How I began my New Year!

When you work at Thoughtworks, it is tough to miss references to Jan Swastha Sahyog(JSS), a voluntary, non-profit, registered society providing low cost preventive and curative health services to the people from tribal and rural areas of Bilaspur, Chhattisgarh, part of central India. Thoughtworks is helping them using Bahmni, an open source hospital system for healthcare providers in low-resource settings. The work done by Dr Yogesh and his team at JSS in healthcare in that region is legendary amongst Thoughtworkers.

During the last few days of December 2014, most of my team was on vacation. As work was slow, I decided to take the last week of December off and begin my new year at JSS, especially since it was going to be my next assignment. I booked a Tatkal (short notice) train ticket to head to Bilaspur on 28 December, 2014.  

It was a 22 hour journey which provided me with the luxury to watch movies, read books and catch up over the phone with family and close friends. It also left me with a lot of time to eat, sleep and reflect. Chhattisgarh, the state I was travelling to, is at the epicentre of the Maoist/ Naxal movement and the book Hello Bastar by Rahul Pandita made for contextual reading on the way. The book describes the movement by highlighting various facts and narrating incidents which gave me perspective about the inequities in the region. I recommend this book to anyone who wants to learn about this movement.

Given that it was winter and the weather foggy, it was a pleasant surprise that the  train was right on time and I reached Bilaspur at 8.40am the following morning. The main hospital, where I was to reach, is located in Ganiyari, a village 20 kms from the Bilaspur station. In order to take in and enjoy the local experience, I decided to take the city bus to reach Ganiyari. By 10 am, I was at the hospital.

Jan Swastha Sahyog, Bilaspur

Dr Yogesh and his colleagues founded JSS around 15 years ago, with an inspiring vision. It helps provide medical care to 70 villages by dividing them into clusters, each with a corresponding sub-centre, and then set up a main hospital at Ganiyari. The attempt is to deal with issues locally as much as possible - first at a village level, then at a sub-centre level, then at the main hospital and if required in rare cases, referring patients to other specialists in Bilaspur city. I spent my time at the main hospital at Ganiyari.

The hospital has an out-patient department, an in-patient department and operation theatres. I was really surprised to know that the doctors perform cancer-related surgeries there as well. In addition, there is a training centre for nurses and accommodation for staff.

Thoughtworkers and Dr. Yogesh Jain

My immediate points of contact at JSS were fellow Thoughtworkers Vivek Singh and Pradipta Kundu. They introduced me to Dr. Yogesh Jain and his team. Right through various interactions during my stay, I found him to be a very simple man, with deep knowledge about equality, healthcare and a passion to better human civilisation. He also came across as a very curious person. In our very first interaction, he asked me questions about various tools and technologies that he can use to record his experiences while treating patients. Pradipta and I recommended that he use Evernote. Throughout my stay, I found him using the tool diligently and asking me for  tips and tricks whenever I bumped into him.

I realised that most of the  team is there by choice. They’re driven by the common goal to provide the best healthcare to those who need it. Understandably, technology isn’t their priority and hence we, as consultants, need to journey with them to make technology relevant and contextual to their work lives.

Bahmni - The Open Source Hospital System

While Bahmni serves as a full blown hospital system, doctors at JSS currently use it for data entry.  They enter details of patient visits, diagnosis made and prescriptions given and use it to view their clinical history. Work is on to build various other visualisations. For instance, I saw a new tabular visualisation for diabetes in action. It highlighted anomalies in various test results and reminded the doctor to ask relevant questions to the patients and refine their diagnosis. That was a ‘wow’ moment for the doctor and for Vivek as well.

It was a pleasant surprise to see all the doctors using tablets - most of JSS is WiFi enabled.You can carry your laptops anywhere. I saw Pradipta introducing new features to the doctors, training them to use it, and taking their feedback while Vivek deployed the fixes to production right there. This is as “agile” as software development gets!

While watching the doctors deal with patients, one after another, I had two epiphanies. One was about how tough a doctor’s job is. They deal with production system issues, like we technologists do. But they do it on a more continuous basis. We deal with IT systems that have similar hardware and software and exhibit consistent behaviour whereas they deal with humans. Though physically similar, every human is unique due to differentiating factors like emotional and psychological conditions and social exposures. This makes the doctor’s problem far more complex. Doctors have to take all these factors into account while making a diagnosis, as any error in fixing issues could have life changing implications.

The second one was really humbling and made me realise that our privileged, urban problems don’t measure up to the problems that most of rural India faces, which are further complicated by illiteracy, lack of awareness and poverty.

An Inspiring Start to the New Year

I’m glad I started my new year at JSS. On New Year’s Day, the admin team there organised a get together in the morning which included an inspiring speech by Dr. Yogesh. He spoke of how the battle they are fighting is not an easy one and urged everyone to stay motivated. Everyone then sang songs about hope, equality and justice.

As the day to return approached, I realised that I felt reluctant to go back and luckily enough my train booking didn’t come through. So I extended my stay by a day and returned on 2nd Jan 2015. On the day of my return, we took a quick walk in the afternoon to a beautiful lake nearby. While work at places like JSS could get intense at times, the rural landscape always provides us with settings like these to unwind.

The Long Way Back Home

As I didn't have a confirmed return ticket, the return journey was a different experience in itself. After stopping overnight at Raipur and visiting my home in Amravati for the weekend, I got back to Pune on the 5th of Jan, with a deepened understanding and empathy for the issues that people in remote and rural India face. It reinforced my belief about how much there still is to do for our country.

At the end of my trip, I’m reminded of these famous lines by Robert Frost

The woods are lovely, dark and deep,   

But I have promises to keep,   

And miles to go before I sleep,   

And miles to go before I sleep.

Thanks to Thoughtworks, I was able to use my vacation not just to get acquainted with my assignment in advance, but also to experience it and learn from it.