Imphal: Over the years, India’s healthcare sector has seen significant transformations with advancements in infrastructure, technology, and accessibility. With its efforts and commitment to bolstering healthcare infrastructure, India has emerged as a world-class cost-effective healthcare destination and a leader in the global pharmaceutical industry. However, despite its commendable achievements on the global stage, residents in remote areas of violence-hit Manipur continue to experience extreme levels of health deprivation due to a lack of manpower and infrastructure.
Problems of health infrastructure and access to healthcare services are more prevalent in the hilly districts of Manipur.
Manipur is a small state in Northeast India with a population of 3.24 million and bordered by Mizoram, Assam, Nagaland, and Myanmar. Geographically, the state comprises two land masses: the valley and the hill districts. Though the state is predominantly hilly, the hill districts lag in every field, especially in the health sector, compared to the valley districts.
Recently, Manipur Chief Minister N. Biren Singh announced that the Government of India has sanctioned ₹104.66 crore for providing advanced medical facilities to the hill districts of the state under the Prime Minister’s Development Initiative for North East Region (PM-DevINE).
Taking to X, the Chief Minister said that for the first time, hill districts like Chandel, Ukhrul, Jiribam, Senapati, and Tamenglong would have access to advanced medical facilities, bringing healthcare closer to home.
The advanced medical facilities include Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI), Intensive Care Unit (ICU) services, and super-specialty care.
Not to mention, the Churachandpur Medical College is already operational, transforming healthcare in the region’s tribal areas, he added.
The curious case of Jessami Village
Home to the Chakeshang Naga tribe, Jessami village is located in the extreme north of Ukhrul district in Manipur, situated approximately 118 km from Ukhrul district hospital and 206 km from Imphal, the state capital. This picturesque village holds significant historical importance as the site of the first battle on Indian soil with the Japanese Army during World War II, in 1944.
Despite its rich war legacy, Jessami, with around 600 households and about 3,000 people, reels under intense difficulties in meeting medical needs. The existing Primary Health Centre (PHC), now upgraded to a Community Health Centre (CHC), has been functioning with a huge staff shortage for years.
As per the upgrade order issued by the Manipur Governor on October 10, 2023, the newly upgraded Jessami CHC requires 78 staff, including six specialist doctors, six medical officers, a dental surgeon, and 19 trained staff nurses. However, at present, the CHC is being operated by one AYUSH doctor, two staff nurses, and one lab technician, and lacks medical equipment like an ultrasound machine, X-ray, and blood test machines.
Besides the Jessami residents, at least seven neighbouring villages from both Manipur and Nagaland also avail healthcare services from the CHC. These villages include Soraphung, Tusom, Kharasom, Wahong, Chingaroi, Razai (Manipur), Mathikhuri, and Lanye from Nagaland.
According to K. Makreiwon, a trained nurse posted at Jessami CHC for the last eight years, whenever a patient seeks medical attention, they contact doctors who were previously posted there over the phone for advice after explaining the symptoms or examining the patients. Medicines are then prescribed to the patients or referred to other hospitals if required.
“Since a doctor is not available, each day we (staff) feel anxious and nervous thinking about what kind of patients we might get for the day. We are also grateful to those doctors who are always ready to respond to our calls and help us, but it is hard to treat patients without the physical presence of doctors,” lamented Makreiwon.
On paper, the health centre has already upgraded to CHC, but unfortunately, even the required staff for the PHC cannot be provided. Since the village is located far from the district headquarters and state capital, having the necessary manpower and equipment at the health centre would be of great help to provide healthcare services to the villagers and other neighbouring areas, she added.
She also said the centre has provided healthcare services to around 1,715 patients in the last five years, and the average number of patients seen monthly is around 100. The total number of deaths in the last five years is also recorded at 62, she added.
She also pointed out that cases of BP strokes in Jessami village are particularly high, along with other complaints of scrub typhoid, diarrhoea, vomiting, cough, and fever.
Loved Ones Lost Due to Absence of Medical Facilities
The absence of medical doctors has compelled the villagers to go from one pillar to another to address the issue. However, their concerns remain unaddressed.
“We have already apprised these issues to the concerned authorities, including the health minister, on multiple occasions. However, despite their bold assurances, no medical doctors have been posted in the village healthcare centre in the last two years,” said Nizote Mekrisuh, former chairman of the Jessami Village Council.
Despite appeals and representations to the state government, their grievances have gone unheard. Having no alternative, the villagers are now planning to employ a medical doctor using their resources to cater to the healthcare needs of the residents.
“Since having a doctor is important for our well-being, we are compelled to find our means and engage a private doctor soon,” said Mekrisuh, who lost his father to a BP stroke.
Sharing how he lost his father due to the lack of a proper healthcare system in the region, Mekrisuh said, “After my dad had a sudden BP stroke, we took him to the village health centre. However, after a preliminary investigation, he was sent to Phek District Hospital, 32 km from Jessami, and then later to Imphal, where he stayed in the ICU for more than a month. Unfortunately, we couldn’t save him.”
In most cases, whenever sick persons are admitted to the village community health centre for immediate medical attention, they are either referred to Phek district hospital in Nagaland, 32 km from Jessami, or the community health centre in Mellori, Nagaland, which is about 31 km from the village. Due to the absence of doctors at the CHC, villagers are compelled to transport patients to Ukhrul district hospital or hospitals in Imphal, which is time-consuming and incurs huge expenses.
Amy Wezah, a local who also lost her mother to a stroke last year, shared the struggles faced due to the absence of proper medical practitioners and infrastructure at the health centre in the village. She feels these major factors contributed greatly to the demise of her mother.
“My mother had a stroke on January 28, 2023, and immediately, my family took her to our village community health centre. Three nurses at the health centre served her with their best efforts. However, due to the lack of a doctor and proper equipment, we lost her. It is hard to accept that my mother is no longer alive. Had all the required equipment and doctors been available at the health centre, we might not have lost her. There may be fewer casualties in the village if the required equipment and doctors are available,” she said.
“On January 23, 2023, morning, my mother was found unconscious due to a stroke, and immediately we rushed her to the village community health centre. However, since her condition was critical, she was referred to Imphal Hospital but died on the way. My mother was one of the active leaders of the village women’s organization, and her sudden demise without any prior sickness was a huge loss not just for the family but for the whole village. So my earnest appeal to the state government is to look into the matter and address the issues regarding the lack of manpower and equipment at the village community health centre,” said Kozote Wezah, another local.
Challenges Highlighted by Health Officials
According to the newly appointed Director of Manipur Health Services, Dr. Chambo Gonmei, many medical staff, including doctors posted in difficult areas, have been displaced due to the ongoing crisis in the state. However, he assured that the issues would be addressed and emphasized the rationalization of postings for doctors, nurses, and medical staff, particularly in hill areas and far-flung places.
The health director also mentioned that in the absence of medical doctors in PHCs and CHCs, district CMOs have tried to conduct health camps for the people living in remote areas. However, the lack of manpower makes it difficult to post staff in those areas during the crisis.
“Sometimes we cannot even conduct health camps because there isn’t enough manpower. To reach those far-flung areas, we lack the means to act, especially during the monsoon season, because accessibility is a major challenge. During the rainy season, we cannot move out because of landslides, road blockades, etc. However, sometimes some doctors sacrifice by walking through muddy roads instead of travelling by vehicle. But such cases are rare,” said Dr. Gonmei.
Dr. Gonmei also stated the need for inter-departmental coordination to address the challenges. Improved road communication would eventually improve the health sector, as staff unwilling to be posted in remote areas would have fewer reasons to refuse, he added.
Strengthening the Local Health Workforce
Dr. Gonmei emphasized the need to raise awareness about the health sector and encourage people, especially youngsters, to pursue careers in the field of medicine. This is necessary to build a workforce within the community instead of depending on outsiders.
“We must give more awareness and strengthen the system so that people come forward to pursue their studies and make a career in the medical field. Only then will we be able to sustain it and address the manpower shortage,” he said.
Role of the Tangkhul Naga Tribe in the Healthcare Sector
The All Tangkhul Medicos Association (ATMA), an association for Tangkhul medical practitioners, has played a crucial role in providing services in the state to combat diseases since its inception in 2012.
At present, the Tangkhul community has produced more than 150 medical doctors and numerous specialists in fields like ENT, laparoscopic surgery, anesthesiology, radiology, gynaecology, and medicine, who work both within the state and outside.
According to ATMA President Dr. Wormi Sharon, the number of doctors from the community increases every year, with 22 more clearing the MBBS exam this year. However, the number of doctors is still not proportionate to the populations of Ukhrul and Kamjong, the two districts where the Tangkhul community resides.
“We are neither a government agency nor an NGO with funding. But we are like-minded people coming together to serve society. With our resources, we try to reach the unreached and render our services through free medical or surgical camps regularly,” said Dr. Sharon.
Dr. Sharon also shared that the Association aims to conduct at least two free medical camps annually in remote areas. However, due to time constraints and work commitments, they sometimes fail to meet this target. In such cases, they organize medical conferences or counselling sessions for medical practitioners and aspirants, he added.
This story has been published as part of the AIPP-EastMojo Fellowship 2024
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