Local residents refer to the district hospital in Pauri town – nearly 6,000 feet above sea level in the Garhwal Himalayas in Uttarakhand – by several names. While some call it a first-aid hospital, others say it is a referral centre.

This is because the hospital refers patients to facilities in Srinagar, a bigger town 45 km downhill from Pauri, for most medical emergencies. Sometimes, when Srinagar doesn’t have the facilities required, villagers have to head further downhill towards state capital, Dehradun, for treatment.

As Uttarakhand went to the polls on Wednesday, access to better healthcare facilities is a major poll issues for residents of Pauri. Other important issues are better education facilities, increased job opportunities and demonetisation.

As many as seven candidates stood from Pauri Assembly constituency, one of six in Pauri Garhwal district. Pauri seat is reserved for a Scheduled Caste candidate.

In the 2012 Assembly elections, Congress candidate and sitting MLA of Pauri constituency Sundar Lal Mandrawal defeated his closest competitor, from the Bharatiya Janata Party, by a margin of 2,906 votes.

In previous Assembly elections, the constituency, which has a voting population of 85,182, saw a turnout of 53.2%. On Wednesday, at 5 pm, the turnout in Uttarakhand was 68%.

Children and elderly suffer

“The worst sufferers of poor healthcare facilities are children who fall sick quite often,” said Manju Devi, 31, as she waited with her toddler outside a poll booth at the Krishi Vikas Kendra in Pauri. “The hospitals here do not have paediatricians so every time any child in our family falls sick, we have to go to Srinagar. The children often get more unwell due to the time it takes to give them proper medication.”

Manju’s mother-in-law Munni Devi, 70, said that the healthcare situation is equally grim for the older population too. She cited the case of a 60-year-old neighbour who was rushed to the district hospital recently after his feet swelled up. He was referred to Srinagar but died on his way there.

The district hospital caters to not only the small population of Pauri town but to over 100 villages around it.

“The healthcare system in Pauri got worse after Uttarakhand became a separate state,” said CB Barthwal, a retired resident of Pauri, who earlier worked as a medical officer with the state government. “Some senior doctors and specialists used to get posted in Pauri till the time Uttarakhand had not separated from Uttar Pradesh. But when Uttarakhand became a new state, senior doctors started opting for postings in non-hilly areas like Dehradun, Haridwar and Haldwani.”

He alleged that the reason for this was because when Uttarakhand was part of Uttar Pradesh, state capital Lucknow was far away. Therefore, it was not easy for doctors to approach bureaucrats and ministers to help them facilitate transfers.

“When Dehradun became the capital of newly-formed Uttarakhand, and a set of newly-emerged legislators emerged, the task became less tiring,” said Barthwal.

Pauri hospital understaffed

At the Pauri district hospital on Wednesday evening, pharmacist MM Nautyal, who was in charge of the emergency ward, presented a grim picture of the available facilities. Nautiyal said that the hospital suffers from a severe staff crunch across all positions – from ward boys to doctors. It has no neurosurgeon, no psychiatrist and it recently procured an expensive CT scan machine but does not have a doctor who can analyse the scan results.

The hospital is further depleted of staff when VIPs visit. Then, teams comprising at least a doctor, a pharmacist and a ward boy, are deployed for VIP duty. Nautiyal was himself part of a team that accompanied National Security Advisor Ajit Doval when he visited his village Ghiri, 32 km away from Pauri town, around two years ago.

“Most referrals happen in the department concerned with treatment of women,” said Nautiyal. “For instance, any complicated surgery related to childbirth will require a gynaecologist, a general surgeon, an anaesthetist and a paediatrician. If one is missing on a particular day, no doctor can take the risk of doing a surgery.”

Call for job opportunities

A 500-metre walk downhill in Pauri town leads to Lower Bazar, a British-era colony now inhabited by a few hundred Muslim families. While nearly half the Muslim population in the area are descendants of businessmen who migrated from Uttar Pradesh’s Bijnor district decades ago, the remaining half are natives of Pauri district who migrated from villages near Lansdowne, a cantonment town 84 km away. While the former communicate in Hindi, the latter speak fluent Garhwali.

Lower Bazar. (Photo credit: Abhishek Dey).

Atop a hill in Chucha village in Pauri, two voting booths had been set up at an intermediate college for women – one for the residents of Chucha and Upper Bazar area, and the other for residents of the neighbouring village of Kandei and the Lower Bazar area. Casting a vote here demanded a lot more than just political will – the climb is steep and tiring for elderly residents of the area.

“Apart from decent healthcare, what Pauri needs at this moment are sufficient job opportunities,” said 56-year-old Danish Khan, a government servant who had come to vote at the intermediate college along with his family. “Jobs are the main reason behind the huge migration rate that Uttarakhand has witnessed for decades. If that has to stop, the government has to ensure that the youth get decent jobs here.”

Khan’s view was echoed by 26-year-old Puneet Singh Negi who stood in a queue outside a booth set up at the Government Model Primary School on a slope down the Mall Road in Pauri. Negi had migrated to Dehradun a few years ago where he studied hotel management. He went on to work for a five-star hotel in Delhi but moved back home after spending three years in the national capital. He now works with a cooperative bank.

“As far as my own circle of relatives and friends is concerned, only three out of 10 youths could be a part of this reverse migration,” said Negi. “The first reason is the scarcity of resources. There are not enough opportunities to accommodate as many youths who migrate from villages. The other reason is lack of exposure.”

He explained what he meant. Negi said that the quality of education was so poor in Pauri that when youths graduate from high school, they do not know what to do next. He said that many, like him, end up in hotel management. And when they move to bigger cities like Delhi, Bengaluru and Mumbai, they are so busy coping with their busy professional lives that they are unaware when the rare job opportunity opens up in their hometowns.

Said Megha Negi, 22, a student at the Pauri centre of the Hemvati Nandan Bahuguna Garhwal University: “Proper exposure can change a student’s life and that, unfortunately, does not happen in Pauri. This is what we want our elected leaders to work on.”

She added: “While regular graduate programmes are available in the colleges here one has to go to Srinagar and beyond for specialised studies including BTech.”

Demonetisation factor

On Wednesday afternoon, on Dhara Road in Pauri, vegetable vendor Dinesh Chandra, 48, was in the midst of an argument with a middle-aged customer over who had caused more damage to Pauri. While Chandra said that local leaders were to blame, his customer, lawyer Vicky Maithani, argued that the people of Pauri were responsible for their misfortune regarding the poor development in the area. According to Maithani, residents of Pauri lack any political will despite being educated.

Vegetable vendor Dinesh Chandra. (Photo credit: Abhishek Dey).

“Whosoever is voting for the BJP here is not voting for the local leader or the party but for one person – Narendra Modi,” said Chandra, who attended a rally on February 12 in Srinagar where Modi gave a speech.

“It is tough to speculate about who will win,” said Chandra. “The effects of demonetisation will also play an important role in this election. Small-scale traders like me were the worst sufferers as sales went down tremendously and we are yet to recover from the effects of the grand exercise.”

He, however, said that he appreciated demonetisation, adding that it was an unprecedented move in the fight against black money. The last comment seemed to have struck the right chord with Maithani, who nodded in agreement.