“Helping these people so far away from the real world is what pulls me out from the bed every morning!”

Sami Siva

Andhra Pradesh, Chhattisgarh, and Telangana are the three states of India that have been caught in the long and ongoing conflict between Maoist groups known as Naxalites (or Naxals) and the Indian Government that began in 2004. This conflict, among others, has seriously jeopardized health care in these areas.

Camille Gillardeau has been the Doctors Without Borders/Médecins Sans Frontières (MSF) project coordinator in these three states for a year. This is her fourth assignment—she has previously worked with MSF in Sierra Leone, Afghanistan, and Democratic Republic of Congo. Here, she talks about MSF’s work in this complex context and her experience in the field.

When did MSF start working in this area?

MSF started working in Andhra Pradesh and Chhattisgarh in 2006. MSF began with addressing the medical needs of the population that was displaced as a result of the internal conflict in the area. Today, MSF is one of the only healthcare providers, especially in very remote areas of these states.

How challenging is it to work in such context?

It is a very complex context. MSF’s charter clearly states that MSF provides medical assistance to people caught in crisis, regardless of race, religion, gender, or political affiliation, and observes neutrality and impartiality.

This project translates these words into action! Establishing our neutrality and impartiality has been just as challenging as it is important for us. At the same time, it is our neutrality and impartiality that has helped us gain acceptance and guarantees our security every day.

There are no healthcare structures central to where these populations live. Given the conflict, for security reasons and fear, it is difficult for the population of these remote areas to seek medical care from the closest health structures, if any. MSF therefore introduced mobile clinics to reach them and provide free primary healthcare services. However, it remains a risk to send out our teams every day amidst the conflict

The fear in the patients’ eyes sets a deep contrast to the calm that prevails in the peaceful setting of these interiors.

What are the main needs of the population?

The population mostly inhabits the parts of these states that are under forest cover. Hence they have no electricity, no mode of communication, no knowledge about healthcare, and little or no access to healthcare facilities. The medical needs of this population are mostly primary healthcare needs. Malaria is the major morbidity in this area, other illnesses being Tuberculosis (TB) and skin diseases.

The custom of giving birth at home coupled with a lack of awareness with complicated delivery cases and a lack of preventive healthcare—for example vaccination for children and pregnant women—has made antenatal and postnatal care an important part of our activities.

The patients are happy to have us there. I remember how a TB patient mentioned to me how reassuring it was to them when we set up the clinic right in front of their eyes to provide for their medical needs. It’s the access to healthcare for people who do not have any other which makes this project so special. In this sense, I feel our impact is more humanitarian than medical.

What were some of MSF’s main activities in the region in 2014?

MSF runs 15 mobile clinics per week at 11 different locations. These clinics continue to provide free primary healthcare services which include diagnostic tests, vaccination, malaria, and TB treatment, and antenatal and postnatal consultations. In 2014, we carried out more than 63,140 consultations, treated over 15,274 patients of malaria, and facilitated 361 safe deliveries.

Our main approach has been to understand the medical needs of the community and customize our services accordingly rather than impose the standard procedures. MSF’s health promotion program has facilitated many valuable conversations with the community where we have tried to encourage them to treat their health as priority.

MSF also refers complicated cases and patients who need secondary healthcare to the closest Government hospital/health structures. We also helped in training ASHA (Accredited Social Health Activists) workers on antenatal care.

Mothers with young children wait for consultation at the MSF mobile clinic in Pusuguppa, which is a small village in AP along with border of Chhattisgarh. MSF mobile clinic provides free primary health care services which include diagnostic tests, vaccination, malaria and tuberculosis treatment, antenatal and postnatal consultations.
Sami Siva