Trust the Blue Caps

Lush. Green. Sparse and Beautiful. Our last day in Mumbai was spent with Impact India in remote villages in Thane District of Maharastra State, three hours north of the capital. Passing through rice paddies, our senses opened to new views, colors, and smells of the countryside.

Impact India started in 1983 as a result of a United Nations declaration to prevent disease. The organization is probably best known for its Lifeline Express, a 5-car train converted into a hospital that is deployed into rural areas. A “runaway success,” the train has provided free restorative surgical care to 700,000 people with the help of over 1,500 volunteer doctors and staff. What a brilliant, radical, and simple idea.

Although we did not see the train, our day in Thane revolved around Impact India’s other major program, the Community Health Initiative. The CHI is a model program that seeks to build healthcare delivery systems in tribal villages of rural Maharastra. The overarching strategies are pinned in community ownership and capacity building. Providing health services to tribal residents is not easy. Providers are often up against longstanding tribal traditions and beliefs that have no place for modern medicine. Now, Impact India has become such an integral part of some communities that just the sight of the ubiquitous blue hats staff wear is now a symbol of trust.

Impact India CEO Zelma Lazarus, Program Administrator Neelam Kshirsagar, and several other staff, accompanied us on five site visits. We first stopped at a primary school where students were appointed as “health monitors” who would be responsible for the health (hearing, vision, skin, etc) of groups of their peers. I thought this was a great way to engage and empower students to become accountable for their own health. Health monitors fill out weekly cards provided by Impact India that document health status to give to the teacher who later passes it along to the local health department. We later stopped at an immunization center 20 min away where malaria and tuberculosis were prominent problems. 

The highlight of my day was our trip to a secondary school of 12-16 year olds where we played a nutrition game with adolescent girls. We prepared two simple takeaways: use soap, drink water, take vitamins, and eat vegetables. Coaxing them with candy, the girls told us why each component was important for health. We spent the rest of the day visiting a community center where a health worker, called ASHA (accredited social health activist), held a workshop for community members. ASHAs are locals trained by Impact India to spread health education and encourage people to seek services. Finally, we visited a primary care clinic, which also provided minor inpatient services. Stepping through muddied floors, we passed by a woman and her family in the maternity room with a newborn girl. Out of respect, I kept my head down and tried not to disturb their private moments. The clinic was the least hopeful point for me on the trip. There is no doubt Impact India does great work. Two doctors see up to 150 patients a day. But it was difficult the limited services the clinic was able to provide. In these rural villages with barely any infrastructure, women in labor who need c-sections are diverted to a hospital more than 30 min away. The pharmacy onsite has a shortage of critical antibiotics. Although access to basic care has increased, people still need access to more sophisticated care like the kind provided on the Lifeline Express. In fact, Mrs. Lazarus agrees. “I hope the train is one day defunct,” she said to us. “I hope health services are in every village.”