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Tribal Healthcare in Melghat
 

Tribal Healthcare in Melghat

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    Tribal Healthcare in Melghat Tribal Healthcare in Melghat Presentation Transcript

    • By MAHAN Trust, Melghat and Kasturba Health Society, Sevagram
    • MAHAN Trust About MAHAN Trust  Meditation  Addiction We stand for Health AIDS Nutrition The only NGO in Melghat -medical care We Are for the reduction of the malnutrition and child deaths amongst the tribal. We provide Tribal focused health service through our different projects.
    • MAHAN Trust MAHAN Trust wanted to become the best health Institution for tribal area of India Vision statement with an aim to uplift the health facet of tribal of Melghat & India.
    • MAHAN Trust Mission statement  Believes in core values of trust, transparency, care and compassion .  Principle of Service, role model MAHAN Trust always through research and monitoring of govt. health system. believes in service to the last  Strives to maintain healthy standards tribal of Melghat with of social governance. dedication
    • Dr. Prakash and Dr. Manda Amte with Satav Family.
    • Motivation for Work  My grandfather Mr. Vasantrao Bombatkar (Sarvodaya leader).  Literature written by Mahatma Gandhi and great saint Vinoba Bhave.  Gandhian teaching : “ Youths should go to the villages to serve as real India is in villages”  Tribal health projects run by Drs. Prakash and Manda Amte, Drs. Abhay & Rani Bang, Dr. Kolhe, Dr. Sudarshan, etc. - Tribal areas need medical facilities to a great extent.  Guidance of Miss Joshi & Mr. Bhagwat sir.  “Shram Sanskar Shibir” - Baba Amte  The guidance by Dr. Ulhas Jaju, Dr. Avinash Saoji , Dr. Kalantri, Dr. Jalgaonkar and Dr. Mrs. Holey .
    • Preparation for future life  During M.B.B.S. course in Government Medical College, Nagpur, I followed simple living.  Due to regular yoga and meditation, study of Geetai , “Experience with truth”, books written by Swami Vivekanand & the book “Seven Habits of Highly Effective People” , my mental strength is increased.  Due to use of Gandhian principals in personnel life, the life in Melghat has become palatable and tolerable.
    • MAHAN Trust Home based Child Care Program Mortality Control Program for 16-60 years Sustainable Nutrition Program Counselors Program Our Programs Well equipped Hospital Blindness Control Program
    • Epidemiology of Melghat Population distribution and socioeconomic characteristics 80 70 60 Uneducated Tribal 50 40 30 Nontribal 20 Population below 10 powerty line. 0 Melghat INDIA • Population is 2,50,000.
    • Epidemiology of Melghat • Korku is the major tribe of Melghat. Most of the tribal(>90%)are farmers or laborers, living very hard life in huts without electricity (90%) .
    • Health Facilities Available Very high under 5 children mortality (>100 children deaths per 1000 live births) and very high death rate in the age group 16-50 years. The health facilities are worst in Melghat as compared to rest of the Maharashtra. (50 years back) No Gynecologist, anesthetist, surgeon, facilities for Cesarean Section etc.
    • 150 100 50 0 NMR IMR U5MR Developed countries India Maharashtra Melghat
    • Region NMR U5MR IMR Developed 5 7 8 countries India 43.4 69 96 Maharashtra 19 31 43 Melghat 62 >75 120 (2004) (Reference: 1,2,3) Book of Preventive & Social Medicine by Park(17th edition), ICDS, Maharashtra & study by Dr. Satav et. al.) (NMR= Neonatal Mortality Rate, IMR=Infant Mortality Rate, U5MR=Under-5 year children mortality rate)
    • Background of Project Due to lack of proper medical facilities & superstitions, tribal goes to traditional faith healers/quacks (pujari & bhumkas) for treatment of illness. Skin is burnt with red hot iron rod for reducing pain known as Damma . Moved by such things, we started the project in Melghat in November 1997.
    • Traditional Health Care Grade 4 Malnutrition Traditional Faith Healer Damma (Bhumka) treating a malnourished child.
    • Aims & Objectives Of The Project  To provide curative & preventive health services to people of Melghat  Community research of diseases in tribal of Melghat  To provide exposure of tribal health problems to outside world.
    • BRIEF REPORT (Nov.1997 to March 2010) Our base hospital is at Karmagram, Utavali which is 140Kms from Amravati (district place). Drainage Area: Melghat (all villages) & surrounding Madhya Pradesh-Tribal area.
    • HEALTH PROBLEMS HEALTH PROBLEMS High neonatal (o-28days child death)& maternal mortality (death of mother) due to home deliveries(>85%).
    • HEALTH PROBLEMS IN MELGHAT- Malnutrition *Prevalence of protein energy malnutrition (Grade I to IV) is 75%. *Prevalence of severe protein energy malnutrition (Grade III to IV) is >10%. Severely malnourished child.
    • HEALTH PROBLEMS IN MELGHAT . Tuberculosis of the spine & Skin. Pneumonia & Tuberculosis (T.B.) are major killer of children & adults..
    • HEALTH PROBLEMS Iron deficiency leading to Anemia & Koilonychias (Spoon shaped nail)
    • HEALTH PROBLEMS Severe Dehydration due to diarrhoea
    • HEALTH PROBLEMS Tobacco, Alcoholism , & Ganja addiction. Bidiwale Baba Woman Purchasing alcohol
    • HEALTH PROBLEMS IN MELGHAT . TOBACCO induced carcinoma of cheek.
    • HEALTH PROBLEMS IN MELGHAT  Malaria, typhoid, etc.  Hypertension  AIDS  Alcoholic gastritis
    • HEALTH PROBLEMS Bitot’s spot (Vitamin A deficiency)
    • HEALTH PROBLEMS IN MELGHAT Rickets (Vitamin D deficiency)
    • HEALTH PROBLEMS IN MELGHAT Goiter (Iodine deficiency)
    • HEALTH PROBLEMS IN MELGHAT Cataract
    • Poisonous Snake Bite
    • Malnutrition status-2006 (Ref: Bhavishya Alliance, Park-PSM, Dr. Satav.) 80 70 60 50 40 30 20 10 0 INDIA Mah Mh-Ru Melghat Severe PEM(%) PEM(%)
    • Nutrition survey Pilot study revealed that marasmus (lack of calories/energy) is predominant type of malnutrition.  24 causes of malnutrition have been detected by our organization.
    • Causes Of Malnutrition Poverty
    • Causes Of Malnutrition Inadequate quantity & poor quality of food. especially by children & pregnant mothers during last trimester. Lack of education(50%) & ignorance about health & nutrition(90%). Unapproachable villages with no proper roads(25%).
    • Causes Of Malnutrition-Big family size. Average couple has 3-5 children. Improper spacing.
    • Causes Of Malnutrition Improper child care Parents go to farms & young children are taken care by 5-6 years old brothers or sisters.
    • Causes Of Malnutrition Unhygienic living conditions & feeding practices (eating without hand wash)
    • Causes Of Malnutrition  Unhygienic living conditions leading to infections.  Delayed complementary feeding usually after one to one & half years of age.  Lack of proper hospital facilities.  Early marriage age: Average age for marriage is 15- 16 years for female.  High unemployment leading to migration.
    • Strength of Melghat Healthy & pure atmosphere, forest & nature. Fertile land Heavy rains Environment suitable for various cropping pattern  Mentally strong people  Less gender bias
    • Mahatma Gandhi Tribal Hospital Entrance- Muthava Baba
    • Curative Activities OPD in the beginning More than 46,493 patients have been treated till now.
    • Serious patient of Brain Hemorrhage.
    • Waiting Room
    • Curative Activities Indoor Hospital (>2800 patients have been treated.) (till June 2007)
    • New Hospital
    • Operation Theatre
    • Curative Activities Indoor. Treatment of Serious patient of heart attack (Myocardial Infarction). Only hospital for treatment of serious patients in Melghat. (>800)serious patients like MI, Brain Haemorrhage , Cerebral Malaria, Meningitis, Tetanus etc. and saved hundreds of precious lives in our hospital.
    • Curative Activities Indoor. Treatment of serious patient of Viral Encephalitis ( Swine flue) with Brain stem involvement with on Ventilator. ARDS with Renal Failure with GI bleed with Coma –
    • A patient of respiratory failure was saved due to oxygen concentrator. (Donated by Caring friends).
    • Curative Activities Surgical camps a. Operated more than 692 cases with Ophthalmic problems especially cataract (intraocular lens implantation-IOL) free of cost. b. Plastic surgery camp: Operated 158 cases free of cost. c. Ten cases of Rheumatic valvular heart disease detected in our camp were operated free of cost by G-66 Heart foundation.
    • Plastic Surgery Camp Cleft lip & palate Before operation. Intra-Operative After operation
    • Plastic Surgery Camp Post Burn Contracture Before operation After Operation
    • Door to door Eye check up
    • 1 2 1. Bilaterally blind patients at home. 3 2. Health worker motivating blind patient for eye surgery. 3. Health worker bringing bilaterally blind Patient for surgery.
    • A-Scan (for Intra-ocular lens power calculation).
    • Intraocular Lens Implantation Surgery by Dr. Kavita Satav
    • Independent life after IOL Surgery
    • Eye Injury After Surgery.
    • Spectacle preparation (Donated by Caring friends, Mumbai.) More than 4000 villagers & students were given spectacles.
    • Happy Tribal with spectacles
    • Surgery after Bear bite.
    • Field OPD (door to door) Ground as examination table. More than 12587 patients have been treated.
    • Curative Activities Specialty Camps More than 16,000 patients have been treated. Gynaecology & Obstetrics camp. Paediatrics. De-addiction camp :The first effort in history of Melghat. Surgical camps : Surgery for Rheumatic heart diseases.  E. N. T. camp.  HIV & AIDS detection camp.  Life style modification camp. Sickle cell & Anemia detection camp.  Tuberculosis detection camp.
    • Specialty Eye - Camp
    • Specialty Camps Pathologist (Dr. Gahukar) examining blood
    • Specialty Camps Fine Needle Aspiration Cytology
    • Curative Activities Specialty Camps Detection of malarial parasites positive patients in the camps activated the government system to start malaria control program on massive scale in Melghat during 2001.
    • Ultra - sono graphy in camp
    • Specialty Camps Ear, Nose & Throat Surgeon treating patient in field
    • Gynecology & Obstetrics camp (Dr. Kuthe)
    • Pediatrician Dr. Tiwari examining severely malnourished child.
    • Road Traffic Accident. We saved lives of around 29 seriously injured persons in road traffic accident by rescuing them from accident site.
    • Ambulance for transport of patients(Donated by caring friends).
    • Blind School eye check-up. More than 14,216 students form more than 102 schools were examined and more than 200 students were given spectacles free of cost.
    • ANGANWADI CHILDREN HEALTH CHECK UP by child specialist (Dr. Bharadwaj & Dr. Yavalkar. )
    • Home Based Child Care Program Village Health Worker Care We trained 17 village health workers (VHW) for treatment of under 5 children. More than 70,437 individuals were treated free of cost in the villages itself from May 1st 2005. Due to it, we could reduce under 5 children mortality by 60% & mortality in productive age group (16-60 years) by 18% over a period of five years which is a cost effective, acceptable and replicable model.
    • Changes in mortality rates(0-5 years children) in intervention area 160 140 120 100 U5MR 80 IMR NMR 60 SBR 40 20 0 2004 2005 2005- 2006 2006- 2007 2007 to 2008 2008 to 2009.
    • Village Health Worker Care Kangaroo Mother Care (KMC)
    • Village Health Worker Care Home Based Neonatal Care-Vitamin K injection by VHW
    • Village Health Worker Care Home Based Neonatal (0-28 days) Care
    • Village Health Worker Care Treatment of patients(>70,437)
    •  Exposure of problem - Our data collection during last 3 years revealed the actual mortality status of Melghat. Government accepted the fact now.  Rajmata Jijau mother and children health & nutrition mission of the Maharashtra government & UNICEF verified our findings, accepted the facts and started action to control the situation. Similar study by mission in other tribal blocks of Maharashtra.  Dr. L. P. Mishra, IAS (National Human Rights Commission) was convinced with our report & asked govt. to formed vigilance committee.  Dr. Shanti Sinha, Chairperson, National Child-right protection committee, was convinced with reality and assured to improve the situation.
    • • Acceptance of prevalence of severe malnutrition in children is very high in all tribal parts of Maharashtra similar to our findings in Melghat. • Acceptance of the concept of Village Child Developmental Centers (VCDC) or home based feeding as state wide policy by Rajmata Jijau Mission of Govt. of Maharashtra . We are the part of planning policy committee for the VCDC for the entire state of Maharashtra. • We were made part of Bhavishya Alliance, an international tri-sectorial partnership for preparation of policy for reducing malnutrition in backward part of Maharashtra. • Development of innovative counselor program for improving govt. hospitals of Melghat and for increasing hospitalization of tribal.
    • Mobilization of the government , N.G.Os. and social minded people. Most of the severely malnourished babies are now getting supplementary nutrition and many deaths due to malnutrition were prevented.
    • ANGANWADI CHILDREN HEALTH CHECK UP More than 9000 pre-school children from 37 villages were examined & needy were treated. Provided nutritious food to more than 300 malnourished babies and mothers for 3 months. Many deaths due to malnutrition were prevented.
    • Weighing of Anganwadi Inmates by Village Health Workers (>7000) Sukarai received Jamshetji Tata National Virtual Academy fellowship for Rural Prosperity.
    • Food distribution to malnourished children.
    • Iron Pan distribution to malnourished children
    • Preventive Activities Health education programme. More than 3732 health education programs for more than 55,911 people. Prepared CD & flipchart.
    • V. H. W. Training programme
    • Trainer’s training for malnutrition
    • Nutrition demonstration education (Mrs. Pendharkar)
    • Demonstration Health education ORS (Oral Rehydration Solution) preparation
    • Flipchart on Nutrition, Malnutrition (Donated by Caring Friends)
    • Mass Health Education-Audio-Visual Show
    • Farmer’s Training for low cost sustainable agriculture
    • Youth dialogue & Health training program Awareness is the key. Due to our continued effort, the government was mobilized to conduct mutation of land on mass scale and many poor farmers became legal land owners.
    • Community Meeting As community participation is very important, we arranged regular gramsabha for various community activities.
    • Impact of Government-NGOs coordination :  Improvement in the Govt. hospitals of Melghat.  Improvement in services provided in ICDS centers (Anganwadi centers) .
    • Results Figures Percentages of patients hospitalized due to counselors in all PHCs and SDHs 13.01794454 Total Admissions of severe malnourished children by counselors in all PHCs and SDHs. 113 Counseling of patients by counselors through Flipchart in all PHCs and SDHs 4213 Total Stay of malnourished children for more than 3 days due to efforts of counselors in all PHCs and SDHs 180 No. of patients referred by counselors in all PHCs and SDHs 819 No. of referred patients accompanied by counselors in all PHCs and SDHs 197 Total no. of pregnant ladies in OPD in all PHCs and SDHs 2315 No. of ladies hospitalized for delivery from home by counselors in all PHCs and SDHs. 165 Total no. of MCP sessions attended by all counselors in all PHCs and SDHs. 265 Quality of the meal served to the severe malnourished children as per the observations by the counselors of all PHCs and SDHs. Good How many percentages of ambulances of PHCs and SDHs are in working condition since last six months? 86% How many percentages of patients were attended by the doctors of all PHCs and SDHs since last six months? 100% (all) How many hospitalized malnourished children were came out of grade III and IV to II/I/normal? 84 Hygiene of all the PHCs and SDHs at satisfactory level All
    • 109
    • Monitoring of ICDS Center
    • Many volunteers & patients trained and treated by us stopped alcohol drinking and smoking.
    • Monitoring & Evaluation Hospital –No. of patients treated, operation conducted & feedback from patients.  Home based care -Vital statistics e.g. IMR, malnutrition prevalence.  Internal regular monitoring and periodic evaluation system.  External monitoring.
    • Socio-economic development activities • Various socio-economic status up-liftment activities like Employment guarantee scheme, Water supply schemes, repairing of roads of few villages and S.T. Bus facilities have been started in many villages of Melghat by the Government due to our regular follow up. Admission of many students to schools was facilitated by us. • Bicycle distribution : 100 bicycles were distributed by Caring Friends , Mumbai to the needy poor tribal people. It made them self sustainable and got easy means of transport for education and earning. • Student education fund: We provided financial support to many students for education. (Donated by Caring Friends , Mumbai). One poor student got admission for medical course this year.
    • Bicycle Distribution (Donated by Caring Friends)
    • Cloth Distribution
    • Paper presentation in conferences International symposium on child health at Hamburg Germany organized by European Society of Pediatric Research. International symposium on “From Research to Improved Practice & Policy in International Health” in The Netherlands. International Symposium on tribal health by Indian Counsil of Medical Research. 3rd Congress of the European Academy of Paediatric Societies, EAPS, Denmark.
    • Paper presentation in conferences International symposium on child health at Hamburg Germany organized by European Society of Pediatric Research. International symposium on “From Research to Improved Practice & Policy in International Health” in The Netherlands. International Symposium on tribal health by Indian Counsil of Medical Research. 3rd Congress of the European Academy of Paediatric Societies, EAPS, Denmark.
    • • National symposium on Tribal Health by ICMR – received best 1st oral paper presentation . International workshop on tribal health by medical school of UK. Interviewed by Jagtik Marathi Academy and Shivaji University, Kolhapur. National conference in AIIMS, New Delhi. Dr. Ashish Satav was invited as an expert on Mumbai Doordarshan for a program “Malnutrition problem” under the program Sapat Mahacharcha. Interview on ETV Marathi- for Samvad program, SAAM TV, NDTV and IBN Lokmat for project activities and on many presentations on ETV and news papers.
    • Awards Young scientist award to Dr. Ashish Satav in national symposium on tribal health organized by Indian Council of Medical Research. Lifebuoy National Child Health Award for Nutrition to MAHAN trust. Yuva-unmesh Puraskar (state level) to Dr. Ashish & Dr. Kavita Satav. M.B. Gandhi award to Dr. Ashish & Dr. Kavita Satav. Dr. V.N. Vankar award for “Health & Hygiene” by Indian Medical Association to Dr. Ashish Satav Comred Godavari Parulekar Smruti Award to Dr. Ashish & Dr. Kavita Satav .
    • Awards  Dr. Dwarkanath Kotnis Health National award to Dr. Ashish satav  Savitribai Fuley State Award to Dr. Kavita Satav  Swatyantravir Savarkar pratishthan - Social equality award to Dr. Ashish & Dr. Kavita Satav.  Karyanishtha Gaurav Puraskar to Dr. Ashish Satav.  Vocational award by Rotary club of Gandhi city.  Sevankur Idol.  Vishesh Karyagaurav Sanstha Puraskar.  Felicitation by SAAM TV and Babasaheb Purandare.  Felicitation by Rashtrasant Tukadoji Maharaj Samiti wardha .
    • Young scientist award to Dr. Ashish Satav in national symposium on tribal health organized by ICMR
    • MAHAN Trust * Acknowledgements ‘I had remarkable experience seeing the Your Satav family on doing of the , ‘The dedication work involvement excellent Dr. life and and is Malnutrition The flipchart inspire me greatly. hospital staff under Dr. Satav’s leadership and then visiting the research MAHAN in Melghat.anis great asset Mr. • Ashish by you Trust) in their home personnelSatav my indian workexcellent Dr. Dr. (of MAHANTheir teacher.- for work prepared is is of an reminds and that Kahane,district administration, ofand Icommunity workers was the recommendTheir work inus impressive. The Canada-International Adam Albert Shwaitzer. that govt. the Dr. Melghat quality and truly village. This maternal infant and in need to serve project demonstrates respect of the Chairperson, expert Dr.problemshould , for it for their willMaharashtra solving. lowoverall said be of in Shanta Sinha use helpful turn gain the the power of community tech investigations of Child-right members education program.Protection Your work to decrease infant child and development of Melghat. SaidDr.care National health is mutually based mortality. home beneficial by L.P. – Dr. Our discussion withIndia. therefore should, be(M.D.- Chief all here Prashant Gangalthe research team over program sustainable.propagated trainer Commission Mishra, IAS of special measurable The rapporteur, have Malnutritionthe Rights Commission improvementDr.me how health program of India, said Human to thinkindicators, of informed inKatoch, Director General, National reduction about the project forofthe US National Institute of • You are He was Health by knowledge Secretary ,impressedworkour ICMR and theGovernment and UNICEF Maharashtra communitygoodResearch, of India. doing very members andat Health – inMaternal workers indicates MAHAN’s Infant Research their trust India. Mr. Dhirubhai Prabhu Govt. ofworking with Dr. Sanjay Mehta, training program ), Dr. Archana Patel Melghat said way of monitoring govt . Health & Network that MAHANtaught us a bigreal statusinof Dr. Nagpur,is Kasturba Health scolded (M.D.-Maharashtra state differenceand President, making the and Society, from SatavMaywe will getthe strength and ICDS program in Melghat Secretary their lives. they have great value stimulation from Promotion reading Malnutritionandindirector ofThank you Breastfeeding the brief visit.Networkour Sevagramcontinue this excellent work.’of many govt. officersMelghat Mahatma conviction to after admits Dr. much!’ – Dr. (Program Sciences, very Archana Nayar HOD, Jobe, MD,IGMCof –RajlakhmiInstitute Shakuntalaofficer India, ), Patel, of Medical Prabhu- Gandhi report. Alan H. Pediatrics, PhD, Professor on Medical Research Foundation, ). and VP, Lata nutrition forand researcher, UNICEF of Pediatrics Maharashtra Professor of Pediatrics- Wadia Sevagram. Cincinnati Children’s Mumbai. Cincinnati, children Hospital, Hospital , Nagpur. Ohio, USA.
    • Approach/Intervention  Why the particular approach? Hospital -intensive care unit.- As there was no hospital to treat critical patients.  Eye hospital –As no eye surgeon who treat curable blindness.  Home based care -High child deaths with no paediatrician.  Govt. System mobilisation-As poor working govt. staff
    • Obstacles in work Lot of obstacles. But these obstacles are not hurdles in the road but a challenge to test and prove ourselves. Example of river through mountains.  Management of patient of brain hemorrhage (7cm in parietal lobe and 1cm in Thalamus).  Experience of Kavita – Conducting delivery and milk brother of Athang. Replication by VHW.  Athang, son –health problems- self treatment.
    • Obstacles converted to opportunity. The key learnings /challenges/risks from the initial interventions?  Tribals not admitting serious children- Home based child care program- Counselor program-success in reducing child deaths and malnutrition. Trained tribal semi literate female village health workers can save lives.  Critical patients can be managed and cataract surgeries can be done even in remote backward forest areas.  Exposure of health problems- government worker –misleading community – solution by Vinoba Bhave way- community participation- government system mobilization.  Achievable, acceptable, approachable, affordable & Safe. Hence replicable.
    • A case study  Problem/Context •Child died due to refusal of hospitalization of serious malnourished and pneumonia baby by his mother .  Solution • Home based child care program. • Counselor program for government hospitals. • Nutrition farm/Kitchen garden.  Implementation Outcome • Reduced child deaths by more than 60%. • Increased hospitalization of severely malnourished children. •Long term sustainable nutrition source.
    • A case study2  Problem/Context • 40 year man died of heart attack due to lack of critical care hospital.  Solution • Well equipped intensive care unit. • Community study of heart attack. • Behaviour change communication.  Implementation Outcome • Saved hundreds of serious patients. • High prevalence of hypertension & causes of heart attack detected . • Treatment seeking behaviour of tribals improved .
    • Solution to health problems Where there is will , there is a way.
    • Future plans. Behaviour Change Communication programs. Mortality control program for economically productive age group.  De-addiction through meditation.  Replication of our program throughout India and developing countries.
    • Requirement: • Financial: 1. Mortality control program for economically productive age group 2. Home based child care & Malnutrition reduction program 3. Corpus funds 4. Construction • Man Power: Doctors, volunteers, experts.
    • Pillars of project: • 1. Caring friends, Mumbai especially Rameshbhai Kacholiya, Nimeshbhai Sumati, etc. • 2. Late Dr. Sushila Nayar, Mr. Dhirubhai Mehta. • 3. Nico Nobel & Stichting Geron , the Netherlands. • 4. Dr. Abhijit Bharadwaj, Dr. Gahukar. • 5. Mrs. Jayashri Pendharkar. • 6. Vijay Kaore. • 7. Palaskar family. • 8. Varangaonkar, Kashikar. • 9. Satav, Renge & Manekar family. • 10. Dr. Gahankari, Dr. Bapat.
    • MAHAN Trust our eminent Partners Kasturba Health Society , Sevagram. Caring Friends Stichting Geron, The Netherlands. Mumbai Arpan Foundation USA. Individual Donors
    • MAHAN Trust Contact Us Address Dr. Ashish Satav (M.B.B.S., M.D.) Dr. Kavita Satav (M.B.B.S., M.S.) Mahatma Gandhi Tribal Hospital Karmagram, Utavali, Tah. Dharni, Distt. Amravati 444 702. Phone no : 07226-202291, 202793 9423118877, 09325094780 drsatav@rediffmail.com