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EVOLUTION
 

Quite encouraged by the success of the community health programme and the role played by the adivasi health workers, the adivasi community felt that the next logical step would be to start a hospital of our own. There was a heavy demand from the village sangams to start a hospital. But the doctors were reluctant, saying that Hospital is a permanent institution which needs to be run 24 hours a day, all through the year - and for many years. The health team at that time was not equipped to handle such an institution. Moreover, the ACCORD team strongly felt that their intervention had to be time-bound and they will withdraw after a few years when the AMS can take over the initiative of protecting the rights of the adivasis. But, hospital is a permanent form of intervention which cannot be withdrawn. And, in any case, where are the nurses in the adivasi community (another basic philosophy of ACCORD was to identify youth from the community itself to deliver all the services to the people and to train them !) ? And, Doctors ??
 

However, the community was strong in its demand and felt that the community health programme needed a hospital of its own to make it much more effective and acceptable to the people. So, they started a search for suitable people. Again as a curious coincidence, there landed up a doctor couple, Shyla and Nandakumar, willing to be part of the health programme. Having the ideal combination of skills as Gynaecologist and Surgeon, they were what the "doctor ordered" and the people were looking for ! Young adivasi girls were identified by the sangams and the new doctors started training them as nurses. Thus was born the "Gudalur Adivasi Hospital" [GAH]. In 1990

TRAINING OF NURSES
 

With the establishment of the Hospital, we realised that this intervention is going to continue for a many years, and structurally it has to be different from that of ACCORD or AMS. So, the health programme, activities and the staff were hived off from ACCORD and a separate legal entity called ASHWINI was registered. From then onwards, Ashwini took care of the health issues concerning the adivasis and poor people of this area. While Deva and Roopa continued their focus on the community health programme, Shyla and Nandakumar started training tribal girls as Nurses. It was a major cultural change for the girls - from innocent village life to a three-shifts-a-day routine in the hospital. Training had to start from elementary Maths and English.
 

These adivasi nurses have come a long way in the next 10 years. They have become experts in conducting deliveries, in assisting the doctors in surgeries, in the general administration of the hospital, in ordering and managing the drug stocks, in designing systems to monitor the performance of the hospital (All the patient details have been computerised after 1996) and in analysing the financial aspects of the hospital management. They are constantly trained and their skills are upgraded to keep up with the growth of the programme.

Today, the Adivasi Hospital is one of the most sought after hospital in the Gudalur valley, not only by the tribals but also by the non-tribals of the local area. Patients are brought from distant villages by ambulance and good quality care is given. As all the staff are from the community and can talk the tribal languages, the tribal patients feel at home.

 Efforts were constantly made to keep the place culturally acceptably to them and the community gradually adjusted to the change. Today, there are cots in the hospital, they come forward for surgeries and many of them regularly show up for antenatal checkups etc. Some more young doctors came and worked in the hospital for brief periods - the health team getting enriched by the interaction with each of these doctors. Some quantitative details on the functioning of the hospital are given in the Statistics section.