Parts of three Indian States - Andhra Pradesh, Chhattisgarh and Telangana - have been caught up in longstanding conflict between the Maoist groups (known as Naxalites or Naxals), and the Indian Government. This conflict has seriously jeopardised healthcare in these areas.
Camille Gillardeau has been the project coordinator in Andhra Pradesh, Chhattisgarh and Telangana for a year. This is her fourth mission having worked previously for MSF in Sierra Leone, Afghanistan and Democratic Republic of Congo. Here she talks about MSF’s work in this complex context and her experience in the field.
When did MSF start working in this area?
MSF started working in Andhra Pradesh and Chhattisgarh in 2006. MSF began with addressing the medical needs of the population that was displaced as a result of the internal conflict in the area. Today, MSF is one of the only healthcare providers, especially in very remote areas of these states.
How challenging is it to work in such a context?
It is a very complex context. MSF’s charter clearly states that MSF provides medical assistance to people caught in crisis, regardless of race, religion, gender or political affiliation and observes neutrality and impartiality.
This project translates these words into action! Establishing our neutrality and impartiality has been just as challenging as it is important for us. At the same time, it is our neutrality and impartiality that has helped us gain acceptance and guarantees our security every day.
There are no healthcare structures central to where these populations live. Given the conflict, for security reasons and fear, it is difficult for the population of these remote areas to seek medical care from the closest health structures, if any. MSF therefore introduced mobile clinics to reach them and provide free primary healthcare services. However, it remains a risk to send out our teams every day amidst the conflict
The fear in the patients’ eyes sets a deep contrast to the calm that prevails in the peaceful setting of these interiors.
What are the main needs of the population?
The population mostly inhabits the parts of these states that are under forest cover. Hence they have no electricity, no mode of communication, no knowledge about healthcare and little or no access to healthcare facilities. The medical needs of this population are mostly primary healthcare needs. Malaria is the major morbidity in this area, other illnesses being TB and skin diseases.
The custom of giving birth at home coupled with a lack of awareness with complicated delivery cases and a lack of preventive healthcare‑for example vaccination for children and pregnant women—has made antenatal and postnatal care an important part of our activities.
The patients are happy to have us there. I remember how a TB patient mentioned to me, how reassuring it was to them, when we set up the clinic right in front of their eyes to provide for their medical needs. It’s the access to healthcare for people who do not have any other, which makes this project so special. In this sense, I feel our impact is more humanitarian than medical.
What were some of MSF’s main activities in the region in 2014?
MSF runs 15 mobile clinics per week at 11 different locations. These clinics continue to provide free primary healthcare services which include diagnostic tests, vaccination, malaria and tuberculosis treatment and antenatal and postnatal consultations. In 2014, we carried out more than 63, 140 consultations, treated over 15,274 patients of malaria, and facilitated 361 safe deliveries.
Our main approach has been to understand the medical needs of the community and customise our services accordingly rather than impose the standard procedures. MSF’s health promotion programme has facilitated many valuable conversations with the community where we have tried to encourage them to treat their health as priority.
MSF also refers complicated cases and patients who need secondary healthcare to the closest Government hospital/health structures. We also helped in training ASHA (Accredited Social Health Activists) workers on antenatal care.