Saving Lives & Building A Healthy Tribal Community, Mahan Trust Melghat

Mahan is a non-government organization that selflessly provides medical facilities to the tribal population of the Melghat region. Melghat is located in a hilly forest area in the Satpuda mountain ranges, 150 kms from Amravati district of Maharashtra, Central India.  Melghat is spread over two talukas – Dharni and Chikaldhara with a population of 2,50,000. Medical facilities in Melghat are grossly inadequate. The doctor to patient ratio is less than 1 M.B.B.S. doctor for every 10,000 patients.

Serving and Building a Healthy Community for the Tribal Population

In the year 2000 this area had very high mortality rate for new mothers, children under 5 years and people within the productive age groups of 16 to 60 years. It also had one of the highest infant mortality rates in the country of 100 per 1000 live births. This is almost twice the Indian average of 52 per 1,000.

At a time when medical students avoided the compulsory rural internship, Dr Satav voluntarily embraced a life of austerity and service and found his calling away from the comfort and security of a city life. As a youngster, Dr Satav was deeply inspired by Gandhi's call to the youth to work in villages. His own grandfather was a leader in the Sarvodaya movement. As a medical student, Dr Satav used to visit Dr. Prakash Amte who did stellar work in the tribal areas of Gadchiroli in Maharashtra. Destiny had designed for Dr Ashish to get a perfect life partner in Dr Kavita, an eye surgeon. She came from a family background which also strongly believed in serving the underprivileged members of the society. Mahan was thus founded by Dr Satav and his wife Dr. Kavita Satav in 1998.

The Satavs have already devoted 25 years of their life to this cause and fearlessly deal with the existential crises in the lives of hundreds of young mothers, infants and children.

The daunting task and the turnaround

The biggest stumbling block the Satavs faced was the reluctance of tribal people to take advantage of modern and scientific medical services either due to superstition or lack of awareness and resources. Dr Satav tried to battle their qualms by going to their homes and educating them about the importance of timely medical treatment. In an area infested with wild animals and snakes, Dr Satav would walk in the dark or travel by bullock cart to serve his patients. He would then persuade them to come to the hospital for treatment if required. It was important to gain their confidence and teach them to help themselves. Often Dr Satav would even arrange for critical patients to reach the hospital.

Dr Kavita too faced a lot of resistance as the tribal people refused to believe that a lady could be a doctor or that eye care demanded a special doctor. After their son Athang was born, Dr Kavita used to travel with the baby just to attend to the tribal people. She also got sick patients to their hospital in the ambulance and often cooked food to feed the tribal patients.

Once Dr Kavita was asked by a tribal family to help them with a complicated delivery. Even though Dr Kavita was not a gynecologist, she decided to help them out because she realized that was their only hope. In the end the delivery was a success. She went a step further by helping nurse the baby as the mother could not breast feed the baby. This helped save the child. This served as an inspiration for the tribal mothers to share their milk with the less fortunate mothers who were unable to breast feed their babies. As a result of this, the Yashodaya Maiya program took birth. The Yashodaya Maiya program encourages lactating mothers to donate part of their milk to help save other babies.

Many of their experiences were daunting but none fazed the couple. They once found a cobra sitting near their head. Dr. Satav simply caught the cobra and released it into the wild.

Once the word spread and the community saw and experienced Dr. Satav’s healing touch, they came around. The faith of the tribal people was now so strong that they would wait for them to come back and not go anywhere else for treatment.

From the inception Mahan has been offering treatment and medical services at a highly subsidized cost. In most cases the treatment is also free based on the economic condition of the patient. Daily the hospital treats several patients, many with critical complications such as heart attacks, snake bites, high blood pressures and hemorrhages. And each day they are successful in saving thousands of lives.

Saving lives and building a healthy community

Mahan continuously innovates with out of the box solutions which are often fashioned into models that have been replicated across the country. The entire population of Melghat has directly benefitted from Mahan’s welfare activities and over 5,00,000 people outside Melghat have benefitted from the policy changes pushed by Dr Satav. A brief synopsis of various ongoing programs of Mahan are provided below.

HOSPITAL FACILITIES

In 1998, the hospital used to run out of 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. The hospital which began in a small hut now has modern medical equipment like 2D-Echo, Ventilator, ICU, Paediatric Unit, Pathology Unit and an Eye hospital. Mahan with the help of renowned doctors like conducts annual Plastic Surgery camps along with eye and cataract surgery camps.Dr. Ajay Kulkarni, Dr. Amal Tamnhe and Dr. Nikhil Nagpurkar regularly help Mahan conduct these camps.Dr. Dilip Gahankari from Australia, Dr. Shailesh Nisal, Dr. Kevin, Dr. Bapat and Dr. Chandak regularly perform very rare plastic surgeries at these camps. Plastic surgeries are performed for post-burn contractures, oral & breast cancers, cleft lips & palates and parotid tumors to name a few.

In order to reduce preventable blindness the Mahan team conducts regular door-to-door eye check-ups. Anyone found with a deficiency in vitamin A is given supplements. The Mahan team has visited over 500 villages and examined over 150,000 villagers.

The positive impact of all their efforts has made Mahan become synonymous with good health in the tribal area of Melghat and is visible from the following statistics:

• Patients benefited at Mahan hospital - 122,000

• Patients benefited in Community/Villages - 540,000

• Critical Patient Treated and Saved (Heart Attack, Brain Hemorrhage, Cerebral Malaria , Meningitis, Tetanus, Snake & Bear Bite etc.) - 4,500

• Critical COVID Patient Treated at hospital - 100

• Patients treated in specialty camps like pediatric, gynecology, dental and ENT - 28,000

• Number of Plastic surgeries performed (free of cost) - 1,500

• General Surgeries performed - 126

• Eye Surgeries (most of them are free Cataract Operations) - 2,355

• Number of Villagers screened for Blindness - 293,000

Home based child care

One day a tribal woman of around 30 years came to Dr. Satav carrying a very sick child . The mother who was recently widowed refused to admit her critically ill and malnourished child to the hospital since she had no one to look after her other children and animals at home. Dr Satav’s team pleaded with her but without success and the child died two days later.The incident moved Dr Satav to work on child nutrition issues with a sense of urgency. The couple soon realized that they could not serve all the 2,50,000 villagers in the region. They also realized that many deaths were related not due to the lack of food but due to poor hygiene and inaccessibility to health services which were too far away from their homes.

Following the model set by Dr. Abhay Bang, Mahan trained tribal women to act as their Village Health Worker (VHW) also called Arogyadoot. They went house-to-house treating children with perennial problems like diarrhea, pneumonia and malaria in their own homes. VHWs also provided treatment to children suffering from malnutrition. Nutrition education and training of VHWs are now playing an important role in providing proper health facilities to rural and tribal families in Melghat.

READY TO USE THERAPEUTIC FOOD

According to treatment guidelines developed by Dr. Dani, Ms. Pendharkar and Dr Satav, Mahan started producing ready to use therapeutic food along with vitamin and mineral supplements for severely malnourished children. The program employs tribal village women to produce and pack 9 varieties of whole and powdered therapeutic food such as sabudana, chivda, dahlia, gud-patti (jaggery and peanuts), chikki, and vitamin mix.

These food packets are high in nutrients and are distributed to the Arogyadoot (VHW). They provide them three times a day for 12 weeks to children in their villages that suffer from acute malnutrition.

Mortality Control

Mortality control programs for the economically productive age group between 16 to 60 years was taken up by Mahan when Dr Satav saw that premature deaths in adults were common. These deaths affected the household critically as it would deprive the family of their sole earning member.

VHWs are trained for early identification and treatment of illnesses in villages to mobilize and hospitalize cases that require urgent attention. With an intent to bring down the mortality rate, those suffering from tuberculosis, diabetes and pneumonia are identified, treated and cured. This helped reduced the adult mortality by over 52%.

The Real Impact

The Village Child Developmental Centre where severely malnourished children are treated at home or by a member of the government staff was launched by Mahan and later replicated by the Maharashtra government. All the programs of Mahan blend together producing amazing results.

• Reduction in mortality rate per thousand live births (>60,000 children treated) - Reduced by 68%

• Reduction in severe malnutrition prevalence - Reduced by 80%

• Improvement of severely malnourished babies receiving supplementary nutrition - Up from 25% to 80%

• Safe deliveries (Aseptic precautions during delivery) - Up from 5% to 75%

• Improvement in breast feeding of babies within one hour of delivery - Up from 10% to 90%

• Deliveries attended by a trained baby care taker - Up from 5% to 70%

• Newborn babies receiving the vitamin 'K' injections - Up from 5% to 85%

Mahan has proved 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. The model of village level Arogyadoot and reduction of malnutrition rates have been widely published and have also got a detailed mention in a joint publication of Harvard University and UNICEF.

Counsellar Program

Another  brilliant  idea of  Dr Satav was the counsellor program that was started in 2007. Dr Satav noticed that over 17 government  hospitals in Melghat were in poor condition. There were no proper ambulances to bring patients and they could not even provide  food to the admitted patients. Adding to these woes, language and communication barriers made the tribal people reluctant to seek medical help.

One man and one woman were appointed as counsellors for every hospital. The counsellors liaise between the government doctors and the tribal people. They understand their problems by talking  to them in their local language Korku and then translating it for the doctor. They also  help organize basic health awareness camps and provide support services such as ambulances to carry sick patients to hospitals.

As a result of this novel initiative, the functioning of hospitals improved tangibly. Critical lives were being saved, severely malnourished babies got treated and there was a heartening 12x increase in patients seeking medical help. Women who used to have deliveries at home in unhygienic environments resulting in maternal and infant deaths, showed their openness to hospital deliveries which doubled. This resulted in maternal and infant mortality rates falling.

This program has earned generous praise from the honorable Bombay High Court which asked the government of Maharashtra to not only restart the program but also asked for it to be implemented in all the hospitals in Melghat.

Kitchen Gardens

Mahan started ‘nutrition gardens’ in several villages in Melghat. They  grew pulses, fruit and green vegetables. The very fertile Melghat soil provided easy food. As a logical extension of this idea, tribal people were encouraged to grow food in their backyards to provide for their families at a minimal cost. Today there are over 10,000 kitchen gardens in Melghat producing 345 tons of vegetables, eliminating the need to buy unaffordable food. These twin ideas have provided a sustainable model and a long-term solution for the prevention of malnutrition.

Umang

Under the innovative Ummang program Mahan has appointed a Yuvadoot (youth workers) who help villagers in seeking benefits from various government schemes. Yuvadoots also influence teenagers to stay away from addictive substances and conduct regular Yoga Camps.

Mahan has benefitted over 10,000 tribal people by mobilizing various government schemes like MnREGa, road, transport, water, electricity, public distribution system and Janani Suraksha Yojana. Furthermore, three villages have become free from the social drinking of alcohol due to Mahan’s intervention and awareness programs.

DOH Model

Farmers of Melghat experience very heavy rainfall during monsoon and severe droughts in the summer. To solve this problem, Mahan with the help of Dilasa & Caring Friends developed “Doh Model”, an innovative model of water conservation that helps farming all year round. The results of this scheme are very encouraging and water in Doh does not dry up despite rivers going dry. Mahan has gifted the Doh schemes to 3 villages who have vowed to give up drinking and channel their energy in progressive pursuits.

Research Respiratory Diseases

In collaboration with University of Colorado, Mahan has taken charge of systematic data collection and evaluation of nasal swabs from children who suffer from pneumonia. This research brings about significant change and sets a pitch for global health policy on the RSV vaccination.

Policy Formation

Dr Satav is closely associated with the government of Maharashtra and has played an important role in framing of 25 important state level policies benefitting over 10,00,000 people through their advocacy work and public interest litigations in the State.

Future Plans

“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.

There are 78 tribal blocks in Maharashtra and thousands all over India . Over 9% of the total population of our country consists of tribal people who are neglected. A rural internship is mandatory at the time of medical college admission but many students pay a fine and get away from the rural stint resulting in a severe lack of qualified doctors in villages. 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 before they move to cities.

Mahan wants to take up a program to promote the de-addiction of alcohol and tobacco and the rehabilitation of beneficiaries post de-addiction. This is a major area of concern for the young tribal population in the region.

Mahan is keen to replicate its own successful models across the country to address malnutrition and infant mortality. Dr Satav also dreams to have a helicopter ambulance to help transport patients to hospitals and get help in a timely manner.

FINANCE

Dr Satav started the hospital with his own savings of about Rs. 7 lakh. Later Dr. Susheela Reddy and Kasturba Health Society have also helped support Mahan financially.

As is the experience of most NGOs, whenever one starts doing good and sincere work, resources and support follows. Mahan has found true partners in caring friends: Sh. Ramesh Kacholia, Nimesh Sumati, Prakash Apte, Anu Aga of MP Lad foundation, Arpan foundation US, Mastek foundation, Virgo Foundation, Paul Hamlyn Foundation UK, University of Colarado USA, Syngenta Foundation, Stichting Geron & Cordaid Netherlands.

Due its widely integrated interventions, Mahan remains in need of funds to successfully implement its various innovative programs and make a difference in the life of Melghat’s tribal population.

AWARDS AND RECOGNITION

Dr. Satav has presented many medical papers at national and international forums and received commendations from government authorities, voluntary organizations, corporate entities as well as courts.

Dr Ashish Satav had the honor of being the keynote speaker in one of the medical conferences held in England with 6 international organizations and over 900 international delegates. Research papers of Mahan have been published in 6 international medical journals.

Dr. Ashish and Kavita Satav have won several prestigious awards and recognition for their outstanding work, some of which include:

• Public Health Champion Award from the World health Organization

• REAL Global Award by Save the Children of UK

• Best Research Project Award and Young Scientist Award by Indian Council of Medical Research

• Doctors Award for excellence in social work by Hon. Chief Minister of Maharashtra (Sh. Devendra Fadanvis)

• Dr. Satav was also felicitated by the former President of India Hon. APJ Abdul Kalam

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Our Visit

Our visit to Mahan and to villages where they are running various programs was very inspirational. We observed a strong sense of purpose and zeal in each and every person of the 200 member team of the Mahan family.

The Mahan team functions on strong values and is based on caring and improving the health of the tribal people. They have touched on every aspect from nutrition to de-addiction. Mahan has been successful in inculcating a strong goodwill and trust by making positive contributions in the lives of the tribal people.

The couple lives by a simple belief: That patients are God, looking after them is worshipping God.

Dr Satav has managed to pursue his unusual vocation with the zeal and enthusiasm being particularly influenced by Vinoba Bhave’s philosophy in his books ‘My Experiments with Truth’ and ‘Geetai’. Dr Satav feels it’s only because of these practices that he is able to withstand the pressures and setbacks at work.

Dr Kavita Satav also maintains a very strong faith in God. Her principle is: Be honest in your work and if you are honest and want to do something for the society then the Almighty arranges everything. Everyone should live with positivity. Dr Satav sums up his mission with a quote from Baba Amte.

“No one can win over a person who competes only with himself”

This is the basic principle of Mahan.

There is a sharp and startling contrast between the India that we experience in our cities versus the pitiable state of affairs just a few hundred miles away. It is also heartening and inspiring to see people like Dr. Satav and Dr. Kavita with their single focused selfless commitment to solving these problems.

Truly an innovative and an inspiring journey. The least we can do is support them in every way we can for the Mahan (great) cause which they are serving.