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  • Writer's pictureAnkita Marwaha

The Nursing Hand of Fate in Sittilingi

Around 60 people sit in an open hall on an August afternoon as they wait for their turn at the Out Patient Department. A wooden signboard stands next to them that says in a crooked font ‘Tribal Hospital’. Its motto, Help Tribals Heal Themselves, is what resonated with Prema when she first arrived at the health centre in Sittilingi valley, Tamil Nadu, in 2007. “The centre is managed by the tribal people and is self-sustainable,” she says. So much so that she came back in 2012 to join the nursing staff at the centre and never left. Today, she is the Nursing Superintendent while her husband Ravi is a Senior Doctor.

The entry of the Tribal Hospital. The OPD patients wait for their turn on the left. (Photo: Dheeraj K)

But this is not the life she had ever imagined living while she was growing up near her family’s tea plantations as a child. Prema was born and raised in Idukki, Kerala. Her aim since childhood was to study and get a job to support her family instead of working on the neighbouring tea plantations. In order to get herself a secured job, she enrolled herself in Christian Fellowship Community Health Centre in Tamil Nadu to pursue BSc in Nursing.

“Since my college was in a small town, it allowed me the opportunity to interact with and work for the locals. This helped me realise that I wanted to work with smaller rural communities,” says Prema. With only Tamil and Malayalam to rescue her, she wanted to work in the underprivileged tribal regions of Bihar, Jharkhand and Odisha.

But her fate was handed to her in disguise in her hand one day in 2001 when the warden in her college hostel gave her a copy of Reader’s Digest to read. “The front cover was of Tha and Gi (Lalitha and Regi) in Sittilingi,” the photograph is still fresh in Prema’s mind. But she thought that the tribal belt of Sittilingi was in the North Indian belt, which contains some of the most poverty-stricken regions in the country. When her fiancé Ravi took her to THI, where he was working as a junior doctor then and made her meet Tha and Gi, the image of the two people running a health centre in a remote hamlet on Reader’s Digest’s cover page appeared in front of her.

Tha and Gi (in photo); The Reader’s Digest cover from 2001 that Prema had come across in college. (Courtesy

Lalitha and Regi George, fondly known as Tha and Gi in Sittilingi, moved to the valley and opened its first hospital in 1993. At that time, the closest hospital was 48 kilometres away via its only connecting road that would be submerged during the monsoon season. One out of every five babies in the valley had died the previous year and maternal deaths were among the highest in the state. Tribal Hospital started from a thatched hut as a small Out Patient Unit in 1993 and today has 30 beds with two operation theatres, an Intensive Care Unit, a maternal ward and more.

Near the OPD of the Tribal Hospital. (Photo: Dheeraj K)

By the time Prema joined the hospital, Tha and Gi had pushed down the mortality rate of children and mothers radically, trained over 20 older tribal women elected by the villagers to join them as Health Auxiliaries for first contact care, and just started the Old Age Health Scheme.

The Vision and Mission statements of Tribal Health Initiative. (Photo: Ashik Krishnan)

“Since the women did not know how to read, we adapted creative ways of colour-coding pills and drawing a rising and setting sun on prescriptions cards to indicate morning and evening,” says Prema. Over the next few years, Prema and the rest of the hospital team came up with different programmes to first identify and then address the various health issues – including mental health cases, a rise in chronic illnesses such as diabetes, hypertension and cancer, and now a foreseeable rise in the cases of renal failure – of the tribal population of the surrounding 22 villages.

Most medical colleges in cities teach their students to refer to patients as ‘cases’. But at the Tribal Hospital, doctors are encouraged to not only know their names but also the distance of their village from the centre, their financial background and other personal challenges so that they can give the most suitable medical advice. One can’t be empathetic doctors while sitting in a hospital and treating patients in an OPD, believe Tha and Gi. That is why medical fellows and nurses visit community clinics, the local school or local meetings to create awareness about minor illnesses.

Prema (extreme right) with the hospital nurses. (Photo: Dheeraj K)

In between managing patient care and administrating the ongoing schemes at the centre, Prema rarely finds time for herself. “My days are hectic, but not stressful,” she smiles at the contradiction. Her Sundays are only for relaxing; she doesn’t like to take up any household chores on that day. “We only eat two meals on Sundays so that we can sleep in till late,” she says. These Sundays are cherished even more so because work days, and sometimes nights, at the hospital can be mentally draining. She comes across many cases of domestic violence, debt and death of bread-earners during her work. “The stories of these people run in my mind the whole day and I keep thinking about how I can help. But I also have to realise I can only do so much and can’t go beyond my individual capacity. I do as much as I can and then leave it up to Fate,” she says.

“We must be happy with what we are doing, otherwise, at the end of the day, we will be disappointed,” she concluded.

Prema talking to a patient’s family at the hospital. (Photo: Dheeraj K)


Watch a film made on the 25 years of Tribal Health Initiative:

Read a young doctor’s account of her experience of ‘rural service’ with Tribal Health Initiative and the path of transformation it paved for her:

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