our experinces in Melghat

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My self Dr. Ashish Satav (M.B.B.S., M.D.) & my wife Dr. Kavita Satav (M.B.B.S., M.S.-Eye surgeon) are providing curative and preventive medical facilities to poor tribal people of Melghat. Our life has been enlightened by 9 years son, Athang.

Motivation for the work / source of inspiration
I was influenced by my grandfather Mr. Vasantrao Bombatkar (Sarvodaya leader) since my childhood. Under his guidance, I read literature written by Mahatma Gandhi and great saint Vinoba Bhave. I was touched by Gandhian teaching that “ youths should go to the villages to serve as real India is in villages” and after 12th standard, I decided to become doctor and serve the rural part of India. After admission to Government medical college Nagpur, I started visiting various rural and tribal health projects run by Drs. Prakash and Manda Amte, Drs. Abhay & Rani Bang, ( main guide), Dr. Ravindra Kolhe, Dr. Sudarshan, etc. After visiting tribal areas, I realized that tribal areas need medical facilities to a great extent as compared to rural area. So during my M.D. training, I decided to start work in very difficult area of Melghat where medical facilities were very scarce.
I stood first in Wardha district (city area) in 7th class scholarship examination due to guidance of Miss Joshi (now Mrs. Deshpande). It increased my interest in study. Attending “Shram Sanskar Shibir” organised by great social worker Baba Amte during 9th standard was a real experience for future social life. I stood first in Sanskrit in 12th class in Maharashtra due to sincere guidance by Mr. Bhagwat sir.
The guidance by Dr. Ulhas Jaju, Dr. Avinash Saoji , Dr. Kalantri, Dr. Jalgaonkar and Dr. Mrs. Holey is always helpful to me.
Mahatma Gandhi & Swami Vivekananda are my real driving force (Preranasthan-Source of inspiration) for all my endeavors.
Due to very active parental and heavy financial support from Caring friends , Mumbai (especially Rameshuncle Kacholiya and Nimeshbhai Sumati), Kasturba Health Society, Sevagram (Late Dr. Sushila Nair & Dhirubhai Mehta ), our activities got momentum and we could acheive sucess in most of our program .

Preparation for future life:

I decided to start hospital in tribal or rural area while doing M.B.B.S. So during M.B.B.S. course in Government Medical College, Nagpur, I followed simple living. During summer (45-46 degree), I used to live without cooler or fan, during winter, I used to take bath by cold water intermittently. Such type of experiences were going on to test myself.
Due to regular yoga and meditation, study of Geetai written by Vinoba Bhave(especially Sthithpradhnyachi Laxane-symptoms of stable mind), “Experience with truth” written by Mahatma Gandhi, books written by Swami Vivekanand , my mental strength is increased to a significant extent. I can control the innate desire of human being like sex, gride, anger, luster, egoistic attitude, envy ,etc. due to regular meditation. It increased my mental piece and physical and mental capacity for my social work. Due to regular visits and discussion with idealistic social minded people, I could develop those values & qualities necessary for future life.
Reading the book “Seven Habits of Highly Effective People” helped me for social work. Due to use of “Ahimsa (Non-violence), Satya (Truth), Asteya (Non-stealing), Bramhacharya (control of sex with other female and other desire), Sharirshram (hard work), Aswad (no attachment to taste), Sarvatra Bhayavarjan (courage), Sarvadharma Samanatva (equal behavior with all religions), Swadeshi (use of material made in own country) , Sparshabhavana (avoid untouchable behavior) ” in personnel life, the life in Melghat become palatable and tolerable.
During MBBS, I attended Movad river flood relief camp and distributed lot of cloths to those who lost everything in the flood.
Pillars of project:
• Caring friends, Mumbai especially Rameshbhai Kacholiya, Nimeshbhai Sumati, etc.
• Kasturba health society sevagram and MGIMS esp. Late Dr. Sushila Nayar, Mr. Dhirubhai Mehta.
• Nico Nobel & Stichting Geron , the Netherlands.
• Dr. Avinash Saoji, Dr. Abhijit Bharadwaj, Dr. Gahukar.
• Mrs. Jayashri Pendharkar, Vijay Kaore.
• Palaskar, Varangaonkar & Kashikar families.
• Satav, Renge & Manekar families.
• Dr. Dilip Gahankari, Dr. Mrudula Bapat.
• Dr. Vibhavari Dani.
In the whole journey my mother(Kamal Satav) and father (Rambhau Satav) , brothers (Avinash & Ajay) and wife stood very firmly behind me and supported when needed.

Some important events in life:

Second life: In 2004, while shifting the luggage to new home during rainy season, myself and my mother received severe electric shock injury. We were unconscious for few seconds. Vitthal Pande saved us by pulling the wire with wood. We were saved. I think, due to our good work we were saved by his messenger. After the incidence , I could continue my work with full strength.

Obstacles converted to opportunity :
There are lot of obstacles while working in Melghat since beginning. But now I think, these obstacles are not hurdles in the road but a challenge to test and prove ourselves. The life is like a river. The river is more beautiful when it flows through mountains, valleys, falls, etc.
In 1998, I resigned from the post of lecturer in the department of Medicine of M.G.I.M.S. Sevagram and registered a voluntary organization named MAHAN and started hospital in Melghat. In the beginning, there was no financial support from anybody. While during post-graduation and lecturer ship in Medical college, I was living a simple life due to which I could save around Rs.1,00,000 . I used those money for running hospital in Melghat. After 4 months, honorable Dr. Sushila Nayar who was the great supporter of the project provided financial support and since then Kasturba Health Society, Sevagram and MAHAN are running this project.
Since last 20 years (in 1998) not a single new M.B.B.S. doctor started non governmental hospital in Dharni. So most of the people could not believe that I can be a M.B.B.S., M.D. doctor.
We started our OPD in a hut at Kolupur and then hospital in a small (four rooms) rented house in Dharni. It was used for out patient department and for indoor patients. In the same house, patients use to vomit etc. and just nearby to it, was my dinning room and bed room. When I was in Government Medical College, Nagpur, I was habitual of working in a big hospital. But in Melghat, while treating the serious patients of brain hemorrhage, heart attack, etc., we faced lot of problems in the same small hospital. But I could manage successfully lot of serious patients.
Once upon a time, at around 12 midnight a patient of serious heart attack i.e. acute myocardial infarction with pulmonary edema was admitted in government hospital. As there was not a single physician, I was called to treat that patient. I was assisted by unqualified attendant and I carried one E.C.G. machine and injection Streptokinase along with me. There was no cardiac monitor or defibrillator. There was not a single hospital for management of serious patients in Dharni and critical care hospital was 150 k. m. from Dharni. When I was in Government Medical college, Nagpur, and in M.G.I.M.S., Sevagram, there used to be a team of 3-4 doctors and trained nurses and well equipped intensive care unit and well furnished library to refresh your knowledge. But it was my first experience to treat such patient in Dharni with minimum facilities. If I treat the patient and if he succumbs, then people will not believe me and I might have to leave Dharni. But then I realized that, if I treat that patient, there is 90% chance that he will be saved. But if not treated, there is 100% chance of death. So my strong will power forced me to start the treatment . I was treating that patient until 4 a.m. . The patient was out of danger at around 4 a.m. and I was relaxed. But after then, till now, I have successfully treated more than 800 serious patients with no fear in mind. Till July 2007, our indoor hospital was in 20* 50 square feet hut .
Once a fifty years old male patient of brain hemorrhage (7cm in parietal lobe and 1cm in Thalamus) was admitted in comatose condition in our small hospital. He was advised by doctors from Amaravati & Indore that he could not be saved and hence should not be hospitalized. I did not cross the boundary of the hospital for 7 days as I was busy in treating that serious patient. I was assisted by one 9th standard passed boy. There was mental pressure of 30 to 40 people daily for that patient. On 8th day, that patient started walking and I was relaxed. From that day, people realized that I am a good qualified doctor and I got acceptance & publicity in Melghat.
I do remember a story of 5 years young girl patient suffering from cerebral malaria with coma with decerebrate posture with convulsions. Not being a pediatrician I thought a lot, whether to treat her or not. But if I won’t treat she will not be saved , it was very 100% sure as there was no pediatric critical care hospital. Hence , I decided to use my all knowledge and courage to treat the child and could successfully save her. It increased my confidence that I can manage serious children also though I am not a pediatrician.
Sometimes I am also surprised that, I could have successfully managed serious patients in such difficult circumstances.
After 2 years, my wife Dr. Kavita (M.B.B.S., M.S.) started her eye hospital in Dharni. For first year, there was no financial support for her work. There used to be very few patients for initial one to two years. As most of the tribal patients in Melghat are very poor, they can not afford charges of operation for cataract. So many times, Kavita got depressed. Probably I will have to operate cataract of a tiger, sarcastically she used to say sometimes. We used to live very simple life so that we could save a substantial amount of money and after few months we purchased operating microscope worth Rs.2,00,000. Mr. Prabhakar Palaskar (retired engineer, P.W.D.),one of our closed well wisher from Nagpur donated Rs.10,000 . Kavita operated upon 10 cataract patients from that donation. And there after gradually we received more financial support for our eye hospital from Kasturba Health Society(Patron respected Dhirubhai Mehta), Sight Savers International, , Mumbai group of friends, etc. Till now, Kavita had operated more that 700 eye patients including cataract patients successfully including Intra-ocular lens implantation free of cost. Due to superstitions, it was very difficult to convince patients for cataract surgery in Melghat.
For one year, Kavita visited more than 50 villages in Melghat and conducted door to door screening and treatment of patients. Our son, Athang was 4 months old. She used to keep him in cradle( zoli) under some tree in those villages and she used to manage the patients. She used to bring patients for surgery in her own vehicle. Many times she used to come at night from villages and prepare food for the blind patients and feed them. It reminded me “ Patient is God and to worship the patient is real worship to god” . In such difficult circumstances, she operated upon many cataract patients. Her surgical results in such difficult conditions were admired by many doctors.
Due to her amicable and loving nature, we could extend our friend circle to very great extent and many of them are now good supporter of the project.
In Melghat, I have to shoulder many responsibilities other than physician and the day become so busy that I cannot spare enough time for my wife and son. For initial years, Kavita and Athang used to get irritated but now they have become habitual of the situation. Athang asks me baba, will you get time for me? For what you work so much?
For first couple of years, I used to go to interior villages through forest either by two wheeler or by bullock cart or walking for treatment of patients and health education. Melghat is famous for wild life like tiger, leopard, wild bear, etc. So Kavita was afraid of my life. My elder brother Avinash gave his tempo trax jeep free of cost for 7 years, due to which we could extend our medical relief work to most interior part of Melghat. Now due to strong support from Mumbai group of friends especially ambulance , we are able to extend our activities to a great extent.
Once upon a time one pregnant lady was delivering the baby. Her relatives were persistently asking Kavita to conduct the delivery. When Kavita went, the condition was critical. Some how she could delivere and save the mother but the baby had birth ashphyxia . She treated the baby and saved her life . But the mother could not secrete breast milk for her baby. At that time, Athang was six months young. Kavita used to send half of her milk to that newborn baby and keep half for Athang. Today that milk brother of Athang is living normal life. Now many of our village health workers & team of supervisors have motivated many tribal female from self examples to breast feedother babies whose mother had lactation problem. Many children were saved similarly.
Once I was in Gadchiroli, Athang developed severe Asthma at 3.00 a.m. He was then hospitalized in M.G.I.M.S. Sevagram. He developed similar attacks many times in Dharni. Once, Athang developed high grade fever. I started medicine but he developed abdominal pain at 2 a.m. in night. How to shift to Amaravati (which is 140 k. m. away and road is through dense forest and mountains,) at odd hours was a great challenge for us. Then I preferred to rely on my own clinical judgment and started other medicine. In the morning he felt better and we were relaxed-a sigh of relief. Three years back Athang developed pneumonia. I treated him with antibiotics for 5-6 days. As there was no significant improvement and as there was no pediatrician in Melghat , I consulted pediatricians in Nagpur and M.G.I.M.S., Sevagram and started new medicines. After 10 days, he became normal. Once Athang developed acute otitis media leading to rupture of tympanic membrane and severe ear pain during night hours. As there was no Ear, Nose & Throat surgeon in Melghat, I treated him at home. In the morning, he felt better.
Once there was important meeting of Bhavishya Alliance in Mumbai for deciding policies of malnutrition control in Maharashtra . Athang had severe attack of Bronchial Asthma . I was very much confused whether to go to Mumbai or not . But then Kavita assured me that you don’t worry , I will manage Athang , you go and attend the meeting . I attended that meeting and opposed the policy of Bhavishya Alliance to use social marketing skills for sale of products. Then Bhavishya Alliance made the policy of no business in social work.
We thought, we both are highly qualified doctor, and we cannot provide expert pediatric facilities to our son. But then we realized that we have to come out of our own personnel comfort zone to serve the nation.
In Melghat, as there was no expert doctors other than us, one has to move at least 100 km to reach to expert doctors and the road is through difficult forest and mountains and during night hours, especially during rainy season it is very frightening experience.
Once Kavita went to a village for supervision of field activities. As there was no return bus from the village she preferred to stay in the village in night. She slept outside the hut of a tribal. Few days back a tiger had attacked that village. At around 5 a.m. , Kavita realized that somebody had put leg on her abdomen(belly) and she frightened to think that probably it is the tiger and she shouted. And when she open her eyes she saw a calf had kept his one leg over Kavita and was ready to put other leg. But due to shouting, that calf ran away and Kavita was saved.
In the next morning, Kavita went to the forest for defecation as there is no latrine in most of the villages. She sat underneath a tree. Within fraction of seconds, she listened rustling sound of leaves and when she saw, she was horrified to see a black cobra snake near by to her. She was not injured and saved.
There was no money with our trust for purchase of land. We purchased one hector of land nearby to village Utavali and gave it on lease basis for 25 years to MAHAN trust without any rent. Today KARMAGRAM is slowly developing there. For initial few days, there were lot of snakes including poisonous snakes like Cobra, Krait and Vipers, etc. Once Kavita was shortly saved from a snake who was on the cloths & I was surprised by black cobra in my hut cum bedroom nearby to head end of my bed. We being Sarpamitra-friend of snakes, we usually don’t kill snakes but catch them and release them in forest. Once a black scorpion was sleeping quietly on bed of Athang throughout night. Hence, Kavita is always worried about myself and Athang. For initial few years, Panther, bear and other wild lives used to pass nearby to our land for drinking water to Sipana river. It further increased her stress.
In 2004-2005, we raised the issue of malnutrition and children mortality via newspaper , television ,etc. Due to which government health and I.C.D.S. department have to work hard today & exposed their negligence. So the government staff in those departments became angry and created lot of problems for me and our organization. We were threatened by many social ill elements instigated by such people. Few people tried to put fake police and court cases against me and our organization. Many of our village health workers were pressurized by those ill elements to leave the work. But we did not bow in front of such pressure tactics and faced all such obstacles with great success at last. Dr. Gite, director, Rajmata Jijau mother and children health and nutrition mission of government of Maharashtra along with Raji Nair, UNICEF , personally visited our project area in Melghat , verified our findings of malnutrition and children mortality . They were satisfied with our survey report and realized the false, under reporting of these issues by government health and I.C.D.S. departments. They started measures to improve the situation as per our recommendations. We also suggested RJMCHN Mission to conduct independent enquiry in other tribal part of Maharashtra which exposed the reality of malnutrition status in Maharashtra. Lakhs of children are benefitted due to it.
Now from 2006-2007, we are getting cooperation from government system.
But as we got success , the local political leaders and other ill elements of society instignated by local govt. employees started creating problems from 2008.
Tribal consider malnutrition to be curse on them. As we exposed the problem of malnutrition and children mortality in Melghat, the disturbed government system and few social ill elements started creating nuisance for us. Many times, it disturbed my mental piece so that I use to think to lodge a police complaint against such people. But our friend and well wisher Dr. Avinash Saoji advised to follow teaching of great Vinoba Bhave
“Fight the sword with shield not with sword itself”. Then we changed our strategy and started increasing our rapport building in the community itself and tried to increase the community participation in the project. And the community itself answered to those ill elements and supported us. Then I thought , Gandhiji went to jail for freedom. Cowdung was thrown on Savitribai Fuley by ill elements for educating girl and Yeshu Krishtha was put to death on cross by goons. So those who want to uplift the society has to bear opposition from ill elements. So I will have to tolerate it, fight for right and not leave right path.

Lack of water, electricity, etc. is now routine for us. Very high temperature up to 48 degree during summer (lack of electricity and so no cooler for many times), cold waves with temperature reaching to 3 degree during winter and incessant heavy rains during rainy season leading to floods in rivers , isolating villages from Dharni & cities leading to stagnation of staff in villages is now routine for us. Many times we saved very critical patients of heart attack, brain heamorrhage etc. in absence of electricity in light of candles, etc. Once I saved a serious case of heart attack by not sleeping throughout night in absence of electricity. Next day a dog of our neighbourer barked at son of that patient. He rewarded me by threatening to lodge a police complaint instead of thanking me.
Once a person lodged a false Atrocity case agianst me and Kavita. Actually we did not commit any mistake. Police tried to pressurise us for settlement saying that we will be arrested. At that time Athang was exam going. In next month , I was supposed to go to foreign for presenting papers in international medical conferences. We thought a lot and decided we will not bow infront of such wrong allegations and bear whatever will be the consequence. But at last police could not arrest us as it was fake case. We realised Mahatma Gandhiji’s sentence “ Truth can be troubled but cannot be defeated.”
In 2007-08, Kavita developed heart problem-neurocardiac syncope leading to ventricualar bigeminny , but she nevere thought of running away from her work or Melghat.

Kharya tembhru experience: Due to negligence of one government nurse in Kharyatembhru village, one child died. So we investigated the case and realised that due to her attitude the health status of Kharya Tembhru is bad. But due to fear, she and some ill elements of the villages defamed us and stopped our work in the village. A PIL has been filed by us in Mumbai High court and hon. Chief justice asked govt. to take action agaisnt the nurse.
Though there are lot of obstacles like this in our path , we both never felt frustrated so as to leave Melghat. This is the greatest achievement of our life.
We had many fights with corruption in government system like:
1. Health camps.
2. Forest wood for house.
3. Atrocity case.
But we never paid bribe nor bowed infront of corrupt personnel .
Development of new horizon:
1. While starting hospital in Melghat in 1998, it was decided by me not to do any other work than medical care especially treatment of medicine subject related illnesses. But after one and half years, I realized that, without health education, most of the tribal health problems cannot be solved. Hence we started health education programs in the form of slide show, group discussion, etc. in various villages. I used to advice them to eat high protein, calories rich diet and fruits and vegetables to prevent malnutrition. After listening it, poor tribal used to say, doctor we will get such diet on the day of bazaar (once a week) only. Being poor, we cannot afford to purchase it regularly. I used to advice regarding Kitchen garden. People said, we fetch drinking water from river at 2 km., go to forest for defecation and for bathing we go to river, then how to develop kitchen garden with limited sources of water? So we realized the limitations of routine methods of health education. Then we started youth training program where we used to create awareness among youths regarding health problems, sustainable agriculture, kitchen garden, de-addiction, government schemes, etc. Now we started experiment of kithcen garden in 17 villages of Melghat under guidance of Agriculture expert Manohar Khake. We could develop around 450 kitchen gardens in Melghat. It is proving to be sustainable long term solution for malnutrition.

2. In 2001, Dr. Kavita started her ophthalmic hospital in Melghat. But at that time, most of the tribal could not even imagine existence of separate doctor for eye care. Most of the tribal were not aware of benefits of cataract surgery and spectacles. There used to be less patients in her hospital. Then Dr. Kavita started Community Based Blindness Control Program in the form of door to door eye care, health education program, diagnostic and therapeutic camps, school eye checkup, etc. in more than 100 villages of Melghat.

3. Children mortality control program:
Melghat is known for malnutrition and children mortality. As I am not pediatrician, I decided not to touch this issue. Once I was in my OPD, a widow tribal female brought 2 years old child who was severely malnourished and suffering from bilateral pneumonia. His chest wall was studded with rice, geru (red liquid), feathers of hen and Damma(skin burnt with red hot iron rod) and garlic mala around neck. He was very serious and I advised the mother to admit that baby. But the mother was reluctant to admit and asked for injection. After repeated request, she denied admission. Then I used my ultimate weapon that if she won’t admit him, he will die. She coolly responded, let him die, I have four more children at home, goats and chicken and who will take care of them and any how he is going to die. She went back with the child. After 3 days, I got the message that the baby died. I realized rule of survival of fittest and thought if I would have been at her place, I might have thought similarly, thanks to the poor situation. But after listening repeated news of children deaths, myself and Kavita used to get depressed. In 2003, 5 children from 2 families of 2 different villages died due to diarrhea. For two nights, Kavita did not allow me to sleep properly. She demanded to arrange camps in different villages to stop children deaths at cost of routine O.P.D. In Melghat , there are 317 villages, our capacity is limited , government could not control the situation in last 10 years by mobile camp approach and whenever there is a disease in villages , timely proper medical care cannot be made available . So I could convince Kavita that mobile clinic is not solution for reducing childhood mortality in Melghat. I was thinking of training bare foot doctors.
During that time, I came across the Home Based Neonatal Care approach developed by respected Dr. Abhay Bang, SEARCH Gadchiroli. I discussed it with Dr. Bang and realized its replicability and acceptability in Melghat.
Our trust adopted 38 villages for this experiment(Randomised clinical trial) . We trained illiterate to semi-literate tribal female as village health workers for treatment of childhood illness. From January 2004, our village health workers started recording vital events i.e. death and birth record, weight record of children in the 37 villages. From May 2005, village health workers from 19 villages of intervention area, started treatment of childhood illness while in remaining 19 villages of control area, only data collection is going on. Today we are getting good result of it. We could reduce the under 5 children mortality & Malnutrition by more than 60 % in those 17 villages which is cost effective and easily replicable model. Dr. Ashish Satav received Young Scientist Award and first best oral presentation in National Symposium on Tribal Health by Indian Counsel of Medical Research. It was presented in 6 international medical conferences.

Sukrai Jambekar, 7th std. pass, our tribal village health worker saved a baby suffering from birth ashphyxia by 60min artificial respiration showing her will power and dedicaion to save the newborn.
Kantabai Wankhede, totally uneducated village health worker saved a baby of birth ashphyxia by artificial respiration in govt. primary health center when govt. doctors expressed their inability to save the baby.
Sumantara Dhande, 6th std. VHW saved a baby of neonatal sepsis in village who was referred by doctors from subdistrict hospital , Dharni.
Shamim Bashir saved a baby of 800 gram by proper newborn baby care in village it self.
Sheela (Keli) and Urmila (Berdaballa) saved babies by breast feeding children of other females.
Now this program will be replicated by government in all villages of Melghat.

4. Counselor program:
Tarubanda story in Sub District Hospital , Dharni (SDH )
Collector of Amravati requested voluntary organizations to admit severely malnourished babies in hospital. MAHAN trust admitted 4 severely malnourished babies in SDH Dharni in 2006. On 4th day the mothers left the hospitals with children and told to us that they were not cared by doctors and nurses. So MAHAN investigated the case and found many lacunaes in the govt. hospitals especially communication gap and lack of facilities.

• MAHAN and KHOJ approached Dr. Mishra (National Human Rights Commission , special reporter), Divisional Commissioner Dr Goyal and District Collector Dr. Bhapkar.
• On our request local tribal youths were appointed as counselors in all government hospitals of Melghat under government and voluntary agencies paretnership, under our leadership . The benefits of the program are:
• Communication development between doctors and community.
• Increased quantitative and qualitative improvements in Melghat government hospitals and patients hospitalisations.
• It saved thousands of precious lives.
This is the first innovative program of monitoring of government hospitals by voluntary organisations in India. Due to this, many social ill elements who were corrupt and robbing govt. hospitals were diturbed and tried to threaten us. One of the corrupt district health officer suddenly stopped this program. We tried at all level to restart it but in vain. Then we filed a PIL in Mumbai High court. Honorable chief justice JN Patel, Mohit Shah and justice VY Chandrachud restarted this program and has advised govt. of Maharashtra to replicate the model all over Maharashtra. They also advised government to implement other suggestions of voluntary organisations for reducing child deaths and malnutrition in Melghat. This episode proved that Justice is till exist in India. If you are true, work for the people, scientific and ready to fight selflessly then one can win the almighty government also. This increased our own faith on ourselves.
Success story:
Everybody has his own concept of success.
1. In the beginning, people were suspicious whether a M.D. doctor can stay in Melghat or he will run away within months. Will tribal patient accept me (because tribal patients don’t go to doctors was a prevalent concept at that time) was itself a great challenge. In the beginning, very few tribal patients used to come to me for treatment. Many of them used to go to other unqualified doctors as I avoid unnecessary injections. But I continued my medical care without becoming depressed. People used to suspect whether a doctor living in hut, using bicycle and running hospital in hut is a really educated doctor or not. But when I treated and saved many serious cases of brain hemorrhage, heart attack, cerebral malaria and meningitis, people got confidence in me and I got recognition. Now those tribal who come to me usually become my permanent patient and I become their family doctor. Today the number of tribal patients attending our hospital for treatment is gradually increasing. My increasing confidence and my decision to stay for ever in Melghat indicates my success.
2. Initially patients were very reluctant for cataract surgery. But with great efforts, Dr. Kavita could operate upon more than 300 patients free of cost. Recently one poor patient even purchased preoperative medicines. It is great achievement for us that the family realised the importance.Now patients themselves are coming for surgery. This indicates some success to our efforts.
3. Since last 10 years, children and infant mortality rate could not be reduced by government efforts. But we could reduce the under 5 children mortality rate by more than 56% over a period of 1 year by home based child care approach (treatment by village health workers in 19 villages). This cost effective approach is the great success of our project. During last 5 years, the village health workers treated more than 75000 patients. The concept of bare foot doctors is now gaining good result. Our project received Young Scientist Award and first best oral presentation in National Symposium on Tribal Health by Indian Counsil of Medical Research – selected by chief of WHO- South East Asia Dr. Krongthorm. Our research work has been accepted in many international conferences. Now govt. has decided to replicate our home based child care program in whole Melghat.
4. Due to our advocacy over malnutrition and children mortality, Rajmata Jijau Mother and children Health & Nutrition mission(RJMCHNM) of government of Maharashtra along with UNICEF verified our survey reports, accepted the findings and started measures to control the situation. After our confirmation, RJMCHNM conducted similar survey in other tribal areas of Maharashtra and found very high prevalance of severe malnutrition. So our study exposed the situation of severe malnutrition in all tribal areas of Maharashtra.
Our NGO has been included in Bhavishya Alliance (international trisectorial partnership) for deciding policies for malnutrition reduction in Maharashtra. This is our great success.
5. In 2004, during winter season, we supplied nutritious food to 300 severely malnourished children from 38 villages of Melghat for 100 days and saved many lives. Most of the severely malnourished babies are getting food from AWW due to our monitoring. We analysed around 20 locally available food and found that many are nutrtionaly good. We prepared many dishes during the nutrition demonstration and trained many tribals from 17 villages for home based feeding & hygeiene . Due to our this experience , we mobilised local govt. health department to start village based feeding centers in 39 villages of Melghat. They got good result and then from this lesson, (RJMCHNM) conducted similar experiment in other part of Maharasthra. Now it is state level policy of VCDC. The root lies in our experiment of 38 villages.
6. During camps we exposed problem of Malaria. D.M.O. pressurised us not to expose. We did not bow . Collector accepted the fact and ordered the government machinery to start malaria control program on massive scale.
7. Road traffic accident: Once a truck carrying more than 50 passenger fallen down in river near Bihali village. More than 10 people died on spot and more than 12 were serious. No vehicle was ready to stop there and remove the serious patients from the river. We 3 got down into the river and removed all 12 serious patients from the river and could sent them to hosptials. Out of them only one died. So we could save 11 lives. Later on our team saved many accident cases by rescuing from the accident site and proper referral.
8. Socioeconomic development especially public Satbara reading. Initially in Melghat most of the tribals were working on the fields given by government to their ancestors. But the were not legal heir of the lands and hence were not getting benefits of government schemes. We with the help of villagers could pressurise government to start mutation and open satbara reading on mass scale. Due to which many tribals are benefitted to great extent.
9. We prepared one flipchart for malnutrition. Many experts expressed that , it is excellent flipchart. Now it is being used in all government hospitals of Melghat and Amaravati.
10. Story of community awakening :
Village Kokmar- 1. Motivation of people for accepting facts of malnutrition : Due to exposure of reality of malnutrition in Melghat, the grass root govt. workers along with some notorious people presurrised Kokmar village health worker (VHW) to stop work. It was a great blow to me , as it was my dream to reduce deaths in very interior village like Kokmar. Then myself with my friends esp. Alhad Kashikar and our staff went to the village in rainy season thorough very dense forest on bikes. The villagers were reluctant to speak as they were told that we are defaming their village by publishing name of the severely malnourished babies. After 30 minutes, we saw a thin boy walking with a roti in hand. He was severely malnourished 3 months back and bed ridden & was not getting proper nutrition from anganwadi. Due to exposure of his name in news paper by us, he was getting benefit of special diet and health care from govt. So now he is able to walk. We explained it to the villagers. They were convinced with the example and started supporting like anything to us since then. We have now full support in the village. The VHW restarted her work.

There is lot to write but to I am finishing it here. At last, I must be thankful to many of our friends, supporters, financers and our parents, family members , staff and especially patients who by heart, supported us to full extent in our endeavor.

Address for correspondence:

Dr. Ashish Satav
Mahatma Gandhi Tribal Hospital,
Karmagram, Utavali
Tah: Dharni, Dist : Amaravati
Maharashtra-444 702
Phone: 9325094780, 07226-202793, 202291
Email: drsatav@rediffmail.com

Add PBC neck 20 yrs female unmarried, operated-, blind suicide prevented.
Our experiences of Melghat.