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Improving Rural Health

By Rutagengwa Claude Shema

Regional Coordinator

Great Lakes Peace Initiative (GLPI)


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     Drs. Rajanikant and Mabelle Arole, a husband and wife team
of physicians, founded the Comprehensive Rural Health Project in
Jamkhed, India, about 8 hours bus ride east of Mumbai.  They
first worked in a hospital, but soon realized that despite seeing
hundreds of patients every day and working tirelessly, they were
reaching only a small fraction of the sick people in their area.

   They then went from village to village, giving demonstrations and
lectures about hygiene, balanced nutrition, and preventive health
care.  But to their disappointment, when they returned a year
later to the same villages, they found that people had reverted
to their old superstitious beliefs and little had changed. For
example, based on false beliefs, pregnant women were not allowed
to eat certain foods which they needed to have a healthy baby.

    So they tried a new approach, which worked.  They invited
villages whose council of elders agreed to participate in their
program to send a representative, usually a young illiterate
low-caste woman, to spend a year at their clinic and observe with
her own eyes the consequences of various approaches.  Instead of
simply telling people what to do, they help them make informed
decisions about their own welfare and share this with others.
When they returned to their own villages, their teachings were
accepted by the villagers, because these health workers spoke
their own dialect, and knew all the local myths and stories that
they could weave in with the new knowledge they had acquired.
They also had a certain status, because they had been selected by
their own village council, usually consisting of elder men.  With
this approach, the Aroles saw infant mortality drop from 176 per
1000 to just 19 over a decade.

     The Aroles published a book in 1994 entitled "Jamkhed: A
Comprehensive Rural Health Project," available for $13 through
the Jamkhed International Foundation, PO Box 291, Carrboro, NC
27510, USA (or  Their international training
center has been spreading their Community-based Primary Health
Care Approach around the world for eight years now.