The Listeners

Like many great medical breakthroughs, Drs. Abhay and Rani Bang’s discovery of how to reduce child deaths in the developing world as much as 75% came from a deceptively simple premise. “We decided to listen to our patients,” says Abhay. That may sound obvious, but in 1986, when the pair returned to their poor, central Indian hometown of Gadchiroli with master’s degrees in public health from Johns Hopkins University, it was a novel approach.

Then, explains Abhay, 55, priorities for the developing world were decreed in abstract by the medical establishment. “For example, everyone said population control was the No. 1 priority and family planning the No. 1 solution,” he says. That approach ran counter to principles Abhay learned growing up in Mohandas Gandhi’s ashram at nearby Sevagram (literally, Service Village), which favored community and consensus over hierarchy and imposition.

He and Rani, 54, had already decided to follow Gandhian principles and live and work with the poor, founding a trust they called the Society for Education, Action and Research in Community Health. After setting up a lab in an old warehouse, they began surveying two nearby villages. The results were immediate. “If you actually talked to the mothers, you discovered women had other needs than just contraception,” says Abhay. “We found 92% had gynecological diseases.”

In 1989, the pair published their research in the journal Lancet. “Within a year or two, there was an entirely new approach to women’s health worldwide,” says Abhay. “The global population policy changed from looking at mere reproduction to the whole issue of women’s reproductive health. That was our first experience of how powerful this approach could be.”

Encouraged, the Bangs listened some more. They identified alcohol abuse as another big issue and began addiction treatment. And given that half their patients were from the forest-dwelling Gond tribe and wary of city hospitals, the Bangs asked them what a Gond hospital might look like. The result is what Abhay named Shodhagram (Research Village), a medical center outside Gadchiroli that resembles a village, with separate huts housing the lab, surgery, pharmacy, wards, library and even a shrine to the Gond goddess Danteshwari.

It was soon after moving to Shodhagram that Abhay and Rani were presented with the tragic inspiration for their greatest innovation. “A tribal woman came in with a tiny baby boy,” Abhay says. “We took him, laid him on our bed, and he died, right there and then.” The child’s death haunted the two doctors. They decided to tackle a subject the medical community had long abandoned: the stubbornly high child-mortality rate in the developing world. Abhay and Rani identified 18 causes of newborn death, from the obvious, like malnutrition, to the surprising, like the habit of expectant Gond mothers of starving themselves and their unborn child for an easier birth. The Bangs found no problems that couldn’t be treated by a health worker with rudimentary skills, some infant sleeping bags and an abacus on which to record every 10 heartbeats.

So Abhay and Rani got a seamstress to stitch the sleeping bags and a carpenter to make the abacuses, and they drew up a health training program that they taught to a newly assembled corps of village health workers. In 1999, the Bangs published the results of their efforts, again in the Lancet. They had cut child mortality in half–a figure that would fall to a quarter by 2003–for a cost of $2.64 for each child saved. The program is being adopted across India, where more than a quarter of the 4 million annual newborn deaths occur, and in Nepal, Bangladesh, Pakistan and parts of Africa.