It was just another day in the late summer of 1992. Fresh from the success of a community intervention that sought to limit the effects of an outbreak of a gastrointestinal infection in a cluster of villages in my project area, I was feeling unusually upbeat.

The district of Yavatmal, in Vidarbha is rarely in the news. It is like the countless other places which pass by in a whirr and make no impression on the memory of a traveller who is passing by in a bus or a train. The people here are peaceful, hardworking and content with their lot. The fact that the nearest railway station has always been a considerable distance away from the district headquarters and that finding a mode of travel that is efficient enough to enable a quick getaway to a larger town is a problem, has never been a reason for widespread discontent among the inhabitants of the area.

Ten scattered clusters comprising of a total of 79 villages was my primary area of work. This was where interventions were to be focused and executed. The plan was simple. Primary health issues were to be addressed. Clean drinking water, accessibility to toilets, basic nutrition parameters for everyone with a special focus on women and children, enrolment and supervision of pregnant women, immunization, and growth monitoring of infants up to the age of six years and communicable disease control were the issues in the scope of the work.

The work was tedious because there were no systems in place. The bunch of village level workers I had to supervise had the task of connecting with the local villagers and along with them, work out a way to prioritise the aspects of their own health that required attention.

I set off early morning for the bus stop. I was to visit a cluster of seven villages that had organized a community meeting for women and I was to take my first session with them. Growth monitoring charts, books, and a weighing scale were my tools for the day. The weather was turning sultry. The bus scheduled for 9 am was nowhere in sight despite a good half an hour having passed by. The crowd of travellers increased steadily. Children running around, goats being tethered to awkward leads, women with vegetable baskets containing greens, the occasional tea and biscuit vendor weaving his way around the group made for an interesting collage.

The bus arrived after a good one hour of its scheduled time. The rush to take seats was obvious. I was lucky to get one in the first row behind the driver. Piling up my big bag before me, I settled down to a bumpy but breezy ride. The bus started with an effort. The sounds of the chatter inside the bus slowly faded into silence. The visuals outside were pleasant. The deep green of shrubs framed the landscape. Trees waving enigmatically and gave the impression of continuity and wellbeing. The ride was progressing like a dream.

I do not remember how long I was in that stupor when the bus came to a sudden stop in the middle of the road; screeching tyres, skidding wheels with its entire insides reeling into abrupt motion from its inertia because of the sudden brakes applied by the driver.

The reason was apparent immediately. Everyone made space for a young couple with a child who the mother was carrying in her arms. They were given space to sit right before me.

It isn’t unusual for a state transport bus to stop mid-route for picking up travellers who thumb a ride. This is a considerate gesture in an area where buses are irregular and there is no other mode of transport available to the poor.

Within moments, however, I realised that this was no ordinary situation. The parents were looking distraught and the child was listless on the mother’s lap, her clothes soiled and a faint odour of bile surrounding her. She moved her lips but was making no sound. Upon asking, I found out that the child had suffered a bad bout of diarrhoea in the night. The morning found her weakened and unable to even take a few steps so as to walk to the field. She had begun to vomit and had trouble retaining anything inside her, including liquids.

I had some oral rehydration salts in my bag (taken for demonstration). I mixed them in my bottle of boiled water and asked the mother to feed the child. She took it gratefully, and did as told. However, the child was too weak to swallow and most of the water trickled down from the corners of her mouth.

Several attempts were made to get something inside her tiny body, but all were futile. I touched the child’s foot and realised that the skin was cold and a little dent made by my finger on her skin remained that way. This was a clear sign of severe dehydration! I was beginning to panic in my mind. My questions confirmed the worst of my fears. The parents had delayed seeking help. I spoke to the driver of the bus and asked him to rush to the nearest primary health care centre or a private medical practitioner.

The driver drove as fast as he could, given the fact that there were many passengers inside and the vehicle was capable of only so much speed. Approximately twenty minutes later, we reached a private clinic where there was a doctor and an attending compounder. An intravenous drip was set up and saline and dextrose administered to the child. She didn’t stir.

The bus went away with the passengers. I chose to stay back with the parents. The doctor was a well meaning but perhaps a not-very-appropriately-qualified medical practitioner. The degrees he held weren’t the usual one I had heard of. The wisdom of waiting at such a place was hovering in my mind. But there are situations where one cannot choose. This seemed to be one of those.

The child was not getting any better. After one bottle of IV fluid, she was the same. A second bottle later, she was still unresponsive. The sun was now turning harsh. I had no way to inform my destination about my whereabouts as this place had no public telephone booth and I did not feel like leaving the child’s parents to deal with the situation by themselves.

Minutes seemed like hours. Time took on a strange stationary quality. After what seemed a lifetime, the doctor gave words to our worst fears. The child had lost her struggle to stay alive.

The news did not surprise us somehow. The parents maintained the resigned silence and conducted themselves with dignity. We arranged for a transport vehicle normally used to ferry goods and took the child home. I moved on to my destination, a good three hours late. What I did later that day as part of the training program is now a blur in the memory.

The situation shook me up like no other in my years of community- based work. It made me ponder on the intricate details of a system which is crucial to our very existence and yet among the most ignored in the regular discourse of community issues.

The right to emergency health care is a basic human right. The situation that I got a glimpse into is neither rare nor shocking in the context of a rural or a semirural setting in our country. The seemingly stoic behaviour of the parents is more a staid acceptance of the finality of what cannot be controlled than an indifference to it.

In one swift episode of a drama in which I was a chance observer, the importance of an infrastructure for basic health care at a primary level became evident. The nature of my seemingly routine work had transformed into something that carried immense relevance.

I worked for a few more years in the locality. My initial enthusiasm was tempered by the wisdom that there is a certain fragility to any situation and that there is often no intimation of its impending significance.

Health care of the most primary level remains a crucial issue even today. There is need to recognise that it is through such situations that violation of human rights can happen in the most unobtrusive of ways. The solution is easy but not simple. The first step is to just give the most simple primary health interventions their due. A compromise in these makes for the most violent human rights abuse. The life of each child is priceless and also the starting point of all of our discourse on Human Rights.