How a Hospital's Definition of Health Care Includes Education and Anti-Trafficking Programs for Dalit Children

Human Trafficking in Rural Bihar: Asha’s Story

HIT partner Madhepura Christian Hospital champions a holistic approach to health that includes 

• Fighting human trafficking

• Opening doors to education for boys and for girls

• Putting off marriage until age 18

The hospital's Community Health and Development Program walks with children on the hard road out of complex poverty towards education, hope, and dignity.

Keep reading to learn more–

For Asha, growing up in the flood-prone plains of Madhepura, Bihar, whatever counts as childhood ends about the same age as other children in India are learning to ride a bicycle – the age when children in her rural village get caught in the stranglehold of child marriage, human trafficking, or migrating with a parent to work.

Through poverty’s lens, “children staying in school doesn’t make sense because (families) are desperate to eat today,” says Arpit Mathew, surgeon and former director at Madhipura Christian Hospital. 

In fact, education seems even irresponsible if a child can earn a small wage or a small meal.

Like 63 percent of the people in Bihar, Asha is considered low caste. And her group, the Mahadalit, is the government classification for the most “backward, deprived, and landless.” Also called Musahar, rat eaters, they have the tragic distinction of being “untouchable to the untouchables.”  

“In a country that is sophisticated in so many ways, it is hard to wrap one’s mind around the discordance between the way other Indians live and the way the Mahadalit still live,” he says. “There aren’t opportunities for thriving, just subsistence.” 

MCH’s Community Health and Development program has been fighting this seemingly unshakable outcome for more than 15 years with a broader definition of “community health.” The hospital invests in holistic health initiatives in its rural community. It also kicks against centuries-old stereotypes that rob neighbors of their health, safety, and dignity.

“People are born into a system that teaches them they are subhuman,” Arpit says. “That they have no value except to do the bidding of others. It works for the oppressor who believes that they are in some way better. And it suppresses the mind of the Dalit, who believes that this is the way life has to be.”

It is in this environment that human trafficking becomes a predatory reality. Agents and middlemen take advantage of families who are desperate and tired, and think there is no choice for their future. When a family hasn't had enough to eat in days, a middleman offering $50 to take a daughter away for "work" in the city sounds less like a crime and more like a lifeline.

Bihar's Geography of Vulnerability

The hospital is located in northeast India near its border with Nepal. Rivers fed by cool, silty snowmelt flow from Tibet through the Himalayan mountains and into the plains, supporting Bihar's agrarian economy.

The flood-prone Kosi River, nicknamed the Sorrow of Bihar, curves around the city. In 2008, floodwaters diverted an old river channel through the Himalayan mountains and rushed through a new course.

Madhipura suffered some of the worst of the disaster that inundated roughly 400 square miles and displaced almost three million people. It destroyed the hospital. For the landless—nearly 90 percent of the Mahadalit community—the only options were migrating to cities for day labor or becoming even cheaper prey to those who profit from desperation.

The devastation became a chance to rebuild more than just the clinic, Arpit says. Teams went into the villages – often on boats – and began to provide flood relief. As relationships grew over time, the team, together with the different groups throughout the community, identified core problems. Then they worked together to identify solutions.  Now the Madhepura Community Health and Development Program is involved in job training and livelihood, health and nutrition, community organization, disaster preparedness, and Dalit empowerment programs. And anti-trafficking education.

Weirdly both ubiquitous and unnoticed, human trafficking is too common to be out of place when a stranger visits a village and offers money for a child. Unnoticed by regular schools or a community that migrates for work, rural children disappeared so often that it is rarely even reported. 

How MCH’s Anti-Trafficking Program Prevents

Child Exploitation

The community never discussed it as a danger – or even seemed to consider it stoppable–but the hospital attacked the issue. 

Along with the village committees, it started educating villagers about the realities of human trafficking.

Adolescent groups in the villages now teach younger children about their rights and the realities of early child marriage, trafficking, and exploitation. The hospital formed child protection committees that register all children, keep track of their whereabouts, and record every visitor and to flush out those who would harm.

“We go to schools and talk about it. We educate in the villages. We’ve built strong relationships since (the flood in) 2008, so there is trust,” Arpit says.

Radical Proximity: Walking with “untouchables.”

Most medical centers would view anti-trafficking education, along with Dalit empowerment programs, women’s literacy, and schools, as outside the hospital’s purview. Maybe even a distraction. 

MCH considers these central to the mission.

“Our goal at MCH, and throughout the Emmanuel Hospital Association, is not just to build hospitals but to be salt and light in the community,” Arpit says. “We want to see God’s shalom.” This is a great challenge for the hospitals as staff examine the realities of the communities. “If we are just running the hospitals without addressing the needs of the community, the hospitals would be doing great work but missing the point.” 

Some groups fight trafficking through legal advocacy or border intercepts. Madhipura Christian Hospital chose proximity.

“It’s not a programmatic model. It’s just walking with the people,” says Arpit. Adding simply: “We know all the children.”

Today, MCH’s network has grown from seven to 35 villages, all of which have child protection committees. In the villages where these committees work, a trafficker hasn’t come for a child in five years.

The hospital’s approach is holistic, attacking the issues of early marriage and exploitation through:

Adolescent Groups: 10 groups that educate young people on their rights.

Vocational Training: Providing skills that increase a person's economic worth.

Non-Formal Education: Schools designed specifically for those who have been excluded from the traditional system.

One of the children that the hospital got to know was Asha.

Dalit Empowerment and the Cost of a "No"

The potential for trafficking is always present. But keeping children out of the estimated $ 236 billion industry of forced labor and forced sexual exploitation may be, grimly, the easiest piece. Harder is the sexual exploitation of child marriage. Especially if the man is older or from a different village, there is no guarantee that the girl will be safe. Neither can MCH care for the children once they migrate for work.

Those battles have to be won daily.

But winning those battles brings on a different type of battle.

Neighbors whispered, why waste money on a girl?

“When there was no food in the house, education felt like a risk,” Asha recalls. “Many girls around me disappeared from school—married off, sent away for work, or taken under the promise of a better life.”

Choosing to stay in school was an act of defiance. It meant walking long distances while facing discrimination and being told she didn’t belong. It meant returning home in tears, feeling "small and unwanted." The project staff from Madhipura Christian Hospital stood with her family during these moments—listening, counseling, returning even when hope felt thin.

Johnson Digal, Community Health and Development Administrator, started working in the community in 2009 and has watched Asha and others grow up. 

Asha’s father was a migrant laborer, away for most of the year, leaving her mother to try to feed and protect their children. MCH helped the family lease land and provided training in vegetable farming.

Which meant Asha’s father could stay with his family.

Which gave the family enough stability that Asha could continue in school.

Now a Role Model

Today, Asha’s life looks remarkably different from the one she was born into. After graduating from MCH’s Non-Formal Education School, she completed a Health Assistant course. She started working at the hospital, got married at age 20—almost a decade later than many of her peers—and has a young son.

Now, she returns to the same villages where she once felt unwanted, offering encouragement to the next generation of girls. 

“Choosing education in such a setting means choosing pain before hope,” Johnson Digal reflects. “Asha’s journey took years of struggle, tears, and resisting the pressure to quit. Her success is not accidental; it is the result of long-term presence, trust, and courage.”

Every year she grew older, the pressure to drop out and get married got stronger. Saying “no” invited shame, gossip, and social isolation. Her family was afraid of angering the community, afraid of violence, afraid of being pushed out, he said.

The work is far from over. Out of 465 villages in the district, MCH currently operates only in 35. The scale of the problem is vast, and the system of caste continues to whisper to children that they are "subhuman."

Expanding Education: Redefining the Value of a Person

“The only way to truly protect them from being trafficked is to increase their (economic) worth,” Aprit says. Even as MCH staff relentlessly show their neighbors that they are worth human dignity, they are fighting the pre-existing price tag of market demand. 

MCH is pushing into more villages and has more ambitious dreams for education. “People tell us it is a waste of time to try to educate Musahar children,” Arpit says.

But walking with Asha gives her village a different story.

“While livelihood training is a pressing need, the ultimate solution is education. The hospital is in the process of purchasing land for a higher education school for the Mahadalit children who graduate from the non-formal schools.

Their money can be stolen, their land can be grabbed, and their animals can die, but education can never be taken away from them. “If we can educate them,” Dr. Arpit says, “we can cause generational change.” 

Amidst the depths of poverty and oppression that MCH operates in, there is often cause for discouragement and despair. However, MCH exists and functions with hope, seeing the value of every individual as part of its calling.

But as the influence and reach of MCH spreads, each precious life that is touched and transformed is worth celebrating and rejoicing over. They press on towards a tipping point when the oppression of trafficking and organized childhood abuse will be a thing of the past, and every child, regardless of caste, can have a childhood.

HIT and our national partners layer tangible solutions to tackle complex challenges. Every generously given donation allows us to continue. Please support our anti-trafficking and education work by donating to Health Care and commenting on how you would like your gift to be used.