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High infant mortality and death of women during childbirth is a fact of life in many hilly areas of Uttaranchal. This is not surprising given the fact that hospitals and medical facilities in remote areas are grossly inadequate. Despite repeated demands by hill communities across the state to improve medical facilities, the government has done little to address this fundamental problem. The nearest basic doctor and chemist are often a day's travel away, with a large part on the journey done on foot. Hospitals are few and far between and where there is a hospital building, it is usually ill-equipped or empty, with no staff for much of the time.
Speaking at a two day para-medic training in Dehradun, organised by RLEK, a Doon-based NGO, Ramavati of Dei village in Mori Block, Uttarkahsi District said that women suffered the worst as a result of poor medical facilities, particularly in the area of childbirth and reproductive health. She went on to say that 'due to the lack of maternity hospitals and gynaecologists in their locality, most women suffer in silence until it is too late'. Given the expenses involved in taking a patient to a hospital in Vikas Nagar or Dehradun, women generally reach the hospital at an advanced stage of illness, when it is often too late for treatment. Adding to this, Vikram Pawar from Bhatwari, Thatyur Block, Tehri District, said that on admission to hospital, patient's families are neglected and not informed about the diagnosis and procedures.
Social stigma makes women ashamed to talk about their reproductive health and problems and the lack of female gynaecologists compounds this situation. Lack of awareness about family planning methods mean that women conceive frequently and within a very short space of time, and as a result are found to be highly anaemic. The traditional social system favours health care of male members and as a result, women tend to neglect their illness until they become too sick to move around and perform household chores.
RLEK, in the course of implementing a community empowerment for sustainable development project in 100 interior villages of three districts of Uttaranchal; Uttarkashi, Dehradun and Tehri, responded to the community's demands for increased access to health care facilities, by training 10 people from each district as community-based para-health workers, who could fulfil the community's basic health care needs. Since November 1999, comprehensive training in first aid, preventative health measures and traditional healing systems has been given to 30 community members. The trainings have been done in three stages; orientation, advanced and refresher. Refresher courses are given at regular intervals in order to check and enhance participants' knowledge. Para-health workers have also been supplied with a basic first aid kit, which allows them to distribute medicines to the community in times of need. To ensure sustainability, patients buy the medicines at cost price, so that the para-worker is able replenish his/her stock when the need arises. This initiative has proved to be highly effective because it has at least given remote village communities some degree of access to basic health care facilities. General awareness about first aid and preventative health care measures has also increased in the villages as the para-health workers share their knowledge with the whole community.
The two day refresher health training held by RLEK on 27th-28th May, 2002 focused on family planning and reproductive health, including the rising instances of HIV-AIDS in rural areas; nutritional needs of women and children and information about various communicable and water-borne diseases prevalent in the hills, such as hepatitis A. The training concluded with the message that education and health are the two main areas, which need urgent attention from NGOs and government departments.