Building trust, treating infections in rural North India
Dr Ashish Abraham was running a medical camp in a village in Madhepura, a rural district in the state of Bihar in North India. He was there to offer care to the Musahars, part of India’s “Scheduled Castes” (i.e. the lowest caste, formerly “the untouchables”), who are barred from entering the main villages.
At the camp that day, Dr Abraham received a special request: “There is a child with a wound on his foot. Can you come and see?”
Dr Abraham agreed. He was led to a solitary child* seated on the ground next to his family’s bamboo hut. His foot was wrapped in plastic and covered by a mosquito net. The child looked weak and sick.
Dr Abraham introduced himself and offered to look at the foot. The child nodded.
After removing the wrapping, Dr Abraham found that the child’s foot was swollen and covered in pus.
Later at the hospital, lab results revealed that the child had Mycetoma, also known as Madura foot, caused by actinomyces bacteria. It would take several months of antibiotic treatment to fight off the infection.
Dr Abraham’s intervention came at just the right time. Previous attempts to treat the boy by doctors at neighbouring local hospitals and by the ubiquitous local quack doctors had failed. Without effective intervention, the boy faced amputation and life-long disability. Thanks to the effective intervention, the boy made a full recovery.
For Dr Abraham, antibiotics are part of larger health and social systems that must be addressed together in order to treat people in need effectively.
“The Musahars are very poor. So poor that health is not a priority—food comes first. They never spend money on their health, except with the local quacks. We realized that to treat them, we’d have to take our hospital to them, to their doorstep, by setting up these health camps,” said Dr Abraham. “That was how we found this boy.”
In his role as Community Health and Development Project Director of Madhipura Christian Hospital, Dr Abraham has made these health camps and telemedicine a key priority.
“These local quacks are usually the first point of contact, since they are available at any moment, and they are cheap. You can pay them in cash or in kind, for example with rice that you expect to harvest this season,” he said.
“They give patients a quick, cheap fix, often with antibiotics or steroids. For two days or so, the patients get better, and then they relapse. Then they go to another quack. By the time these patients reach us, they have often been ‘treated’ multiple times,” Dr Abraham said.
This inappropriate use of antibiotics means that Dr Abraham sees patients with infections that are far more advanced than they would be otherwise.
“We see a lot of resistant infections,” he said.
To care for these people, Dr Abraham and his team carry out outreach and human development activities, including livelihood support, disaster preparedness, and countering human trafficking.
“We’ve started building the rapport and earning their trust,” said Dr Abraham. “That is the first step in providing them with accessible healthcare, including effective treatment of bacterial infections.”
*Story has been shared with the patient and his family’s permission.