Bitter Pills:Medicines & The Third World Poor | Page 127

been a definite fall in the incidence of severe dehydration, and of skin diseases
such as scabies. The birth rate in the project area is now about a third less than
that for the rest of the country, and whereas the infant mortality rate in Savar
is now about 120 deaths for every 1,000babies born, the national rate is 140deaths,
and higher still in some rural areas.
But the Gonoshsthaya Kendra team are the first to acknowledge that their health
activities can only be seen as a qualified success. They have had difficulty
encouraging active community participation in village health, so outsiders still
play a key role as health promoters in the villages. Originally, health volunteers
were recruited from the Savar villages, but they showed little commitment and
were replaced by the full-time paramedics. Many of the paramedics are young,
unmarried women from outside Savar. As unmarried women in a traditional
Muslim society, they cannot live alone so they have to be based at the centre, not
in the villages. The fact that they are outsiders also means that many move on
to live and work in other areas, leading to a fairly high drop-out rate.
Many of the villagers have little time for the paramedics who go round the villages.
They prefer to walk all the way to the main centre, or a sub-centre, where they
assume the services must be better. Village health committees were set up to
encourage people to take an active interest in health and participate in running
the sub-centres, but these initiatives were blocked by apathy and political
constraints. As a result the better-off, more powerful people in the community
have been able to manipulate the health committees to their advantage.
This highlights the major obstacles the poor face in attempting to improve their
health. Real progress is held back by the social and economic forces underpinning
poverty. The poor are ultimately at the mercy of whoever owns the land they
work, and controls water supplies and credit. In the words of the woman in
charge of Bhatsala People's Health Centre (which is modelled on the Savar
project): "The poor feel that lack of food is the root of their health problems.
A change in their ability to produce enough food is necessary for any change
in the health status." |4)
To free the poor from the oppression of the landowners and the money lenders,
the team at Gonoshasthaya Kendra set up Gono Krishi Khamar (or the People's
Farm). This scheme aims to increase food production by trying out new farming
methods, and to make credit available to poor landless farmers through a credit
cooperative. Initially, some local landowners used intimidation to try to destroy
the credit cooperative. Now it is firmly established, but the intimidation continues.
The landowners have been taking advantage of the fact that the landless poor
can obtain credit from the cooperative. So they have increased their charges for
supplying water from the tubewells, which were installed under a joint Government
and UNICEF programme. These tubewells were of course intended to benefit
the whole community, but the powerful managed to wangle things so that the
wells were dug on their land.
132