A medical education, typically, spells success, money and a good life. To a young Ashish Satav too, it meant a good life but with a difference. Having reared on Mahatma Gandhi and Vinoba Bhave, it meant a good life enriched by selfless service to the downtrodden.
Dr Satav found his calling early. The writings of Mahatma Gandhi and Vinoba Bhave and their exhortation to serve the villages influenced him in his early teens. To prepare himself for a life in the wilderness, he roughed it out as a medical college student – he would stay without a fan in peak summers and take cold water baths in the harsh winter to condition his body for the tough life he had planned for himself.
On completing his M.D (medicine) from Nagpur University, he moved to Melghat in 1997. Infamous for its malnutrition deaths, Melghat is a densely forested region spread over two talukas – Dharni and Chikaldhara – of Amravati district in Maharashtra, with a mostly tribal population of 2.5 lakhs. It has one of the highest infant mortality rates in the country – 100 per 1000 live births among the Korku tribals. The incidence has come down to 48 per 1000 live births following Dr Satav’s tireless efforts. Virtually the entire population of Melghat has directly benefitted from one or many of Dr Satav’s welfare activities. Another five lakh people outside Melghat have benefitted from the policy changes in Maharashtra pushed by Dr Satav.
Dr Satav lives by a simple belief: “A patient is God; worshipping him is worshipping God.” He hand-holds tribals in all walks of life. His trust, Mahan, runs a critical care hospital, home-based health care programmes for children, awareness programmes for health and hygiene, counsellor programmes and nutrition programmes. “We work on three principles: direct service; do research and prepare pilot models; and lastly, mobilise the government machinery and change policies,” he says.
Dr Satav identified Melghat as his work station after discovering its deplorable public health system. His eye surgeon wife, Kavita, joined him after marriage and together, they have built the health care apparatus in Melghat step by step. Unlike an average couple whose daily crisis involves dealing with their child’s short attention span or a depleting bank balance, the Satavs deal with existential crises in the lives of hundreds of young mothers and children with a slim budget that is founded on their own savings.
Mahan hospital with Dr Susheela Reddy
In 1998, Dr Satav founded a trust, Mahan (Meditation, AIDS, Health, Addiction, Nutrition) and a hospital in a hut in Dharni. The hut remained the hub of their activities till it shifted to a building ten years later in Karmagram, Dharni taluka. A few months after founding it, Mahan found support from Dr Susheela Nayar. Since then, Mahan runs the hospital in partnership with Kasturba Health Society, Sevagram.
Dr Satav started with the idea that he would attend to cases coming to the hospital. But he had not reckoned with the general tribal reluctance to deal with institutionalised health care. In an area infested with wild animals and snakes, Dr Satav would ride a bike in the dark to find his patients, persuade them about the need to come to hospital for treatment. It was only after his brother, Avinash, donated a Trax jeep for his work that the bike trips ceased. Still, travel was a must to take the tribals into confidence and help them help themselves. Often, Dr Satav would fetch critical patients and bring them to his hospital.
The biggest stumbling block he faced was the reluctance of tribals to take an ailing family member to hospital due to superstition or plain lack of resources. Dr Satav tried to battle both by going to their homes and educating them about the need for timely medical treatment. It was a slow starter. But once the word spread and the community saw and experienced his healing touch, they turned around.
Till 2014, the hospital has treated 89,000 patients, many with critical complications such as heart attacks, snake bites and haemorrhages, and saved thousands of lives. The multiple challenges thrown his way in the last two decades have only made Dr Satav dig his heels in deeper and try harder. In the process, he has had to continuously think out of the box and work out innovative solutions, some of which are fashioned into models that have been replicated in Maharashtra and can be easily replicated across the country.
Home Based Child Care
Dr Satav’s second major initiative was born of a tragedy that made him rethink his hospital-oriented focus.
A tribal couple refused to admit their critically malnourished child to hospital. Dr Satav’s team persistently pleaded with them without success and the child died two days later. “It disturbed me and Kavita immensely. After two sleepless nights, we realised we cannot cater to 320 villages through a hospital. It was important to take medical facilities to their doorstep instead of making them come to hospital,” he recalls. Through the home-based child care programme, Mahan trained select tribal women and made them go house-to-house treating children with perennial problems like diarrhoea and malaria in their own homes. This simple methodology has worked like a charm all over Melghat.
Lakshmi’s story is a case in point. Mahan’s field workers came upon this 23-month-old girl in a critical condition. She had the worst degree of severe malnutrition and was suffering from severe pneumonia. Her weight was 5.3 kg, half of the average weight for her age (see pic). Dr Satav’s team requested her family to admit the child to hospital for treatment. But they refused flatly, saying that she had been admitted in various government hospitals.
Laxmi before and after treatment by Mahan
Now, they had left it to “God’s will.” After two days, a Mahan team visited Lakshmi’s house and found the mood in her home sombre. Agarbattis were being burnt and the family was praying for her life. The Mahan team decided to take the chance of treating her in her own house even if the relatives were unwilling to take her to hospital.
Still, it took a great deal of persuasion to make the family accept treatment even in her home. Mahan’s village health worker, Meerabi, treated her according to treatment guidelines developed by Dr. Dani, Ms. Pendharkar and Dr. Satav. To everyone’s relief and delight, Lakshmi showed quick improvement. Her weight increased to 7.8 kg in 70 days (see picture). Today, it is impossible to relate this healthy, cherubic child to the sickly baby in the old pictures.
In Toranvadi village, a two-year-old orphan, Reshma Kakde, lived with her grandmother. She was born with a cleft lip and palate and could not speak or eat properly. Her idea of communication was limited to crying. Because of her inability to eat well, Reshma was severely malnourished and weighed a frail five kg.
She got a lease of life when she visited the free plastic surgery camp at the Mahatma Gandhi Tribal Hospital organized by Kasturba Health Society, Sevagram, and Mahan. Plastic surgeon, Dr. Dilip Gahankari, from Australia, operated upon her. It was a delicate operation as Reshma was extremely weak and severely anaemic. Thanks to the care and nursing by the medical team and other staff, her surgery went off well.
Within 15 days, Reshma showed remarkable recovery. After discharge, she was successfully treated at home by the Mahan team. The continuous care has paid off. Now, Reshma speaks well and, usually, with a smile. Crying as a mode of communication is history well forgotten.
Dr Satav has proved on the ground that severe malnutrition too can be treated at home by a trained health worker or counsellors through a scientific diet based on locally available food material and prepared by local tribal women under close supervision.
Along with these outreach initiatives, Mahan adopted a holistic approach that makes Melghat a much happier place today. Dr Satav’s interventions have been multi-pronged — from medical facilities to de-addiction programmes to educational initiatives to monitoring to research.
The Village Child Developmental Centre where severely malnourished children are treated at home or by government staff was launched by Mahan, and later replicated by Maharashtra government throughout Melghat. Dr Satav and Mahan have been instrumental in changing seven to eight of government policies through their advocacy work and public interest litigations.
One of Dr Satav’s exceptional innovations was the counsellor programme. The 17 government hospitals in Melghat were in a bad shape, without adequate ambulances or even proper food for inmates. Under this programme started in 2007, Dr Satav’s counsellors would liaise between the government doctors and the tribals to organise basic health care support services such as ambulances. “One man and one woman were appointed as counsellors for every hospital. So, if somebody needs an ambulance and the government staff at the hospital does not send one, the counsellor would step in and get it done through us or through the mediation of a higher official,” says Dr Satav. As a result of this novel initiative, the functioning of hospitals improved tangibly, critical lives were saved, severely malnourished babies got treated and patients received round-the-clock care, an idea unheard of in those parts. For the first time in the country, government hospitals were being monitored by a voluntary organisation.
The counsellor programme hit rough weather in 2010 when an officer discontinued it. Not willing to shelve one of Mahan’s biggest successes, the mild-mannered Dr Satav fought it out in the courts with the help of friends. Far from getting stifled, the programme went on to make history by engendering positive changes in tribal policies in Maharashtra. It earned generous praise from the Bombay high court which asked the Maharashtra government not only to restart the programme but also for its implementation in all hospitals in Melghat.
Food availability and mortality control
Awareness programmes taught the tribals basic hygiene such as the importance of washing hands before eating and after defecation to prevent diarrhoea. In order to feed tribal children nutritious food, Dr Satav floated an organisation that taught local tribal women to cook the right types of food.
Cooking was one part of the malnutrition problem. The second was availability. Mahan started 300-400 ‘nutrition gardens’ in 16 villages in Melghat which grew pulses, fruit and green vegetables. It provided employment to tribals while the very fertile Melghat soil provided easy food. As a logical extension of this idea, tribals were encouraged to grow food in their backyards to provide for their family at minimal cost. Today, there are over 3,000 kitchen gardens in Melghat, eliminating the need to buy unaffordable food. These twin ideas have provided a sustainable model and long-term solution for the prevention of malnutrition.
Mahan also began intensive behavioural change campaigns to improve the health and hygiene of people. The campaigns have had a great impact, causing maternal mortality rate to drop by 50 per cent.
Mortality control programmes for economically productive age group of 16 to 60 years were taken up by Mahan when Dr Satav saw that premature deaths in adults were common. These deaths, even more than that of the children, affected the household critically as it would deprive the family of their sole earning member. “We trained village health workers to treat people in this age group. Those suffering from TB, diabetes, pneumonia, were identified, treated and cured. This reduced adult mortality by 52 per cent,” says Dr Satav.
All the programmes blend together to produce amazing results. Under-five child mortality in Melghat has reduced by 67 per cent and severe malnutrition by 82 per cent.
After spending most of his adult life in this inhospitable terrain, Dr Satav’s dream is to start a medical college in Melghat which takes in only those students who commit to working in tribal areas for three to five years. “Doctors don’t like coming to tribal areas. There are 78 tribal blocks in Maharashtra and thousands all over India which are in a state of neglect,” he rues. “There is a provision of a rural stint in medical admissions today but nobody takes it seriously.”
Marriage and Family
For most prospective grooms, good looks and dowry rank high on their list of must-haves for the bride. Dr Satav had different needs. He did not want to give up the work he had started because of a wife and came up with an unusual charter of demands: his wife should have at least an MBBS degree from a government medical college; she should belong to a different caste – “the only way I could ask others to break the caste barrier was when I break it myself” ; she had to agree to live in an under-developed area; she should be willing to ask donors for money for patient care – “it’s easy to ask for money for yourself, but I needed money to run my projects. People in Melghat could not afford a doctor’s fees or medicines for that matter. I had to provide for them,” says Dr Satav.
As fate would have it, he met Dr Kavita through a friend’s mediation. An eye surgeon, she more than met the first qualification and readily accepted the other criteria. “Kavita adjusted very quickly and became my partner in every way,” says Dr Satav. After their son, Athang, was born, Dr Kavita would travel with a nursing baby in her arms and let him swing in a cradle hung from a tree while she attended to poor tribals. Once, she was asked by a tribal couple to help deliver a baby. After hesitating initially as she was not a gynaecologist, she realised she was their only hope. The delivery was successful. Dr Kavita even gave her son’s share of mother’s milk to the infant for a while as his mother could not feed him.
True to the service culture prevailing in his family, Athang, a strapping teenager today, wants to serve Melghat after becoming a doctor like his parents. He has seen the ups and downs, the highs and lows but is far from deterred. The Satavs have had to sacrifice quality schooling for their son to continue being in Melghat. “Sometimes, I worry about him. But we know there are people who will take care of him,” says Dr Satav. For them, no price is too hard to pay for their dreams which always but always revolve around the tribal community. “I have achieved much beyond my expectations. I had never thought I would impact so many lives and even those outside Melghat. But while that is a source of tremendous joy, I hope to be able to do much more in the next 25-30 years,” says Dr Satav.
At a time when medical students avoid the compulsory rural stint at any cost, with some of them even willing to pay a stiff fine for it, the Satavs have voluntarily embraced a life of austerity and seva, and found their calling far removed from the comfort and security of a city life.
Keeping at it
If Dr Satav has managed to pursue his unusual vocation with the zeal and determination of an evangelist, he gives the credit for it to yoga and meditation. Many a noble intention falls through the crevices of harsh reality but Dr Satav has weathered all storms equanimously. “I learnt a few meditation techniques from the Vivekananda Kendra. I am particularly influenced by ‘My Experiments with Truth’ and Vinoba Bhave’s ‘Geetai’ in which he narrates five signs of a stable mind, ‘Stithprajna che lakshane’. It’s only because of these practices that I can withstand the setbacks and pressures at work,” he says. It helps him control negative emotions like greed, anger, lust, ego and envy.
Many experiences were daunting, but none fazed him. In a village called Kolupur which has no pucca houses, a cobra entered his room and sat near his head. “I knew there was a cobra in the house and had been unable to spot it. When we did, we simply caught him and released him in the wild,” says Dr Satav, who stayed in Kolupur for a year.
After starting the hospital with his own savings of about Rs 7 lakh, Dr Susheela Reddy and Kasturba Health Society have been supporting him. Soon, word spread and his work got the recognition it deserved. Money from well-meaning patrons and companies started coming in. Today, he gets support from Caring Friends, a thoughtful bridge between NGOs and donors, Arpan Foundation, Mastek Foundation and many more.
Awards and Recognition
Dr Satav has presented many papers on his work at national and international fora and received commendations from government authorities, voluntary organisations, corporate entities as well as courts.
He is active in policy-making and monitoring: he is a member of the state-level Village Child Development Committee of Rajmata Jijau Mission, Maharashtra, member of the European Society of Paediatric Research, member of the district Navsanjeevan committee for monitoring child health and nutrition activities, member of the mentoring committee of the district National Rural Health Mission.
Dr Satav has received widespread recognition including the Spirit of Mastek Award in 2010-11, ICMR’s Young Scientist Award, Americares Foundation’s Spirit of Humanity award for child nutrition, but the biggest pat on his back comes from the children he saves against impossible odds.
Mastek Foundation is supporting Dr. Satav’s endeavor for the past three years. In the Financial year 2014-15, Mastek Foundation supported the project- MORTALITY CONTROL PROGRAM IN ECONOMICALLY PRODUCTIVE AGE GROUP (MCPEPAG). By supporting Mastek Foundation you are supporting Dr. Satav’s mission of nurturing hope and creating better future.