In 1986, driven by a deep commitment to alleviating suffering, a doctor couple, graduates of Government Medical College, Nagpur and Johns Hopkins University in Baltimore, USA, made a life-changing decision. They moved to Gadchiroli district in Maharashtra, one of the most impoverished regions in India, to serve the most vulnerable.
Starting with an old warehouse in Gadchiroli town that once stored tendu leaves, they began treating patients and laying the foundation for their organisation, SEARCH (Society for Education, Action, and Research in Community Health). Their work would leave an indelible mark on the lives of the district’s tribal population, forever changing the face of Gadchiroli.
Now 73 and 72 years old, Dr. Abhay Bang and Dr. Rani Bang continue their mission. This is their story.
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Gadchiroli is a land of lush forests and rolling hills, with 76 per cent of its area covered in trees and a tribal population of 40 per cent. The district consistently ranks low on socio-economic indicators, with healthcare remaining a particularly critical challenge. While development initiatives have brought some change, significant gaps remain.
In October 2023, I embarked on a journey to visit their campus, located a few miles outside Gadchiroli town (about 215 kilometres from Nagpur airport). We passed through small settlements, vast swathes of open land, and places of worship. A flash of vibrant blue caught my eye as a kingfisher skimmed the surface of a shallow lake. The landscape transitioned from agricultural lands to dense forests, light fading as we passed the mining town of Umred, where coal dust hung heavy in the air.
Over the next two hours, we left the districts of Bhandara and Chandrapur, encountering ever-thickening forests and a marked decrease in human habitation. The mighty Wainganga river flowed alongside our path, full and vibrant.
Upon arrival at the 45-acre SEARCH campus, located in the middle of teak, mahua, and bamboo trees, one immediately senses the conscious effort to replicate the region’s biodiversity. Surrounded by thickly wooded hills reminiscent of neighbouring States like Chhattisgarh, where mining is a significant economic activity, Gadchiroli faces potential challenges from iron ore extraction in the future.
In 1993, thirty years ago, SEARCH relocated from Gadchiroli town to Khudawadi village, where its present campus, named Shodhgram, resides. The term ‘Shodh’ in Marathi signifies search, reflecting the ongoing quest that defines the organisation.
As the sun sets, I stroll around the campus, noting its seventy buildings, with the hospital structures being the only two large double-storied ones, designed to accommodate workflow and functional requirements. The rest, including residences, offices, hostels, and various facilities, are single-story structures, blending seamlessly with the surrounding greenery to recreate the ambience of tribal dwellings. While all constructions are reinforced concrete structures, the sloping rooftops are topped with red tiles, and the external walls sport a terracotta finish adorned with tribal designs, serving as a deliberate social communication strategy to foster a sense of comfort and familiarity among the tribal communities.
One of SEARCH’s significant achievements is earning the implicit trust of the needy and impoverished, who are the organisation’s raison d’être. However, this wasn’t always the case, as Dr. Abhay Bang later recounted to me in his office, mentioning earlier instances of antagonism.
Dr. Abhay Bang’s grew up in Sevagram, Wardha, deeply influenced by Gandhiji, shaped his commitment to serving the underprivileged. His father’s involvement in the Quit India movement further instilled a sense of social responsibility. After completing medical education at Government Medical College, Nagpur where he met his wife, Dr. Rani Chari, the couple started medical work in villages near Sevagram and Vinoba Bhave’s ashram at Paunar.
Their initial focus was on providing medical aid to villagers in Kanhapur, near Wardha, where they faced challenges beyond healthcare. A dispute over compensation for an injured farmer (his hand got crushed in the threshing machine and had to be amputated) revealed to them the limitations of a purely clinical approach in addressing complex social issues. Reflecting on this experience, the Bangs realised the necessity of a more comprehensive strategy to tackle rural problems effectively.
As Dr. Abhay Bang recounted during our discussions, the incident at Kanhapur compelled them to adopt a more grounded approach to addressing public health issues by conducting comprehensive research into villagers’ challenges. As a result, they pursued Master’s degrees in Public Health at Johns Hopkins University, Baltimore, USA, before returning to India to work. They chose Gadchiroli due to its extreme poverty, backwardness, and numerous health issues, committed to serving the Madia Gonds in their habitat.
A unique treatment
Visiting the medical facilities, I observe the outpatient department (OPD) and inpatient department (IPD) of the hospital. The 100-bed facility operates a round-the-clock laboratory, providing free treatment, food, and accommodation for bystanders. Dr. Datta, the medical-in-charge, guides me through the wards, where a snakebite victim is recovering from a Russell’s viper bite, highlighting the commonality of such incidents in the region.
Dr. Datta discusses prevalent ailments among the population, including malaria, filariasis, sickle cell disorder, leprosy, and tuberculosis. Spinal problems, particularly among women, are attributed to their lifestyle, involving heavy lifting and prolonged bending. Special spinal surgery camps are conducted to address these issues.
SEARCH has been providing patient care and medical facilities in the region for nearly four decades and has found ways to make tribal people feel at ease with modern medicine. | Photo Credit: P. Krishna Gopinath
The hospital, Maa Danteshwari Hospital, named after the tribal goddess, holds cultural significance. Tribals believe that their health outcomes align with the goddess’ wishes, making modern medical intervention more acceptable when framed as divine direction. This cultural understanding enhances patient compliance and trust in modern medicine.
At the OPD, patients queue at the registration counter, receiving case documents before consulting with the relevant doctor. Despite the lesser crowd on my visit, psychiatric support is available, addressing the emerging mental health issues, particularly among women. Social workers document patients’ cases, illustrating the holistic approach to healthcare provision at Shodhgram.
As I exit the OPD building, I run into Dr. Rani Bang, the co-founder of SEARCH and a highly esteemed gynaecologist. Her contributions to the gynaecological health of tribal women are unparalleled. I spoke with her extensively over the next two days. Despite using a walking stick and being accompanied by a nurse, Dr Rani Bang remains actively engaged in all activities at Shodhgram. After suffering a stroke last November, she made a remarkable recovery and stressed the importance of interacting with patients in the OPD as a form of therapy. Her pioneering work has significantly improved the understanding of tribal women’s health issues, resulting in substantial reductions in infant mortality rates in Gadchiroli.
One of SEARCH’s notable innovations is the Mobile Medical Unit (MMU), which serves 230 villages in the Dhanora taluka. Recognising the challenges faced by villagers in accessing healthcare due to distance, lack of transport, and poor access to roads, the MMU brings medical services directly to their doorsteps. Starting in November, the State government plans to extend this initiative to cover 50 more villages, underscoring its effectiveness in reaching those in need.
Accompanying the MMU to Kisneli and Marma, two distant villages in the Dhanora taluka, I witnessed the meticulous planning involved. Two days before the visit, an Arogya Sevak, or health supervisor, informs villagers about the upcoming medical team’s visit, coordinating a suitable time and putting up banners. In Kisneli, the team arrives by 9 am, comprising a doctor, technician, pharmacist, eye technician, and a driver. On this particular day, two additional young women accompany the team to familiarise themselves with the work for the upcoming government coverage of fifty villages.
Patients are registered upon arrival, and vital signs are measured before consulting with the doctor. For returning patients, their medical history is reviewed. Laboratory tests are conducted as necessary, and prescribed medications are dispensed by the pharmacist, with SEARCH providing only generic medicines to reduce costs. Dr Kirti Dhankar leads the medical team, addressing common ailments such as back pain, viral fever, hypertension, and gynaecological issues in Kisneli. By 11:30 am, after examining 57 patients, the MMU prepares to move on to the next village as villagers head back to their daily tasks in the fields or forests.
I joined the medical team on their visit to Marma, a smaller village located about 13 kilometres from Kisneli. By the time we arrive, it is already past 12:30 pm. The protocol remains consistent for all village visits: plastic tables and chairs are unloaded from the van and arranged at three different spots. Despite the bright sun, a shaded area is identified under a nearby tree. One table and chair are designated for registration, another for the dispensing unit and technicians, and a third for the doctor, with a stool placed beside it for patients. A small area is left for waiting patients.
A public announcement is made through a handheld microphone in the Gondi language, informing villagers about the arrival of the SEARCH medical mobile unit and encouraging them to take advantage of the free medical services offered, covering various ailments such as gynaecological issues, skin problems, eye problems, malaria, high blood pressure, and diabetes. This announcement is repeated until villagers gradually start arriving.
In Marma, most adults were busy with harvesting in the fields, while some women were out collecting firewood in the forest. Consequently, only seven patients attended the camp on this particular day. One woman’s spinal problem necessitated a hospital referral at Shodhgram for specialised care. Another patient, a robust 22-year-old, was diagnosed with anaemia, due to iron deficiency, after undergoing tests and was provided with tablets. I inquired about the prevalence of hypertension among patients, and the doctor attributed it to the meat-based diet followed by the tribal community, along with excessive use of salt and chilli in cooking. Also, there is a high rate of diabetes among tribal people due to the high sugar content in some of their beverages.
The MMU project proves highly beneficial for these remote communities where no other medical facilities exist. However, there are challenges with follow-up care: villagers often fail to adhere to doctors’ advice and prescriptions. When their medications run out, they are supposed to visit the nearest Primary Health Center (PHC) or Sub-Center at Mormugao or Sawargaon to replenish their stock, but many do not.
Similarly, when referred to the hospital at Shodhagram, patients often fail to follow through. Interestingly, the ASHA worker in the village maintains a stock of commonly required medicines, yet villagers do not approach her, suggesting a communication gap. Despite these challenges, the scheme successfully draws most tribal people towards the benefits of modern medicine, steering them away from the influences of quacks, tribal healers, and superstition.
Among their achievements, they managed to reduce the infant mortality rate in the region and successfully establish a mobile medical unit. In photo, Dr Keerti Dhankar and her mobile unit is at work in Kisnelli village. | Photo Credit: P. Krishna Gopinath
It is late evening when I return to Shodhgram, where I find Dr Abhay Bang in his office. He states that SEARCH projects stem from a thorough assessment of tribal people’s needs, with priorities continuously re-evaluated. Shodhgram hosts an annual fair that draws people from several villages to the campus. This event serves as both a celebration with song and dance and a platform for discussing public health issues in the tribal health assembly. Villagers voice their health concerns and propose strategies and solutions, which are then collectively considered. Based on these proposals and further deliberations, an action plan is devised.
For instance, addressing the prevalent issue of malaria required community involvement. Alternatives were presented to the villagers, leading to the adoption of a three-point program involving spraying of insecticide, usage of mosquito nets, and administration of anti-malarial medicines. Villagers were also trained to conduct blood smear tests. While such measures might seem trivial to urban dwellers, they are crucial in Gadchiroli’s forested terrain, where each step must be taken with the people’s informed consent. Villages participating in the malaria eradication program witnessed a 60 per cent reduction in the disease over three years compared to those that didn’t.
Dr Abhay Bang highlights the ineffectiveness of a top-down approach in healthcare among tribal communities. Predetermined solutions often fail due to the lack of a data-driven basis. He stresses the importance of learning from the people themselves, echoing Gandhiji’s principle, which guides SEARCH’s focus on data-driven action plans formulated with full community participation.
One of SEARCH’s significant achievements lies in neonatal care and the reduction of infant mortality. The program began in 1995 when hospital-based deliveries were rare, and home deliveries in unhygienic conditions were common. Through a study involving women in Wasa and Amirza villages, it was discovered that 92 per cent of women suffered from various gynaecological problems. In the absence of doctors, village midwives were trained to provide proper medical care. These midwives, known as ‘Arogyadoots’, were equipped with knowledge, tools, and hygiene practices to ensure safe childbirths.
Through diligent data collection and analysis, SEARCH identified pneumonia as a major cause of infant mortality. Arogyadoots were trained to detect and treat pneumonia symptoms promptly, leading to a significant reduction in infant mortality rates. The successful Gadchiroli model has been replicated in various Indian States and other parts of Asia and Africa, showcasing the impact of community-led healthcare initiatives.
The next morning, I visited the village of Bodli and met with Anjana Uike, a 55-year-old Arogyadoot who has been serving the village since 1995. Bodli has a population of 2,400, comprising both tribal and non-tribal communities. It appears relatively prosperous compared to other villages, with many permanent houses and TV antennas adorning rooftops. Anjana has assisted with numerous births over the years and proudly showcases the equipment in her kit. Dr Sanjay Baitule from SEARCH joins us, overseeing the work of 39 Arogyadoots across as many villages.
Since the inception of SEARCH’s Home-Based Maternal Newborn Child Care program in 1995, significant changes have occurred. Today, 97 per cent of births in the district occur in the Gadchiroli district hospital, aided by the Janani Suraksha Yojana scheme, which provides financial incentives to mothers. Upon the mother and baby’s return home, community workers, like Anjana, plays a crucial role, conducting health checks on the newborn twice within 28 days. Previously, in cases of home deliveries, daily monitoring of the child’s weight, temperature, and overall condition was necessary, with more frequent visits for high-risk infants.
However, with increased education and awareness, birth rates have declined, and many couples opt for family planning.
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In addition to monitoring newborn health, Arogyadoots are now being trained for additional tasks. They are acquiring skills as masseurs due to the rising prevalence of back and spinal problems. They are also equipped to handle cases of fever, malaria, and certain infections. Dr Rani Bang noted that they could also assist in monitoring TB treatment, as TB prevalence remains a concern, requiring strict adherence to treatment protocols.
As the evening approaches, a tradition unfolds at Shodhgram. At 6:30 pm, people gather in the prayer hall for the evening prayer, a practice adopted from Sevagram and Acharya Vinoba Bhave’s Paunar retreat. This spiritual gathering transcends any specific faith, beginning with a Buddhist instrumental invocation and the soothing melody of wind chimes. It progresses with an excerpt from the Koran translated into Marathi, followed by the Lord’s Prayer from the Bible (Matthew 6:9-13). An excerpt from the Ishavasya Upanishad and a Gandhian prayer are also recited, concluding with a hymn invoking Lord Vittal, sung by the late vocalist Pandit Jitendra Abhisheki, whose haunting voice captivates the listeners, transporting them to a different world.
P. Krishna Gopinath is a Delhi-based writer.
