Rural Unit for Health and Social Affairs

A good term to sum up the CMC would be "mission creep." It seems that throughout every undertaking in the organization, they started with a small, limited scope, and it slowly became larger and broader, while still retaining the original mission. The hospital itself is an example of this, starting from a one room hut designed to treat the poor farmers, becoming an enormous hospital system with nearly 3000 beds serving people across and even outside of India.

This term is especially appropriate for the Rural Unit for Health and Social Affairs (RUHSA) which Moriah and I toured this afternoon. It was started in 1977 to provide care to the rural populations surrounding vellore, and has a similar mission to CHAD, described in an earlier post. Like CMC itself, it started as a small inpatient unit with an outpatient clinic, but has slowly grown into something much more, to the point that the term hospital is hardly appropriate.

The founders understood that in order to make a difference in the healthcare of the rural villagers, they would need to bring healthcare to them. These farmers and laborers to not have sick days, and a day spent traveling and waiting at a clinic is a day without pay. RUHSA covers a large area with a population of around 130,000 people, which they divided into 18 districts, where they established peripheral service units. At each of these sites they placed a rural community office (RCO), a person with a masters degree in social sciences, who was placed in charge of a group of family care volunteers, mainly former midwives who were married, and children and were well respected within their communities. They received some additional midwife training, specifically how to recognize high risk pregnancies, as well as some basic training on common medical problems. Their job was to encourage people to attend the doctor and nurse mobile clinics in the area, and build goodwill to the CMC.

The family care volunteers have done such a good job at this aim that they are gradually becoming obsolete; the people in the community have become well connected with RUHSA, and it is likely that this program will begin to be phased out in the coming years.

What is replacing the family care volunteers are community self help groups, usually a group of 20-30 women in the villages who with RUHSAs help joined together to fulfill the role of the family care volunteer. But here is where the term "mission creep" really applies; the self help groups have become truly powerful agents of social change. Initially started as a way for RUHSA to ensure that the individualized community needs were being met, they have become important financial institutions for the community.

Observing at the RUHSA clinic

Most of these villagers have very meager savings, a financial hardship making them extremely vulnerable to poor harvests or emergencies. Before they would have to depend on money lenders who would charge exorbitant interest, locking them in debt sometimes for decades. Some of the self help groups began to collect a small amount of money from each member family each month, and would save it collectively. When one family required money for an emergency, they would go to a meeting of the group to request it, and would pay the fund back at a very small interest rate. Eventually the groups decided to start businesses to raise additional funds, and we're able to borrow money at very reasonable rates from banks collectively. Most of these self help groups now run small businesses to support the community. One of them runs the canteen at RUHSA, another runs a coffee cart at the main campus. Some buy livestock and sell milk, others make bags, jewelry etc.

These groups have a wide array of other affects on the community, aside from the financial benefits. Most interestingly, they have given the women who run them a very clear leadership role. It would be interesting to find out if these villages have lower incidents of domestic violence or mental illness.

RUHSA also decided to tackle another severe problem in the rural area, unemployed youth. They established several degree programs to allow young men (not women yet) to become mechanics, electricians, and a few other vocations. The graduate unemployment rate is less than 15%, compared to their demographic which approaches 50% in some areas of the country. Some of these men now work outside the country for auto manufacturers.

With all that it does for the community, it would be difficult to call RUHSA simply a hospital. It started out as a clinic with the aim of improving the communities' health, and has allowed their infrastructure to broaden to attain that goal. Truly a special place.

Dave