Dr. Azariah Ebenezer from the class of 2005 and his wife, Dr. Dawna work in Dangs District, Gujarat. After finishing their MBBS, they went on to do their Masters as well. They could have taken up lucrative offers in the city, instead they wanted to serve people in remote villages of North India. In this article, we give you a glimpse of their work and provide snippets of our conversation with the couple.
(For more details, please visit: https://www.asktrust.org)
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When we ask Azariah for stories from his villages, he usually shares something recent – maybe from the previous day, or the past week. The needs of the people are that many in count, with pain and helplessness being everyday visitors to the clinic bringing along their victims and their sorry stories.
“One of my neighbors in the village was a 62 year old man. He had Wernike’s encephalopathy – a condition related to lesions in the brain caused by Vitamin B deficiency. The patient also caught a bad case of pneumonia in the winter and he needed to be admitted to a hospital”, Azariah says.
Apart from other medication, he also required a nasogastric tube – basically a tube that carries food via his nose.
“I asked the villagers to admit him to a hospital”
But they said they couldn’t do it. The hospital is at a two-hour travel distance, and if two adults had to make that trip, it would mean the loss of daily wages of 2 adults – something the villagers couldn’t afford.
Azariah had to improvise.
“I started his first dose of antibiotic injection and taught the villagers how to powder tablets and give it through a nasal tube. I asked one of the men to keep an eye on him, for fear of the patient pulling out the tube while asleep.”
Azariah pauses to explain – “Try putting something in through your nose – it can be very irritating.”
“The following morning I had to leave the village. When I got back after 2 days they told me that the patient had pulled out the tube, and had stopped the food flow through his nose. He hadn’t eaten anything in 2 days. The patient had pulled the tube out while asleep, I asked them to buy a new one but by the time they got it, the man passed away.”
If there was an in-bed facility we could have saved this man, Azariah says in retrospect.
As Azariah shares this story, there are several things that cross our minds.
Number one, given the absence of trained professionals to provide medical care to the sick, the villagers and family members of victims have to rise up to the occasion. Within days of someone falling sick, family members occasionally have to be trained on powdering tablets, and introducing nasal tubes and what-not.
Number two – something that is very obvious in this recount is the lack of hospital facilities in the village.
We ask Azariah how he manages to see patients without a hospital.
We built a small clinic in Dungarda, it has minimal facilities, but we have it open at all times.
Pic: Dr. Azariah meeting with patients in the clinic
When we asked Azariah if the clinic was effective in solving the problem of sickness among the villagers, he had an answer that surprised us.
“I visit a total of 14 villages including the village that I have my base at. And for the people of these villages, to come to the clinics was cumbersome. Also, the travel across the jungles was not best option for the sick. The commute around here is neither regular or comfortable to travel for the sick. Apart from these shortcomings, going to the hospital meant the loss of daily wages for the workers”
“When we realized these issues, we knew we had to find a solution”, Azariah says. “We had to find a way to make medicine accessible to the villagers without them having to travel too far, or losing their daily wages. That’s when we decided to get ourselves a mobile medical unit (MMU).” An MMU is a vehicle with basic medical facilities that Azariah and Dawna can drive up to the villages they visit.
Pic: Mobile Medical Unit
Pic: Dr. Dawna meeting the sick inside the MMU
Once the MMU arrived, I needed to get a heavy vehicle license to be able to drive the MMU to villages. So I applied for one and got it. We make daily visits to the villages. Initially, the villagers were confused as to whether I was the driver or the doctor. I have adopted 14 villages. We cover all 14 villages every week, sometimes covering 2-3 villages in a day. Occasionally – depending on the condition of certain patients – we have to make more than one visit per week to the village. On many occasions, we sleep in the villages overnight. For a long time, I was doing the driving as well as meeting patients. Because we couldn’t afford to keep a driver. Only recently we have been able to hire a driver.
According to Azariah, there are other major problems in the villages that somehow get tangled into medical problems as well. One such problem is the prevalence of superstitions and witch doctors.
“During one of the daily village visits, I saw a 10 year old boy who had been suffering from stomach-ache for more than 2 years. I made a record of his history and then to examine him, I asked him to remove his shirt. I saw a lot of burn marks on his stomach.”
Pic: 10 year old with burn marks across his abdomen
“Upon questioning the boy’s parents, they told me that they took him to the local witch doctor who diagnosed it instantly to be the work of “the evil stomach-pain spirit”. The witch doctor then used burning rods on the boy’s stomach to drive out the evil spirit.”
“I explained to the parents what caused the pain”, Azariah continues. “It was what we call peptic ulcer disease or in simple words ulcer in stomach due to acidity.”
Azariah gave the boy a few tablets and told his parents what to feed him and some food to avoid. The couple and the boy came back 2 weeks later to thank Azariah. Because the pain had stopped after he took the medicine.
The villages are rife with superstitions. According to the viillagers, any sickness is the work of one spirit or another, and these spirits had to be appeased as a bargain for the cure. The long term solution to such issues to to alleviate their ignorance.
Not all of Azariah’s stories have a happy ending. The case of the 18 year old boy, for instance.
“He came to us one morning saying he hadn’t urinated in 2 days”, Azariah says. “We had to drain his fluids using a catheter. We refered him to another hospital, since as we did not have any beds in our clinic to admit him. He needed a surgery. The other hospital drained his fluids as well, and they also advised surgery but the 18 year old refused to have a surgery. He died a week later.”
Azariah also tells us about another story.
“One morning I got a call from the village. Someone was very ill and wanted to know if I could see him. When I saw the patient, he was completely yellow. He had a bad jaundice. He was an alcoholic with liver cirrhosis at a very advanced stage. He needed to be admitted and treated IV (through injections). Again we did not have the facility to admit him at our clinic. They went to a hospital about an hour’s drive from the village. The patient was kept there for a week, and when he showed some improvement, his family brought him back. Because the family couldn’t afford loosing daily wages. The man died after 2 weeks. He was in his early 40s.
Such cases are not very rare in these regions.
Dr. Azariah and his wife work with the Ashirwad Sewa Kendra (ASK) Trust. When Azariah’s Mother was still alive, she inaugrated a girl’s hostel for empowering the women in the villages. The hostel is named Lydia Hostel, and has been functional for over a decade now. The women are trained to use computers and are taught tailoring and basic English so they can take up any jobs in the towns near by.
In June 2017, ASK English medium school was inaugurated to meet a growing demand for education of the village children. Dr. Dawna recently covered the 72nd Independence Day celebrations at the school in her blog titled, “Little Citizens of Tomorrow”
Pic: Independence Day at the English Medium School
Pic: ASK Hostel girls volunteering for a self supporting project at ASK Campus, Dungarda.
In spite of the hardship over the last few years, the doctors remain positive that things are about to improve. Last month when monsoon hit the villages, all the roads turned into a swamp, and as Dr. Dawna writes about it, the ASK campus turned into “a murky mire”. This whole mess made the journey for the MMU difficult. But the couple look at this everyday challenge as “an adventure of sorts”. It is probably this ability to see beyond the challenges, to look at each murk as an adventure that is the biggest strength of this missionary couple.