Even in the middle of the afternoon, it's a lovely long walk from the corner of the Rishi Valley campus, where I am, out to the Rishi Valley Rural Health Centre. Kartik and Vidya, the doctor couple who run the Centre, spent years working in the Air Force all over the country before coming here. Kartik is an ex-student of RV, which explains the attraction. That is, if the clean breeze, the quiet, the trees, the chirping birds and the professional satisfaction are not explanation enough.
This afternoon, both are in, and there's a crowd of patients sitting outside to see them. I sit against a wall and talk first to Kartik, then to Vidya, as they examine these people.
An old man in a white dhoti and shirt comes in, to me he looks thin and a little bent, but otherwise OK. Kartik asks me to feel the man's bicep. I can encircle his whole arm with my thumb and forefinger. That's the first surprise. Second surprise: the man weighs 36 kilos. 36! I'm nearly two-and-a-half times as massive as him! What's more, Kartik tells me he's actually doing well -- he's had TB, and they've been treating him for four months, and he's responding. Two months to go. What did he weigh four months ago? Kartik looks at the papers ... yes, here we are. 33 kilos.
He's here for a followup visit, but today, on finding out that he's put on 3 kilos, the man asks Kartik if he can discontinue the treatment. Genially, Kartik turns him down.
A slim woman, perhaps 40, is next. I'm talking to Vidya at the time; Kartik interrupts and asks me to look at the woman's fingernails. "Completely white, see? She's severely anaemic." Again, to me she looks slim but otherwise fine. But there are plenty of women in the area like her. Chronically anaemic, chronically deficient in calcium. Why? Really because, says Vidya, they remain chronically hungry.
This is an interesting story. One angle to it is that this is a drought-prone area, and there have been some years of poor rains. So for farming families here, which is to say most families here, the next meal is always doubtful. The immediate result is that the women deprive themselves. They eat less. They become anaemic.
Another aspect is that a lot of these families own cows. Each cow produces 5 or 10 litres of milk a day. Milk is a good source of calcium, so why are the women deficient in it? Because the families won't drink the milk. They prefer to sell it and make some money. On a good day, 70 or 80 rupees. That money is more useful than the milk -- or at least, more immediately useful. Or at least, so they think. Who thinks of anaemia?
So what's the answer? Calcium tablets? Urge the women to feed the milk to their families? Urge them to feed themselves?
Vidya shakes her head. This is a deeper problem that won't respond to tablets and the like. Thing is, family incomes across this area are about Rs 1000 a month for a family of five: a pitifully small amount. Kartik tells me that the bus fare to the Rishi Valley gate is Rs 5, but to the Centre is Rs 6. That extra one rupee -- yes, one rupee -- is enough of a deterrent to enough people who need his care that they won't come here. Yes, in 21st Century liberalizing globalizing shining Security-Council-aspiring India, there are many people to whom one extra rupee is too much extra.
Anyway, Kartik has been lobbying the Andhra Pradesh State Road Transport Corporation to extend the Rs 5 fare up to his gate. The APSRTC response? "But we are already a loss-making venture." How much of a loss-making venture, I wonder, do sick people who cannot afford an extra rupee amount to? Kartik keeps at it, hoping they will eventually agree to the reduction.
But back to Vidya shaking her head about tablets: the real challenge, the real solution, she says, is to find ways for the women to bring in a little more income. Because that will mean they won't deprive themselves of food. There'll be enough to go around.
The link between health and purchasing power: clear as the air outside.
So to that end, Vidya -- a doctor by training and practice -- has found that part of her job involves doing something quite un-doctor-like. In a few villages, she urged the women to form small groups, contributing small amounts to form a little pool of money. A couple of years ago, when tomato prices had sunk so low that farmers were throwing away the crop rather than taking it to market, she got the women's groups together and asked if they could think of something they could do with the vegetable.
"Pickle," they said. "But where's the market?"
Vidya said, "This first time I'll arrange for a market" -- the Rishi Valley School dining hall -- "but if it works, after that you're on your own."
And she did, and they did the pickling, and they earned Rs 1200 on a Rs 300 investment, and that gave them a sense of the possibilities.
And so, if this idea picks up, and if the self-help groups can come up with more such ideas, who knows? One day, perhaps even before the APSRTC responds positively, people here will be able to afford that extra rupee. Perhaps Kartik and Vidya will start seeing fewer scrawny old men and anaemic women.