RAIPUR: Serving as a doctor in rural areas of Chhattisgarh isn’t for the faint-hearted. It means braving jittery walks on rickety bamboo bridges, crossing rivers on foot, long, sweaty trudges through jungles to handle hundreds of patients a day, and the occasional run-in with Maoists. No wonder hardly any doctor or nurse takes the risk.There is no incentive – either in terms of pay or even housing – to make it worth the pain, say doctors who have served in remote locations.The dearth of medical staff is most acute in the Maoist-affected tribal districts of Bastar , Bijapur, Kondagaon, Kanker, Narayanpur, Sukma and Dantewada. There has never been a gynaecologist, paediatrician or anaesthetist, nor even a surgeon or general physician at the district hospitals of Narayanpur.In Kanker, there is a sanction of 62 specialists, but only five are posted. The district’s healthcare runs on the tireless work of these five doctors and 96 nurses. Villages depend solely on Aanganwadi and PHC health workers . The less said about the villages in the interiors, the better. Their lifeline is the medical camps that are held now and then – when doctors and nurses trek for miles through jungles, watching out for snakes, wade across forest streams and (when they are lucky) tiptoe across swaying bamboo bridges.A doctor at Dantewada’s district hospital told TOI just how difficult it is. “The government fails to provide residential quarters, and adequate security for women doctors. There isn’t even water to drink, not to talk of shortage of medicine and emergency equipment. The labs have malfunctioning equipment – that is when we have a lab assistant. There are very few nurses. There’s tremendous pressure on doctors 24x7,” he said, adding: “It’s only the sheer dedication of the doctors that saves hundreds of lives in these parts.”Everyone who serves here reaches a breaking point. Kondagaon district hospital’s gynaecologist, Dr Manharan Netam, said, “I was directly hired at the district hospital and being paid through Collector’s District Mineral Fund, but I am resigning in a day or two because I simply cannot tolerate the pressure. Its relentless. I am overworked due to shortage of staff and other reasons.”“I single-handedly see patients in OPD, carry out ultrasound and perform surgeries all day. I cannot afford to make the slightest mistake, and that adds to the pressure. Moreover, the medicines supplied in government hospitals are very often of substandard quality, which have no desirable effects on patients. Slowly, we tend to lose our faith in the outcome of the treatment. In such a situation, we neither assure a patient’s recovery nor challenge the medicine corporation,” Dr Netam said.Doctors in these parts also have to contend with political pressure. “They tend to create political pressure and force us to see every case under their directions. We give preference to critical cases but despite counseling, the patients recommended by local leaders create a ruckus,” said a doctor.A medical officer in-charge, Dr Keshav Chandra Sahu , said, “Technically, an MD is equivalent to Class-I gazetted officer, but I get no respect from the administration. Doctors feel harassed as they need to appear frequently in courts for post-mortem reports. It eats into our time.”What’s more, Dr Sahu said, the government often doesn’t pay the salary promised at the time of recruitment. “For instance, block level medical officers do not receive the promised rural allowance of Rs 25,000,” he said, adding: “I work in villages of my will.”"There is tremendous pressure, no social security, no scope to educate our children or bring the family,” he explained, adding: “MBBS doctors join remote area on government offers but most of them resign as soon as they receive a lucrative offer from better towns or cities and they don’t even mind paying the penalty of around Rs 30 lakh for breaking the government’s bond.”Doctors can manage with poor mobile connectivity, said one. “But what we can’t manage is when there is no electricity to run equipment or conduct surgeries.”Till recently, there were just two doctors for 85 villages of Kanker district, said Dr Gautam Baghel, who has been there for long. “During monsoon, medical teams of two doctors and a nurse each treat over 10,000 patients. In emergencies, villagers still contact us through hand-delivered letters because the mobile network is so poor,” he said.Due to the absence of roads, mobile towers and illiteracy, the role of doctors is very challenging in Bastar, he pointed out, adding that bringing a patient to a healthcare centre means laying them on a cot and trudging miles through jungle.

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