The full history of mobile medical units!

Bringing healthcare to rural India has been a struggle since the British Raj’s period. Any state’s public health records are replete with references to physicians coerced into taking government positions in rural government hospitals. A significant part of this resistance stemmed from the shortage of opportunities for evening profits from private practice. However, several doctors objected to the substandard services in rural Primary Healthcare Centres – an objection that continues to plague doctors placed in rural India today.

The doctors’ inability to operate and remain in villages is not the only impediment to developing rural India’s access to health care. There are only two Primary Healthcare Centers (PHCs) and one Block Hospital in FORRAD and Michelin’s new project region (31 villages). These are expected to represent nearly 30,000 individuals each and are significantly understaffed. As a result, doctors see patients for just a few hours per day. In addition, two of the three PHCs are inaccessible by public transportation (intermittent sharing autos or daily buses), rendering them much more challenging to navigate for pregnant mothers, persons with disabilities, and the elderly.

Lack of adequate and consistent treatment makes it more challenging to treat sickness and even crises and contributes to a lack of knowledge about practices that can help promote and sustain neighborhood wellbeing. Area residents are expected to travel considerable distances for routine medical care. Additionally, individuals are prone to ignore signs and delay seeking medical attention before their disease deteriorates, resulting in several diseases getting handled at a time when problems have developed. Due to the lack of adequate public transportation, many find the trip virtually tricky. In the case of a medical emergency, an ambulance from a distant facility is sent to the scene – whether it is not still in use. Though Periyapalayam Hospital does have an ambulance, it is not often sent to the scene of an accident. Due to the lack of clarification about which emergency is sent, the lack of clarification when the ambulance requires an average of over an hour to arrive. As a result, many people choose to hire a car to transport them to Chennai’s Government General Hospital (forty kilometers away from Periyapalayam).

Although insufficient access to medical services through sickness is a large part of the problem, a lack of knowledge regarding wellbeing and what defines a safe lifestyle is an equally pervasive problem. PHCs overcome this concern by hosting weekly camps for pregnant mothers, where they get tips about how to sustain a healthier diet and lifestyle through pregnancy. Unfortunately, these camps are not as successful as they should be due to the inaccessibility of PHCs. Additionally, food intervention is not limited to pregnant mothers. Through my experiences with doctors in PHCs, I discovered that hypertension, high cholesterol, and hyperglycemia are both highly prevalent in the project region (this trend is widespread in most south India) – both of which are associated with a sedentary lifestyle. Doctors in PHCs can administer drugs (and always do) yet have little means of monitoring any prescribed improvements of food or activity to relieve the symptoms of these diseases, considering the inaccessibility of the remainder of the 31 settlements.

These issues of access and accessibility to healthcare and a lack of knowledge of how one’s climate, nutrition, and lifestyle will influence one’s health are neither recent nor remarkable to India. Throughout the second half of the twentieth century, the intuitive response to these challenges was mobile health services – or, as they are now known, Mobile Medical Units.

A Not-So-Short History of Mobile Medical Units

Mobile Medical Units were designed initially for military usage during World War II. However, they were rapidly phased out in favor of the more common and powerful Mobile Army Surgical Hospitals (MASH), which were often capable of performing frontline surgery before transferring soldiers to better-equipped hospitals located farther from the front. However, the concept of an MMU was not entirely discarded. Indeed, it rapidly gained popularity among the civilian population in many nations, including the United States, the United Kingdom, Cuba, and (you guessed it) India.

Though Mobile Medical Units (MMUs) have a lengthy background in India, I doubt there was a more fascinating MMU project than “Skippo,” which was undertaken by the All-India Women’s Conference (AIWC) in the years following World War II. Mrs. Hilda Seligman of London, a renowned sculptor, embarked on a new project in 1943: she published a 24-page children’s book named “Skippo of Nonesuch” about the brave mountain goat Skippo, who jumped to the moon to save his lady love. Though Mrs. Seligman hoped children would love her novel, she also had another goal in mind: the profits would be used to establish a fund to buy a Mobile Health Van for rural India. Motivated by a sense of gratitude for Indian soldiers for participating in a war she thought was not theirs, Mrs. Seligman desired to ‘offer something back to their nation, especially Indian women. She was informed that most Indian jawans were from rural areas of the country and that healthcare was difficult to access in rural India, especially for women. Mrs. Seligman determined that the best way to show her gratitude for the dedication of Indian soldiers to the war effort was to increase women’s access to and standard of health care in rural India. She mobilized her vast network of contacts, who all replied enthusiastically, donating their time and resources to the cause. Mrs. Seligman was also acquainted with Indian politics due to her youth spent in India. She was also an outspoken advocate of Indian democracy. She connected effortlessly with the All-India Women’s Conference (AIWC), which soon accepted the initiative. As part of their daily tasks, the AIWC then started coordinating the Village Mobile Health Van Project, and the first Health Van began operations near Bombay in 1946. By 1957, they had secured funds from various Indian and foreign outlets to buy and retain approximately 12 such buses, which the AIWC’s seven divisions owned. What set this project apart was the AIWC’s conviction that it was entirely essential to get a ‘lady doctor’ on board the Mobile Health Van, which was quite amusingly called “Skippo.” Skippo worked in rural areas of many Indian provinces until the 1970s when the project seemed to lose favor.

The AIWC spearheaded this mission, although it was supported by a variety of Indian and non-Indian organizations in locations as diverse as London, Canada, California, and New Zealand. The first significant financing coup for AIWC occurred in 1952 when the Skippo Fund drew the New Zealand Council of Organizations for Relief Services Overseas Incorporated (CORSO). Mr. Colin Morrison, the Dominion Secretary for New Zealand, arranged for the donation of two brand new Medical Health Vans to the Skippo Fund, designed to the standards specified by Mrs. Seligman’s community of London mates. It marked the start of a long relationship between CORSO and the AIWC. CORSO continued to help the Skippo Fund with an ongoing contribution and monthly shipments of medication and milk powder. However, this was not a one-way flow. In August 1953, the steamship ‘Wairimu’ carried a rare passenger – an elephant called Bhavani, bound for Wellington from Calcutta. Bhavani was donated to AIWC by the Mysore Zoo in memory of the organization’s donation to the Skippo Fund.

On August 17th, 1953, Mr. Morrison informed Mrs. Saran, Vice-President of the AIWC, that CORSO had gratefully obtained the elephant in question. He continued by outlining Bhavani’s designs for Wellington:

“The transfer of ownership from CORSO to Wellington City Council (which operated the zoo) is scheduled for August 26th. The Naming Contest would be launched promptly to inform as many children – and, incidentally, their parents – as possible about the essence of the gift. The gift has received widespread attention, not only in Wellington but across New Zealand, and I am certain that this has contributed significantly to strengthening the already strong ties between New Zealand and India.” 1

Skippo trundled along for many years but was unable to maintain itself as an AIWC initiative. Though Skippo’s popularity waned in the 1970s, Bhavani’s tale continued until she died in 1983. Her skeleton is on display at Wellington Museum.

What services did Skippo provide? It served as a Primary Healthcare Center, delivering essential healthcare to remote communities unable to receive federal health facilities. It also provided immunization services for infants, implemented anti-epidemic initiatives, provided antenatal care for pregnant mothers, and counseled residents’ birth control methods. A nurse, a compounder, a professional health worker, the pilot, and sometimes a lady doctor were on board.

The Foundation for Rural Recovery and Development (FORRAD) recently launched a Mobile Medical Unit to serve the project area’s 31 settlements. The Michelin Corporate Foundation in Paris funds this MMU, which is managed by a doctor, nurse, health assistant, supervisor, and driver. In addition, six rural health workers are sent to communities on their list.