Sittilingi: a tribal valley’s inspiring success story

On a misty Monday greeting successful the Sittilingi valley, nestled snugly betwixt the Kalvarayan and Sitheri hills successful occidental Tamil Nadu, radical trickled into a chromatic compound of single-level structures made of sundried bricks, Mangalore-tiled roofs, and arched windows.

The earthen structure, resembling a colony retreat, is simply a tribal infirmary providing secondary healthcare facilities successful 1 of the remotest parts of Tamil Nadu, astir 45 km from the artifact office of Harur successful Dharmapuri.

Among the visitors that time was Revathi. She had brought her parent from Navakollai, 20 km away, arsenic she has been doing for the past 10 years, bypassing the superior wellness centre conscionable 5 km from her village.

“I’ve ne'er seen thing similar this spot anywhere. They instrumentality women’s problems seriously. The doctors instrumentality clip to perceive and explain, spending astatine slightest 15 to 20 minutes with a patient. Even successful backstage hospitals, doctors don’t perceive to our complaints,” she says.

Sometime successful 1993, a young mates successful their aboriginal 30s, some clinicians from Gandhigram, arrived successful the tribal vale of Sittilingi with a dream: to beryllium doctors successful a spot wherever they were needed, wherever nary different doctors had gone until then.

This imagination would instrumentality signifier arsenic a 35-bed tribal infirmary and springiness commencement to the Tribal Health Initiative (THI), a assemblage wellness programme (CHP) that would overturn Sittilingi’s abysmal babe mortality numbers wrong a decade, and spell connected to radically redefine the scope of wellness beyond the clinical, extending it to the societal and economical determinants of well-being implicit the 3 decades since.

Gynaecologist Lalitha Regi and anaesthetist Regi George chose Sittilingi due to the fact that of its geographical isolation, which has constricted entree to attraction arsenic successful each tribal areas, and its appalling babe mortality complaint (IMR) – 147 babies per 1,000 unrecorded births – astatine the time.

If the mates conceptualised a CHP, the level of morbidity and mortality called for a antithetic benignant of action.“There was truthful overmuch morbidity that we needed to code that first,” says Dr. Lalitha. They took implicit a poramboke land, wherever locals helped enactment up a one-room mud-and-thatch structure. “For 3 years, deliveries and immoderate surgeries took spot nether a 100-watt bulb, connected a bench.”

Then came, done ActionAid, a 10-bed infirmary and a centre to bid locals to look aft themselves. “The content then, arsenic it is now, was that immoderate readying and resources had to travel from here, not from outside,” adds Dr. Lalitha.

Early November this year, the McGill School of Population and Global Health named the Regis co-recipients of the prestigious Paul Farmer Award for Global Health Equity. The citation described their achievements arsenic “countering the failures of imagination” and “having lived a beingness of accompaniment”.   

Building from the crushed up

The couple’s archetypal wellness idiosyncratic was a Class 8 passout Rajamma, who joined the infirmary arsenic a trainee successful 1994. “We went to the villages asking for educated girls to assistance america astatine the hospital,” says Dr. Lalitha. 

But the State’s all-pass-up-to-Class 8 curriculum, meant that young girls similar Rajamma could work alphabets but not words oregon afloat Tamil sentences. Therefore, their grooming began with basal connection and arithmetic earlier progressing to anatomy, physiology, pharmacology, diagnosis, and treatment.

“Diagnosis focused connected the diseases prevalent successful this area, thing extra. What they would see, however they would diagnose and treat…” added Dr. Regi. “That’s wherefore we called them wellness workers, due to the fact that they were overmuch much than nurses.” Similarly, they trained laboratory technicians and an accounts team. Much was improvised arsenic determination was nary money. The hospital’s archetypal autoclave was a unit cooker. “We had to marque bash with what we had for each sorts of emergencies, due to the fact that radical couldn’t spell anywhere,” adds Dr. Regi.

Health Auxiliaries 

“We were seeing radical lone erstwhile they came to the hospital. There was nary 1 to spot what was happening successful the village. So, we asked each colony to prime 1 idiosyncratic escaped of child-rearing responsibilities.” Twenty-one villages had sent 25 women, who would go trained wellness auxiliaries, and spell connected to signifier the backbone of the assemblage wellness programme.

The archetypal extremity was to tackle babe mortality. Since malnutrition, respiratory diseases, and diarrhoeal diseases accounted for a precocious proportionality of under-five deaths successful astir places, wellness auxiliaries were trained to absorption lone connected these, done nutrition management, malnutrition prevention, aboriginal detection and attraction of respiratory diseases, recognising symptoms of pneumonia, and harmless transportation practices.

“In the villages, skilled mothers did location deliveries. The wellness auxiliaries would show location deliveries and bring them to the infirmary successful lawsuit of an emergency,” says Dr. Lalitha. 

By 2003, the IMR dropped to 60, and further declined to 20 by 2008, erstwhile adjacent the Tamil Nadu mean was 35 and the nationalist average, 53. Today, Sittilingi’s IMR stands astatine 8.

Maadeshwari’s beingness changed aft 1 specified colony gathering successful 1998. She had completed lone up to Class 8. When the infirmary came up, she knew she wanted to bash thing there. “Seeing my teachers and Dr. Lalitha, I excessively wanted to beryllium similar them and execute thing successful life.”

She wrote her SSLC examinations and joined the infirmary arsenic a wellness idiosyncratic trainee. She was trained successful deliveries, surgeries, out-patient and cognition theatre. “Initially, 1 of america (trainee) would faint astatine the show of blood. But, Dr. Lalitha and Dr. Regi trained america patiently, showing america each measurement – from the mother’s accomplishment to the transportation and beyond.” 

Then came different large step.

Focus connected farming

At the Sittilingi Organic Farmers Association (SOFA), 1 of the 700 integrated farmers registered with the offshoot of the THI peers into a laptop camera. “This seeding of biometric information is for the certification of the integrated nutrient from the peculiar farmer’s land,” says Manjunath, coordinator of SOFA and 1 of the earliest assemblage members of the THI.

“In 2003, we carried retired an outer valuation of the THI,” says Dr. Lalitha. “Among the observations was that if we privation to execute what we did with the IMR, determination are different social, economic, and governmental determinants of health, similar food, employment, and income [we should consider]. Unless you code the system of the people, you cannot archer them what they should eat.”

“There were galore complaints — schools not functioning, mediocre roads, transport, and water. But 1 accordant contented was that farming was astatine a loss, yet it was the lone happening they knew,” explains Dr.Regi.

Farmers were initially resistant to integrated farming, fearing losses. But aft 2 years of talks, 4 farmers took it up, and soon, the inaugural spread. SOFA was formed, which contiguous represents 700 integrated farmers successful the Sittilingi Valley. Sittilingi’s integrated produce, including millets, turmeric, pulses, and a assortment of millet-based products specified arsenic biscuits and savouries, is present a regular diagnostic successful integrated stores.

Reviving a mislaid art

In consequent years, the THI’s absorption connected the section system deepened. The Sittilingi panchayat besides includes 2 Lambadi villages and 1 Dalit village. “I noticed that the affluent trade of Lambadi embroidery had died due to the fact that cipher wore that attire anymore,” Dr. Lalitha said.

A small probing led her to Neela and Gammi, 2 women successful their seventies who had learnt the trade from their grandmothers. “They wore sarees, and their mothers wore sarees, but their grandmothers were the past to deterioration the Lambadi attire,” she said.

They remembered the art, and successful 2006, 10 young radical came guardant to larn it. Tamil Nadu Lambadi embroidery was frankincense revived. Porgai (which means pridefulness and dignity successful the Lambadi language), an artisans’ relation formed successful 2009, has been registered arsenic a Producers’ Company with 70 shareholders this year.

“It is an unfair marketplace successful India for crafts, and artisans don’t gain much. So we thought we’d bash thing different: make creation that is viewed and valued differently. They organised an at-home artists’ residency for 10 artisans, wherever artists travel to enactment and larn for 4 months.” 

This year, 20-year-old Sindhu graduated from NIFT, becoming the archetypal postgraduate of plan from Lambadi community. Similarly, women wanted sustained work, arsenic cultivation opportunities were constricted connected marginal landholdings. Vanavil, a tailoring work nine for brands, was calved retired of that demand.

The THI’s precocious notes came successful 2019, erstwhile it radically pushed the boundaries of a CHP into section self-governance. Health idiosyncratic Maadeshwari contested and won the Panchayat elections by a borderline of 500 votes. Madagapaadi, a colony of 50 houses located 55 km away, received a slew of firsts, including electricity, houses, h2o proviso done over-head tanks, during her tenure. “At first, our friends thought we were brainsick to bash this. But Maadeshwari won and did large work,“ says Dr. Regi. 

The Sittilingi Model

“We relation arsenic a secondary attraction hospital,” said Dr. Ravi, 1 of the earliest doctors to articulation the infirmary aft akin agrarian stints successful Odisha. “In immoderate population, retired of 100 patients, 50 tin beryllium seen by a regular aesculapian officer, different 30 volition request a specialist, and the remaining 20 volition necessitate higher-level hospitals. A mean transportation should beryllium managed by a bully superior oregon secondary-level healthcare facility. That’s what we are trying to do. We are not trying to regenerate the authorities system, but to supply an alternate secondary attraction that whitethorn not beryllium available.”

In 2018, a Rural Sensitisation Programme was started for 35 aesculapian students and immoderate doctors, who came to enactment successful Sittilingi for 3 days to spot however a secondary attraction infirmary successful a tribal country could lucifer what backstage hospitals successful the metropolis were doing, but successful a overmuch much economical and meaningful way.

“They spell to the villages, spot the villagers successful their homes, witnesser their lives and problems, and recognize their entree to health. They travel backmost and discuss, and instrumentality changed, questioning wherefore this is not portion of the aesculapian curriculum,” says Dr. Regi. 

But the doctors wanted much than conscionable 3 days to marque a beingness decision. So this year, question fellowships for doctors were conceived. “We talked to organisations moving successful agrarian areas, slums, and tribal regions. The travelling doctors would sojourn these places for 2 to 3 months to spot however these organisations are tackling problems. With changing geographies, diseases vary, and they spot the existent India. By the extremity of it, they are wholly transformed,” says Dr. Regi. 

Can the Sittilingi Model beryllium replicated everywhere? “The State can, if it wants to,” says Dr. Lalitha. “It has the infrastructure. But occurrence comes with assemblage involvement. What is applicable for a tribal country similar Sittilingi, with a homogenous tribal community, is not needfully applicable adjacent for a taluk similar Harur. People are different, and their attitudes are different. First, you person to beryllium down and perceive to people. All our programmes are tally by the section people, which is what makes them successful.”     

According to Dr. Regi, Sittilingi model, arsenic we picture it now, was a bid of spontaneous interventions that present makes sense, having elevated wellness to a definite level. “It is to amusement doctors that determination is different mode of tackling health. We person planted a seed; the effect should beryllium taken and planted elsewhere too.”

At the bosom of the conversations was a azygous underlying thread: respect. The patients wanted to beryllium respected, and truthful did the community. Clearly, that is wherever meaningful and sustainable alteration begins.