Barefoot doctor

Binayak Sen's activism in the cause of universal health care clashed with the interests of authorities in the mineral-rich State.

DR BINAYAK SEN belongs to the post-Independence generation of Indians who believe in contributing their knowledge, skills and talents to the nation-building effort. It was in this spirit that he gave up a flourishing career in medicine to devote his life to the cause of public health in the tribal areas of Chhattisgarh. The section of people he belonged to, largely the middle classes, also took seriously its right to criticise the exclusionary policies of the Indian state.

Naturally, it followed closely the case against Sen in the Raipur Sessions Court and the drift of the proceedings had prepared it for punishment for him. Yet, when the verdict came, the response was one of shock and disbelief. For, it never crossed their minds that he could be jailed for life on the charge of sedition.

Binayak Sen's has indeed been an exceptional life, made more so by the intolerance of the state. The barefoot doctor, as he is popularly called, began as a public health specialist and eventually made the transition to a health activist. He kept his focus on the fight against tuberculosis and malaria and also took a keen interest in training health workers so as to improve access to health care in villages. He even took to organic farming to raise the nutrition levels in tribal communities.

His involvement with public health began in the Christian Medical College in Vellore, Tamil Nadu, where he enrolled in 1966 for an undergraduate course. He went on to do his master's in paediatrics there: his thesis was on Marasmus and Malnutirtion in Children'. His deep involvement in children's issues extended to the study of large-scale malnutrition, mortality and morbidity in them. This was also when he saw himself working as a community health worker in the poorest districts of India.

It was in Vellore that he married Ilina Sen. Their association has as its core the love for social work. He was of the firm view even then that medical education in India had a huge urban bias and was elitist. This formed the crux of his argument in a paper he wrote, titled A suggested system of undergraduate medical education. It won him the first prize in an essay competition.

After graduating from Vellore, Sen joined the Centre for Social Medicine and Community Health at the newly opened Jawaharlal Nehru University in New Delhi in 1977. But his love for working in the field drew him to the Quaker Centre at Rasulia in Madhya Pradesh, where he met Marjorie Sykes, one of the last Quakers in India, and learnt about her commitment to peace and conflict resolution. (The Quaker society had been involved in running schools, colleges, hospitals, libraries, children's clubs and farms from pre-Independence days.)

Around 1981, Sen was at the Friends Rural Centre at Rasulia and Ilina was working for a community education programme in a neighbouring village. This was also when the trade union leader Shankar Guha Niyogi, a chemical engineer working at the Bhilai Steel Plant, was going from village to village trying to understand the inequalities in India. The differences in the working conditions of permanent workers and contract workers in the steel plant prodded him to take up the cause of workers, which culminated in the formation of the Chhattisgarh Mines Shramik Sangh (CMSS), a trade union movement that involved the entire State of Madhya Pradesh and spoke about political and economic equality, cultural pluralism and ecological justice, issues that are relevant even today.

When the Friends Rural Centre under a new head decided in 1982 against modern medicine and started experimenting with indigenous systems of healing, Binayak Sen offered Niyogi his services in a clinic with a higher goal of building a hospital for the tribal communities. The clinic in Dalli Rajhara near Bhilai grew to what is now Shaheed Hospital. Sen's journey into the lives and rights of tribal communities began during the five years he spent here.

He and Ilina found extreme levels of poverty and malnutrition in central India and also understood that massive state injustices, such as displacement without rehabilitation of tribal people, played a big role in the prevalence of these conditions in the rural hinterland, home to most of India's mineral and natural resources. He found that the forest villages, illegal in the eyes of the state, and the natural resources were the only means of survival for the tribal people. These areas had no schools, no public health centres and no state programmes that their residents could gain access to.

Niyogi was murdered in 1991 but that did not deter Sen from continuing his work among the people of Chhattisgarh in order to secure them medical services. It was thus that the Bagrumnala clinic came to be set up in Nagri block of Dhamtari district in Chhattisgarh. According to government estimates in the 2001 Census, in this block alone 78,351 people were in the below-poverty-line category. The members of the Kamar tribe numbered just 3,000 and were on the road to extinction. Today, health workers of his clinic serve at least 247 villages in the area, though Sen's absence is felt severely in the daily activities of the clinic.

Sen's quest for a universal health care system saw him becoming a part of the Medico Friend Circle in 1976. He remained, until his arrest, an active member of this socially conscious group of individuals across the country working towards ending the exclusionary tendencies in health services. He espoused the same cause in the Jan Swasthya Abhiyan, or People's Health Movement. In the 1980s he joined the People's Union for Civil Liberties (PUCL).

With the formation of Chhattisgarh State, he became an active human rights activist, too, as that work related directly to his activities in health care. In one of his interviews, he made the point that Chhattisgarh had one of the most malnourished populations in India and yet the State had signed the largest number of memorandums of understanding with corporates to dig out the State's mineral resources. He felt that the people of the State should also be beneficiaries of the mineral resources.

He holds the view that the Indian state has shown little interest in the development of the tribal people and that it is only because of common property such as forest resources, water and so on that they have been able to survive. Sen has been a vociferous critic of Salwa Judum, or people's peace movement, which was meant to counter the naxalites but ended up perpetrating atrocities on people. Sen has helped document the number of villages it destroyed and the number of people it killed. He has also debated in public the high number of custodial deaths, fake encounters and rapes in the State.

When Chhattisgarh became a State in November 2000, he was invited by the government to participate in community health programmes, such as the Mitanin Programme, to reach out to the tribal people. All was fine as long as Sen kept to the role of a public health specialist. When he began to raise questions of human rights violations, it did not endear him to the authorities.

However, there is nothing he has done that human rights activists across the world have not done. There have been other people who have raised issues of human rights violations in the name of curbing naxalism. He gave as much importance to social medicine as he did to his own health care activities.

Today, he has been charged with sedition and conspiracy. The accusation against him is that he acted as a courier of letters of Narayan Sanyal, an alleged Maoist, to a businessman called Piyush Guha.

One of the accusations against him is that he took up the issue of prisoners' rights after a naxalite prisoner in Raipur, Madanlal Banjare, wrote to him about the inhuman conditions in the jail. Sen, in his capacity as general secretary of the PUCL, sent the letter to local newspapers and television channels. Another accusation against him is that he met Narayan Sanyal. However, the fact is that his meetings were official and were done under the supervision of the jail superintendent. Besides, Sen attended to him as a doctor. The prosecution's case against him is replete with such flaws.

The human rights lawyer Nandita Haksar wrote in one of her reports: If Binayak Sen is guilty of meeting naxalites, so am I. In fact, I visited some of the senior naxalite leaders in Warangal Jail in January 2008 when they sent a letter to me, inviting me to discuss with them the issue of prisoners' rights.

The police charge sheet chooses to ignore all his work in Chhattisgarh when it states: Dr Sen is certainly a doctor, but is a big zero in terms of actual practice of medicine. During the search of his house, no material as would be found in a clinic or any medicines was found. Obviously, they did not know that Dr Sen was a member of the State's own Health Advisory Board. Dr Sen had said on one occasion that he was being made an example of for many who dared to raise their voice against atrocities perpetrated by the state's agencies.

He has been kept in solitary confinement with permission to come out of his cell only for two hours each in the morning and evening. Such treatment, says human rights activists, is meted out only to murderers and criminals. A political prisoner like him needs to be treated with more respect.

Sen had come to the nation's help throughout his life, yet the nation failed him and many others like him.