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They gave the newborn a nickname that has stuck to this day:
"The dead person who has come alive".
It was not a miracle, of course. But deep in rural India, long
slow miles along rutted roads from the nearest clinic or hospital,
what saved Shital is something that falls not so far short.
A village woman, recently trained as a health worker, had
realised the baby was asphyxiated and swiftly put into operation
the set of emergency procedures she had been taught.
Her training had come from a remarkable husband and wife team of
physicians, Abhay and Rani Bang, whose insights have now saved
millions of lives throughout the developing world.
Their story began in the US, where the couple trained as
doctors. After training they turned their backs on comfortable,
financially-lucrative careers, and instead made their way to
forgotten corners of the Indian countryside, where they developed a
new practical approach and philosophy of empowerment.
The result has revolutionised social medicine in the developing
world – as the model they pioneered has been rolled out across
India and parts of Africa.
"The mother said the baby was dead. She said 'you cannot do
anything'," recalls the health worker, Kaju Bai Undirwade. "But I
refused. I said 'I have been trained'. I had nothing to lose."
Ten minutes later, after removing mucus from the baby's throat
and performing mouth-to-mouth resuscitation, the child started to
cry and the health worker swiftly pushed it towards her mother's
breast. "I was spellbound," says the baby's mother, Shakuntala. "I
had never heard of such a thing."
Fifteen years later, the baby who was saved on that rain-blasted
monsoon night is a bright, engaging schoolgirl with a passion for
languages and an ambition to become a nurse. Meanwhile, the
practical training scheme that ensured she lived, has been adopted
by the Indian authorities as a national programme and sparked
interest from governments around the world. Kaju Bai, now aged 60,
hosts health officials in her simple hut and trains them in the
techniques that have had such impact.
Today the work of Abhay and Rani Bang, deep in the teak and
bamboo forests of Maharashtra, forested with teak and bamboo, in
which Maoist rebels still operate, is supported by Save the
Children – one of the beneficiaries of The Independent's 2011
Christmas appeal. The Bangs say they have never regretted the
decision they made to turn their back on a comfortable life in the
West.
Inspired by the teachings of Mahatma Gandhi, the couple set
about providing healthcare for the villagers, many of whom are from
tribal communities and of which an estimated 80 per cent live below
the poverty line. They carried out detailed research and listened
to the requirements of the villagers, rather then enforcing their
own ideas upon them. They also decided it was essential to live
among the people they were trying to help.
Among their most shocking discoveries was the local infant
mortality rate (IMR). A combination of poor diet, a cultural
tradition of avoiding breastfeeding for the first three days after
birth, the impact of pneumonia, and a lack of access to healthcare,
meant that for every 1,000 births, 121 babies died. The couple
believed that simple health care and some new ideas could reduce
the death toll. They starting using these techniques and saw the
IMR fall to about 60 in those cases where it was used.
But the problem was getting the expectant mothers to a clinic.
"International guidelines say 'get the mother to a hospital', but
the hospital could be 200 kilometres away," says Abhay Bang. "The
hospital model did not work for us."
Instead, the couple decided to train local women, empowering the
villagers and turning upside down the medical profession's received
wisdom. In 1994, women from 39 villages, some of them not even
literate, were selected for an intensive training course that broke
down the topics into a series of simple steps.
They were taught about hygiene, the importance of breastfeeding
and of keeping a baby warm. They learned to screen for pneumonia
using a low-cost method developed in Papua New Guinea that did not
require X-rays or a stethoscope, and how to give injections. They
were also taught what to do in case of emergencies and they were
told to be present at each birth. "We transformed every hut into an
intensive care unit," says Dr Bang.
The results were nothing less than stunning. In the villages
where the neo-natal care programme was implemented, the IMR fell by
more than 60 per cent to 26 deaths per 1,000 births. For each
newborn child that was seen, the costs worked out at about 350
rupees (£4.40).
The medical world was amazed by the work of Abhay and Rani Bang,
their NGO and their team of village health workers. A research
paper about their achievements was published by The Lancet in 1999.
Five years ago, that report was included in a collection of the
journal's "landmark" papers that have been published since
1823.
The impact of the Bangs' breakthrough, which locally reduced
infant deaths from 121 to 20 per 1,000, compared to a national
average of 50, has been vast. In India, where about 1 million
newborn children die every year, 800,000 women called "ashas", from
the Hindi word for "hope", are being trained as health workers, and
21 state governments have dispatched trainers to the Gadchiroli
headquarters of their NGO, which is called Search, to learn the
programme and then go back and teach others. The governments of
Nepal, Pakistan, Bangladesh, Malawi and Tanzania, are just some of
those who have adopted the scheme internationally.
Dr Bang, whose two sons also work at the hospital and research
centre they have set up, said Western nations, increasingly
challenged by centralised healthcare systems that take up more than
a third of GDP, were also interested in the savings that could be
achieved by local care.
But as impressive as the results have been, the implications of
the philosophy behind the programme may be even more remarkable. In
a world where knowledge represents power – especially so-called
specialist knowledge – the Bangs have democratised such information
and skills, and proved the vast capabilities of those at the bottom
of society.
The import of this accomplishment in a place such as India,
where discrimination remains pervasive against the so-called low
castes, is unlimited. "These women have such potential. It is our
tragedy that we do not recognise it," says Rani Bang.
On a recent morning, The Independent accompanied Kaju Bai as she
made the rounds of her village, Ambeshivani. Her first call was at
the home of a young woman, Sheela Kasture, who had given birth to a
daughter, 25 days earlier. Her mud-floored home was next to fields
of paddy, and in the small courtyard were tethered three cattle.
The health worker stepped inside to the dim interior.
As she set about her work – thoroughly washing her hands with
soap, allowing them to dry in the air, checking the baby's weight
and scolding the mother and grandmother for wrapping the child in
synthetic fibre rather than cotton – she explained that Mrs
Kasture's daughter, Divya, was also not breathing when she was
born. "We realised the baby was not breathing. That made us worry,"
said Mrs Kasture, whose husband is a farmer.
A government nurse, a young woman, was also present at the
birth, but when they realised the child was asphyxiated, she asked
Kaju Bai to take over. Kaju Bai did not flinch. The veteran of more
than 500 births, of which about 15 involved babies who were not
breathing, knew what to do and started the newborn girl breathing.
The revolution Abhay and Rani Bang began 17 years ago had just
saved yet another life.
Charities we are supporting
Save The Children
Working in 120 countries, the organisation touches more than
eight million children each year – keeping them alive, getting them
into school and protecting them from harm.
www.savethechildren.org.uk
The Children's Society
The Children's Society offers crucial support to vulnerable
children in England, including those who have run away from home.
Staff provide essential support to desperate youngsters with
nowhere else to turn.
www.childrenssociety.org.uk
Rainbow Trust Children's Charity
It provides emotional and practical support to families who have
a child with a life-threatening illness. The Trust offers the
support without which families would struggle to cope.
www.rainbowtrust.org.uk
The Independent believes these charities make a huge difference
to many children's lives.
CLICK HERE TO DONATE NOW.
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