Dr. Varad Puntambekar of NIRMAN receives prestigious Rhodes Scholarship of Oxford University

Dr. Varad Puntambekar, presently working as a Public Health Fellow at SEARCH has been selected for the prestigious Rhodes Scholarship and will be pursuing a Masters/PhD at Oxford University from September 2022.

A native of Bhopal, Varad completed his MBBS from AIIMS Delhi. Rather than following the usual route that most young doctors do, Varad was seeking opportunities to work in the area of public health and managing health systems.

He became part of NIRMAN and that brought him to Gadchiroli for the first time. Post his internship at AIIMS, he decided to work full-time at the grassroots to broaden his understanding and contribute to solving issues at the community level. In sync with the spirit of experimentation, he received NIRMAN’s Kar Ke Dekho Fellowship and started working in Gadchiroli from February 2021. 

At SEARCH, Varad has been a part of a variety of activities – preparing community guidelines for Covid-19, improving vaccination coverage in villages, providing clinical services in OPD and IPD, benchmarking mental health service provision by deciding indicators to improve quality of mental healthcare, training of community health workers & awareness for de-addiction in villages – to name a few.

His internship in Delhi changed his perspective of looking at healthcare systems. “My stint as an intern during MBBS provided me with the important learning that a clinician is just a small though important part of the healthcare system. There are a lot of other things which need to be mended,” says Varad, citing it as his motivation to become a ‘Problem Solver’ & solve community health problems rather than just playing the limited role of a clinician.

Varad believes that grassroots level experience is the only true experience. “Working in a confined & comfortable environment will only give you a diluted view. It is essential to explore & experience the real challenges in order to prevail over genuine community health problems. For that we need to first work at the grassroots level,” adds Varad encouraging young doctors to take up challenges at the grassroots level.

In addition to actual real-life work experience, Rhodes Scholarship will offer Varad an excellent opportunity for academic training at Oxford. He wishes to continue working on problems prevalent in the community in the long term.

They say difficult roads often lead to beautiful destinations. When your choices are unique, the outcome is often extraordinary. Varad’s story is one such case!

We congratulate him for his achievement & wish him the best for future endeavours!

‘जाऊ स्वतःपलीकडे – परिपूर्ण आयुष्याच्या शोधत’

‘आरोग्यम् धनसंपदा’ हे शब्द आपण अनेकवेळा ऐकत असतो. परंतु आरोग्य म्हणजे केवळ शारीरिक असा मर्यादित अर्थ घेत मानसिक आरोग्याकडे दुर्लक्ष केले जाते. वस्तुतः मानसिक स्वस्थता नसणे हे एका व्यक्तीच्या जीवनात अनेक नकारात्मक परिणाम घडवू शकते. विशेषतः मनसोपचारतज्ञांची तुटपुंजी उपलब्धता असलेल्या ग्रामीण भागांतील रुग्णांना व पर्यायाने त्यांच्या परिवाराला अनेक भीषण परिणामांना सामोरे जावे लागते. मानसिक आजारांबद्दल समाजात असलेला न्यूनगंड आणि ग्रामीण भागांतील ढिसाळ आरोग्यव्यवस्था यामुळे मानसिक आरोग्यसेवा पुरवणे हे आव्हानच ठरते. हेच आव्हान समर्थपणे पेलण्याचे काम करत आहे आपली नाशिकची निर्माणी मैत्रीण डॉ. हर्षाली मोरे.  

हर्षाली तिच्या प्रवासाबद्दल सांगते - “दहावीला चांगले गुण मिळाले होते पण तोपर्यंत करिअरचा गांभीर्याने विचार केला नव्हता. म्हणून माझ्या पालकांच्या सल्ल्यानुसार विज्ञान – बायोलॉजी – वैद्यकीय प्रवेश परीक्षा असा प्रवास करत मी MBBS (सेठ जी.एस वैद्यकीय महाविद्यालय – मुंबई) पर्यंत पोहोचले. त्यात माझे आई-वडील स्वतः डॉक्टर असल्यामुळे या क्षेत्रात काम करणं म्हणजे स्वतःमध्येच लोकांना मदत करण्याचं एक माध्यम असतं हे मी मला ठाऊक होतं.”

 

विचार उद्युक्त करणारे अनुभव

हर्षाली तिचा MBBSचा अनुभव सांगते - “जिथे प्राथमिक पातळीवर आरोग्यव्यवस्था रुग्णांपर्यंत पोहोचायला हवी तिथे तसं न होता रुग्णांना अगदी शेवटच्या स्तरापर्यंत आणि मोठ्या रुग्णालयांपर्यंत धाव घ्यावी लागत होती. यात रुग्ण आणि रुग्णाच्या नातेवाईकांना होणारा त्रास दिसत होता. या गोष्टीचा रागदेखील येऊ लागला आणि रुग्णांवर केवळ उपचार न करता त्यापलीकडे त्यांच्याशी संवाद साधण्याचा प्रयत्न मी करू लागले.” हर्षालीसोबत मुंबईला शिकणारा आणि निर्माण सातचा मित्र डॉ. मयूर पवार सांगतो – “स्वतःच्या भावनांवर नियंत्रण ठेवत समोरच्या व्यक्तीच्या भावनांना समजून घेण्याची क्षमता हर्षालीमध्ये आहे. या क्षमतेचा रुग्णांसोबत संवाद साधताना निश्चितच उपयोग होतो.”

 

महत्त्वपूर्ण वळण – निर्माण

आयुष्याच्या या महत्त्वपूर्ण वळणावर हर्षाली निर्माण या शिक्षण प्रक्रियेत सहभागी झाली. “निर्माणमुळे मला स्वतःपलीकडे पाहण्याचे धैर्य प्राप्त झाले. अवतीभवती चाललेल्या करिअरच्या जीवघेण्या शर्यतीतून मी बाहेर पडू शकले. रुग्णांकडे केवळ ‘Case’ म्हणून न पाहता त्यांच्याकडे माणूस म्हणून पाहण्याचा दृष्टीकोनदेखील मला निर्माणमुळे मिळाला.” निर्माणच्या शिबिरांनंतर वैद्यकीय क्षेत्राला एक वर्ष सेवा देण्याच्या बॉण्डची (अटीची) पूर्तता करण्यासाठी हर्षालीने डॉ. अभय आणि डॉ. राणी बांग यांची SEARCH (गडचिरोली) ही संस्था निवडली. इथे हर्षाली Mental Health Department मध्ये मेडिकल ऑफिसर म्हणून सेवा देत आहे. “पुढे जाऊन Medicine, Public Health किंवा Mental Health या व्यापक विषयांपैकी एक विषय निवडण्याचा माझा मानस होता. बॉण्डसाठी SEARCH निवडण्याचे कारण म्हणजे इथे विषयांच्या खोलात जाण्याची संधी आणि उपलब्ध असलेले अनुभवी लोकांचे मार्गदर्शन. त्याशिवाय ग्रामीण व आदिवासी भागांतील रुग्ण तपासण्याची संधीदेखील इथे मिळणार होती.” घरून या निर्णयाला तीव्र विरोध झाला नसला तरी हर्षालीच्या आई-वडिलांना चिंता मात्र वाटत होती. परंतु जशी तिला पुढील दिशा स्पष्ट होत गेली तशी त्यांची चिंतादेखील कमी होत गेली. “आपल्या कुटुंबाचा पाठिंबा मिळवण्यासाठी आपल्या विचारांमध्ये स्पष्टता असणे महत्त्वाचे असते”, असे हर्षाली म्हणते.  

 

गडचिरोलीतील अनुभव आणि मानसिक आरोग्य

गडचिरोलीमध्ये सेवा देत असताना आलेले अनुभव हर्षालीला अजून प्रगल्भ करत आहेत. मानसिक आरोग्याशी संबंधित समस्यांचा ग्रामीण / आदिवासी कुटुंबांवर होणारा परिणाम, व्यसनांमुळे उध्वस्त होणारे परिवार व त्यांचा समाजावर होणारा दुष्परिणाम आणि उपचार केलेल्या रूग्णांच्या चेहर्‍यावरील समाधान पाहून अजून चांगलं काम करण्यासाठी मिळणारी ऊर्जा असा व्यापक अनुभव सध्या हर्षाली घेत आहे.

SEARCH रुग्णालयातील अनुभवी नर्सिंग असिस्टंट आणि हर्षालीच्या सहकारी रंजीता डे सांगतात – “एखाद्या रूग्णाला शांतपणे कसे हाताळावे व डोकं थंड ठेवून कसं काम करावं या गोष्टी डॉ. हर्षालीकडून मला शिकता आल्या. अनेकदा वेळ-काळ व स्वतःचं खाणं-पिणं मागे ठेवून रूग्णाला सेवा देण्याला प्राधान्य देताना मी डॉ. हर्षालीला पाहिलं आहे. तिला आपल्या जबाबदारीची पूर्ण जाण आहे हे यातून दिसतं.” 

मानसिक आरोग्याच्या प्रश्नावर काम करतनाचा अनुभव हर्षाली सांगते - “कित्येकवेळा मानसिक आजार हा केवळ एका व्यक्तीचा त्रास म्हणून पाहिला जातो. परंतु ग्रामीण व आदिवासी भागांतील कुटुंबांत जर एकमेव कमावती व्यक्ती मानसिक आजाराला बळी पडली तर पूर्ण कुटुंबाचे हाल होतात. गावातील एखाद्या मानसिक रूग्णाला वेडा म्हणून वार्‍यावर सोडून दिलं जातं. अशा रुग्णांची वेळेत व योग्य उपचार मिळाल्यास ठीक होण्याची शक्यता असते. याशिवाय दारू व तंबाखू सारखे व्यसन हे सबंध समाजासाठी घातक कसे आहेत हे देखील मी गडचिरोलीमध्ये जवळून अनुभवलं.”  

 

पुढील दिशा

पुढे जाऊन हर्षालीला Psychiatry मध्ये पोस्ट ग्रॅजुएशन करायचे आहे. मानसिक आरोग्य ठीक नसलेली व्यक्ती परिपूर्ण आयुष्य जगू शकत नाही असे तिला वाटते. “आपल्या अवतीभवती समस्या ठळकपणे दिसत नसली तरी अनेकजण मानसिक आरोग्याच्या समस्येने त्रस्त असतात. मुळात मानसिक समस्या असणं, ती ओळखणं आणि त्यावर उपचार करायला तयारी दर्शवणं याचं प्रमाण आपल्या समाजात कमी आहे. शिवाय Depression, Anxiety यासारख्या सामान्यतः आढळणार्‍य मानसिक समस्यांमुळे देखील एखाद्या व्यक्तीची उत्पादकता आणि त्याच्या आयुष्याचा दर्जा खालावत जातात. अनेक अभ्यासांतून असेदेखील पाहण्यात आले आहे की या सामान्यतः आढळणार्‍या मानसिक आरोग्याच्या समस्यांचा जास्त धोका हा तरुण व नोकरदार वर्गाला असतो. यासगळ्या गोष्टींवरून मानसिक आरोग्य किती महत्त्वाचं आहे हे स्पष्टपणे कळतं.”

समाजाच्या मनातील न्यूनगंडापासून ते मानसिक आरोग्याच्या समस्यांशी लढण्यासाठी असणार्‍या तोकड्या आरोग्यासुविधांपर्यंत अनेक आव्हानांचा सामना करत हर्षाली पुढे वाटचाल करत आहे. मानसिक आरोग्याच्या क्षेत्रातच पुढे जाऊन लोकांसाठी काम करण्याचं तिचं ध्येय आहे. “एका व्यक्तीच्या जीवनातील नात्यांचा त्याच्या मानसिक आरोग्याशी असलेला परस्परसंबंध कसा असतो हे मी मानसिक आरोग्याच्या प्रश्नावर काम करताना शिकले. त्या अर्थाने आपण सर्वच आपल्या अवतीभवतीच्या लोकांना त्रस्त करून सोडलेल्या या समस्येवर मात करण्यासाठी महत्त्वाची भूमिका बजावू शकतो. स्वतःपूर्ती मर्यादित न राहता स्वतःपलीकडचा विचार करून लोकांसाठी काम करण्याचा अनुभव मला समृद्ध करणारा वाटतो. असंच पुढे मानसिक आरोग्याच्या क्षेत्रात काम करण्याचं माझं ध्येय आहे.”

डॉ. हर्षालीला तिच्या आयुष्याची दिशा स्पष्ट दिसत आहे. तिच्यासारखेच अनेक तरुणतरुणी, विशेषतः आरोग्याक्षेत्रात काम करू इछिणारे तरुणतरुणी आज त्यांच्या आयुष्याची दिशा शोधत आहेत. अशा प्रत्येक तरुणतरुणीने स्वतःला प्रश्न विचारायला हवा –

‘स्वतःपलीकडचा विचार करून समृद्ध व परिपूर्ण आयुष्य जागण्याची खुणावणारी संधी मिळवण्यासाठी मी ‘स्व’ च्या कोशातून बाहेर केव्हा पडणार? 

Dr. Mrudula Bhoir: A Medical Officer in Delanwadi

It is quite a transformative journey from being one of many medical students in Mumbai, to running a primary health centre (PHC) in Delanwadi, a remote village in Gadchiroli district in Maharashtra. As daunting as this transition sounds to any urban dweller, fear was never a passing thought for Dr Mrudula Bhoir, a medical graduate from Seth GS Medical College and KEM Hospital. Originally from Thane, Mrudula is completing her MBBS bond as the PHC’s primary medical officer. My interview with Mrudula was an attempt to understand her journey and her lessons as a government officer and a propeller of social change. My visit, however, transpired to be more than just an interview. It was a glimpse into the reality of healthcare challenges in rural India, through the lens of a young doctor in search of her social purpose.

As Delanwadi awoke from its slumber on a crisp December morning, I entered the gates of the village’s PHC to interview my friend and medical officer Dr Mrudula Bhoir. In the early hours of the morning, even before crowds gathered for the comfort of chai and poha at the local tapriwala, eager patients awaited their doctor who was deeply engrossed in a heap of paperwork as I entered her quarters. She had been tallying the doses of vaccinations administered that month over a warm cup of green tea, in preparation of a monthly administrative meeting with the taluka (block) health officer. A typical Wednesday for Bhoir.

As part of her usual supervision duties, I accompanied Mrudula to a sub-centre (an affiliated health unit under the PHC) in the village of Kulkuli. The facility was thoroughly managed by a jovial and sincere ANM (auxiliary nurse midwife), Sister Karangame. As both of them spoke over the monthly activities of the sub-centre, a grave expression overtook Sister Karangme as she discussed the concerning case of Tulsi, an expectant mother, two-weeks past her delivery date, who had refused to visit the PHC to seek care. Post-term deliveries pose great risks to the fetus and have higher chances of resulting in maternal death, a steadily decreasing yet serious cause of mortality in India. To examine the baby’s health and determine the reason behind Tulsi’s reluctance to seek medical attention, the three of us set out to visit her home in the village of Ramtola.

Surrounded by farmland, Ramtola was on the periphery of a slim kuccha pathway, the only connection to the main road, which made it nearly impossible for Mrudula’s car to progress. With Vidarbha’s punishing heat and relentless rains, making the main road inaccessible in the monsoon, I could only imagine the struggle it would take an ASHA worker or a pregnant mother to travel to the PHC by foot. It would have taken at least half a day.

Besides a frail grandmother resting on a cot in the backyard, the house was empty. There was no sign of a pregnant woman. As we waited outside the home, Mrudula pointed to an inscribing on the wall. Marked on the side of the house where a list of dates on which a healthcare worker had visited Tulsi’s home. Every pregnancy, birth and death are meticulously recorded by ANM workers, who regularly visit and examine women to ensure a healthy progression for the mother and baby. To encourage her to go to the PHC, Tulsi’s house was visited 13 times in the last month of her pregnancy. This was no mean feat as I recalled our journey to reach Ramtola.

We were startled by the rattling noise of shifting vessels from behind the house. Our patient had been cleaning the house. With the hem of her sari tucked at her waist and beads of sweat trickling down her brows, it seemed Tulsi had been at work all day. She turned to face us, and our eyes immediately locked onto the protruding bump. Her petite frame managed to balance her immensely swollen belly remarkably well as she swooped to pick up the washed vessels. Mrudula broke the silence- her voice sharpened at the sight of Tulsi’s exertion. Dawakhanat kashala nahi yet? Khup dhoka hou shakte tula ani tujha balala. Kiti vaat bagsheel? (Why do you not come to the PHC? You and your baby could be at risk. Why are you waiting for so long?) To which Tulsi’s only reply was mala kahi traas nahi hote madam (I have no pain madam).

Upon Mrudula’s persuasion, Tulsi agreed for an examination. I was surprised at Tulsi’s agility and stamina at this stage of pregnancy as she managed to lift an entire wooden cot for Mrudula and Sister Karangame to examine her. The frail grandmother inched herself into the room and crouched near the door, keeping a watchful eye over her granddaughter. Tulsi mentioned she could not feel the baby move as much as the previous week. Mrudula and Karangame exchanged worrying glances but did not voice their apprehension. With Tulsi lying on the cot, Mrudula examined her belly to find the baby’s position was breached, which could cause complications during birth. Mrudula lowered her stethoscope to examine the baby’s heartbeat. She could not find it. Sister Karagngame took a chance by positioning the stethoscope on the other side of Tulsi’s abdomen. She could not find it either.

Mrudula, looking determined, tried a third time. She listened intently, almost as though she were in a trance to locate the rhythm of life. Sister Karangame mentioned how women avoid seeking care during the final weeks of their pregnancy in government facilities, out of the fear of a cesarean section. With mistrust in the medical system mired in many rural and tribal societies, Karangame suspected Tulsi’s family might have had the same reservations. The realization of the medical system’s folly in neglecting to change people’s perceptions of healthcare was quite pronounced at that moment.

I looked around the room. Five women with five different worldviews. One was a woman of old thought, three were women of science. I could only hazard a guess at what Tulsi might have been; sandwiched between tradition and modernity. We were all thinking about it. Had the medical system failed Tulsi and her child? My thoughts were disrupted by a sudden exclamation. Aahe! Heartbeat aahe! (It’s there! The heartbeat is there!) said Mrudula. Sister Karangame rushed to confirm the sound. The baby was alive but in distress. Immediate medical care at the PHC was crucial for the baby’s survival. Both Mrudula and the Sister pleaded Tusli to visit the hospital, but she avoided to meet their eye. Gharvale nahi mante (My family says no) was all she said.

Tulsi’s husband and father-in-law entered the house during the midst of our coaxing. They did not seem surprised to see us there, it felt as though they did not want to acknowledge our presence. Mrudula shared the severity of Tulsi’s health with the family and urged them to bring her to the PHC. She even offered to conduct any procedure at a minimal cost. All the family had to do was bring Tulsi to Delanwadi. Her persuasion was met with an unconvincing reply from her the father-in-law. Alas, we left Tulsi’s home hoping she would make it to the PHC or that the baby would be delivered soon.

It took 14 visits from a dedicated health worker to an isolated home to convince a pregnant woman to seek basic care. Only at the most fundamental level of India’s social structure, deep in the villages of Gadchiroli, did I realize the absolute necessity of health education, the influence of social norms on health outcomes, and the importance of building trust between the medical community and the people it intends to serve.

As Mrudula and I returned to her quarters at the PHC, she assured me this was a typical Wednesday. I was eager to hear more about her experiences in Delanwadi. And so, I started the interview.

Being a medical officer is an immense responsibility. It must be a tall order to match given you are a novice in your profession. What is it like to run the Delanwadi PHC?

Nine thousand eight hundred forty-seven. That’s the number of people under the jurisdiction of this PHC. As a medical officer, I examine around 1500 patients every month. Though, I would say seeing patients is just 20 percent of my job. A large portion of my duties occurs outside of the clinic such as overseeing the five sub-centres affiliated with Delanwadi, supervising field visits to villages, managing administrative tasks, deputing staff, distributing (and withholding) salaries, organizing surgery camps and training the thirteen ASHA workers in my jurisdiction. And, the budget. Managing the annual budget, which borders around 80 lakh rupees is a herculean task, for which I am grateful to Delanwadi’s previous officer Dr Pankaj Aute…and my clerk (laughs). As part of a national health program, I also need to consistently update my knowledge of new medical procedures, vaccination policies, cold chain system management and the demographic statistics of my area. Above all, my most important responsibility as a medical officer is to be calm in the face of adversity.

What have been your most valuable lessons?

Managing staff who are much older to me and who address me as ‘madam’ was odd during my initial days. But it made me realize the hierarchy within the medical system. It was important for me to give my staff respect for their experience no matter their social standing. However, I have not let my staff’s seniority compromise the quality of work I expect. Being in charge of people, I also had to learn the art of delegation rather than taking all the responsibility on myself. As a perfectionist, I couldn’t trust others. I learnt that the world has its own pace, and I need to try to work with it patiently. After all, I can’t expect things to progress with the speed of Mumbai’s local trains.

You went to a prestigious medical college, where the quality of your education was unparalleled. What aspects of your learning and growth did college not nurture?

Empathy. Patients were treated as a case rather than as a person. There is so much more to a patient than their symptoms, like where they come from, what they live through in their daily life and their perceptions of the world. This is not something we are taught to even consider as a part of our diagnosis. In college, patients were regarded as people with white clothes on a bed, which never made me care about their background. In healthcare and medicine, learning about people’s habits matters. Learning where people come from to a hospital, matters. Being an ’outsider’ in Delanwadi, I now realize the importance of social context in my line of work.

During my internship, using finite resources and working within limited means was not a priority. At KEM, our MRI and CT scan machines were running 24 by 7. These facilities definitely made diagnosis easier, but consequently, we spent less time understanding the patient, which made medicine seem like treating the disease rather than a person. Running a multitude of tests on the first day of admission for an anaemia patient, went as far as conducting a bone marrow biopsy. Maybe this is necessary at a tertiary level because doctors don’t have much time to invest in each patient. But many tests could have been avoided and the diagnoses could have been narrowed down if we knew patient history better. Again, context matters. Delanwadi is not equipped with these tests and patients often don’t have the luxury to afford CT scans or breast exams. So, I improvised. I developed an algorithm of diagnosing patients, where their cultural context and habits are key indicators.

In places like Gadchiroli, with a high rural and tribal population, infectious diseases are a scourge for the masses. It’s not that we lack basic treatment methods. People’s health-seeking behaviour and perception of medicine are quite poor. People need to know what they are suffering from and need to receive quality treatment. I’ve learnt that people’s needs are very basic, and half the battle in treatment is being amiable to patients and lending an ear to give them the sense that they are being heard. And honestly, medicine is not rocket science!

Have your ambitions and illusions changed since being a medical student?

As a medical student, I wanted to be a ‘successful’ doctor. Success for me was to be famous and richer than my parents. I saw myself having completed my postgraduation and working in a hospital in Thane. As I entered college, I noticed students had many talents apart from being good in academics. Yet preparing for postgraduation was the most common career choice for students. Many had aspirations to practice in the US and started solving USMLE exam questions since the first year. There were very few people who did things apart from studying for postgraduation, as options were quite narrow and so was people’s ability to accept an alternative career route. I always wanted to do something that others didn’t do. I had an element of righteous anger for injustice and I was also quite the jugaadu (laughs). I recall listening to Dr Rani Bang’s speech at KEM. She spoke about her work at SEARCH (Society for Education, Action, Research in Community Health), in Gadchiroli and how youth should strive to make their careers socially relevant. She was such a fierce personality, it’s a trait I really admire in women. I want to be like her! It was her speech and genuine curiosity that made me apply to SEARCH’s youth development programme, NIRMAN.

NIRMAN ne kuch alag hi jaadu kar diya. It disillusioned me from my previous notions of being a ‘successful’ doctor. At NIRMAN I learnt the story of a woman named Kaju bai, a veteran community health worker in SEARCH’s pioneering home-based newborn care (HBNC) program. Her story still brings tears to my eyes. She is a widow in the lowest rung of society from the village of Ambeshivani, who may not have studied beyond the fourth standard. Yet the life she has lived and the lives she has saved is no short of a miracle. She has accomplished what pediatricians can perform only after years of training. Her story showed me the power of empowering people through education at the primary level, in inaccessible areas where no one is willing to venture. Kaju bai’s resilience has made me want to inculcate education with my career in medicine. I used to equate random acts of kindness with social contribution. There is so much depth and beauty by directly being in touch with people, which is in the nature of my profession. I want to be the agent of social change to spread that understanding to others. I was convinced that I would go the conventional way by doing a postgraduation. Kitna narrow tha humara perspective…I mean mera. That’s something else I learnt, when you are talking about yourself, don’t talk about the world. I would have done something socially relevant, but not with the conviction and social awareness that I got through NIRMAN and my time at Delanwadi. Indian society is rather rigid and at times unforgiving about achieving life’s milestones at the right age. I would have not been able to accept my decision to come to Delanwadi had it not been for the realization of life’s richness beyond completing graduation for the sake of prestige. This realization gave me the confidence and freedom to live a life with purpose, on my terms.

Didn’t you have any apprehensions before choosing to come here?

Life in Mumbai was certainly different than my reality at present. But I wanted to learn about medicine, the people it impacts and government administration beyond what KEM could teach me. So, I chose to come to Delanwadi. Where else would I have been able to interact with the population I serve so directly? I had no apprehensions of living alone in a village. I lived at home for the 24 years so staying outside of my comfort zone gave me an immense sense of freedom and allowed me to take ownership of my choice to practice here. I also wanted to learn to be more patient and communicate better with my patients, employees, co-workers, and seniors. I would not have learnt this skillset in postgrad; I would have been surrounded by work instead.

Living alone does come with its set of challenges, which I previously didn’t tackle gracefully. I found it difficult to hold it together, especially when I needed an emotional support system. Being in Delanwadi has taught me to seek guidance from my colleagues and seniors at KEM. I’ve learnt to share my difficulties with mentors and keep my cool. I also feel a greater sense of contribution to health education through my work. I have certainly faced many challenges here, which have made me lose my patience at times. But any form of social change requires an investment of time, patience, and perseverance.

advice would you give to MBBS students who are uncertain about their future?

I think to flourish as a doctor, you need to devote your heart to what you feel content in. As unusual as it sounds, happiness and satisfaction are a crucial part of medicine. Medical students really need to ask themselves where their happiness lies. Part of their happiness should also lie in the well-being of others. If you feel unsatisfied with the prospect of being a clinician, then change your line. Work with the administration, government, or NGOs. There is a lot more than you can do, a lot more than our health system needs beyond clinical care.

I would also advise students to derive a personal definition for their purpose in life. The purpose is an internal discovery; it should not be imposed. My purpose is to see society become more equitable through the betterment of our health system. It is a force which drives my life.

Article and images by Jainetri Merchant. Jainetri has completed her Bachelor of Science from the University of Toronto in Canada.

The goal of the NIRMAN program is to contribute to the flourishing of youth in India, facilitate their search for pro-social purpose and nurture them as social changemakers.

A Doctor With A Difference!

I began my journey with NIRMAN in 2014. I was a 2nd-year student of MBBS at the Grant Medical College in Mumbai at that time. As every medical student, my goal was clear, to pursue post-graduation. But what next? What after PG? Maybe super speciality? Maybe private practice? Maybe government practice? I had no idea. As most of the students, I was also unaware of the problems in our society.

When I attended the 1st NIRMAN workshop, I started understanding the challenges which our society faces every day. In the beginning, it was really difficult to digest them and my reaction was that these problems are so big and I can’t do anything about it. It made me helpless. But that’s when I started consciously looking around me and started understanding the gravity of issues faced mostly by the poor and most vulnerable communities in our society. Being working in a government hospital, I did not have to go somewhere else to see how much people suffer. I could feel their helplessness, their limitations to get the healthcare that they really deserve. The 1st workshop of NIRMAN gave me the insight to look into the community and how to identify the problems. As someone said, “Your eyes can’t see what your mind does not know.” So my mind opened and so did my ‘eye’.

But this was just about realization. What next? Was it enough just to have a realization of the problems? The answer was NO. This is where the 2nd NIRMAN workshop helped me. The 2nd workshop was about – “Yes there are problems, but how can I contribute to fix them?” The 2nd workshop gave me the tools required to break down a large problem into smaller ones and then try to fix them. It helped me to convert my helplessness about a problem into a realistic approach to solve it, at least partially if not completely. It also helped me keep realistic and achievable targets and not to be in some dreamy state. The first two workshops were mostly about theoretical knowledge though we also got chances to interact with many people who have done significant work in their fields. But again a question came in my mind that these all people were very senior, age-wise and experience-wise, to me. And as usual, I thought it would be easier for them to solve the social problems with their expertise but I’m nowhere near them to do so. The third workshop of NIRMAN was a perfect solution to this query of mine!

In the 3rd workshop, I actually got to meet a lot of youngsters who were of similar age to me and who were currently working on some specific problem in society. This gave me the confidence that this can be done by young people too. As perfectly matching with the true concept of NIRMAN, this was meeting with and being a part of a ‘Team of Young Social Changemakers’!

Throughout these three workshops, one thing has been common – I have made new friends who think like me and who are willing to do something for society.

The whole NIRMAN process helped me to think rationally and make my decisions wisely and not just based on what others are saying or what is trending. I got a habit to put ‘why’ in front of every choice I now make. There are so many influences in our lives, if we go as per their choices then it’s not our life. I got that courage to go against the flow when I felt I should.

After completing my MBBS, I joined the SEARCH Hospital in the remote district of Gadchiroli and worked as a Medical Officer for 10 months. I saw more than 10,000 patients, predominantly from a low socio-economic background, during this period. I handled OPD and IPD duties, helped organize surgical camps, handled emergencies including snakebites and malaria. 

This entire experience helped me grow academically, socially and personally and solidified my conviction. I gave my 100% efforts during this MOship, saw a variety of patients and learnt so much clinically. Slowly I started treating the patients as humans and not as persons with a disease. Every patient I saw was an opportunity to learn new things. Talking to patients not just about the disease but about their family and occupation was also a learning experience for me.

I was lucky enough to get guides who helped me understand the meaning of ‘medicine’ beyond the disease and I will be forever grateful to them. I have always believed in quality care and not just a quantitative number of games. Every human deserves quality healthcare. During my MOship period, I met with many people from a variety of backgrounds and learnt a lot about things other than medical education, some of them will be staying with me for the lifetime. With this in mind, I decided to pursue post-graduation in medicine and started preparation for the NEET entrance exam. The preparation year was full of stress and competitiveness, but my experience in MOship helped me in solving my questions and the memories with my patients motivated me to do better. After spending one year exclusively with books I, fortunately, got a good rank and I have now joined a residency in medicine in Mumbai.

 I’m looking forward to providing quality care to each and every human being I come across in my work and alleviate his/her suffering as much as possible. I feel that at the end what matters the most is not having any regrets, that I could have done this or that, but I didn’t. I feel content that I enjoyed organizing college festivals and going for bike trips with friends during MBBS, I helped my patients during my MOship and also studied day and night when required for the PG preparation. Hopefully, this journey of personal satisfaction and social contribution will continue for years to come!

 

Dr Amit Giram

NIRMAN 6 Batch

MBBS, Grant Medical College Mumbai

Currently Pursuing MD Medicine at GMC Mumbai

The goal of the NIRMAN program is to contribute to the flourishing of youth in India, facilitate their search for pro-social purpose and nurture them as social contributors.

NIRMAN 11 Batch Begins the Journey

After a long break, taking time to alter its avatar, we are happy to bring back Simollanghan! Ready to bring to you enriching educational content, we are equally excited to inform you about the latest happenings on our front.

Eventful Days Are Back

Eventful days were back in Shodhgram on the occasion of NIRMAN 11.1 A workshop. With the ever green campus turning even more beautiful due to the advent of monsoon, the workshop, held from 23^rd July, 2021 to 30^th July, 2021, initiated the latest season of workshops after a long time of over 15 months. The workshop participants brought in fresh and renewed enthusiasm.

Diverse in Backgrounds, United in Objectives

Now, you must be aware about the academic as well as geographic diversity of NIRMAN. The batch consisted of 50 participants from diverse academic as well as geographical backgrounds. Roughly, half the participants were from medical background / were medical students, while the remaining half came from different academic streams such as Sciences, Agriculture, Engineering & Arts. While, there was a participant from the southernmost state of Kerala, there were participants also from the national capital of Delhi. The spirits were high right from the beginning of the workshop. Though from different academic & geographic backgrounds, these 50 like-minded youth bonded brilliantly together & had one common agenda – their quest for a purposeful life.

Serious Stuff without a Serious Face

We, at NIRMAN, believe in doing serious stuff albeit without a serious face. This batch of 50 young minds went through an intense process, having a rendezvous with concepts like emerging adulthood and flourishing. The process was equally enjoying as much as it was intense. From group discussions to various activities, as the workshop progressed, participants moved inch by inch closer to their ‘Why’. The participants themselves contributed tremendously, both in cognitive capabilities as well as in emotional terms.

All’s Well that Ends Well

Just as the workshop began on a high note, it ended with a high as well. As you know, NIRMAN is an ongoing educational process. NIRMAN is where you are! NIRMAN is what you do! Individual by individual, plans after the workshop were discussed and equal emphasis was laid on what the participants can do post workshop for their own growth as well as to improve their understanding of society and societal issues around them. The workshop concluded on 30^th July, 2021 & 50 young minds dispersed in different directions to continue their search for meaningful life, with renewed vigor, strengthened determination & concrete action plans to guide themselves.

Experience the Workshop in Participants’ Words

The feedback of the participants says a lot of their experience of the workshop. Dr. Bhavik Bansal, aged 20, a bright medical student from AIIMS Delhi, mentions about his participation in the NIRMAN process in his blog - https://bansalbhavik.wordpress.com/2021/08/01/youth-for-purposeful-life/

Similarly, another enthusiastic participant, Dr. Soumitra Patil, MBBS from Seth GS Medical College (KEM Hospital), Mumbai, states his personal experience in his blog - https://thepensive.blog/2021/08/15/nirman/

Applications for NIRMAN 12 are ON!

The blog must have certainly created curiosity about the NIRMAN process, if not given a clear idea about the exact content of the workshops. Worry not! The contents of the workshop are truly enjoyable and enriching only when experienced in person! So, if you are one who is yet to find it out, do apply for upcoming NIRMAN 12 batch using the following link – https://nirman.mkcl.org/selection/selection-process  and if you have already attended these workshops and are already a part of NIRMAN process, then do the best you can by urging youth in your vicinity to go through the selection process and encourage them to start their own quest for a purposeful life.