An authoritative voice booms out from the speakers inside the minute lean-to shack which Lagan Ray uses as his consulting room in Muzaffapur District, India. It is the “city doctor”, whose face and image have been transmitted by broadband cable into a setting
that is anything but urban: buffaloes tethered to the side of the street, ripe paddy rice shimmering in the afternoon sun, dozens of thin, gaunt women dressed in colorful saris gathered around a couple of rickety benches. One of these women has brought her
three-year old son to speak to the city doctor who appears on the laptop screen at the
Sky Health telemedicine center. She is concerned that her son’s abdomen just below the ribs seems to have become sucked inwards, even though she has been avoiding ‘cooling’ foods and has been rubbing ointments on his chest since he first started breathing
quickly three days ago. The child has pneumonia, says the city doctor.
Pneumonia is the principal cause of children’s death in India and in many other poor countries. Even qualified providers find it difficult to diagnose, and too many families allow the symptoms to deteriorate before they seek care. If it is caught before
complications set in, it can be treated with a simple antibiotic, but in severe cases, the blood can become starved of oxygen.
Lagan Ray is one of the first informal private providers in the world to be able to screen for this complication: he takes a small clip-like device which he fixes over the child’s finger and in a few minutes he is able to determine that the child’s oxygen
saturation is 93, just above the level that would trigger him to use the oxygen canister that he has leaning against the wall of his shack.
In South Asia, 80 percent of care-seeking for pneumonia is in the private sector. In a state like Bihar, in the north of India, there are hundreds of thousands of informal private providers who cater for the needs of sick families, especially in rural areas.
Their knowledge of diagnostic practice tends to be minimal, and since they are not members of an association or other network, it is hard to reach them with training and better clinical tools. But at least in Bihar, this is beginning to change with the intervention
of an NGO called ‘World Health Partners’. As Lagan Ray’s skills improve, the crowds around his shack will grow, and more children will be brought promptly to his attention and that of the city doctor he summons
on his laptop.
Other changes are also affecting children’s health in Bihar: the state’s efforts to reduce the prevalence of malnutrition are expected to substantially reduce the numbers of children falling sick with pneumonia, and the highly effective pentavalent vaccine
may soon be introduced in the state as it was in nearby Haryana during the month of October. In Muzaffapur, the sun is beginning to set on childhood mortality from pneumonia.