email a friend iconprinter friendly iconCommunity Health
Page [ 2 ] of 11

But Kale's belly is so tight that it is hard to detect anything. Sathe looks worried; she believes the baby is out of position. "But sometimes they move," she says. She tells Kale, "We'll come back in an hour or two. If the position is still not normal, we'll take you to the hospital. If you begin labor, just send someone for us." Salve asks one of Kale's aunts to give her tea. "Everything will be fine," she says reassuringly.

Next stop is the home of Manisha Mane, mother of a three-month-old boy with a cleft palate. Sathe and Salve watch the baby suckle, and then put him in a sling and weigh him: nine pounds. Not enough. "You have to supplement," says Salve. They tell Mane how to make a porridge of sorghum, oil, and vegetables. They show her where the baby falls on a growth chart and talk about vaccinations. After tending to Mane's mother-in-law, who suffers from hypertension, Sathe stops at a kindergarten where a government worker is scheduled to give vaccines. When word gets out, the kindergarten quickly becomes a makeshift clinic. Pregnant women and mothers of newborns stop in, and older women come in for blood-pressure checks.

Jawalke is a very different place because of Salve and Sathe. Salve has been doing rounds in Jawalke since 1984. By her own count, she has delivered 551 babies and says she's never lost a single infant or mother. "When I started, the children all had scabies and there was filth everywhere," she says. Small kids used to die. Pregnant women died during and after delivery. Poor sanitation led to malaria and diarrheal diseases. Children went unvaccinated. Leprosy and tuberculosis were common.

I ask Salve about Jawalke's health problems today. "Hypertension and diabetes," she says— rich-country illnesses. In most of rural India, only the fortunate suffer from such diseases.

The shortage of doctors in poor countries is widely lamented, especially in English-speaking countries such as Ghana, Malawi, and India, where doctors often leave for high-paying jobs abroad. They are pushed to leave by abysmal conditions—major hospitals may have only a handful of doctors and a dozen nurses to care for hundreds. Patients die unnecessarily. Pay is terrible and often months late. But doctors and nurses are also pulled to places like the United States, Canada, Britain, and Australia. These countries don't have doctors willing to work in rural areas or enough nurses at all. They fill the gap with health professionals from poor countries.

Page [ 2 ] of 11