In the Twilight of Trust: The Rural Doctor & the Lost Faith of a Grateful Nation
By Dr R.Pohsnem
“Happiness was but the occasional episode in a general drama of pain.’’
— Thomas Hardy, The Mayor of Casterbridge
Each year, as the country raises garlands and tributes on Doctor’s Day, it does so perhaps unaware that, far from the limelight of ceremonial stages and floral speeches, the doctor who once stood closest to the people’s hearts is now fading from their memory. The rural doctor — once revered not for his degrees but for his presence, his constancy, his companionship in suffering — now walks in the shadows of a health system grown indifferent.
In those quieter times, a doctor in the village was not a mere agent of medicine. He was woven into the grain of daily life, as steady as the monsoon, as familiar as the soil. His arrival at a doorstep, often at dusk or midnight, brought not just clinical hope but moral comfort. The poor saw in him not only treatment, but a form of assurance: that someone would stand with them in the face of society’s indifference.
He was called upon without hesitation, with cries from courtyards and knocks upon tin doors. Sometimes he arrived soaked in rain, sometimes bone-tired from sleepless nights. But he came. Always. Not because he was compelled by policy, but because the work called him like prayer.
A Grave Beneath the Memory Tree
In the depths of my childhood stands a moment I can neither erase nor fully remember. My youngest sister lay burning with fever. We rushed her to the Primary Health Centre in our village. The diagnosis was vague—perhaps typhoid, perhaps malaria. We never knew for sure. What we did know was this: the doctors there, though limited in tools and training, offered all they had. Their hands moved swiftly, their eyes held sorrow, and their duty was never in question.
We trusted them without hesitation, without doubt. We surrendered to their healing hands because they were all we had — and in truth, we believed they were all we needed. In those days, referral was a distant concept. Higher hospitals were like faraway castles in clouds. The rural doctor was our last stop, our only thread of hope.
She passed away, quietly. Not because no one cared, but because no one beyond could be reached. Her death carved a quiet hollow in our lives. But our trust in the rural doctor did not die with her. If anything, it deepened. Because we saw in their effort the limits, not of their will, but of a system that left them so cruelly alone.
And in our hearts, we carried not blame, but a sorrowful understanding. It was a grief shared with the very hands that had tried to save her.
A Profession Beyond Reach
Today, the path to becoming a doctor has grown ever steeper. While qualifying NEET is now a common threshold, what lies beyond it is often a mountain too high for children of farmers, daily wage workers, and those whose dreams have mud on their boots.
The boy who once ran barefoot to school through paddy fields must now race against coaching centre clocks in distant cities, where time is paid for in thousands. In our time, when the 12th exams were over, we returned to our villages—not to prepare for another test, but to help our parents in the fields, carry firewood, and live as sons and daughters of the soil while we waited for results with quiet hope. Today, even that pause is unaffordable. NEET preparation begins the very next morning, and the poor must somehow fund both hope and hunger.
Though admission is merit-based, the true barrier lies not in the entrance test, but in the unseen costs—the coaching, the distance, the forbidding fees demanded by private and even many state-run colleges. The dream remains, but only for those whose wallets match their will.
And the child of the village, whose hands have fed fields and healed wounds without name, watches from outside the gate. The boy who lost a sibling. The girl who helped deliver her sister’s baby. They would have once walked with fire in their veins to serve the suffering.
But now, they are asked to carry purses heavier than dreams.
And so, medicine loses not just a few bright minds, but a generation of quiet healers—those whose empathy was lived, not learned. We speak of equity in healthcare, of inclusion and access. Yet the very soul that might have served the underserved is denied entry before the first lecture begins. The corridors of medicine, once imagined as spaces of healing, now echo with absence. The village child, full of untaught empathy and resolve, is left outside. A loss not only for them, but for us all.
So when we lament the absence of doctors in villages, let us first ask: who was allowed to become one?
The Cracks of Estrangement
In the vacuum, the relationship once built on faith now turns brittle. Doctors are transferred like files, known not by face but by designation. Villagers queue not to be heard, but to be moved along. Empathy, once the pulse of rural care, is drowned beneath protocol, referral, and fatigue.
In many rural health centres today, doctors appear for their shifts but remain distant. Overworked or transient, they are unable to offer continuity of care. There is no shared history with the patient, no personal knowledge of the family’s struggle. As a result, the health system feels more mechanized than human. Trust weakens, and frustration brews.
Once unthinkable, violence against doctors now finds root in betrayal. But the betrayal is not personal. It is the breaking of an old promise: that the doctor was one of us, not above us. That his clinic was a place of listening, not just of prescriptions. It is a grief transformed into rage, born from the absence of the doctor who once knew their name, their pain, their story.
When Care Becomes Commerce
In the cities, medicine has donned new robes. Glass-walled hospitals rise like temples, but entry is priced. The poor stand at the gates, not with hope but with fear. Prescriptions multiply. Machines whirr. But the touch — that old, human reassurance — grows rare.
And even in government halls, the doctor bends under burden. Files pile. Supplies fall short. The patient becomes a number. The healer becomes a clerk. The sacredness that once adorned the profession grows thin.
The commercialisation of medicine has shifted its compass. It now turns toward convenience, lifestyle, and profit. Where once the doctor asked, “What ails you?” they are now asked, “What do you pay?” In such a setting, the quiet dignity of rural care is drowned in marble halls.
And yet, somewhere between policy and aspiration, a curious wind has begun to stir. Investments are being weighed, and choices are being made—not loudly, but with decisive consequence. In some corners, the effort is toward towers and titles, where white coats parade through lecture halls. In others, there lingers a plea: that the old PHC walls be mended, their rooms lit, their beds not left cold.
There are whispers that some hands might be pulled away from the village bedside to polish institutional dreams. That the very lifeblood of primary care—its reach, its rhythm, its human presence—may quietly be thinned to staff distant monuments. And those who watch closely, who remember fevered nights and dusty courtyards, grow uneasy. As Hardy once captured in his silences, “There are things that the heart thinks of but dare not say.”
The Road Back to Belonging
Yet all is not lost. If we look again to the village, we may still restore what slipped from our grasp.
Let scholarships bloom for those with stories in their eyes, not balance sheets in their pockets. Let us honour those who have stayed, served, and held hands through long nights. Let rural postings feel like planting, not punishment. And let home visits return—not as nostalgia, but as necessity. For what is healing, if not the act of being there?
Imagine the village boy who once sat weeping beside his dying sister becoming the very doctor he once awaited. Imagine him walking those same roads, entering those same homes, speaking the language of compassion that once comforted him. That is the restoration we must dream of.
Medicine is not just science of cells and systems; it is a quiet response to unseen suffering. The soul of Indian healthcare once lived in mud-swept lanes, where care arrived unbidden and doctors were kin.
Let the village no longer be a place where prayers go unanswered, but where healing walks quietly among its people. And if such a day comes, a child will remember not loss, but life—held gently by hands that knew both grief and mercy.
(The writer is Primary Care Practitioner, Meghalaya)