Hathras, UP: Three guards, clad in gentle pink, stand sentinel outside the Bulandshahr Ashram of Bhole Baba a.k.a Narayan Sakar Hari. These guardians hail from far-flung corners of UP and neighboring states, visiting the Ashram every three months to offer a week of “seva” (holy service). Baba himself hasn’t visited the place in a decade now ever since his ascent to fame. Yet, his absence does little to deter the unwavering devotion of his protectors.

A curious journalist, perplexed by their stoicism, inquires, “Why stand guard if the Baba no longer walks these grounds?”  A serene smile graces one guard’s face. “His physical presence may be absent,” he replies, “but his spiritual essence forever permeates this space.”

The journalist, confused, persists in her inquiry. “What compels you to join his service?” One speaks up, his voice soft yet firm. “I had a constant ache in my heart. But after attending a satsang with Baba, it vanished.”  Another adds, “A head injury plagued me, leaving me perpetually unwell. But since joining the satsang, those ailments are a distant memory.”

A daily wage earner from Badaun chimes in, “Since joining, illness has become a stranger to me. My home is a haven of peace, my mind tranquil.” None of them hold Baba Bhole responsible for the stampede at his Satsang in Pulria village on July 2, which resulted in the deaths of 121 people.

Bhole Baba, a Jatav spiritual leader, gained fame for his alleged healing powers. He started holding satsangs (religious gatherings) after quitting his job as a police constable two decades back. Most of his devotees are Dalit. Many devotees believe Baba can cure illnesses and point to a 2000 incident where he claimed to revive a dead girl (though he was arrested for it).  

Professor V Sujatha, a sociologist at Jawaharlal Nehru University who studies health-seeking behavior, explains this phenomenon. “In his book, Sudhir Kakar categorizes traditional healers, who have always been part of Indian culture, into three groups: local shamans offering amulets or chants, mystics distributing blessed objects like soil of their feet or holy water, and established systems of medicines like Unani, Siddha, and Ayurveda.” The plural health behavior of seeking out various types of practitioners cuts across all social classes in South Asia. “However, the issue arises when this leads to a substitution of proper institutional medical care due to accessibility challenges,” she adds. 

The stampede began when devotees in a large crowd surged forward to collect “charan raj,” soil believed to be blessed by the Baba after touching his feet.

“On the day of the stampede, when women and children were dying of suffocation, Baba’s sevadars told their relatives they would be revived with his magical power. This created more confusion,” says Shailendra Kumar, a resident of Garhia village who witnessed the mayhem.

The phenomenon of self-styled godmen attracting followers and offering unregulated healing practices or just false hope in the form of totems is nothing new. It’s a worrying trend that hasn’t skipped the attention of public health experts.  “It certainly triggers the need for research and inquiry,” says Raj Shankar Ghosh, Senior Advisor at the Public Health Foundation of India. 

“This tendency poses a significant threat for several reasons. These godmen and healers offer a perceived alternative service, which can create apprehension towards proven medical practices,” he adds. 

This trend also highlights the shortcomings in our public care system that allow these ‘babas’ to step in. “The public health services often fail to build trust within the community or are unavailable when needed. In contrast, these godmen are always accessible. What do you do when essential TB medicines are not available at the local health facilities?” he asks.

Dalit and Adivasi communities face a disproportionate burden, often lacking access to even basic healthcare services. Even with the growth of private healthcare, comprising 62% of the infrastructure, it remains largely inaccessible for marginalized groups.

According to an Oxfam India report, utilization rates for private facilities by Adivasis and Dalits hover around 4% and 15% respectively. This stark disparity can be attributed to the crippling out-of-pocket expenses associated with private care, 524% higher than public facilities. This burden is insurmountable for communities where a significant portion (45.9% and 26.6% of Adivasi and Dalit populations) belong to the lowest wealth bracket.

Dalits and Adivasis face a constant battle against bias, denial of entry, and extended wait time. This systemic prejudice is compounded by the urban bias of private hospitals, with a staggering 67% concentrated in big cities, leaving rural Adivasi and Dalit populations even more vulnerable.

“Soft discrimination towards people from marginalized communities is quite common within the healthcare system, they are often treated with disdain which makes them averse to availing institutional care,” says V Sujatha. 

The government’s flagship health insurance scheme, PMJAY, was intended to bridge this gap. However, the program’s reach among Dalits and Adivasis remains low. Only 1.6% and 4% of private hospital admissions under PMJAY were from Dalits and Adivasis compared to their projected eligible population share of 19.7% and 15.4% respectively. 

For women from marginalized communities, the healthcare situation is even more dire. A UN report on gender gaps in health revealed a shocking disparity: Dalit women die 14.6 years younger than their upper-caste counterparts. Research by Thapa et al. (2018) titled “Caste Exclusion and Health Discrimination in South Asia” highlights contributing factors. Restricted mobility after marriage and limited involvement in healthcare decisions significantly limit Dalit women’s access to essential services.

The high female attendance at the Hathras gathering, led by a “faith healer,” exemplifies this. These faith-based entities often address a critical gap – community-organized transportation for women, a service lacking in public healthcare facilities.

“Access for women is a huge issue,” says Ghosh. “Public health cannot wait for people to change their mind or simply ask them to come.” This highlights a crucial flaw – the system expects demand instead of actively creating the supply of the product or the facility. 

Reliable public transport is critical for women’s healthcare access. “States like Madhya Pradesh and Tamil Nadu may have similar facilities,” says V Sujatha, “but accessibility differs. In Tamil Nadu, women can reach a clinic 10 kilometers away for just Rs 10 on a public bus. In Uttar Pradesh, the lack of public transport creates a major hurdle. Here, most families own bikes, but men typically ride them, limiting women’s mobility and increasing their dependence on men,” she says.  Further, an increase in bikes also causes more accidents. 

The Hathras tragedy has also starkly revealed a troubling phenomenon of victim-blaming. The assumption that Indians are inherently superstitious and averse to modern medicine is a misguided stereotype. V Sujatha explains, Indians often practice “pluralistic health-care behavior.” This means seeking both biomedicine and traditional remedies, not out of superstition, but as a cultural norm. “Studies show they readily embrace modern medicine when available, in fact, it is their first preference,” she adds. 

Our healthcare systems often struggle to address the deep impact of social factors like poverty and marginalization on overall health.  The high prevalence of domestic violence, alcoholism, and chronic stress among the poor – often overlooked as public health concerns – have profound consequences.  

“Alcoholism can lead to anemia in men, while domestic violence increases the risk of abortions, bleeding, and overall poor health in women. Poverty’s chronic stress can manifest physically, causing lower back pain in women that medical tests may not be able to explain,” says V Sujatha. 

The diagnostic-centric and clinical approach to healthcare, prioritizing specialists over general practitioners, and the decline of the family doctor have all contributed to increased patient alienation.

“In public and mental health, professionals have lost the art of listening,” remarks Dr Soumitra Pathare, a psychiatrist and the Director of the Pune-based Centre For Mental Health Law and Policy. “Sometimes, what you call the placebo effect is simply the result of being heard. Healing is not always about offering a cure; the patient-doctor dynamic is integral to the healing process,” he emphasizes.

“For many, visiting weekly satsangs helps with mild to moderate depression and anxiety. It provides catharsis and someone to listen to them,” says Pathare. 

One powerful way to protect vulnerable communities from exploitative gurus is by championing our time-tested traditional medicine systems, suggest experts. To this end, the government’s Ayush (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) push is in the right direction. 

“There is a tendency to lump healers, mystics, and Ayurvedic doctors together in an attempt to discredit them. However, misuses of the Ayush brand by some do not invalidate the entire system. Ayurveda, Unani, and Siddha are rooted in pharmacological principles and are established methods of treatment now gaining recognition in the West,” says V Sujatha.

Simultaneously, experts advocate for culturally nuanced gestures and practices within modern medical settings at local facilities. The integration of local customs can significantly enhance trust in institutions. For instance, in Tamil Nadu, practices like feasting during tribal women’s maternal check-ups and conducting bangle ceremonies by healthcare providers make individuals feel valued and included, thereby bolstering trust in the healthcare system.

Another example of this integration can be seen in mental health care. Traditional methods such as “jhar phuk” continue to be practiced due to limited alternatives. Collaborations between local healthcare providers and communities have shown promising results. A prime example is the shrine of Hazrat Sayed Ali Mira Datar in Gujarat, a site that has drawn devotees for over 500 years. Thousands of mentally ill patients seek help here, as it is believed that the rituals performed at the shrine possess healing powers. This belief attracts a diverse group of visitors from all religions. Now, a public health initiative aptly named “Dawa and Dua” (medicine and prayers) involves maulavis (religious leaders) at the shrine referring individuals for medical treatment while also performing rituals.

The tragic stampede in Hathras, claiming 121 lives, demands a thorough investigation into its root causes. Equally vital is the need to strengthen and make our institutions more accessible to prevent such catastrophes. Uttar Pradesh’s healthcare system’s failure to manage the casualties, as reported by Health on Air, exacerbates this tragedy. This represents a dual failure: placing vulnerable people in perilous situations and an administration unable to protect them in their time of need.

Feature Photo: Stephin Thomas/HoA