A search for answers
Before telling you about Sangwari, let me share why and where the journey began. It will give the shared experiences a broader perspective and make this a part of a bigger journey of deciding what to do in life and discovering the purpose of life (if any exists so) or simply the journey of living life.
The first two proffs had been really busy and I never got time to explore beyond academics. It was only in the 6th semester that time was available for disillusionment in life. I started feeling discontented with the health care system and myself. Health care system because I was unable to see how it was helping the unprivileged (all apart from politicians and relatives of healthcare workers). Was it really helping? I was beginning to question the trinity mission of AIIMS, clinical care, research and education. What can I imagine myself doing in life among or beyond these three? I was searching for answers and the comparator was not AIIMS, it was absolute. Would it be helping the most underprivileged person you would meet? Or rather simply, how could I deliver healthcare to all as I would provide it to my own family members?
Beginning of the journey
I had previously visited JSS and SEARCH, well-established organisations by then. They were similar in structure to CCM (though work done there was with greater passion, efficiency and vision directed). Sangwari is different in that it has yet not reached its final form yet. I had hoped to get an opportunity to visit an organisation in its inception. My objective was to know the team and structure and processes of a budding organization and be actively involved in its work.
What did I find?
Sangwari means “partner”. Health care professionals working as partners for a vision of equity and health, also partner in sense of companionship provided to people in times of good and bad health. Sangwari is different from other organizations I have visited, it is actively trying to create a work culture of friendship not hierarchy and it is based on improving healthcare systems rather than just running a hospital by a few highly inspired doctors.
I have asked myself often how many patients an NGO will be able to treat. What impact will it have? In the words of Dr Yogesh Kalkonde, just direct clinical care done by any NGO would never be sufficient to solve the problem. Yet it is important for two reasons. First, it gives you direct experience of the village ecosystem and problems faced by people and thus helps in designing better systems than just observing people’s problems through a telescope (professional goal). Second, it keeps the people working grounded (a spiritual goal).
What did I learn?
1. These people and organizations are simultaneously different and not different from us and the organizations we work in.Don’t expect to see something startling while visiting such organizations or interacting with such people on the surface. It is different not in the way it treats MI or TB. It is also not different from departments like Community medicine in methods and tools used for practising public health. The difference lies in their vision/purpose of equity and more importantly equity in health.
2. It is easy and not easy: It is easy in that one need not do an MPH to be a public health practitioner. It is not easy as public health physician since in resource-limited settings one’s clinical medicine need to be much stronger than someone practicing at academic institutions. You don’t just see scabies, ARI and diarrhea in villages. One sees a wide variety of complex problems including non-communicable diseases. The problems are not only limited to diseases. You need to repair the health systems (which happen to be in stable equilibrium) for which interaction with different stakeholders (politicians, local community leaders etc.) is required and it is not always a pleasant experience.
3. I need to set clear goals and objectives (they may change with time and place) and make plans in accordance with them. This applies to research, academic learning and life. For example, if I am visiting an organization, I should write what my objectives are.
4. Don’t idolize people: I shouldn’t make someone my role model as most of the time I just have a cognitive image of that person created by books or a few personal interactions in real life. When we face their true version (which was always the same), we get shattered. So what I want to do in life should solely depend on my experiences rationally (and sometimes suprarationally).
5. Expand your comfort zone: Rather than working far outside my comfort zone and getting mentally fatigued, I should try to expand my comfort zone gradually. I need to keep exploring new places, meeting new people and developing a clearer idea of how I want to live my life.
Dr Adarsh Pal
MBBS, AIIMS Delhi.