REMEMBERING DR. ANTIA

 ----A tribute to Dr. Antia who integrated the principle of Trusteeship advocated by Mahatma Gandhi into his medical practice and successfully used the wisdom gained from it for the betterment of the poor, including leprosy patients. On 8th February, 2022, we celebrate his birth centenary.

Although many of us do not remember him today, Dr. NoshirAntia was a legend who had a formidable reputation as a public health specialist during his lifetime. He is considered to be one of the architects of the National Rural Health Mission (NRHM), and wasone of the members of the Apex committee on NRHM, chaired by the Prime Minister. His contribution to the publication of the famous ICSSR-ICMR Report on ‘Health for All-an Alternate Strategy’ is well-known. He also founded two institutions---Foundation for Medical Research (FMR) as well as the Foundation for Community Research (FRCH) in Pune.

1.     Life of Dr.Antia

·        Dr.Antia was born on 8thFebruary, 1922 in Hubly, Karnataka.After completion of his schooling and graduation, he joined the Grand Medical College in the year 1940 andtook his MBBS degree. His becoming a doctor was purely accidental, althoughhis desire was to become a Forest officer like his grandfather and uncle. He joined the Army Medical Corps during the Second World War.

·        In 1947 he went to England to learn surgery, where he had the opportunity to be trained by the legendary surgeon Dr. Harold Gilles, considered to be the father of Plastic Surgery. He also learned the management of burns at the Birmingham Accident Hospital, with Dr. A.B. Wallace in Edinburgh.

·        He returned to India in the year 1955 and joined the Jahangir Nursing Home, Bombay. It was while working in that hospital that he had a chance to visit the Government Leprosy Hospital at Kondhua in the outskirts of Pune. There he started using plastic surgery for correcting disease- induced deformities in leprosy patients. Remembering those times, he had described how he had to perform surgeries on leprosy patients, with the help of other patients, since no one was prepared to come forward to assist him. Often these surgeries were performed on a rickety wooden table or at times on the floor. It may be remembered that he could have earned thousands of pounds, had he decided to conduct cosmetic surgery on wealthy patients.But he chose to help those who had no oneto care for, that too using very simple techniques, without using any costly equipment. Soon he became a pioneer in that field.

·        After completing three years at the Jahangir Hospital, he joined the J.J Hospital, Bombay. There he was instrumental insetting up the first plastic surgery unit in India.

While working in JJ Hospital, he observed that most patients came from far-flung areas of the state spending a lot of their money and time for getting treated at the hospital.

Dr. Antia noted the intimate relation between poverty and disease, and concluded that poverty drives nearly 85% of the people in the direction of illness.He wondered whether, instead of forcing them to travel long distances, spending their time and money, if basic facilities could be provided in the village itself, prevention, promotion, as well as treatment of diseases could be simplified.

·        With the support of his friend and industrialist Navel Godrej, he started training women in a place called Mandhua, just across the Bombay Harbour. Lateron, he took up a similar project in another place called Malshiras. He was convinced that if the women were trained in basic health care in simple language, demonstrating the benefits to them, then 80% of the health problemscould be solved at the village level, 10% at the Taluka level and only the rest at the city hospitals.

·        The project did not succeed due to resistance from local vested interests. But the valuable experience and insights gained from it were instrumental in his setting up two complementary institutions on research and community health, namely, the Foundation for Medical Research (FMR) and the Foundation for Community Health (FRCH), with the help and support of his well-wishers.

·        The ICSSR-ICMR Report which he jointly prepared with the well-known educationalist late J.B Naik in the year1981 was also based on these experiences. This report was considered to be the blue print for health care delivery in India and contributed much to the drafting of India’s’ Health Policy in the year1983.

2. Dr. Antia’s VisionThe core of his vision, could be summarized as noted below: -* The concept of health in reality is very simple. It is we who have made it look very complex.It needsto be demystified to ordinary people.

* Healthcare, including prevention and treatment of diseases, ought to be decentralized, with peoples’ participation.

 *Every individual, family as well as community, should be made responsible for their own health.

*The strength of our traditional systems also needs to be utilized in public health delivery.

 *The concept of health based on western science and technology is rooted in greed.It has corrupted the teacher, the preacher and the healer.

*Modern medicine seeshealth only from the physical side and does not see the connection between the mind and the body.

*We have transformed health as illness and illness as profitable business*Routine functions like taking the pulse, measuring the BP of a patient should not be mechanical, but should be a part of patient care.

* The practices followed in the traditional systems teach us that systematic investigation does not need costly machines.Thereby, the cost of investigations can be brought down considerably.

 *In the present healthcare system,‘the rich are over-medicated, the middle class perplexed, and, the poor left to fend for themselves’.

 

3. Parinche ProjectHe invited me many times to visit the Parinche project near Pune. I finally could visit the project, along with him, sometime in the year 2006.

Parinche is a village with a population of 3000 in Purandhar taluk near Pune, Maharashtra.It takes about an hour and a half drive from Pune to reach Parinche.It occurred to me that the knowledge I gained about health care in that short time could not be obtained by reading even several books on the subject.

I was very much impressed by thesimplicity and cleanlinessof the center set up by him. Two practitioners of modern medicine and one Ayurveda doctor were present at the centre. The center had training facilities, besides having a small library for the use of the public.Diagnostic services were also available at a nominal charge at the centre.

4. Involving women in health care

Under the project women (called “Tai”) from fifty villages were given practical training in basic healthcare in very simple language. The results were also demonstrated to them. They were paid a small amount of money every month, besides their travel cost to the project site. I found these women sitting in a circle under a grove of mango and Tamarind trees sharing their knowledge and experience amongst themselves. The more experienced amongst them called Sahayoginis provided leadership to the group, as supervisors.

The training covered health -related subjects like nutrition, drinking water and sanitation. They were also trained in veterinary services so that they could take care of the health of cattle and poultry in the villages. Training on agriculture practices and allied subjects helped them to earn their livelihood. I realized that here health care is not viewed in isolation, but as something which is woven intricately to the fabric of the daily life of ordinary people.

One interesting thing I noticed was that each Tai was connected to the main center with a VHF set so that she could clarify her doubts, seek counsel and guidance from the doctors. The VHF sets, I was told, were donated by one of the well-wishers of Dr. Antia to the Centre. (mobiles phones were yet to be popular at that time).

5. OutcomesWe visited the home of one of the Tais. After talking to the Tai and her family members, I realized that the training had made her indeed very self-confident. The respect and support she received from the village sustained her. Many of the Taisnarrated their experiences, like urging girls to go to school, preventing incidence of female feticide, saving the lives of pregnant mothers and new born babies and the like.They were able to collectively sell their produces in the nearby towns and earn better incomes.

The outcome of the project was that 60% of the cases could bedealt by the Tais in the village itself, only 40% were referred to a public hospital.

It was alsogood to know that the Tais were accredited to the National Open School, so that they could improve their career prospects. Dr.Antia was very proud of those women whom he had trained. He often used to boast that he had learned basic health care from those women, instead of their learning from him.

6. Children and healthcareDr. Antias’ vision of health encompassed a world where everything is inter-connected. In his view, the children should know the world around them intimately and get themselves involved in the life around them.We also visited a school nearby. The children were trained to survey the local resources, including the local trees and plants. Theyalso learned to test water quality in their village. They could also take up a campaign on construction of toilets in every house in the village.

7. ASHAI returned to Delhi enriched and enlightened by my experience of visiting the Parinche project. The concept of ASHA (Accredited Social Activist) in NRHM wasmodeled on the success of projects like Parinche. I remember that Dr.Antia had expressed his concern about ASHA -that she should not be the last link in the official hierarchy of the healthcare system, that she should not be trained by Government officials only, but should be trained and mentored by voluntary organizations with good track records etc.

8. Healthcare as People’s MovementDr.Antia was concerned about the implementation of NRHM in general. He felt that it should be implemented as a peoples’ movement, rather than as a government sponsored program. He felt that although the NRHM had taken into consideration the ICSSR-ICMR Report, it needs to be implemented in spirit.

9. Simplifying healthcareWe human beings have a unique ability in making every simple thing around us appear very complex and then find complicated solutions to deal with them.The greatness of Gandhi and Einstein lies in the fact that they could simplify everything around them which appeared complicated. Dr. Antia was like them. He demystified the concept of healthcare making it appear simple, humane, and at the same time, very inexpensive.His greatness lies in the fact that he was able to practice what he preached.

10. TrusteeshipDr. Antia showed that Gandhi’s Trusteeship Principle could be successfully integrated with public health. Even after being trained as a modern medical professional who had received the very best quality training abroad, he had the rare insight and vision to recognize the limits of modern medicine. When more and more super-specialty hospitals are built around in the country, and when more and more sophisticated equipment andpotent drugs invade the markets, when more and more doctors go in for specializations, it is convenient to forget people like Dr. Antia, who, firmly rooted in Indian soil and its traditions, advocated a model of healthcare based on prevention of diseases, which is highly suitable for a poor country like India. Politicians as well as policy makers and health professionals therefore ought to take a note of his vision. Otherwise, we will have a complex edifice of health infrastructure without a core.

Dr. Antia passed away on 26^thJune, 2007. Although he is not with us today his nobility, commitment and dedication to the cause of public health, and compassion for the poor will always remain with us as an inspiring presence.

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