Today Dr. George, with major experience as an orthopedic physician in both Northern and Southern India as well as Canada, discussed the general healthcare system of Uttarakhand and the Lower Himalayas in general. As a brief overview of the region, significant figures that stuck out to me were the percentage of institutional births (36%) and vacancy of health care positions, especially for female medical officers (greater than 60%).
The former, pertaining to giving birth in clinics and hospitals, being such a low number can be attributed to the practice of traditional medicine as well as the major problem of lack of access to health services. Access was repeatedly highlighted by Dr. George. Many of the factors he mentioned that influence health also impact the actual attainment of health care services in the first place. Major factors influencing health, especially in the rural areas in the Lower Himalayas, include: its nature as a disaster-prone area with high seismic activity which leads to land loss, poverty, and migration out of the area, terrain in general which influences transportation, and cultures and attitudes held by the people pertaining to ailments and treatments. The first factor of the land being so sensitive to natural events affects health in the manner of a cascade. Understandably, when a natural disaster such as a landslip occurs, people lose their livelihoods when they lose their homes and land. Not only may this remove a source of food for those who rely on subsistence agriculture, but it creates an economic burden for those who rely on crops as a source of income. This results in less money to spend on health care and other life necessities, so many are forced to leave the area. Dr. George informed us that there has been a corresponding increase in human trafficking with the rise in human migration. The next factor, terrain, can be combined with the matter of transportation. The geography of the Lower Himalayas is diverse and harsh when considering that people need to travel over long distances to receive health care services. Whether traveling by foot or vehicle, roads are often impossible to lay in areas of variable terrain, and roads that are built may lack safety and integrity. This results in extensive travel time that may cause serious implications for a sick individual. The last factor we discussed was the attitude and cultural viewpoint held by people surrounding health care. Whether in terms of spirituality, religion, or biomedicine, personal opinions of the cause of disease especially influences the type of treatment people seek. For example, many people with mental illness are prevented from getting care by family members due to social prejudice as well as religious beliefs involving spirits.
My second figure mentioned above revolves around the role of women in health care. This was not a major speaking point of Dr. George, but so far throughout my time in India, I have been noticing major gender roles within the community and am especially interested in how these carry over into medicine. The fact that greater than 60% of female physician positions are vacant speaks to the lack of gender equality that remains in this region. However, I was impressed to learn that many of the most effective initiatives going on in the region are majorly led by women. For example, Dr. George discussed the National Rural Health Mission (NRHM) that includes a Reproductive Child Health Program (RCH). The RCH includes accredited health activists that are often women who support a specific number of families, especially those who have recently has a birth in the family. These women then stick with that family for some time to ensure that the child and other family members are healthy by checking in with vaccination status and other important health indicators. I find this to be a perfect example of why more women need to be implemented into the health care system at the clinical level. The NRHM has been proven to be influencing rural health in a major way, so similar initiatives should be put into place. This goes hand in hand with Dr. George’s final remark in response to the question of what the most pressing issue of India’s health care currently is and should most immediately be addressed. His response was that there is an urgent need for health professionals to increase their willingness to reach out to underserved populations, a matter more of the heart than the actual system. Men and women alike must be willing to share their expertise not only in regions that are comfortable and safe to raise families in, but those areas that need the most help. If this is fulfilled, Dr. George believes that India’s health care system will see major improvement, and I find that this is a point that could change the trajectory of country-wide health not only in India but every country of this world.