trust funded MGIMS to convert the existing hospital into a makeshift hospital where pregnant women could be cared for, and delivered and pneumonia and diarrhea - the deadly villains that kill babies could be treated. MGIMS also acquired necessary equipment, upgraded the diagnostics and treatment related facilities and built hostels where young graduates and faculty could stay, enjoy internet connectivity and do their professional duties. MGIMS bought land to build a multispecialty hospital in Utavali village and also bought four flats in the vicinity.

Now a team of obstetrician – gynaecologist, paediatrician, anaesthetist, medical officers, interns, nurses and other paramedics is working 24/ 7 to offer preventive, promotive and curative services this region so badly needs.

MGIMS is conscious of the fact that for an effective public health to function, all stakeholders should join hands and work together. The Sub District Hospital Dharni and our centre work in tandem, We expect the central and the state governments to recognize our activities and fund our projects aimed at reducing mother and child deaths.

Four nurse midwives visit 52 villages once a month and provide community based antenatal services, advocacy about antenatal, postnatal, neonatal care in the villages. They are supported by 4 medical officers – who visit these villages 4 days a week.

Over the last four years, we have cared for 20467 outpatients, admitted 1811 inpatients, performed 700 surgeries, delivered 210 babies, performed 85 caesarean sections and operated on 30 women who required hysterectomies and surgery for ovarian tumours.

The first caesarean section was performed on 21st January, 2012. The mother and the child went home a week later. A woman with cancer of ovary underwent hysterectomy on 15 February, 2012. The woman is doing well 2 years after her operation.

We have also been arranging screening camps in the villages : we screened 226 individuals in March 2012, 1036 in February 2013, 1107 in 2014, 1107 in 2015 and 1883 in 2016. We also assessed children with cleft lip and cleft palate in December 2013. Plans are afoot to launch family life education and community based disability detection.

The Dr Sushila Nayar Hospital at Utavali is also active in the following villages- close to the hospital- where nurses, paramedics, interns and medical officers pay regular visits to collect data on determinants of ill health, educate children, adolescents, men, women and elderly about various health-related problems, provide them point of care medical help and also help those who require medical care in the hospital. Active in 65 villages around the base hospital, the team plans to provide community based healthcare in 35 more villages, soon.

Sr. No	Village	Population
1	Tangada	474
2	Rora	512
3	Kadhaw	800
4	Mangiya	818
5	Bulumgawan	645
6	Sonabradi	936
7	Kund	110
8	Rangubeli	390
9	Dharanmahu	2022
10	Chethar	632
11	Duni	2000
12	Kekababod	1004
13	Chatawabod	1471
14	Jutapani	1256
15	Diya	1445
16	Chichagat	1180
17	Dhulghat	1010
18	Hatnada	394
19	Shirpur	1448
20	Hatida	1040
21	Takarkheda	406
22	Patiya	1825
23	Bherdaburu	1087
24	Titmba	2695
25	Chikhaldhana	290
26	Harda	787
27	Chwarakund	1090
28	Baru	1207
29	Forestmalur	201
30	Gobarkhau	1064
31	Zapl	630
32	Kutanga	2108
33	Khamda	316
34	Bairagad	2543
35	Ukupati	840
36	Bhokarbardi	1800
37	Kakrmal	850
38	Kalpi	630
39	Tangtangdhana	180
40	Mandu	1218
41	Talai	1165
42	Ranitamboli	1440
43	Mandwa	745
44	Karda	1278
45	Dhahinda	1700
46	Nirgudi	763
47	Sawalkheda	820
48	Ratnapur	2070
49	Pankhya	749
50	Ghuti	1003
51	Talaikamp	1055
52	Mokha	1100
53	Utavali	1100
54	Bhondilawa	876
55	Dhakrmal	938
56	Gonwadi	1685
57	Kusumkhoth	1089
58	Bod	1065
59	Tembli	1845
60	Chutya Nandgaon	701
61	Babanda	774
62	Chakarda	1845
63	Jirtdhana	239
64	Hardoli	847
65	Chikhalpat	130