This is a story of small country, blessed with numerous beautiful mountains and rivers. A story about villages and towns with people living happily with blessed nature all around.
At the Downstream…
One day, few people living in a village situated at downstream of a river, were going to their farms. They saw a person drowning in the river. One of them, who happened to be a good swimmer immediately jumped into river and whisked him out. They were happy for their good deed.
After few days, when these villagers again saw someone drowning in the river, while they were going to their farms. One of the villagers, again a good swimmer, jumped in, to save them. Soon he realized that not one, but three persons were drowning, of whom, he could save only two. One unfortunate was drowned into deep of water. Still villagers were happy that at least they could save two of them.
After few days, the incident got repeated. Villages again found few persons were getting drowned. This time, more villagers jumped in the river to save the people. In spite of greater rescuing efforts by villagers, they could not save all lives. The villagers mourned the loss of lives, and were satisfied that at least they could save few lives, if not all.
Over time, there were recurrence of such incidences and villagers were putting their all efforts to save as many people as they can, putting all hard efforts.
The Story continued…
The leaders and government of that country come to know about such frequent unfortunate incidents in that village and soon the authorities swung into action. A team of qualified and trained rescuers were deployed at the riverbank and with their help, the rate of saving lives improved.
Yet, few casualties continued, and especially during the monsoons, when the torrent of river was getting wild, deaths due to drowning, escalated. To reduce these losses, the government deployed more well equipped teams, provided equipment and other aids to facilitate rescuing.
Some Other Places at Downstream in the Country…
This was not happening in isolation. Many other villages situated at the downstream frequently reported similar cases of mishap, demanding scaling up of efforts across all such places by the government.
Efforts escalated up…
With escalating of efforts, the government soon learnt that apart from drowning, many people got injured and many survivors were developing disabilities or illnesses due to the trauma underwent during drowning. Following this, the rescue operations were now having added facilities of ambulance and services of a qualified medical team and established medical care centers near rescue sites to attend to all possible medical eventualities.
With the increase in the frequency and number of drowning cases, there was a lack in the availability of qualified/trained rescuers as well as medical/paramedical personnel. Hence institutes and training centers were established to prepare a trained cadre of medical/para medical personnel. Soon, to improve the quality of rescue and medical care, the latest state-of-the-art equipment and devices were procured. There was need to generate finances to fund these arrangements. Being a resource scarce country, to meet the rising expenses, the government mobilized funds internally, by slashing down the budget earmarked for other activities such as education, road and infrastructure development, citizen welfare schemes, etc. With increase in efforts and resource allocations they could save more lives if not all and better managed the injured and disabled they could do in past.
The Story did not end here….
The situation continued for years. The requirement of budget kept on escalating year by year affected the developmental activities of the country. It was worrisome situation, but government was deep in the rescuing and managing the injured. Government was riding high in applauding self for establishing a well operational system, equipped with advanced equipment and modern methods in managing these causalities at downstream.
One fine morning at the downstream…
One child playing near river bank every day, curiously watching the rescue operation and management of injured people by medical team, asked an innocent question to the team engaged in it, “What is wrong up there so as to which, so many people are drowning down from upstream?”
They were taken aback by the sudden query. They stood speechless in front of the child for some time and went away quietly. Engrossed in rescue and rehabilitation work, such a thought had never occurred to them.
Most of the team members, while discussing the matter over dinner time, opined that quality rescuing, medical relief and rehabilitation were the definite ways to casualties and dismissed the child's query, as a useless question by silly person. But few of them were not in agreement with them.5
Moved by the child's reflective question, few of the members decided to go upstream and get answer for it.
The Journey to Upstream…
The cynics tried to dissuade the visiting team, many got mad at them, some warned them, while the rest told not to waste time. They even warned them, if they would derelict their duties of rescuing and medical care, it would be disservice to the country and harming the interest of people. But without distracted by these arguments the team of small moved up. They were determined to be focused in reaching to the root of the problem. They visited few places upstream and found…
There were many small villages at upstream and people living there had to cross rivers daily for routine requirements like, visiting their farms, home purchase, attending schools trade related activities, etc. There were very few bridges and many were in old, dilapidated and dangerous condition. Many of villagers fell down while crossing these broken bridges. At few places bridge like arrangements were made by tying ropes between two banks. Also at many places; there were no bridges. In such cases, villagers were crossing rivers from ‘identified points’. Few of them were using unstable raft like structures to cross the river. People slipped from the rocks or lost balance and hence suffered fall into the river. There were also cases of the rafts getting upturned. Those who needed to venture out more frequently to tend to the daily needs and the old and infirm, pregnant women and kids were more at risk. Incidents of drowning were increasing during rainy seasons due to increase in the winds and flow of the water.
They also found more or less, the similar conditions prevailed in all upstream locates, wherever frequent drowning of people was reported.
Working at the Upstream
The group of like minded people initiated awareness generation programs, motivating people to use safety precautions while crossing rivers and avoid the use of dilapidated bridges and risky short cuts to cross the river. They identified the ‘danger’ points and marked them with placards, to prevent people from venturing into river especially during rainy seasons. They held dialogues with the government authorities and convinced them to repair the broken bridges and spend on building new bridges to meet the routine requirement to villagers living at upstream areas.
Fruits of Works at Upstream
Next year, as much as 90% reduction was recorded in the cases for drowning in villages at downstream. Encouraged by the positive results, the authorities built bridges at upstream on as many rivers as it could. With increased transportation and diligence on the part of the people in villages upstream, all the rescue and medical centers at downstream reported reduction in load of drowning, injuries and death. The need to create more rescue and medical care centres and buy costlier equipment was no more a priority. Instead, the money saved was used for other development activities to increase the happiness and prosperity quotient of the country.
This happened only after ‘SOMEONE’ decided to look and act at the ‘UPSTREAM’.
Post script Nuggets: Refocusing at upstream
Clinical care at hospital is like working at the downstream, while community health care is about working at the upstream for prevention of diseases and early deaths.
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Richest of rich countries cannot afford to keep on building hospitals ignoring the factors leading to increase in diseases and early deaths.
Dr AM Kadri
Editor-in-Chief
(Adopted from: A story told by Irving Zola, a medical sociologist, as cited by McKinlay, John B in “A case for refocusing upstream: The political economy of illness.”
In Conrad and Kern, The Sociology of Health and Illness: Critical Perspectives)