By Rupal Ramesh Shah

“I was inspired by the Navnirman Andolan movement in the Indian state of Gujarat in 1974 to demand the removal of the chief minister. People were tired of the corruption and economic turmoil. It was a revolution that led to many changes, and since then I have always believed in working for and with the people.” – Nimitta Bhatt 

Rupal Ramesh Shah

The past couple of years, as the world has experienced a pandemic, healthcare has become a central topic in every conversation and on every news outlet. In low- and middle-income countries, as well as in some communities in Maine, community health workers have been at the forefront of the pandemic, caring for their patients. In fact, the pandemic has highlighted that the healthcare workers who know, understand, and have cared for their communities for years continue to have more success in caring for them during this pandemic. This piece describes one such community and its healthcare workers

Nimitta Bhatt and her lifelong partner Ashvin Patel have dedicated their lives to bringing quality healthcare to the most rural communities in Gujarat. In 1987, they formed the non-profit Trust for Reaching the Unreached (TRU), located in India’s Panchmahal and Vadodara districts. “At that time, we had no money, just inspiration and ideas,” said Patel. With a starter loan of 20,000 Indian rupees, and hope, they decided to give life to their vision. 

Many of TRU’s patients and their families are agriculturists, industrial workers, and construction and casual laborers – those who pick up odd jobs when available. As a result, most villagers from both districts earn modest wages. According to Bhatt, access to quality healthcare remains one of the biggest concerns for these citizens. 

Bhatt studied science at St. Xavier’s College in Kolkata and has been involved in health management for over 25 years. Although she does not have formal training as a social worker, she has acquired a deep understanding of the field by paying close attention to the community’s healthcare needs. From programs on nutrition to mental health to sanitation, Bhatt has developed expertise about the specific needs of the community she serves. 

Patel has a medical degree from the Medical College of the Maharaja Sayajirao University of Baroda in Vadodara. After working for 15 years in the field, he decided to study epidemiology to develop sustainable health interventions for his patients, and enrolled in the London School of Hygiene and Tropical Medicine, where he earned a master’s degree in epidemiology. 

“I believe that in order to strengthen the healthcare systems in rural communities, we need to work closely with the community members, as the solutions come from within those systems,” Patel said. “In order to do my work, I have to be able to simplify science and medicine so everyone can understand and appreciate the basic information and knowledge.” This community-based approach is what makes TRU unique. 

Together, Bhatt and Patel have built an organization that now serves over 700,000 people a year. The organization offers a number of programs, including a robust mental health program with a focus on children. “Mentally challenged children have a lot of difficulty integrating into the society. It causes further challenges for their families, and therefore, we work with all of them as a family unit,” said Patel. 

The key element that makes Bhatt and Patel’s work in mental health uniquely successful is the fact that it is truly centered around the needs of the community. “In our community, people with mental health illnesses lose their standing in their family and eventually their community. However, once the patient is provided supportive therapy and counseling, we provide community-based rehabilitation. According to our records, in 2019 we were able to integrate more than 85% of the patients back into their society,” said Bhatt. 

According to a February 2020 study published by Lancet, approximately 197.3 million people in India have mental health disorders. Both Bhatt and Patel say that the need for mental health services for people in low-resource settings such as the villages of Gujarat seems to be increasing. Bhatt pointed out that mental health always disproportionately affects women: “When men suffer, it’s their primary caregiver, such as the mother, wife, or sister, who is highly affected. When the woman suffers, she is shunned by her family and possibly her entire community.” 

The healthcare center’s work would not be possible without community health workers, who get on-the-job training while assessing and solving real life issues as they work with experienced peers in areas such as maternal and child health. “This is the model of learning and working we have utilized in the communities of this village for many years. We currently have a group of 25 community health workers that are not only well-trained but also understand the history, culture, and dynamics of this community, which is essential when caring for patients,” said Bhatt. The organization has also trained over 200 nongovernmental organizations all over Gujarat to adopt the basic principles of community health in their ongoing work. 

The COVID-19 pandemic has impacted the work of the community health workers, especially in terms of reaching the most vulnerable patients. But Patel remains devoted to her work. “Our work at TRU is deeply intertwined with the needs of the community, which has faced crises such as floods and earthquakes in the past. But our philosophy is to develop solutions together. This pandemic is no different, as we continue our work with the people of the community.” 

In this same way, community health workers in Maine also continue the important work on the ground, of caring for the people and providing the most essential resources they need – quality healthcare. Without a dedicated and passionate health workforce, the progress in healthcare could not be made, in Maine and all around the world, especially during this pandemic.

Rupal Ramesh Shah is a third-generation Tanzanian who grew up in an ethnically Indian family in the town of Moshi, at the foot of Mount Kilimanjaro. Her family immigrated to the U.S. when she was a teenager.