Marriage or Medicine? A contemplation on healthcare in rural India
RUNNER UP - SANDS COX CHARITY ESSAY PRIZE 2019
On a cool Sunday night in May, our taxi pulled into Padhar, a remote village hidden in the highlands of central India. Over the coming month, I would see first-hand the challenges the doctors at Padhar mission hospital face in treating the tribal community. Some challenges I expected, such as the financial difficulties of providing healthcare to an impoverished community lacking the means to pay for their treatment. Others came as a bewildering surprise, and none more so than the mystifying conflict between marriage and medicine in this secluded settlement at the heart of India.
Marriage carries enormous significance in rural India and affects all aspects of life, including healthcare. This is no more evident than during Wedding Season, a time of year when the sleepy village comes alive with endless wedding ceremonies, which last days at a time and are attended by hundreds of people. No sooner has one festivity finished than it is time for the next. This is a joyous time of year, as the village folk celebrate their loved ones joining together in holy matrimony.
However, undercutting the merriment of the unending festivities is an unfortunate neglect of healthcare. During Wedding Season hospital beds are sparse, not because people are fit and well but because those in desperate need of medical attention are busy celebrating. This is no time for lengthy and expensive hospital stays, so serious ailments are often overlooked at this time of year. The most bizarre display of this attitude was when two men enrolled on a community outreach programme for alcohol dependence attempted to leave the programme to attend a wedding. They were only persuaded otherwise when the doctor contacted the local tribal chief who explicitly instructed them to stay.
It was not until I attended a local wedding that I could make sense of this perplexing behaviour. Wedding celebrations in Padhar are a vibrant spectacle, attended by people from all around. I recall being disturbed at home one afternoon by the sound of a large wedding procession pouring out of the local church. Music blared through the village air while men and women in colourful dress danced through the street, rejoicing the union of a local woman from the village with an older man from a neighbouring state. The celebrations continued on into the night with a lively reception attended by what seemed to be the whole village. After attending my first Indian wedding, it was not hard to see why they carry such significance and why local people would choose weddings over wellness.
It is not just the wedding ceremonies that create conflicts with healthcare, but the wider customs in rural India surrounding marriage itself. The traditional view of the wife being adopted into her husband’s family has largely disappeared in Western culture but is still very much alive in Padhar. Arranged marriages are commonplace and represent a transaction of sorts, as the husband’s family receives the wife into their home in exchange for a dowry. This transactional view of marriage in Padhar reflects a deeply troubling perception of wives as property rather than people. Such a ghastly attitude has unfortunate repercussions for healthcare. A newlywed woman who was receiving treatment for an unsightly leg wound was terrified of her new husband’s family finding out about her condition. She feared that, if the family discovered her wound, they would annul the marriage as she was a “damaged product”. The husband of another young woman presenting with an ectopic pregnancy was chillingly unphased by the news that his wife’s life was in danger, only interested in whether she would still be able to have children in future. Tragic stories such as these are rife in Padhar, as marriage culture threatens the health of wives across rural India.
The choice between marriage and medicine is one that I will never have to face. However, visiting a culture that values its traditions above health has given me pause to reflect on our own priorities in the UK. Cases of work-related stress and depression are in the hundreds of thousands1, which may reflect a society that prizes work over wellbeing. Perhaps health is always playing second fiddle to some other pursuit.
Health and Safety Executive. Work-related stress, anxiety or depression statistics in Great Britain, 2019 [Internet]. 2019 [cited 2019 Nov 30]. Available from: http://www.hse.gov.uk/statistics/lfs/index.htm