Quacks are the go-to persons for villagers as primary health centres do not function in most parts of the State North 24 Parganas, West Bengal: When the public health system fails, quacks rule the roost. Chakla, a village in North 24 Parganas district of West Bengal, stands testimony to this fact. Located just 50 km from State capital Kolkata, Chakla has 140 quacks, if Zero Foundation founder Abdul Nasar is to be believed.The village has a population of 2,269 people as per the 2011 Census, and covers a land area of 229.61 hectares. Though it has a primary health centre, the nearest functional government medical facility is located about 30 km away. The villagers, mostly daily wage labourers, seek quick relief from ailments. “Only then can we go for work the next day,” reasons Pia, a farmhand.She is quick to guard her ‘doctors’ from misjudgement. “These pharmacies have been here for years together. As a child, my parents took me to Ayyub doctor. Whenever my kids fall ill, I carry them to the same clinic where his son Rana treats patients now.”&nbsp; &nbsp;Quacks operate out of village pharmacies, which are equipped with a medical store and outpatient/inpatient centres where even minor surgeries are performed. They cure patients with medicines they found effective through the course of their ‘practice’. The villagers find their treatment cost-effective, especially when the place does not even have an ambulance service or basic medical equipment support.<div class="embed-container" align="center"><img src="https://assets.ramen.101reporters.com/inpic/2022/12/101RPT1513092/8.png" id="1535966" style="width: 100%;" title=""></div><div class="embed-container" align="center">A patient (left) at a quack's (right) clinic. Local quacks enjoy generational trust of families (Photo: Chithra Ajit)</div> Running the show on expired medicinesQuacks purchase medicines from the nearest town or collect sample/expired medicines for treatment. If that seems scary to you, consider these facts: most of these ‘doctors’ have primary school education only; even a pharmacy sweeper can launch a clinic of his own, if he is diligent enough; a widow can inherit a clinic when her ‘doctor’ husband passes away.“I had assisted my husband all these years. I knew the medicines he usually prescribed. Therefore, I decided to run the clinic when he passed away. This clinic is my only source of income,” says the widow of a quack, on condition of anonymity.&nbsp;Nevertheless, these ‘doctors’ only earn a daily wage labourer’s income. They charge no consultation fees and are ready to give medicines at a discounted price. What is more, they are even ready to lend them! Familiarity and affordability thus make quacks the go-to persons for the villagers in distress.&nbsp;In earlier times, paid DPham certificates were available and people who had purchased them could sell the licence any one by manipulating them. Using the certificate, quacks could purchase medicines easily.&nbsp; “After the implementation of the Goods and Services Tax, medicines could be purchased only by pharmacies with a valid licence. So, quacks now depend on agents, who sell sample and expired medicines to them,” explains a pharmaceutical dealer in Barasat, on condition of anonymity.Ariful Haque worked as a helper in a clinic for three years, before starting his own facility in Chakla. A class 10-pass, he hailed from an agricultural family. “I know the common illnesses that people here face, so I prescribe medicines from my experience. They have trust in me. I can handle minor stitches and surgeries, too,” he says confidently.&nbsp;&nbsp;<div class="embed-container" align="center"><img src="https://assets.ramen.101reporters.com/inpic/2022/12/101RPT1513092/ariful_haque.png" id="1535964" style="width: 100%;" title=""></div>Ariful Haque, a matric pass 'doctor' in Chakla village (Photo: Chithra Ajit)A class 2 dropout is a leading ‘doctor’ in Harinkhola village. When Nasar, whose Chakla-based Zero Foundation works for rural development, invited the Muslim Educational Society to open a clinic in Harinkhola, this quack’s father donated 15 cents of land, with an ulterior motive to take over the clinic’s activities gradually.But in no time, they realised that they cannot interfere in the clinic’s functioning and began to spread propaganda by teaming up with other quacks in the vicinity. They successfully managed to keep the villagers away from the clinic.&nbsp;The woeful lack of qualified doctors was quite evident when Partho (37), a tea seller near Baba Mandir in Chakla, told 101Reporters that he had never met a qualified doctor in his life. “I regularly take my kids to the ‘doctor’ in the locality. Years ago, he had cured my leg fracture using a fish bone. He is even ready to lend medicines when I have no money.”&nbsp;&nbsp;However, not all are happy with their ‘practice’. “A lady attended our foundation’s medical camp last month.&nbsp; She had a wound in her leg. The dressing was soaked in blood and pus as the quack she had consulted had not properly attended to it,” said Nasar.On what is problematic with a quack’s prescription, he said, “Most often, children suffer due to wrong treatment or overdose of antibiotics. Quacks always prescribe a lot of medicines.”&nbsp;&nbsp; An unhealthy practiceIn West Bengal, quackery is common to such an extent that one can easily find ‘doctors’ with 25 to 30 years of experience. “Actually, people never consider them as quacks. They have access to only these ‘doctors’ for primary health needs. Secondary-level treatment is beyond their reach. The government system is excellent, but medical infrastructure needs improvement,” PB Salim IAS, Secretary, Monitoring and Coordination, Chief Minister’s Office, West Bengal, tells 101Reporters.<div class="embed-container" align="center"><img src="https://assets.ramen.101reporters.com/inpic/2022/12/101RPT1513092/9.png" id="1535965" style="width: 100%;"></div>In West Bengal, quackery is so widespread that one can easily find ‘doctors’ with 25 to 30 years of experience&nbsp;(Photo: Chithra Ajit)Citing acute shortage of qualified doctors in rural Bengal as a prime issue to be handled, he informs how the government had in August last year decided to absorb quacks into the State health sector after training them. “However, medical organisations opposed this. Discussions are still on.”According to West Bengal Health Secretary NS Nigam IAS, over one lakh such ‘practitioners’ are present in the State. “The government considers them as 'rural doctors'. People approach them because there is a severe scarcity of qualified doctors. Presently, we have no plan to absorb them into the system. But training programmes have been going on for the last six years to enhance their skills,” Nigam tells 101Reporters.Meanwhile, Indian Medical Association (IMA) Calcutta chapter president Dr Nirmal Maji says the medical body has not wholly dismissed the State government plan. “Quacks can be trained as health workers to assist qualified doctors. However, we are against the idea of absorbing them into the health sector.”&nbsp;High school dropout rates in villages and the concentration of available skilled workforce in cities are a few reasons that fail Bengal's health system. Noting that medical officers are often not present in rural PHCs spread across the State, Dr Faruk Hossain Gazi, a medical practitioner in Kolkata, says his native place has more than 50 quacks.&nbsp;A Sundarbans native, Dr Gazi conducts weekly medical camps in his village with the help of his doctor friends. “I am training a few village youth to test blood pressure and sugar, and to spread awareness on childcare and menstrual hygiene. It is a basic step, and I cannot improve the conditions personally.”On why the government should stop promoting quackery, Dr Gazi says, “Quacks prescribe a lot of medicines, including antibiotics, without knowing their dosage, course or side effects. Though the number of qualified doctors is increasing, there is still a long way to go.”While most of the illnesses among villagers are due to the non-availability of proper food, clean water and unhygienic practices, lack of awareness and accessibility to early treatment further aggravate the matter. Kidney and heart issues are common. Likewise, cervical cancer rate in females in the nine to 28 years category is very high in villages.Oblivious to these facts, quacks run their businesses out of their small, dusty clinics. And for villagers, there is nothing unusual about these ‘doctors’. They are a part and parcel of Bengal society. The cover image is of a&nbsp;village woman removing her plaster by wetting it in dirty water on the advice of her 'doctor'. Clicked by Chithra Ajit.Edited by Rekha Pulinnoli