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The Ten-Rupee Doctor Who Sparked a Health Revolution in Kerala’s Tribal Highlands

Dr. V. Narayanan’s Swami Vivekananda Medical Mission Hospital in Agali — known locally as the 10-rupee hospital — stands as one of the most remarkable community health transformations in modern Kerala

Dipin Damodharan

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Image credit: Dipin Damodharan/ Edpublica

The road to Attappadi coils through steep cliffs and dense forests, revealing slivers of green and shadows of mountains that appear to move with each turn. For years, headlines from this tribal hotspot in Kerala’s Palakkad district were heartbreakingly similar: child malnutrition, maternal deaths, anaemia, and a healthcare system fractured beyond recognition.

We were travelling from Kochi not to revisit that trauma, but to meet the man whose quiet, steady efforts helped change it.

When Dr. V. Narayanan arrived in 2002, Attappadi’s healthcare landscape was desolate. A few primary health centres existed in name, but medicines were scarce, staff irregular, transport unreliable, and trust nearly non-existent. Many Adivasi (tribal) families walked hours for simple ailments. Women delivering babies often did so without skilled care.

“In those early days,” he recalls, “you wouldn’t even see a bike on the road. Healthcare wasn’t inadequate — it was absent.”

But absence was precisely what he had come to confront.

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The roots of his journey stretch back to his teenage years. “I was in Class 12,” he says. “It’s an age when you question everything. I began reading Vivekananda deeply. His call to serve the poor, to work in backward areas — that stayed with me.”

Medicine wasn’t his ambition. Rural development was. But his family persuaded him to study MBBS, believing it would broaden his capacity for service. It did — but only because he refused to choose the conventional path.

After completing a postgraduate programme in child health, he didn’t apply for a job. He headed straight to Attappadi — without doubts, without second thoughts. “This wasn’t a career decision,” he says. “It was a life decision.”

His first “clinic” was a mobile medical unit borrowed from the Vivekananda Medical Mission in Wayanad. Every evening he visited a different hamlet, listening to people speak about water scarcity, hunger, infections, unemployment, fear, distrust — and neglect that had accumulated over generations.

Slowly, he became a familiar figure in the valley. Mothers insisted he be the first to hold their new-borns. Elders began greeting him as one of their own.

A belonging was forming — one that medicine alone cannot create.

In 2003, as patients multiplied beyond what the mobile clinic could handle, he opened a small outpatient centre in Agali. By 2006, after raising 22 lakh rupees from well-wishers and small donors, the Swami Vivekananda Medical Mission Hospital opened its doors with 10 beds, two consulting rooms, and a lab.

Its defining principle was radical: Adivasi patients would be charged only ten rupees. Always.

Administrators warned him it was economically unviable. But the doctor had seen families pushed into debt by even minor medical expenses.

“The hospital must belong to them,” he says. “Cost should never decide who lives and who dies.”

People came. Trust deepened. And trust became infrastructure.

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A patient visited in the hospital says, “Here, we feel like human beings. Not cases. Not numbers. Narayanan doctor listens to us like we are his family. That is why we come.”

Another woman added softly: “When we step inside this hospital, we feel safe. There is no fear here.”

For communities long accustomed to humiliation and exploitation in medical spaces, this emotional safety mattered as much as treatment.

A Global Gap Mirrored in a Valley

Attappadi’s early struggles are not isolated. Across India, Adivasi (tribal) communities face some of the poorest health indicators — high maternal mortality, anaemia, malnutrition, tuberculosis, and limited access to skilled care.

Globally, too, Indigenous communities — from the Māori of New Zealand to Native American nations and Aboriginal groups in Australia — experience higher infant and maternal mortality, limited access to hospitals, distrust due to historic exclusion, lower life expectancy, and underfunded primary care

A 2021 UN report states that Indigenous peoples worldwide are nearly twice as likely to lack basic healthcare access. What was happening in Attappadi was part of a wider pattern — the world’s margins suffering the world’s worst health outcomes.

Dr. Narayanan stepped directly into that gap.

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Healing Required More Than Hospitals

Over time, he realised medical treatment alone could not fix Attappadi’s pain.

“Pregnant women worked until delivery because they had no choice,” he says. “Many ate barely one meal a day. How can a baby survive that?”

He conducted a participatory rural appraisal across several hamlets — and what he saw changed everything. Malnutrition was linked to income instability. Illnesses persisted because basic hygiene wasn’t possible. Women were dying because poverty didn’t allow rest.

“It felt like pouring water into a pot full of holes,” he says. “We had to strengthen the pot — not just keep pouring.”

The hospital expanded into a movement that worked on, restoring nutrition, improving sanitation, supporting livelihoods, strengthening housing, reviving agriculture, education, and building self-reliance.

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Village health workers — trained women and men from each hamlet — became ambassadors of preventive care. From an initial 40, tthe network has grown to nearly 130 health workers across Attappadi.

Education too became central. The Mission school today teaches 600+ children, and the valley now has young people pursuing medicine, nursing, and engineering — an unimaginable shift a decade ago.

Growing, But Never Losing Its Soul

The hospital today has 50 beds, 12 full-time doctors, and over 80 staff. Across the Mission’s programmes, more than 200 people work toward one idea: dignity. Nearly 70% of all patients remain Adivasi (tribal).

The next dream: a 100-bed hospital. Construction for new OP wings and a skill development centre has already begun.

CSR funding keeps the institution afloat, but the ten-rupee fee remains untouched.

“It will never change,” he says. “This hospital exists because of them. It must always belong to them.”

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A Revolution Fuelled by Belonging

When asked what sustains him, Dr. Narayanan doesn’t speak of recognition. Instead, he points to his staff — many of whom left better-paying jobs to join the Mission.

“They believe in this work more than anything I’ve done,” he says. “I’m just one person. They are the movement.”

Two decades after he arrived here, the Ten-Rupee Doctor still walks through the corridors of his hospital with the same simplicity and calm that first won the valley’s trust.

In the world of global public health — dominated by budgets, systems, and crises — Attappadi offers a different narrative: that change is possible when a community finds a place where it is seen, heard, and treated as human.

Sometimes, revolutions don’t begin with policy. They begin with one person who refuses to turn away.

Dipin Damodharan is the Co-founder and Editor-in-Chief of EdPublica. A journalist and editor with over 15 years of experience leading and co-founding both print and digital media outlets, he has written extensively on education, politics, and culture. His work has appeared in global publications such as The Huffington Post, The Himalayan Times, DailyO, Education Insider, and others.

Society

How a South Indian Startup Is Reimagining Agriculture From the Sky

From flood-ravaged fields in Kerala to precision farming systems powered by drones, Fuselage Innovations is rethinking agriculture through data, efficiency, and real-time intelligence.

Rishika Nair

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How Drone Technology In Agriculture Is Helping a South Indian Startup Reimagine farming
Image credits: Fuselage Innovations

Drone technology in agriculture is rapidly changing how farmers monitor crops, manage resources and improve productivity. A South Indian startup is now using aerial innovation and precision farming tools to reshape agriculture from the sky

In 2018, catastrophic floods swept across South Indian state of Kerala, submerging farmland and leaving behind more than visible damage. When the waters receded, they revealed a deeper crisis—soil chemistry had changed, salinity had increased, and farming systems that had sustained communities for generations no longer behaved the same way.

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For many farmers, the land had become unfamiliar.

For Devan Chandrasekharan, an aeronautical engineer with roots in farming, this moment marked a turning point.

“That moment made it clear that agriculture needed more than incremental change,” he says. “It needed a different way of understanding what’s happening in the field.”

Today, as co-founder of Fuselage Innovations, a Kerala-headquartered agritech company with operations expanding across southern India and early international pilots, Devan is part of a new wave of innovators rethinking agriculture through technology.

Drone technology in agriculture being used above farmland for crop monitoring and precision spraying in modern farming.
Image credits: Fuselage Innovations

Drone Technology in Agriculture: From Fields to Flight Paths

Modern agriculture is increasingly shaped by data. But while satellite systems offer scale, they often lack immediacy. Cloud cover, delays, and low resolution limit their usefulness in time-sensitive decisions.

“In farming, timing is everything,” Devan notes. “If you cannot act at the right moment, even the best data loses its value.”

Fuselage Innovations addresses this gap using drones equipped with multispectral sensors, capable of capturing real-time, high-resolution data directly from the field. These systems detect early signs of stress—nutrient deficiencies, pest risks, or water imbalances—long before they become visible.

Farming as a Predictive System

The company’s approach goes beyond aerial imaging. It is built around a stage-wise model that tracks crop growth from early development to harvest, linking each phase to targeted interventions.

This transforms farming from a reactive process into a predictive one.

“Instead of responding to visible damage, we can identify stress signals early and intervene precisely,” Devan says. “That changes the entire economics of farming.”

The results are significant. Field applications have shown yield increases of up to 35 percent, alongside a reduction of nearly 50 percent in pesticide and fertiliser use. Precision spraying has also cut input volumes dramatically—from 150–200 litres per acre to just 10–15 litres—reducing both costs and environmental impact.

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Scaling Beyond Boundaries

While the company’s early work was rooted in Kerala, its reach has expanded into Tamil Nadu and other parts of India, with pilot projects now extending to international markets such as Canada.

“Farming challenges may vary across regions, but the need for efficiency, sustainability, and better decision-making is universal,” Devan says.

Yet adoption remains a challenge. Farming is inherently risk-sensitive, and new technologies are often met with caution. To address this, the company initially offered its services free of cost, allowing farmers to see results before committing.

“Trust is the biggest barrier,” Devan says. “Farmers need to see the impact on their own fields before they adopt something new.”

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Devika Chandrasekharan, Devan Chandrasekharan

The Future from Above

As climate pressures intensify and resource constraints deepen, agriculture is entering a new phase—one where data and precision will define productivity.

“Technology alone cannot solve agriculture,” Devan emphasises. “But when it is aligned with the realities of farmers and ecosystems, it can become a powerful tool for transformation.”

What began in the aftermath of a flood has now evolved into a model for the future—where farming is not just guided by tradition, but informed by intelligence.

Because the future of agriculture may not lie only in the soil—but in how we see it from above.

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Society

The Coal Paradox: More Coal Plants, Less Coal Power

A new Global Energy Monitor report shows global coal capacity rising in 2025 even as coal-fired electricity generation declines amid rapid renewable energy growth.

Rishika Nair

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Image credit: Dapur Melodi /Pexels

The world is building more coal plants, but using less coal than before. That contradiction lies at the centre of a new report by Global Energy Monitor (GEM), an international organisation that tracks energy infrastructure and the global shift toward cleaner power.

According to GEM, whose databases and research are widely used by institutions including the IPCC, IEA, UNEP and the World Bank, countries are continuing to expand coal power infrastructure even as coal’s role in electricity generation weakens globally.

The latest edition of GEM’s Boom and Bust 2026 report found that global coal power capacity grew by 3.5% in 2025, while coal-fired electricity generation declined by 0.6%. The report describes the trend as a major structural shift in the global energy system, where coal remains politically important in several countries even as renewable energy increasingly replaces it in practice.

China and India Drive Coal Growth

The contradiction is most visible in China and India, the world’s two largest coal consumers. Both countries commissioned large amounts of new coal capacity in 2025, even as coal generation declined because of record additions in solar and wind power.

China expanded coal capacity by 6% in 2025, while coal-fired generation fell by 1.2%. India recorded a similar pattern, with coal capacity increasing by 3.8% even as coal generation dropped by 2.9%.

The report suggests that coal’s decline is becoming increasingly durable despite global energy uncertainties, including geopolitical tensions affecting fuel supply routes such as the Strait of Hormuz. Renewable energy expansion has continued rapidly enough to reduce coal’s role in meeting new electricity demand.

Christine Shearer, Project Manager of GEM’s Global Coal Plant Tracker, described the trend as a defining paradox of the global energy transition.

“In 2025, the world built more coal and used it less,” she said. She added that 95% of all coal plant construction is now concentrated in China and India, even as both countries expand renewable energy fast enough to displace coal generation.

China’s Coal Pipeline Continues to Surge

China remained the dominant force in global coal expansion during 2025. The country recorded a record 161.7 GW of new and revived coal projects, while more than 500 GW of coal-fired capacity is currently under development.

The report warned that if these projects move ahead, China could remain locked into years of additional coal use throughout its 15th Five-Year Plan period from 2026 to 2030, despite official commitments to reduce coal consumption during the same timeframe.

India Expands Coal While Renewables Accelerate

India is also continuing major coal expansion plans. The country recorded 27.9 GW of new and revived coal proposals in 2025. Overall, India now has more than 107 GW of coal capacity in pre-construction planning and another 23.5 GW already under construction.

The Indian government has announced plans to add 100 GW of new coal capacity over the next seven years, even as renewable energy growth continues at record pace. In 2025, non-fossil fuel sources crossed the milestone of accounting for more than half of India’s installed electricity capacity.

Coal Development Shrinks Outside Asia

Outside China and India, coal development is shrinking rapidly. Only 32 countries were proposing or building new coal plants in 2025, down from 38 countries the previous year and less than half the 75 countries pursuing coal expansion in 2014.

Coal construction activity outside China and India accounted for just 5% of global coal construction capacity in 2025, marking a record low and highlighting how geographically concentrated coal development has become.

Several regions also made notable progress away from coal. Latin America achieved “No New Coal” status in 2025, while South Korea committed to a complete coal phaseout.

Türkiye, which is preparing to host COP31, now has only one active coal plant proposal remaining, compared with more than 70 proposed projects in 2015.

Delayed Coal Retirements Raise Concerns

The report also found that retirement plans for existing coal plants are slowing in several regions. Nearly 70% of coal-fired units scheduled for retirement globally in 2025 failed to retire as planned.

In the European Union, many delays were linked to energy security concerns that emerged during the 2022–23 energy crisis. In the United States, several ageing coal plants remained operational because of direct government interventions aimed at maintaining grid reliability.

Indonesia continued expanding its coal fleet, which grew by 7% in 2025, largely driven by captive coal plants supporting nickel and aluminium processing industries.

South Asia and Southeast Asia Show Mixed Trends

Elsewhere in South Asia, Pakistan rapidly expanded distributed solar energy, helping stabilise its electricity system against volatile fossil fuel markets. Bangladesh, meanwhile, continues to face fuel supply and technical challenges linked to its fossil-fuel-based power sector.

Across Southeast Asia outside Indonesia, coal commissioning declined for the third consecutive year. However, disruptions in regional gas supplies during 2026 led some countries to rely more heavily on existing coal infrastructure as a temporary backup source.

In Africa, new coal proposals remain limited and are mainly concentrated in Zimbabwe and Zambia.

Renewable Energy Reshapes the Global Energy Transition

The report concludes that coal is no longer expanding as a universally accepted solution for rising electricity demand. Instead, coal development is increasingly concentrated in a small number of countries, even as renewable energy demonstrates its ability to meet growing demand more efficiently and sustainably.

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India Built the Pipes. Now It Needs Better Water Data

JalSoochak is helping strengthen rural water delivery in India by turning paper-based records into real-time data for faster monitoring and response.

Rishika Nair

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Digital monitoring system used to improve rural water delivery under India’s Jal Jeevan Mission.
Jalsoochak is a platform designed to make frontline water delivery measurable, verifiable, and useful, all the way up the system. Image credit: By Special Arrangement

>> Rural water delivery in India has expanded rapidly under the Jal Jeevan Mission. But ensuring that water actually reaches homes every day now depends on better data, real-time monitoring, and systems like JalSoochak.

India built the pipes. Now comes the harder part.

Under the Jal Jeevan Mission (JJM), more than 1.5 crore rural households have been connected to piped water supply — a number that would have been unthinkable a decade ago. But connection is not the same as service. The pipe in the ground tells you nothing about whether water came out of the tap this morning, in what quantity, or whether the source feeding it is under stress.

That gap — between infrastructure built and service delivered — is where India’s rural water systems are now being tested. And it is a gap that turns, fundamentally, on data.

Why Rural Water Delivery Depends on Better Data

Pump operators and Jal Mitras are the ones who know. They manage supply cycles, monitor pumps, and record water delivery across thousands of villages every day. But in most states, those records live in paper registers. They cannot be verified, compared across districts, or acted on quickly. By the time a problem surfaces through the usual channels, it has often been festering for weeks. Engineers and administrators are left reconciling inconsistent figures instead of responding to the thing that actually went wrong.

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Arghyam, a Bengaluru-based philanthropic organisation founded by Rohini Nilekani, has been working on this problem. In partnership with Assam’s Public Health Engineering Department (PHED), it developed JalSoochak (Water indicator) — a platform designed to make frontline water delivery measurable, verifiable, and useful, all the way up the system.

How JalSoochak Is Transforming Rural Water Delivery

“Since the expansion of rural water infrastructure, understanding what is actually happening on the ground at scale has remained difficult. JalSoochak addresses this by enabling frontline workers to capture a simple image as evidence of water supply, while also giving Jal Mitras a verifiable record of their service delivery and attendance,” said Kailash Karthik, Secretary, Public Health Engineering Department, Government of Assam and Mission Director, Jal Jeevan Mission Assam.

The tool itself is straightforward. A frontline worker photographs a meter reading on their mobile phone. The image is processed using AI, the user verifies the reading, and it is logged as a daily record. What used to be a handwritten entry in a register — easily disputed, easily lost — becomes a time-stamped, verifiable data point that engineers, block-level officers, and state administrators can all see and act on.

JalSoochak platform supporting rural water delivery monitoring in Indian villages.
JalSoochak platform supporting rural water delivery monitoring in Indian villages. Image credit: By special arrangement

Accumulated over months, those daily records start to show things that no single entry would. A supply dip that recurs every fortnight. A pump whose readings are quietly declining. A source under pressure before anyone has formally flagged it. Problems get caught earlier, and the people responsible for fixing them have the evidence they need to act.

How Assam Is Digitising Rural Water Delivery

The numbers from Assam are substantial. More than 16,500 pump operators now use JalSoochak, collectively logging over 20 lakh readings. Together, those entries account for more than 37,600 million litres of water supply recorded.

Assam also made something else clear: what works in one state will not simply work everywhere. Each state has its own administrative logic, its own infrastructure, its own ways of capturing supply data. JalSoochak had to be rebuilt to absorb that variation rather than ignore it.

The platform now supports multiple modes of input — bulk flow meters, electric meter readings, pump operation duration, IoT devices, and manual entries. It works in local languages. Rather than running parallel to existing government systems, it is built to plug into them, so the data flows to where decisions are actually made, without creating extra work for anyone in the chain.

“JalSoochak is not just a technology platform. It is an attempt to strengthen service delivery to ensure that the investments made in rural water systems translate into reliable services for people. The journey from Assam to a national scale Digital Public Good has been about one core idea: making data useful for action, where it matters most,” said Deepak Gupta, Director of Digital Infrastructure and Government Partnerships, Arghyam.

JalSoochak is part of a broader effort to build a Digital Public Infrastructure for India’s water sector — a set of open, interoperable systems through which data can move across programmes and institutions, enabling governments to respond to problems where and when they actually occur, rather than when they finally show up in a report.

Crores of households now have a connection. The question that follows is simpler, and harder: is the water actually there? Getting a reliable answer to that question, consistently, across every village and every state, is what the next phase of rural water delivery will depend on.

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