A young doctor as DC sizes up Changlang

Civil Society News, New Delhi

CHANGLANG has a size problem. It is one of the biggest districts in Arunachal Pradesh and the second most populous too. But its people live in such small clusters of villages, far apart from each other, that taking government services to them can become an intricate challenge.

The district has an area of 4,662 sq. km, which is roughly three times the size of Delhi. It has a population of around 200,000, which is big by Arunachal’s standards, but a tiny number for the huge area of the district.

Being a lot in the plains, the district’s roads are better than those in the other districts of the state. But then it rains six months in the year and there are floods. Connectivity becomes a problem.

Changlang is also a border district and abuts Myanmar. It is adjacent to Nagaland as well. As a result, it has experienced insurgency and has received people of the Chakma tribe in large numbers. There are doubts over the status of the Chakmas and a question mark over whether they should be recipients of government schemes.

Dealing with these multiple big and small challenges is the Deputy Commissioner, Dr Devansh Yadav. He is all of 31, and a physician by training. Changlang is his first posting as a Deputy Commissioner (DC).

Dr Yadav has plunged into running the district with the enthusiasm of someone who has joined the Indian Administrative Service (IAS) with the idealism to serve. He gets a thrill from making the wheels of governance move.

In the past one and a half years that he has been in office, Dr Yadav has come up with innovations in healthcare, school education, de-addiction and waste-recycling. He has shown that he can measure up to the unique and seemingly intractable circumstances that prevail in Changlang.

Dr Yadav took the civil services examination after he had done his MBBS from the All-India Institute of Medical Sciences (AIIMS) in Delhi. He got through in the first try and decided to make the switch.

 

A DOCTOR AS DC

Has being a trained doctor helped him in his role as a Deputy Commissioner? It has, he says, in several ways. But he has also learnt a lot and perhaps got back as much as he has given. It has been a reality check for him.

“The background has been beneficial. It is not just health but public health,” he says. “The MBBS course, apart from a knowledge of basic medicine, teaches you to identify a problem and solve it.”

“When I go to any health facility and ask a doctor about the problems there, I know what the cause can be. It is difficult to bluff me,” he says.

In this respect, Changlang is lucky to have him. The district desperately needs better health facilities. Well-trained physicians and surgeons aren’t willing to go there because they see the district as being troubled by insurgency.

“I have issued an advertisement for a gynaecologist and an anaesthetist at a salary of `1.5 lakh and not found takers. My district comes under the Armed Forces Special Powers Act (AFSPA) and though doctors haven’t visited here they think it is dangerous. They don’t want to come,” he explains.

Dr Yadav hopes to meet doctors and personally persuade them to serve in the district. But, even if well-trained specialists were to be appointed, there is much that remains to be done by way of creating infrastructure so that ordinary health requirements are taken care of and medical personnel agree to go purposefully to remote health centres.

“The challenge is that when you have such a vast and thinly populated area how do you provide health services in every nook and corner. There is a set-up, but you will not find anyone there because there are no facilities. Nurses won’t get the basic facility of a mobile network, so why would they stay there?” he says.

The solution Dr Yadav has found, is to focus resources on four or five key locations where the population density is relatively high and it is possible to have an impact and produce results in a short period of time.

“In this way our health indicators will shoot up. We are sending health and wellness officers there and providing infrastructure. With this we expect our institutional deliveries will increase to 40 percent. The idea is to optimize resources because you can’t cover everyone. It is a fact,” he explains.

“There is the problem of day-to-day monitoring as well. For instance, my district has 52 percent of pregnant women and children who are anaemic. The supplies of folic acid tablets don’t arrive on time,” he says about an important but less visible health issue.

“So, as a district, we are going to be tackling anaemia head on. If we can’t deal with anaemia there is no point of going ahead and trying to tackle hypertension and diabetes.”

Technology has made many things possible. Dr Yadav has used his personal networks to piece together solutions.  For instance, telemedicine facilities have been provided at three centres after roping in some of his batchmates and getting a start-up in IIT Kanpur to help with a solution.

“At these centres we don’t need doctors to be physically present. Nurses can be in charge and coordinate the consultation with a doctor who is far away. We have an e-prescription issued by the doctor and the medicine is given. We try and find such solutions. It is jugaad, as we say,” Dr Yadav explains.

The COVID-19 vaccination drive has been successful. Roughly 90 percent of the population has taken the first dose and 60 percent, the second dose. There is not much resistance to taking the vaccine, but the rains have been a problem. Now with the dry season coming in, he hopes the entire population of the district will be vaccinated.

There are many things that he has learnt from being posted here. One of them is the role played by practitioners of traditional medicine in public healthcare.

“Without the AYUSH (traditional medicine) doctors my strength of doctors would be reduced by 40 percent. This is completely contrary to what one learns in an MBBS course — that an allopath is the main doctor and that there should be no dilution with other forms of medicine.”

“So, one realizes in the field that outside your idealistic world there are a lot more difficulties on the ground,” he explains.

 

UNCLE MOOSA’S LIBRARIES

How did we come across Dr Devansh Yadav? Uncle Moosa introduced us.

Satyanarayanan Mundayoor (which is his full name) is the architect of a unique community library movement in Arunachal Pradesh. Over several decades he has helped young people discover books and find meaning in life.

Several years ago, Uncle Moosa was in the Civil Society Hall of Fame and we visited him and his libraries in Arunachal to document his work. Our headline for him was: ‘Life coach in the library’.

This year, Uncle Moosa was given the Padma Shri. He was in Delhi in early November to receive his award. The next day he was over at our office for tea and amidst our banter about Arunachal, he mentioned Dr Yadav’s work in Changlang.

Uncle Moosa with his Padma Shri

Dr Yadav has taken help from Uncle Moosa to set up 12 village community libraries in the district. For this task, 12 young people have been chosen.

More than being a source of books, the libraries serve to bring people to a common space from where they can access the world at large. Young people get mentored, discover their talents through book readings and elocution, are introduced to social issues of the day and generally find purpose in life.

In August, Dr Yadav held what he calls a ‘school preparation month’. He estimated that schools would reopen in September. There was a need to help students who would be promoted to the next class a year and half after schools had been closed.

“During the pandemic, when schools were closed, children fell behind in their learning. With schools likely to reopen in September children would be perhaps going to Class 3 completely ill-prepared. Distance learning mostly hadn’t worked because of the lack of smartphones or connectivity or very simply the inability to cope,” says Dr Yadav. 

In a concentrated way the month of August could be used to catch up and perhaps young people, unemployed and with Class 12 degrees, could help coach primary schoolchildren who missed out on formal classes.

More than 700 young adults applied out of which 500 were chosen to serve as friendly tutors. In this way children came prepared for school in September. The idea of having community libraries in the district came out of this experience and he reached out to Uncle Moosa.

 

DRUG DE-ADDICTION CENTRES

Arunachal has a noticeable drug addiction problem. Poppy has been traditionally grown in parts of the state. Poppy is not cultivated in Changlang, but the district is close to the Golden Triangle and opium comes in from Myanmar and Assam.

“In medicine we learn that if you take opium even twice you go back to it because the withdrawal symptoms are so severe,” he says.

Treating three or four youth does not lead to long-term gains. They tend to go back to their addiction no matter what is done for them. The district administration’s approach has been to work through the community. Instead of treating individuals the strategy is to work with the entire village.

“We are trying to identify villages where people are coming forward on their own and we are establishing community level de-addiction centres. We feel there is no point in treating one or two people at a time. It is better to take care of the entire village. Making an entire village de-addicted has a much bigger impact,” Dr Yadav says. “This is where we need women’s groups and the kind of volunteers that we have for the community libraries.” 

Sports facilities have been a way of making villages drug-free

So far, eight villages have been made drug-free and four more are on the way. It is a slow process and daunting too considering there are more than 300 villages in the district.

But the idea is to create examples of success and through them demand for de-addiction services. Support groups have been set up to help reformed drug addicts. They have also been given help with poultry farming and piggeries and fisheries. Sports facilities have been created. But it is a long haul.

 

PLASTIC WASTE

Among the multiple innovations that the district administration has been able to come up with, has been the handling of non-recyclable plastic waste.

There has been no waste processing facility in eastern Arunachal Pradesh. Waste is picked up and carried away to landfills.

Setting up a processing unit would also not be feasible because the plant’s capacity would be much higher than what a small population would generate.

Instead, what has worked are units in four districts for shredding non-recyclable plastic into small pieces of 2 to 3 mm, which can then be used along with bitumen for road building and carpeting.

“We basically wanted a small solution. A solution which caters to our needs. When plastic is used for road construction it improves the life of the road. We started this in 2019,” says Dr Yadav.

“The important thing is that we did not take any government funding for this. It is funded under Extended Producer Responsibility. Companies like Pepsi and Parle, which generate plastic waste, are required to invest in technology and solutions that take care of plastic waste,” he explains.

The costs of transportation, wages of people running the units and all other expenses are met by companies which channelize the funds through a start-up called Recycle.

 

MEDICINE TO THE IAS

With a good medical degree to his name, what prompted Dr Yadav to make the switch to the IAS?

 “AIIMS has a discussion-based environment,” he says. “Many of my seniors have joined start-ups. Many have gone abroad. People do different things. I applied for the civil services. It was a complete change,” he says.

Dr Yadav first came to Changlang as an Additional Deputy Commissioner, a role in which he worked at the block level. It allowed him to get a grasp of how things are at the lowest levels of the district administration.

“It was valuable experience,” he recalls. “Usually, we get posted directly as Deputy Commissioners and don’t have an idea of what goes on much below. I was lucky to begin at the bottom.”

Changlang is a world apart from Mathura in Uttar Pradesh where he grew up as a small-town boy and went to school. His father runs a guest house there. His brother is in the family business.

For Dr Yadav, getting to study at AIIMS was an opportunity to be in Delhi and explore an India he didn’t know about first-hand. He was curious about politics and life in a big metro and the shift was in many ways transformational.

But if Dr Yadav took himself out of Mathura, he doesn’t seem to have let his small-town past be taken out of him. He can understand the needs and aspirations of people in Changlang. He has quickly become a part of their lives. He is at ease in the district and eager to deal with the problems that come with its remoteness.