Whenever Lalibati, a poor farmer's wife in western India, falls sick, she heads for only one person: the local faith healer.
"The Bhopaji waves a peacock feather fan on my head, gives me a little packet with some ash and that cures me," the middle-aged woman giggled, as she sat on the floor of a mud hut with the end of her bright red sari clenched between her teeth.
"It's a question of faith."
Lalibati is one of millions of rural Indians who are forced to turn to faith healers and quacks, sometimes with deadly consequences, because of the abysmal quality of healthcare centers in the countryside.
While India's urban healthcare industry has boomed recently with a host of private hospitals offering state-of-the-art services for the cash-rich middle class, rural India remains untouched by the change.
It depends on an extensive network of government-run primary health centers -- one for every 30,000 people -- but experts say most of them are dogged by rampant absenteeism among doctors, lack of adequate medicines and poor infrastructure.
"We actually have the best primary health care infrastructure in the world. But it's like a sick public sector unit," said Sunil Mehra, a doctor and health policy expert in Delhi.
"We want to do everything for globalization, but not for investment in health."
A survey by the Massachussetts Institute of Technology and Princeton University of 100 villages in the poverty-stricken desert state of Rajasthan showed that 45 percent of medical personnel are absent at village level centers.
QUACKS AND SHAMANS
That isn't all: many centers in the state of stunning lakes and palaces are housed in dilapidated buildings with rusty stretchers.
It is this problem the new left-backed Congress government, which has promised to usher in reforms with a "human face," hopes to address with its plans to increase health spending to between 2 percent and 3 percent of GDP from less than 1 percent.
So far, the government has not indicated how the fresh funds will be spent, but a health ministry spokesperson said the emphasis would be on enhancing public-private partnership in an effort to improve delivery.
Until then, rural Indians are still trapped in a growing spiral of disease: while the nation tries to grapple with newer problems like AIDS, older ailments like polio and tuberculosis refuse to go away.
India has 5.1 million people suffering from AIDS, the second highest in the world after South Africa, with an increasing number of victims now in rural areas. But public healthcare centers are ill-equipped to deal with the disease, which now is spreading with frightening speed to the country's children.
Even the polio virus, almost eliminated worldwide, still exists in certain pockets, such as the northern state of Uttar Pradesh, where people have shunned the vaccine because of rumors it is part of a conspiracy to limit the birth rate of Muslims.
As a result, millions of Indians fork out a small fortune to faith healers, shamans and quacks who thrive across the countryside: in one recent case, a quack cut off a young girl's tongue in Delhi to cure her stutter.
"Many of them are not real doctors but apprentices with little knowledge. All they do is give injections with distilled water," said Sanjana Mohan, a doctor working with Seva Mandir, a non-governmental organization in the western city of Udaipur.
MIDWIVES
Still, illiterate villagers in the desert state of Rajasthan have more faith in private "doctors," and are willing to pay them huge sums.
Surveys show 65 percent of households in India go to private hospitals or clinics or doctors for treatment while only 29 percent use the public medical sector. Even among poor households, only 34 percent use public health centers.
If they use their neighborhood government clinics, it's mostly for diarrhea, tuberculosis and childbirth. For anything more complicated, they have to travel to bigger government hospitals that are often located many kilometers away.
In Rajasthan's Madri village, women with complicated pregnancies have to travel about 50km to Udaipur on a bumpy road cutting through rolling hills to deliver their children. Some die on the way.
As a result, many women still rely on village midwives or dais, who often deliver babies on filthy jute matting with a kit consisting of little more than scissors and mustard oil.
Today, the government and NGOs like Seva Mandir have launched extensive programs to train midwives, but activists say about 1 million women die of complications related to pregnancy and childbirth every year, one of the highest rates in the world.
The other big killer is tuberculosis: every year, nearly 500,000 die of TB and the disease costs India more than US$300 million a year of which more than US$100 million is incurred in the form of debt by patients and their families.
"Medical care has emerged as the second largest cause of indebtedness in the country next to dowry because allopathic [conventional] medicines are very expensive," said public health expert Mira Shiva of the Voluntary Health Association of India.
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