Arole, Mabelle Rajanikant

The simple curative medical practice begun by the AROLES in a small lent cowshed in Jamkhed won them acceptance by community leaders and the voluntary construction of a small hospital.
To make preventive medicine a reality they utilized the semiskilled personnel and unsophisticated equipment at hand.
To ensure that villagers acted for themselves, the doctors subordinated their work to local leadership, and as outsiders were only catalysts.
The AROLES are refining their movement for mobilizing rural initiative and leadership, and sustaining their commitment to continue learning from the villagers whose cause they share.
The RMAF board of trustees recognizes their creating a self-sustaining rural health and economic betterment movement in one of the poorer regions of West-Central India.

Modern medical science has made immense strides throughout Asia during the past two generations. These advances were facilitated by the widespread availability of “miracle drugs” that began with sulfa derivatives and antibiotics. Yet in practice only a minority of South and Southeast Asians benefit adequately.

Physicians, clinics and well-equipped hospitals almost invariably cluster in or near urban centers, serving chiefly the articulate, educated and more prosperous citizens. Patients’ ability to pay continues to promote a concentration of medical skills and facilities. Where village-based health services have been organized, they tend to flounder and disappear when the innovators move on. Critical is the poverty that still is the lot in life of the majority of rural families for whom population pressure has made malnutrition the most prevalent and rapidly growing illness.

When Drs. RAJANIKANT and MABELLE AROLE chose to practice in Jamkhed taluka (sub-district) in Ahmednagar district of Maharashtra in 1970, they had prepared themselves meticulously and thoroughly researched the community. Both products of an Indian Christian education’ they had chosen each other in marriage with a pledge to share in serving rural India First joining a small voluntary hospital in Maharashtra, they refined their ideas for service; graduate medical studies in America followed.

Deliberately the AROLES selected a region where the villager’s existence was grim and seemingly hopeless. Two consecutive monsoon failures compounded chronic drought. Much topsoil had washed away after forests were cut for firewood. Villages were split into factions by caste and clan. Leprosy and tuberculosis were prevalent, although often unreported. Infant mortality ranged from 80 to 150 per 1,000 live births. Malnutrition, especially among children under five years of age, was made worse by gastrointestinal diseases carried in the often contaminated water taken from streams and ponds. Everywhere want produced despair among a people denied the means and lacking the will to achieve better.

The simple curative medical practice begun by the AROLES in a small lent cowshed in Jamkhed won them acceptance by community leaders and the voluntary construction of a small hospital. But they found permanent answers demanded a changed environment. To make preventive medicine a reality they utilized the semiskilled personnel and unsophisticated equipment at hand. To ensure that villagers acted for themselves, the doctors subordinated their work to local leadership, and as outsiders were only catalysts. Village Health Workers, often illiterate older women nominated by their neighbors, were trained to give simple treatment and bring serious cases to a mobile weekly medical team. Wells were drilled for potable water, located in the village section inhabited by Harijans, or untouchables. Young Farmers Clubs reclaimed idle land, built dams and roads, planted trees and otherwise utilized the food-for-work program to grow added crops, partly for children’s feeding programs.

Changes wrought by this Comprehensive Rural Health Project above all cemented a new sense of community, erasing many caste barriers among the 40,000 inhabitants of 30 villages. At an annual per capita cost of 70 U.S. cents—excluding the cost of special treatment for tuberculosis and leprosy patients—this scheme is being extended to another 30 villages in neighboring Karjat taluka. Now in their mid-40s, the AROLES are refining their movement for mobilizing rural initiative and leadership, and sustaining their commitment to continue learning from the villagers whose cause they share.

In electing Dr. RAJANIKANT SHANKARRAO AROLE and his wife, Dr. MABELLE RAJANIKANT AROLE, to receive the 1979 Ramon Magsaysay Award for Community Leadership, the Board of Trustees recognizes their creating a self-sustaining rural health and economic betterment movement in one of the poorer regions of West-Central India.

My husband and I thank you for honoring us with the Ramon Magsaysay Award. In the life of the late President Magsaysay we find inspiration to serve our fellowmen and bring credit to the great humanitarian in whose memory this Award is given.

One of the most sensitive and accurate indicators of the development of a society or nation is the status and condition of its women and children. In most countries of the world, women and children are exploited socially and economically and, to this extent, these countries are not truly developed. The plight of women and children in the rural areas that I have seen is beyond description. Living in abject poverty, women alone have to bear the burden of childbearing and child raising. It is also the women who have to do the backbreaking work in the fields, very often even acting as beasts of burden. Worse still, these tasks have to be performed under the hardship of unbelievable social restrictions and oppression. They are subject to the whims of society and strictures of caste and community. Women and female children are the most nutritionally deprived and they lack access to education because of social taboos. They have little or no decision-making power or self-esteem, even when they are the main wage earners. Ultimately, the only choice left to them is whether to live in silence or not live at all. Only death relieves their suffering. They are caught between the Scylla of poverty and the Charybdis of tradition.

The need then, for comprehensive social and economic change for the betterment of women cannot be overemphasized. Health services, no matter how efficient, cannot change the condition of women unless we help them to be self-reliant. The traditional role of woman as a wife and mother needs to be expanded by involving them in leadership positions and transforming them into change agents. The liberating effect of education and consciousness-raising on oppressed women has been well documented. Women’s participation in deciding on policies, and in planning, implementing and controlling human development programs, will result in self-reliance.

Simple, humble illiterate women around Jamkhed have a potential for full development. We put our trust in this potential. Initially, the women in this area would not believe that they could be trained. With perseverance, they soon found out their own capabilities. Scores of women have come forward and acquired knowledge and skill in health matters. They have acquired organizational skills. They can produce educational materials and communicate with the masses through audiovisual aids, drama and other media. They have learned to be sensitive to injustices heaped on the weaker sections of society and they have found ways and means to combat these practices. These illiterate women have dramatically reduced infant mortality, maternal mortality and the birth rate, and have helped other villagers enjoy better health. They have helped the community overcome irrational traditions, have spread education, and have improved the quality of village life in general.

We, the educated elite, need to realize that formal school and university education is not the only education for bettering the quality of life. People, our best assets, can learn from doing. Common people need to be trusted and equipped with knowledge and skills so they can stand on the own feet. This process of non-formal education must permeate rapidly if we want to alleviate the suffering of the masses who are existing in inhuman conditions today. We professionals form part of the community in which we live and work. A continuing dialogue is necessary between the broad community and those of us who have knowledge. Such a dialogue enables us to acquire a better understanding of the community’s feelings, its hopes and aspirations. For their part, the people will learn to identify their own needs and learn to become involved in and promote community action for health and human development.

Thus, society will come to realize that health and human developments are not only the rights of all but also the responsibility of all and in doing so, we professionals will find our own proper role.