Independent Appeal: 'The mother said her baby was dead. But I refused to accept it'

A remarkable husband and wife pair of physicians are behind a scheme teaching healthcare in remote Indian villages – and their protégés are saving millions of lives. Andrew Buncombe reports

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The Independent Online

When Shital Chaldragiri started to breathe, her mother said it was a miracle. Word hurried through the village, and neighbours made their way to the house where she had just given birth to an apparently stillborn child.

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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.

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The Children's Society

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