Most rural poor have problems in accessing health care services not because they lack trust on biomedicine as is usually thought but because of the failure of the state to take cognisance of social spaces in health care policies. Secondly, the biomedical approach to human suffering is clearly inadequate especially in developing countries. Findings of a study of the leptospirosis epidemic in Gujarat show that the quick supply of drugs, opening of special wards in the hospitals, increased allocation of equipment, doctors, health workers, during the 1997-99 epidemics failed to save lives. The improvement of services and equipment temporarily during epidemics at PHCs and community health centres did not help change the reputation of these institutions overnight.