On a dusty road, blood red in colour, a ‘development’ scarred mountain chain dominating the landscape, in the mining town of Dali Rajhara, stands a monument to working class ingenuity, leadership and labour. Unlike other monuments, it is neither a tourist attraction, nor a silent memorial of bygone times and people. It is a living, throbbing hospital, often overflowing with patients seeking affordable medical care. Shaheed Hospital, nicknamed pauper’s hospital, was a gift from the ‘illiterate’, ‘unskilled’ workers of Rajhara Mines to the people of Dali and adjoining districts of Chattisgarh. Financed, built and managed by contract workers, its principal purpose was to serve the poor subjects of a prosperous nation. It derives its name from the 11 martyr who laid their life in the struggle of 1977, when the formed Chattisgarh Mines Shramik Sanghatan (CMSS) and began advocating their demands for better wage and working conditions. Its been 35 years since, the mines have become fully mechanized, the vanishing jobs has also diminished the role of workers in managing the hospital and yet it has continued to serve the poorest and vulnerable people of Dali Rajhara and adjoining districts of Chattisgarh.
‘Not at your Mercy’
In 1982, Kusumabai, a female contract worker on the mines died due to complication in her pregnancy. The lack of medical facilities in Dali Rajhara Mines, inaccessibility of Bhilai Steel Plants (BSP) Hospital in Bhilai and the alleged negligence shown by staff at the BSP hospital, frustrated the workers. Not willing to suffer discrimination and destitution, the contract workers, who had organized themselves into CMSS, decided to raise a maternity hospital in their community. The money came from a months arrear allowance of workers. It was about Rs 100/- a head, but there were many heads to count, over 10000. The workers would volunteer their labour to construct the hospital, taking on the additional burden after a rigorous shift on the mines. But where will the doctors come from? Where will the trained nursing staff come from? Would it all be undone by the system that has priced out ‘knowledge’ and ‘expertise’ from the reaches of the poor working class.
Enter the ‘idealist’ doctors who believed that ‘knowledge’ and ‘expertise’ were social products that cannot and shall not be packaged into commodities. These doctors were initiating their own experiments of training local communities to efficiently address their medical needs. It was to become the ‘Public Health Movement’. Dr. Saibal Jana, who currently manages the hospital, and was one of the founding team of doctors said “we recognized that a health movement is not independently sustainable, that we needed a people’s movement that incorporated ‘Health’. When we heard of this effort by the contract workers and Shankar Guha Niyogi, we decided that we will support them.” Apart from Dr. Jana, the team included Dr. Binayak Sen, Dr. Ashish Khundu and others. These doctors began training the contract workers and their children to become adept at nursing, care giving and even assisting in surgeries. Puguram Thakur, a retired mine worker, who takes care of the administrative tasks of the hospital, said “Some of the workers volunteered to become health workers at the hospital. After our shifts we would come to support the activities of the hospital. It meant taking care of medical stock, checking on patients and attending to their needs, maintaining the place and other such work. We also took out campaigns in the locality for improving water quality and preventing diarrhea deaths. Many used to die due to Diarrhea, especially children. We decided to eliminate this.” The nursing staff was recruited from the population. “initially there was no specific entry criteria, we trained them all. You see, these tasks don’t require text book knowledge. You learn with training and experience. Today, we only take in those who have passed 12th standard, more as a filter as there are so many willing to join” said Dr. Jana. Thus by 1984, a well stocked, well staffed hospital for the workers became operational. The workers could now access quality health care with ease at a fraction of the cost.
Values of the Working Class
Heirarchy, Bureaucracy and Specialization are the hall marks of the capitalist system. Bourgeoisie intellectuals have sang platitudes to its ‘efficiency’. But at Shaheed Hospital, the contours of a workers managed institution took shape. There are no specialists here. It is not merely a maternity hospital but caters to child care, orthopedic care and other health issues. The doctors, the nursing or administrative staff, have to multi task within their broad spheres in order to run the show smoothly. The influx of patients and the lack of adequate staff necessitates that every one is prepared to step into others roles. This was also a corner stone of ‘public health movement’ in its approach to health care.
In stark contrast to the bureaucratic management of private and public hospitals, workers formed committees to manage the hospital. From major administrative decisions such a purchase of equipment to the daily tasks were decided in these committees that comprised, health workers, doctors and representatives of CMSS. This allowed the workers to have a decisive say in the functioning of the hospital, while also learning valuable lessons on the way. This also enabled a seamless feedback system with the community to address their grievances and improve the services. By keeping wage differences low between doctors and staff, and by creating a democratized decision making process with involvement of all staff, the workers tried to also flatten hierarchies. Jagguram Sahu, a health worker at the hospital since its foundation, takes us around the hospital wards, speaking with nurses, introducing us to them. He takes great pride in what has been built with their labour. ‘This is our hospital, we don’t consider this as some paid work. In fact until we retired we did not get any pay for this work. It is because we, the workers are its true owners’ he says. Even after overturning every management rule, the hospital has served the community for a fraction of the cost that private sector hospitals demand and in a sustainable way.
As the mines reduced its labour strength from the thousands to mere hundreds, the role of workers in the hospital has also diminished. Of the many that used to run the daily operations, there are but four health workers left. Some have passed away, many have moved on after their retirements and loss of jobs. As the movement led by Shankar Guha Niyogi, began to ebb following his assassination and the more recent split within the movement, the patronage that the hospital enjoyed from the workers has also greatly diminished. With time, many of the initial members have also been replaced with younger staff. Given the times, some of the cherished values have to come to great strain. Yet, the perseverance of the staff and doctors and the strength of the movement, continues to uphold the founding values of this novel institution.
‘A Glimpse of the Future’
Shaheed Hospital faces numerous challenges in the near and long term. The new law on clinical establishment 2015 which places strict demands on equipment and staff qualifications. A hospital that prides on its training rather than on textual qualification and one that cuts cost by maintaining less equipment finds itself under threat of losing recognition. The hospital has become dependent on the Central and State Government Medical Insurance Scheme for its revenue. While it has remained steadfast to providing quality medical care at bare minimum prices, the lack of sustained financial support from the workers in the region makes it vulnerable to this state source of funding. In order to attract doctors to volunteer as resident doctors, the hierarchies with pay , perks as well as decision making is widening. The working class support for the hospital is essential if it has to overcome these challenges while maintaining its class character and its defining principles.
However, Shaheed Hospital, will forever stand as a shining illustration of what the workers can envision, endeavour and establish when they work as a collective. Against every iota of common wisdom, a population of uneducated contract workers, engaged in hard labour, eking out a sustenance wage have managed to build, own and operate a hospital that has been the essential source of medical care of the poorest of the poor. With only minimal help from professionals and intellectuals, CMSS workers have proved that the working class has the ability, tenacity and the foresight to establish enduring institutions built on principles of universal service, equality and fraternity. From the depths of their everyday misery, the workers were able to perceive a just and sustainable future. They also had the courage to give concrete shape to this vision. They invite us to expand our horizons and dream of an egalitarian future without succumbing to the mediocrity of our every day life. In doing so, they have chartered a course for the workers of today, to think big, think further and think in collectives rather than as individuals. The inspire us to act in hope of a better, just and equal future and not despair. It is our responsibility to support this dream and bravely replicate the same.