There is an immense deficit of basic primary and secondary health care medical services in our service areas of Eturnagaram, Thadvai, Mangapeta, Mulugu, and Govindaraopet of the Warangal district. Though the World Health Organization (WHO) recommends 3 in-patient hospital beds for every 1000 people, India has an average ratio of 0.85 beds for every 1000 people. The Warangal district is even more underserved, averaging about 0.3 in-patient hospital beds for every 1000 people.

There are two hospitals already existing in the area, each with 30 beds for an intensive care unit (ICU), critical care unit (CCU), pediatric care unit, and general medical-surgical floor. They have one operating room each. Ancillary services include a diagnostic lab, and radiology set-up. There is also a tuberculosis (TB) center, HIV/AIDs diagnostic, and pharmacy. These hospitals are also supposed to have anesthesia, OB/GYN, and surgical services.

The government medical network consists of healthcare workers and Accredited Social Health Activist (ASHA) workers. Each hospital has about 7 referral primary health centers (PHC) with sub-centers. There are nurses, nurse assistants, and nurse aides. Each PHC has a medical doctor with a Bachelors of Medicine and Bachelors of Surgery (MBBS) qualification, which is the equivalent of a doctor with a medical school degree.

The ASHA workers and other health care workers will be following up on the health care conditions of every village. There may be 1-2 ASHA workers per village, or 1 health care worker for every 5-8 villages. The ASHA workers are basically volunteers who don’t receive any salary or compensation; however, they can receive incentives for referring a pregnant woman to the health center for prenatal and postnatal care or similar.

The healthcare workers are different from the ASHA workers, in that they are paid employees of the government health department. They are responsible for surveillance of the health conditions of villagers, and for referring sick patients to the primary health centers or sub-centers. The primary health centers are equipped with a basic pharmacy and follow an outpatient clinic set-up; one doctor per PHC. The PHC do not have any diagnostic faculties. The doctor will refer patients to area hospitals as needed per their assessment. Area hospitals have the faculties for in-patient care if needed. There is still only one doctor on duty, however they have an OB/GYN, surgeon and anesthesiologist on call if needed. Each area hospital then serves as a referral point to the tertiary hospital if needed, which is in the nearby city of Warangal (about 135 km [84 miles]) from Eturnagaram.

There is only one qualified private doctor serving a population of 100,000 for the three mandalas of Eturnagram, Tadvai and Mangapeta. Each mandala also has non-qualified medical practitioners who practice some basic allopathic medicine without any formal training or qualifications. There are approximately 100 of these providers in the mandalas. There are also a few practitioners who practice traditional tribal medicine, but lack any type of formal medical training. These practitioners serve the majority of the medical needs of these people by initiation of some basic treatment. If the recommended treatment does not work, these providers will then refer the patient to Warangal city private hospitals. However, these providers are not always working in the best interest of their patients. They often receive bonuses for referrals to private clinics or hospitals.

Due to the wide-spread corruption and inefficiency of the healthcare system, the delivery of quality care in these rural tribal areas is a complete failure. In addition, due to the absence of basic infrastructure (education, health, transportation, security, and economy), the elite and professional community rarely choose to settle down in these underserved areas. There are no schools for their children to attend and many villages have no access to education at all . A vast majority of these areas are devoid of proper roads and transportation. During monsoon season, several small lakes in the area that overflow and wash away what portion of an informal dirt road that may have existed. Residents may have to swim to escape the area at that point. Even in our current era of technology, where the rest of India is highly networked through cellular connectivity, there are many villages devoid of access to said network. There is also a shortage of electricity and drinking water. Drinking water is not provided by the government, nor is there any water purifying system in place; sewage, drainage, and sanitation is not a priority in this area. Most of these people do not have the luxury of indoor running water, including the means to establish sanitary human waste disposal. The healthcare available to the people in this area is significantly impacted by these limitations. Cultural factors also play a role in the understanding of these people in regards to their health and hygiene. The people of this area have a need to be educated regarding healthy living habits, practices, and conditions.

Extensive deforestation in the past decade has also caused a major shift in the ecology and migration of disease. Disease causing hosts from the previously forested area have migrated into human habitation, causing mysterious or undiagnosed life threatening illnesses and disabilities. There is also an increase in the deaths caused by known infectious diseases. Death is common in this area from various types of fever as well, particularly in the monsoon season. This toll adds to the prevalence of other common diseases, including cancers, diabetes, hypertension, coronary artery disease, and stroke. Lack of appropriate health awareness, hygienic living tips and practices, skilled, professionally trained and competent medical providers/workers, basic immunizations-vaccinations, and basic diagnostic facilities/equipment all add to an increased morbidity and mortality rate for this population.