OUR EXPERIENCE NTI Bulletin 2000, 36/3 & 4,
NATIONAL SAMPLE SURVEY TO ESTIMATE ANNUAL RISK OF
TUBERCULOSIS INFECTION IN DIFFERENT PARTS OF INDIA
- OVERCOMING HURDLES IN FIELD WORK
Organizing field survey requires considerable skill and intelligence. A person should have the ability to mingle with community, face all vicissitudes, adapt himself to different environment, specially when he has to work with people of different culture. According to me, the term Leadership in field work has got the following elaboration for each letter.
The National Sample Survey for Annual Risk of Infection (NSS ARI) in which we are to cover 26 districts throughout the country where a total of approximately 2 lakh children are to be tuberculin tested, is a source of great experience and inspiration to us. In this context, I am going to highlight some of the significant clusters of the selected districts in terms of hardship faced, while officiating as Overall in-charge / Team Leader during my tenure.
Junagadh in Gujarat was the first district to be taken up for the National Sample Survey by the National Tuberculosis Institute (NTI), Bangalore. We left for Junagadh on 28th January 2000 with a team of 10 members comprising of 3 NTI staff and 7 Contractual Field Workers. I was assigned the responsibility of a Team Leader to lead the team. We reached there on 31st January 2000 and started our field work from the very next day.
Every day was adventurous for us. We used to leave the camp by 7.00 a.m. and the time of return was uncertain. My motto was, we should leave the village only after covering testing of 85 children. All the team members were absolutely outstanding in their respective performances.
So far as the topography of the district is concerned, it is almost a total dry area with scarcity of water, lacking vegetation and some areas with black soil. Almost every day, we have to travel about 20-25 kms, on an average (except in few clusters) through kutcha roads, country roads where there were chances for the vehicle to skid, the blades of the vehicles may get cut and so on.
As Gandhiji (Father of the Nation) was born in Porbander tehsil of Junagadh district, people seem to have inherited his culture and tradition. They were too decent, honest and co-operative which really impressed me. We had left no stone unturned, in making Junagadh a Total successful Venture.
In village Ghodadar, a child apparently became unconscious while being administered the tuberculin test. The villagers were irritated to such an extent that they were ready to assault the team. All of us persuaded and I said that we shall not leave till the child comes to the normal state and even assured to visit the village the very next day to take stock of the situation. The villagers also noted the address and telephone number of Akshaygadh TB Hospital, Keshod, district Junagadh, where we were put up.
At night, the Ayurvedic Practitioner of the village called me over telephone and told that the child had fever and he is the only son in his family. I assured him that it was not due to tuberculin testing and the child can be given an antipyretic. The very next day I went to the village with the Medical Officer of the respective Primary Health Centre (PHC). He saw the child playing. The villagers were very happy. While examining, the doctor found the child to have some nervous disorder. He assured to treat the child to get completely cured. I expressed, if the child would not have been tested, the disease would have come to light at a later stage. The villagers thanked us for this gesture and conveyed their gratitude.
I still remember the eventful day of 21st March 2000, when we were returning after planning the village Mekhadi. Suddenly, the vehicle got struck in a stream after skidding. The driver tried his level best but all his efforts ended in smoke. We lost all our hopes and thought to stay overnight, as the area was remote and there was nobody to rescue us. Meanwhile, I saw a group of 6-7 persons approaching us. They appeared to be primitive with long hairs and gigantic figure. We all thought what is lotted cannot be blotted. But, things were totally different. They came near the vehicle and told, if we permit they will drag the vehicle out, as it was their profession and source of earning. I felt that God is great and has manifested in this form. Within no time they lifted the vehicle and brought it to the main land. We had tea and snacks together and on asking, I briefed about our purpose of visit to their place and the work we are rendering in Gujarat. The local health worker was helpful, as he was translating my conversation into Gujarati. They were so impressed that they did not take a single penny from us in spite of their arduous work.
Gurdaspur is situated in the state of Punjab, the land of five rivers and the centre of Sikh faith. The district borders Pakistan and is well known for its agricultural wealth. Because of fertile soil all around, we find lush fields of wheat, rice and mustard making an attractive circuit.
So far as the living standard of the people is concerned, it is comparatively higher as compared to other places. The children were quite healthy due to adequate nutritious diet. Regarding field work, the adverse factors were:-
a. Since the survey continued in the peak summer of May, June and July 2000, the team had to work under maximum temperature going upto 45°C.
b. Frequent checking of vehicles by security personnel in the beginning, because of the terrorism influenced by neighbouring Pakistan. It was a regular phenomenon, which used to hamper the field timings but when they came to know about our programme, they obliged us to a considerable extent.
The warm and cordial welcome extended by the people of Gurdaspur was deeply appreciated by all the members of the survey team.
In Pherochechi, the villagers were divided into two fractions on the basis of Sarpanchs and ex-Sarpanchs supporters. The Sarpanchs faction wanted the children to be tested, while the ex-Sarpanch's wanted it otherwise.
I tried to convince the villagers and told that the village is lucky to be selected out of the 57 rural clusters in Gurdaspur. Moreover, if the disease is dominant in the village, through tuberculin testing, it will come to light. For their personal jealousy they should not make the children suffer, who are our nations wealth, and the Government may also take disciplinary action for not supporting a national programme. The school teacher who stood by my side, translated my conversation into local language. Later on, the villagers realised their fault and the work was carried out smoothly. They also apologised for the inconvenience caused.
The district Kangra in Himachal Pradesh rises up a spur of the Dhauladhar range. Superb natural scenery, interesting walking trails through the green canopy, grassy downs and a marvelous opportunity for trekking, mountaineering and other adventurous sports makes Kangra a Tourist Heaven.
In terms of field work, it was a tough area. Because of inaccessible hilly terrain in some clusters, the team had to walk about 5-7 kms. after travelling in the vehicle, to reach the destination. At times, the vehicle had to cross streams and canals to reach the cluster. The villages were also thinly populated and vastly scattered. Peak rainy season continued upto 15th September 2000. Almost every day we had to carry umbrellas and pilot torches since the roads were not easily accessible during the late evening hours. After long duration of work of about 10-12 hours a day, the team had to forego their noon meals as there was no hotel or restaurant available in the villages. However, the block level workers were very helpful, as they not only knew the terrain well upto the last house but also the residents personally.
In spite of the arduous work we never used to feel tired, as we were in the lap of nature. The snow line was not far away and the dramatic peaks rise above the district. People were humble, hospitable and co-operative.
The villagers in Chaunki thought us to be fake, as an untoward incident had taken place a week before our visit. A group of persons posing to be doctors and para-medicals entered the village and said that they have come from Government Organization to inject children with Hepatitis vaccine and had even collected Rs.100/- for each child. Later on when some persons informed the police, it was detected that they were injecting normal saline and all of them were taken to police custody.
The team had a very tough time as fear psychosis prevailed in that village. All of us proved our identity by showing our Identity cards, letters of Chief Medical Officer, Deputy Commissioner, Director of Health Services etc., but still they were suspicious. At last when all our efforts failed, I told the villagers to call the police so that we could prove our identity. Meanwhile, the Health Supervisor along with the Multi-Purpose Worker arrived there, as they had received intimation about our programme from the Block Medical Officer. We heaved a sigh of relief and expressed our problems to them. They felt sorry for the inconvenience caused and explained the villagers the purpose of our visit. Later on, work was carried out smoothly.
An ideal Team Leader should not be stubborn, rather he should be understanding and receptive. Maintaining necessary rapport with local authorities and harmony among the team members should be the prime objective for the smooth functioning of the survey. The National Sample Survey provided me an opportunity to interact with people from different spheres and culture including politicians and bureaucrats. The hardships during organizing field work gave me inspiration and strength to become more self confident. Overcoming the hurdles in field work made me mentally tougher and innovative to take on the spot decisions. I express my sincere gratitude to our Madam Director, Dr (Mrs) Prabha Jagota, Sr. Epidemiologist, Dr V.K. Chadha and Section Officer Dr Preetish S Vaidyanathan, who not only encouraged my hard and dedicated work but also applauded my selfless contribution and able leadership for the successful completion of the survey.
* Field Investigator, Epidemiology Section,
National Tuberculosis Institute