The Power Of Listening In Grassroots Work

The art of talking isn’t my forte, but a recent conversation altered this perspective I had about myself. In our lives, sometimes we meet people where a conversation leaves a lasting impression on us. This time, the shared moment of vulnerability had a profound impact on that person and me. I have been working with Innovators In Health (India) in Dalsinghsarai, Bihar for a while now and counseling Person with TB (PwTB) is a skill I have been trying to pick up. The organisation works in strengthening public health systems and provides end to end care to Person With TB (PwTB).

The First Meeting

I was on a field visit along with my colleague and today the visit was to sub division hospital, Dalsinghsarai. The hospital was bustling with chatter of people. My colleague guided me to a person sitting in the waiting area. The person in question, in his late 50s, was diagnosed with Drug Resistant TB (DRTB). My colleague encouraged me to speak with the man. I approached the man not knowing what to tell. He already looked in a bad state.

I went and sat down next to him and started making conversation. I found out his name is Kundan* and he was waiting for his consultation with the doctor. He was clutching a folder with all his reports and on asking he gave it to me. While flipping through his reports, the weight of his diagnosis became evident. DRTB is potentially more life threatening than DSTB with a low mortality rate. The treatment regimen can last from 6 to 9 months or 18 to 24 months that also causes various side effects.

A Heart To Heart

The challenge for us was to ensure he stays in our care via linkage to the public health system. On conversing with him, he told me that he has been sitting for 4 hours but he is only running from pillar to post in the hospital with no clear end of his ordeal at sight. He said this is the reason he will now switch to a private doctor as they are more attentive and one doesn’t have to run after them to get treated.

He asked, “where do you seek treatment when you get sick?”

Never in my life have i sought treatment at a government hospital. The question and ensuing face to face with my privilege made the rest of the conversation a bit of a blur for m. The essence of it was mostly I tried to listen to him as much as I could and offered a space for him to share his vulnerabilities. I assured him that if he decides to go along with his treatment in hospital, my colleagues will help him navigate his journey till the end of his treatment. For the first time in my life, I didn’t offer sympathy – which was unsettling for me. I left with the parting words of hoping to meet him again in future.

A Glimpse Of Change

Fast forward to two months later, I found myself back in the field visiting PwTB in the community. My colleague and I, complained about the weather and walked towards a house which was semi pucca. As soon as we entered, I was greeted by a voice that felt familiar. It took me some time to recognize the face in front of me and it was Kundan. His wrinkled face was lit up with a warm smile as recognition sparkled in his eyes. 

“Because of what you told me, I didn’t switch to a private hospital,” his voice was filled with gratitude. “I trusted the government health system and I am feeling much better now”. His words came as a win for me. The purpose with which I undertook this journey in grassroots now made more sense. I realised the power of words at the face of helplessness.

Importance Of Comprehensive Care

There are so many people like Kundan out there who are in need of a supportive healthcare system which puts them at the center. This incident made me realize the importance of trust in public health systems.

Many people overwhelmed by their situation often take the quickest route of seeking care in a private hospital that seems alluring. The treatment for TB is very costly in the private healthcare system which often results in an increase in out of pocket expenditure incurred by PwTB. Under the National TB Elimination Programme, the cost of TB is free in all government health systems along with provision of 500 rupees as direct benefit transfer under Nikshay Poshan Yojana. 

Comprehensive care for PwTB is not limited only to medication. It Includes nutrition support, psychosocial support, along with educating the community. By addressing all the components that surround the PwTB will help them in navigating this journey effectively. 

The Way Forward

I left after saying my goodbyes and again counseling Kundan on drug adherence and nutrition. It left me with a renewed strength of purpose that even if it was just one person, at least it made a difference in his care journey. Our brief conversation became a profound moment for both of us when we connected as humans, beyond his diagnosis of TB. 

The story of Kundan is important in wider context to highlight the need to build trust within communities and understand them better as people. In our quest to treat “patients”, let us look beyond the diagnosis to offer a hand to another person who has hopes, fears, and a desire for understanding. It’s essential to look at every person as more than just a “case”.This one incident made me realise that the act of listening which can open a space for comfort can pave the path for shared experiences to unfold. 

*Name changed to protect identity