In a country where conversations about sex and pregnancy, childbirth and abortions, and women's health, in general, continue to remain taboo even in the metro cities, a doctor in Odisha's Kalahandi district is creating awareness about the benefits of family planning.
In the quarter of a century that he has spent in the region - since 1996 when he took on the job as an assistant surgeon - Dr Sadanand Panigrahi (58) has managed to break down all kinds of barriers to inform the people in the region about the need for small families.
Currently posted as a Senior Consultant in Obstetrics and Gynaecology, in Sub-divisional Hospital in Kalahandi's Dharmagarh, he has conducted 30,009 family planning operations, in keeping with the 'small family happy family' norm of the National Family Welfare Programme.
He was felicitated by Odisha CM Naveen Pattnaik in 2014 for his contribution, apart from being awarded by the state's Department of Health and Family Welfare several times. He has also been honoured by USAID in Delhi as a "Champion Family Planning Service Provider".
What makes Panigrahi's achievement noteworthy is not just the high number of operations, but also that these procedures were made accessible in one of the remotest areas of the country, where education and health facilities are difficult to come by.
India launched its National Programme for Family Planning in 1952, and Panigrahi is among those who are ensuring its implementation in a region largely dominated by rural and tribal populations. Kalahandi has, in the past, seen deaths due to starvation and poverty.
In 2016, the district made national headlines because of the heart-wrenching story of a tribal man - Dana Majhi - who had to walk for over 10 km carrying his wife’s dead body, due to the lack of availability of a vehicle.
Of the 13 blocks in the district, Panigrahi has managed to bring about a noticeable change in at least 10, helped by the district administration. Despite the long distances, he pays visits to the local health centres on a weekly basis, to allow the people to get to know him. For him, the medical part of the process comes much later.
He relies on faith-building conversations to work as icebreakers between him and the villagers. "It was important for me to first gain their trust, and that would happen only if they see me regularly. Each block is around 40-50 km away from Dharmagarh where I am posted. Since the roads are good, I drive down by myself. I quite like it," he says.
The doctor says that transportation continues to be a challenge in some parts of the region. Till 2008, Panigrahi recalls, villagers had to take the state bus, which was the only mode of transportation at the time, to Thuamul Rampur, the southernmost block in the district, where he had to camp for three to four days to conduct operations.
"The terrain is mountainous, and there was only one bus. It would ply between 12-2 pm, so I had to arrange for food and accommodation not just for myself, but also for the patients who would travel 20-25 km to avail the facility. There are now more government and private buses on the route, but it is still a challenge," he says.
Erratic electricity was another problem that he had to deal with until 2002 after which inverters were installed. "Most of the time there would be no electricity so we used generators and headlights during the operations," he says.
As Panigrahi spoke to the women, he realised that most did not want more than two children, but the inaccessibility, especially in the 90s, was pitiful. "During counselling of women, I observed that most of them wanted to restrict their families to two children but due to lack of services at the health centres in their proximity, poor counselling, misconceptions, poor male participation, they were not able to avail the said benefits," he says.
There were also misgivings about the safety of the procedures, which was something that he worked hard at to alleviate. "I worked with ASHA and Anganwadi workers to educate them about the procedures in their local language. Family planning enables women to be healthier and allows them equal opportunities to pursue education, and have financial security," he says.
The villagers are told about both temporary - contraceptives like condoms, pills - and permanent options like female sterilisation and vasectomy. Panigrahi says that there is negligible acceptance for vasectomy, but women’s perspectives have changed.
A firm believer in leading by example, Panigrahi is certainly proud of the change that he has brought about, but he admits that healthcare in the region has a long way to go. The good doctor hopes his efforts inspire his co-workers to keep the good work going.