In 1970 the Aroles returned to India and established the Comprehensive Rural Health Project in Jamkhed, a small city that is about an eight-hour drive east of Mumbai. They chose the location—not far from where Raj Arole grew up—because it was in one of the poorest parts of the state, frequently drought-stricken almost to the point of famine. There was no local industry or train service. People stayed alive by cultivating small patches of sorghum. Irrigation consisted of asking the gods for rain.
When they came to Jamkhed, the Aroles started a small hospital in an abandoned veterinary clinic. A hospital was necessary to treat complicated illnesses and emergencies, and it gave the project political support and credibility. It also brought in fees from patients who could pay. (Those fees, together with donations, contribute the bulk of Jamkhed's $500,000 annual budget for their village work even today.) But the Aroles knew that curative medicine could do very little for the poor. They needed to emphasize preventive medicine, and bring it to the villages. So they decided to engage the villagers themselves. A village health worker, Arole says, can take care of 80 percent of the village's health problems, because most are related to nutrition and to the environment. Infant mortality is actually three things: chronic starvation, diarrhea, and respiratory infections. For all three, you do not need doctors. "Rural problems are simple," Arole says. "Safe drinking water, education, and poverty alleviation do more to promote health than diagnostic tests and drugs."
When Salve and Sathe started their work in Jawalke, they were destitute. As members of the Dalit, or Untouchable, castes, they were considered nonpersons, so reviled that higher caste people would throw out food if it even touched the edge of their saris. They went barefoot in the village, as Untouchable women were not allowed to wear shoes. Sathe remembers standing for hours at the local water pump—which she could not touch—waiting for a higher caste woman to take pity on her and fill her bucket. Salve was so poor she washed her hair with mud and owned a single sari. When she laundered it, she had to stay in the river until it dried.
As the Aroles expanded their program to a hundred or more villages outside Jamkhed, they encouraged villages to select women from lower castes. "An educated woman likely comes from a high caste—she may not [want to] work for the poorest of the poor," says Arole. The Aroles believed that empathy, knowledge of how poor people live, and willingness to work were more important than skills and prestige.