_This is part two of the two part interview with Dr._ _Rajesh and Mrs._ _Rajkumari Singh of the [Garhwal Community Development and Welfare Society](http://healthmarketinnovations.org/program/garhwal-community-development...) in the Tehri Garhwal district of Uttarakhand._ _They spoke to me on the founding of their hospital, "Masiha Hospital" as it is locally known, and the challenges they faced in the under served region._
**Starting of community services**
Within a year and a half (1993) we realized the patients were very poor and could not afford expensive services and there were lot of problems. Compounded with this was high requirement of medical intervention in the area. We decided to go to the villages and see how we can manage the problems. That’s how we decided to start an organization. We went to a village called “Bhaur” and started weekend clinics there. Tuberculosis was rampant in that region. So we started our community work treating patients with Tuberculosis. Curative services were provided in the villages too and this continued for three years.
**First government project….**
In 1994, the Uttar Pradesh state government got a project from USAID – SIFPSA. They were looking for private organizations they could work with for family planning services in the rural areas. We were by then known by the community and the chief medical officer was also impressed by our work. He recommended our organization for the project and that’s how we officially began working with the government. The project was for INR 200,000 or $8885 USD – a large amount of money for us. From then on my wife took over the community health work and I focused more on the hospital while supporting the community health work.
Our work attracted **Meenakshi Gautham**, a public health expert. Through population council of India she obtained a research project for documenting the care seeking and quality of care provided by ISMP – Indigenous System of Medical Practitioners
What were your initial challenges?
Finances were the biggest challenge and also my limited knowledge of sources of funding. Even to this day, very few funding agencies know of our work but the state government is aware of us and do talk to us.
At the community level the health awareness was very low. They believed more in witchcraft than professional services. My wife and I conducted many awareness programs in the village. We showed them evidence as to why their practices were wrong and dangerous. It took a long time for the community to accept us and our services.
**Have the needs of the community changed?**
The awareness levels have increased so the demand is for more systematic management of a condition. People now know that for persistent fever they should get some medical care.
**What do you think is required for this district?**
The first and foremost need is that of medical manpower with the ability to manage complications and other care. Right now, I am the only one. So if I am away for a day, the patients have no other alternative and some of them succumb to fatal consequences.
**Yashoda, a former community based distributor (CBD) who was trained by Garhwal Community Development and Welfare Society**, agrees with Dr. Singh, saying:
“There is an immense need for hospitals in this region. Uttarkashi district hospital (public hospital) is big with all the needed facilities. Our district hospital has nothing. We are asked to purchase medicines from a nearby shop. When the patient has no money with him how can he buy them? If we have to buy our medicines we might as well go to a private hospital. There never is a doctor when you need one and patient is helpless in the government hospital. We need a hospital with equipments and doctor."
Yashoda now works as an ASHA and refers her patients mainly to Dr. Singh’s hospital, Masiha Hospital. She explains her reasoning:
The most important fact I like is that the emergency treatment is available. The nearly dead people are brought alive here. By the time we take people to Rishikesh or Dehradun (100 kms), they die on the way due to profuse bleeding and other factors. We only come here to this hospital as we have faith in this hospital and it is close to us. When the doctor was sick, we felt as if our God went away and we were all orphans.
**How can the CHMI platform help you as an organization?**
We would require organizational development – to the executive board. Most often it is a “one man show” and the board really does not know much about the actual operations and challenges of an organization.
Second is access to funds for our programs to sustain. Low interest loans will not help us much as the revenue generation is less. We are involved in charitable work. For organizations involved in revenue generation activity loans may be feasible. One possible way to increase revenues would be to start a training centre.
We would also be interested in internship with medical students/doctors with international academic institutions. This could also become a revenue stream for us and people can also learn about community health programs. We are ready to train organizations to develop their community health programs. But the person should be willing to spend a minimum of two months.
**What would you say to some who wants to start such an organization?**
For starting such an organization you need to be committed, focused on the work and willing to sacrifice comforts. **But above all you need to be courageous. Without courage you cannot work in rural areas**.