![What the numbers do not account for…..night beat in KG Halli]()
by iphindia | Oct 24, 2012 | Blog, Latest Updates
Life has its unique ways of showing you what you might be looking for. As a purely logistic decision, it made more sense for me to stay overnight in the community centre and this gave opportunity to observe a different side to KGHalli….after dusk. Suddenly “urban” lifestyle took on new meaning for me in the context of health planning.
A walk down Tannery road at 10 pm is like walking down any other big street in Bangalore at 7pm. Like the jaws of a aging man, dark gaps where the bike workshops punctuate the shining rows of shops, many with brightly lit interiors, the city seems to swallow one up. I notice most of the people walking the street are men; the rare family, but as a single unaccompanied woman, I do not draw many glances. This is a world where anonymity is the norm. People are very occupied, earning their living. Every street corner has a hole in the wall eatery with the owner dishing out hot chicken wings from a frying hot ‘kadhai’. Large neon signs in every colour advertise “goodies” of all kinds, from clothes to shoes to accessories to ….and here we have it…. to medicines. As I strolled along, three large, glass- fronted pharmacies caught my attention, the window displays abundantly showcasing expensive and (to my mind), unnecessary products. The vitamins of old have been successfully replaced by “sugar-free” and equivalent products meant to lull the obese patient into the ‘soft’ pill option.
It is well known that many hospitals have their own pharmacies – convenience for the patient being the supposed rationale. By extension, the small clinics often have a drugstore next door. However, by a strange twist, the unstated, unpalatable truth is that the drugstore has the clinic and therefore the doctor. So it was with a great sense of curiosity that I wandered into the newly built 15 bedded hospital adjacent to the large glass fronted pharmacy. I had met the Managing Director , a twenties- something doctor when the hospital opened an hour ago, but community feedback was that it had not really take off. So I was surprised to see three patients in the ’emergency’ ward, all on ‘glucose drips’ , two of these being children. I caught sight of two ‘duty doctors’ identifiable by their stethoscopes and slightly preoccupied air. Evidently the beds are slowly filling up, although there is no permanent staff in place.
As I continued down the road I greeted an older homeopathy doctor known to me. When our team did a survey of existing service providers he had said he comes only once a week. Now, he sheepishly told me ,he comes every night between 9 and 10 pm, this is clear understanding with his regular patients.
And as I continue to walk down Tannery road, every clinic locked in the daylight hours when we have been visiting has been magically opened…with functioning health service providers. It appears they have each created their little niche with specific timings and patient profiles.
When we sit and plan the number of doctors required to serve a particular population ….24/7 services and continuity of care, my lesson from this night would be “Beware the oversimplifying standardisations…..you need to factor in the ingenuity of the human being in his need for survival, where he will not just meet a demand, but unblinkingly create it!’
So one more challenge to the complexity of local health systems……
Take a walk, my friend, take a walk……..
by iphindia | Aug 20, 2012 | Blog
Where Do I Begin………….. to tell the stories of urban polity …
the enduring tales of life as it is least meant to be …..
in a just fair world……?
(To be sung to theme tune of Love Story)
Did you read the where do I begin part-1 ?(click here)
In the afternoon…..
Our next halt takes us to the home of of Anwar bhai, 42 year old dialysis patient. Anwar has been in the business of recycling for many years, he describes Bangalore as a city that has undergone immense changes, none for the better in his opinion, “yeh jabh computer companies aye hei behen, bangalore ki halath bilkul kharab ho gai hei” (Since the computer companies sister, bangalore has gone to the dogs). He outlines how the rich have gone steadily richer, but nothing has improved for the poor. His wife, pleasant faced, cheerful, brings out the ubiquitous chocolate flavoured 3 roses tea in the tiny cups. This hospitality is a hallmark of practically all poor patients who are residents of K.G Halli.
“It all started,” she says, “when in 2008 he visited Ambedkar and Bowring hospitals. He was diagnosed to have a kidney problem and advised dialysis 3 times a week.” They were visiting Mahavir Jain Hospital for treatment when one day, when returning in the auto, he had a stroke. Distraught as one hand and leg no longer moved and he had lost his speech, she rushed him back to the hospital to be told he had a clot in the brain. We need to take a CAT scan they said and this was the beginning of a 9 day hospital stay that cost them 28 thousand rupees. As she talks. I’m leafing through Anwar bhai’s medical files, a testimony to over-investigated defensive practise of medicine. One of the lucky ones, he has some use of his limbs and his speech remains slurred but he is not bedridden. However his kidneys continue to malfunction and so the trips to the hospital continue. They have now been forced to visit Al-Amein hospital which seems to have the cheapest dialysis rates in the area. In contrast to the 1800 rupees quoted in other hospitals, Al-Amein officially charges only 750 rupees. However, the begum says, the total trip comes to 1000 rs per session, including the travel, a snack and sometimes a bribe. When I asked her how they coped with paying these vast sums of money, she said very matter of factly, all her jewellery is gone. In addition, 2 college going suns have been withdrawn and now are apprentices in welding workshops where they are paid a stipend in addition to learning the skill. The third boy, doing his 10th standard has stopped school and now works in a shop on M.G road. The last boy, tired from his roza fasting, lay asleep on the floor. Anwar bhai is perplexed by his condition. “I never smoked, I never drank,” he says, “I wonder why Allah had this in store for me.” And we are brought up short again, remembering hypertension being described as the silent killer. His wife on the other hand, stoic in her narration, breaks down only when she describes the doctors attitudes. “We don’t expect them cure everything and know all,” she says, “but is it too much to expect them to have a kind word and an explanation for patients and relatives who do not know what is happening?”
And we walk back to the centre…….
Jyothi is a middle aged, grey haired lady who trudges up the staircase of our centre, with her little granddaughter of four years, Darshini. Tired after teaching in the local school, classes 6-10 she has forgotten to bring the medical files we requested her to bring along. She has been teaching for 22 years and earns 4000 rupees per month. Extra income comes from tuitions to the occasional student. She describes three medical crises in the family over the last year. Her daughter Shankari (Darshini’s mother) had had an IUCD insertion after Darshini’s birth. A rare complication, she suffered an ectopic pregnancy and complaining of abdominal pain went to a local hospital. She was diagnosed there with appendicitis and when there was no improvement after two days, they took her to Ambedkar hospital, who referred them to Bowring. Jothi describes the stress of travelling with this daughter in autos and finally being referred to KIMS where she was operated for the ectopic pregnancy. This happened 8 months ago. 3 months later Jothi herself has symptoms of vomiting and nausea and visited the local hospital. With no improvement, her husband rushed her in acute pain to Ambedkar where she was told the operation theatre was closed because of some viral infection. They moved on to Bowring where 4-5 scans were taken and finally she had an hysterectomy- she still has low blood pressure and occasional bouts of vomiting. What might be the straw for the camel’s back is her husband who has cirrhosis of the liver. Chronic alcoholic in earlier days, he has been advised today to get admitted in Ambedkar hospital. Jyothi has two sons, Vinod who has passed his tenth and Arish, 2nd PU failed. Neither of these young men feel obliged to contribute to the financial crisis in the family. “When I asked him to go to work, they ask me to get them motorcycles,” she says, shaking her head sadly. “I really don’t know what to do next.” Jothi has spent to the tune of 1.5 lakh rupees ( 150,000) on medical care in the last one year.
And then we take the bus home……..to work on some fledgling ideas of health financing for the poor……
by iphindia | Aug 6, 2012 | Blog
Where Do I Begin…
to tell the stories of urban poverty…
the grimmest tales that tell of what the ‘We’ do to the ‘we’… Where do I start…?
(To be sung to theme tune of Love Story)
Sometimes I don’t know whether to laugh or to cry………
This in an era of experts helping us towards reaching the millennium development goals……
My week began with two field visits with our ‘girls’ (community health assistants) to homes in K.G Halli. I’m sharing these stories because I think they give faces to the graphs linking urbanisation and poverty…..catastrophic health expenditure in 2012.
The first house was probably 10 feet square. Lined against one wall, were the total belongings of this 7 membered family,trunks, blankets, clothes, a stove, and assorted vessels. The youngest entrant in the family is tiny, all of 40 days. Josephine, our CHA, informed me that the mother, Shahina (name changed) had received 4 bottles of blood, while delivering this little one. Shahina’s husband, roughly 35 years old, prematurely aged is a wall painter, often out of work. Their older children, aged 14, 10, 8, 6 were lined up like sausages, with the father, sitting up at one end. Hastily, they drew out a mat to seat us and as always offered us refreshments. On enquiry we found everyone was fasting because of the holy month of Ramdan. Their problem was, they wanted no more children. It turned out that when Shahina delivered, she could not undergo a tubectomy because it would extend her hospital stay (and who would look after the family?) So, the staff fairly forcefully suggested the insertion of an intrauterine contraceptive device (IUCD). Shahina now has to look after the same family with profuse bleeding and a constant backache. It appears that our family planning services, far from a cafeteria approach really cannot meet the needs of an individual women.
Next we saw Aasha (Name Changed) pregnant for the fourth time with three little boys. She’s 2 months overdue her period and wants to abort this baby because she has had enough. Her husband to, probably not knowing the repercussions of such a procedure, both physical and psychological is urging her towards an Medical Termination of Pregnancy (MTP). The only thing holding her back so far has been the cost. She cannot afford to pay the 600Rs. Suggested in the nearby govt. centre. Aasha is thin, anaemic and probably representative of the chronic malnutrition or hunger situation that our country is screaming about. I ask her whether she is eating properly and she says, “I’m just so tired amma, I don’t have the energy to eat”. Interestingly Aasha is a Tamil speaker who has brought to the centre by her Muslim neighbour who speaks both Urdu and Tamil. Getting all these details is always in K.G Halli a three way translation discussion.
Our final halt for the morning takes us to the house of a young woman who is carrying on, despite all. Her father passed on three years ago, after “ keeping everything ready for her marriage” , simple kitchen utensils, a stove, a bed….. But he did not prepare her for a time she would need to fend for herself. Her younger brother committed suicide three months ago after a short- lived “love- marriage”….we do not know why, and now she and her mother have no source of income. The house, smelling of garlic from round the corner, is full of these pods as the two women peel four kilos a day for the royal sum of sixty rupees. There is a small bright lamp in this house with the oppressive atmosphere of unexpressed grief, in the shape of a young 12 year old boy, her cousin, who stays with them and helps with all the chores and running around…….His cheeky wit and quick answers bring andwering smiles from all of us……
And we walk back to the centre…….
to be continued…Where Do I Begin (part-2)
![What the numbers do not account for…..night beat in KG Halli]()
by iphindia | Jul 14, 2012 | Blog, Latest Updates, Research
It was another day in the field collecting data for Health Inc project. The team reached village near Nelamangala. After meeting staff in Gram Panchayat (GP) we were asked to talk to Anganawadi teacher and take her help to identify the houses for collecting data. But the teacher was not happy to accompany us. She said “why should I help you? it is GPs responsibility”, however we managed to convince her to accompany us.
Source*
Interesting discussion started after that, we gave her the list of household and explained where we got that list. She said…oh then I have that list with me and I also have many cards in the cup board and she took out box full of Rashtriya Swasthya Bima Yojana (RSBY) smart cards. When asked why cards were not distributed..she said…”why should I give, it is GPs responsibility”! It was clear there was no coordination between Anganawadi teacher and GP. But it was poor who were deprived of benefit. I asked teacher, do you know what this card is. She said yes it is health card!! Do you know anything more than that? No…that is the only information given on the day of camp!!
Then team got divided and along with Mr Omkar I followed teacher to one house. Teacher first entered the house and said there are some people who want to collect information and she started walking out. I heard female voice from inside asking what information? Teacher screamed from outside.. “about that PAN card you collected from me last week”!! I said …what!! PAN card…no no we are not here to collect information about PAN card…teacher smiled and said “madam these people don’t understand” and she started walking away….I questioned myself…who does not understand? Does the teacher understand? How does she know they do not understand? Anyways it was time for me to get inside the house and sit with Omkar.
When Omkar showed RSBY smart card asked do you know about this card….informant said yes it is AADHAAR card (AADHAAR is Unique Identification number issued by Govt India) and when asked who told you that…Anganawadi teacher came and called us to take photo for AADHAAR card and she gave this card later. Informant showed some paper which was given on the day photo was taken; those papers were related to AADHAAR.
I thought on the day of camp did they take photos for AADHAAR and RSBY? Why was no information given to people about RSBY? Why did Anganwadi teacher call people for AADHAAR card? Did not get answer but thought may be people responsible to issue cards felt poor people will not understand or they did not want to give information? Not sure but I moved to next house thinking does different types of card means the same for poor…NO BENEFITS & NO INFORMATION?
*http://www.rsby.gov.in/
by iphindia | May 4, 2012 | Blog
ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರದ ಕಿರಿಯ ಮಹಿಳಾ ಅರೋಗ್ಯ ಸಹಾಯಕಿಯರು ತಮ್ಮ ಕ್ಷೇತ್ರದಲ್ಲಿ ಎದಿರುಸುತ್ತಿರುವಾ ಸಮಸ್ಯೆಗಳು ಮೇಲೆ ನಮ್ಮ ಕ್ಷೇತ್ರ ಭೇಟಿಯ ಅನುಬವಗಳು
ಪ್ರಾಥಮಿಕ ಆರೋಗ್ಯ ಕೇಂದ್ರ ಮತ್ತು ಸಮುದಾಯಗಳ ನಡುವೆ ಅತ್ಯಂತ ಬಾಹ್ಯ ಮತ್ತು ಜನರ ಆರೋಗ್ಯಕ್ಕೆ ಸಂಬಧಿಸಿದ ಮೊದಲ ಆರೋಗ್ಯ ಸಂಪರ್ಕ ಕೇಂದ್ರವೆಂದರೆ ಅದು ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ. ಪ್ರತಿ ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರಕ್ಕೆ ಸಾಮಾನ್ಯ ಪ್ರದೇಶದಲ್ಲಿ ೫೦೦೦ ಜನಸಂಖ್ಯೆ ಇರಬೇಕಾಗಿದ್ದು ಹಾಗೂ ಗುಡ್ಡಗಾಡು ಪ್ರದೇಶದಲ್ಲಿ ೩೦೦೦ ಜನಸಂಖ್ಯೆ ಇರಬೇಕು ಎಂಬುದು ನಿಯಮವಿದೆ ಆದರೆ ಪ್ರಸ್ತುತವಾಗಿ ಸಾಮಾನ್ಯ ಪ್ರದೇಶದ ಕೆಲವು ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರಗಳಲ್ಲಿ ೭೦೦೦ ಕಿಂತ ಹೆಚ್ಚು ಹಾಗು ೨೦೦೦ ಕಡಿಮೆ ಜನಸಂಖ್ಯೆ ಕೂಡ ಹೊಂದಿವೆ, ಪ್ರಸ್ತುತವಾಗಿ ಭಾರತದಲ್ಲಿ ೧,೪೫,೨೭೨ ಆರೋಗ್ಯ ಉಪ-ಕೇಂದ್ರಗಳು ಕಾರ್ಯನಿರ್ವಹಣೆಯಲ್ಲಿವೆ. ಪ್ರತಿಯೊಂದು ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರದಲ್ಲಿ ಕಿರಿಯ ಮಹಿಳಾ ಆರೋಗ್ಯ ಸಹಾಯಕಿ (ಕಿ.ಮ.ಆ.ಸ) ಮತ್ತು ಕಿರಿಯ ಪುರುಷ ಆರೋಗ್ಯ ಸಹಾಯಕ (ಕಿ.ಪು.ಆ.ಸ) ಎಂಬ ಸಿಬ್ಬಂದಿಗಳ ಮೂಲಕ ಈ ಕೆಳಗಿನ ಸೇವೆಗಳನ್ನು ಒದಗಿಸಲಾಗುತ್ತಿದೆ. ಉಪಕೇಂದ್ರದಲ್ಲಿ ದೊರುಕುವ ಮುಖ್ಯ ಸೇವೆಗಳು ಎಂದರೆ; ತಾಯಿ ಮತ್ತು ಮಗುವಿನ ಆರೋಗ್ಯ ಕಾಳಜಿ ಅವರ ಪೌಷ್ಟಿಕತೆಯ ಬಗ್ಗೆ ಪೋಷಣೆ, ಮಕ್ಕಳಿಗೆ ಮಾರಕ ರೋಗ-ನಿರೋಧಕ ಲಸಿಕೆ ನೀಡಿಕೆ, ಅತಿಸಾರ ನಿಯಂತ್ರಣ, ಸಂಪರ್ಕ ರೋಗಗಳ ಬಗ್ಗೆ ಜನರಿಗೆ ಅರಿವು ಮೂಡಿಸುವುದು ಮತ್ತು ಅವಗಳ ನಿಯಂತ್ರಣ ಹಾಗೂ ಪರಸ್ಪರ ಸಂವಹನ ಮುಖಾಂತರ ವರ್ತನೆ ಬದಲಾವಣೆ. ಪುರುಷ, ಮಹಿಳೆ ಮತ್ತು ಮಕ್ಕಳಿಗೆ ಅವಶ್ಯಕ ಆರೋಗ್ಯ ಬೇಡಿಕೆಗಳಿಗೆ ಬೇಕಾದ ಚಿಕ್ಕವ್ಯಾದಿಗಳಿಗೆ ಮೂಲ ಹಾಗು ತುರ್ತು ಔಷಧಿಗಳು ಕೂಡ ಲಭ್ಯವಿರುತ್ತವೆ.
ಆರೋಗ್ಯ ಇಲಾಖೆಯ ಅಡಿಯಲ್ಲಿ ಯಾವುದೇ ಹೊಸ ಕಾರ್ಯಕ್ರಮಗಳನ್ನು ಪರಿಚಯ ಮಾಡಿ, ಆ ಕಾರ್ಯಕ್ರಮ ಯಶಸ್ವಿಯಾಗಿ ಅನುಷ್ಟಾನವಾಗಬೇಕಾದರೆ, ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಹಾಗೂ ಅದರ ಕಿ.ಮ.ಆ.ಸ ಪಾತ್ರ ಬಹಳ ಮುಖ್ಯ ಹಾಗೂ ಅವಶ್ಯಕ. ಈಗಾಗಲೆ ಆರೋಗ್ಯ ಇಲಾಖೆಯಿಂದ ಹಲವಾರು ಕಾರ್ಯಕ್ರಮಗಳು ಅನುಷ್ಟಾನವಾಗಿ ಕೆಲವು ಯಶಸ್ವಿ ಹಂತದಲ್ಲಿದ್ದರೆ ಇನ್ನು ಕೇಲವು ಕಾರ್ಯಕ್ರಮಗಳು ಗುಣಾತ್ಮಕವಾಗಿ ಯಶಸ್ವಿಹಂತದಲ್ಲಿಲದಿದ್ದರು ಕು೦ಟುತ್ತಾ ಸಾಗಿವೆ. ಇದಕ್ಕೆ ಕಾರಣ ಏನು ಎಂದು ನೋಡುತ್ತಾ ಹೋದರೆ ಆರೋಗ್ಯ ಕಾರ್ಯಕ್ಷೇತ್ರದ ಮೂಲಮಟ್ಟವಾದ ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರ ಹಾಗೂ ಕಿ.ಮ.ಆ.ಸ ಎದಿರುಸುತ್ತಿರುವ ಹಲವಾರು ಸಮಸ್ಯೆಗಳು ಪರೋಕ್ಷವಾಗಿ ಈ ಕಾರ್ಯಕ್ರಮಗಳ ಅನುಷ್ಟಾನ ಗುಣಾತ್ಮಕತೆಯಲ್ಲಿ ಕಡಿಮೆ ಆಗಿರುವುದಕ್ಕೆ ಕಾರಣ ಕಂಡುಬರುತ್ತದೆ
ಹಾಗಾದರೆ, ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಮತ್ತು ಅದರ ಕಿ.ಮಾ.ಆ.ಸ ಎದಿರುಸುತ್ತಿರುವ ಸಮಸ್ಯೆಗಳಾದರು ಏನು? ನಮ್ಮ ಕಾರ್ಯಕೇತ್ರ ಭೇಟಿ ಸಂರ್ದಭದಲ್ಲಿ ಕೆಲವು ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಕಿ.ಮಾ.ಆ.ಸ ನಮ್ಮೊಡನೆ ಹಂಚಿಕೊಂಡಿರುವ ಕೆಲವು ಸಮಸ್ಯೆಗಳುನ್ನು ಇಲ್ಲಿ ಪ್ರಸ್ತಾಪಿಸಾಲು ಇಚ್ಚಿಸುತ್ತೇನೆ; ವರದಿ ತಯ್ಯಾರಿ ಮತ್ತು ರೆಜಿಸ್ಟರ ಬರೆಯುವದು, ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ (ರಾಷ್ತ್ರೀಯ ಗ್ರಾಮೀಣ ಆರೋಗ್ಯ ಅಭಿಯಾನ) ಬರುವುದಕಿ೦ಥ ಮುಂಚೆ ೧೬ ರಷ್ಟು ರೆಜಿಸ್ಟರಗಳು ಪ್ರತಿ ಕಿ.ಪು.ಆ.ಸ ಬರೆಯುತ್ತಾ ಬಂದಿದ್ದು ಈಗ ಇವುಗಳ ಸಂಖ್ಯೆ ಹೆಚ್ಚಾಗಿದೆ. ದಿನಗಳ ಪೂರ್ತಿ ಹಳ್ಳಿಗಳ ಮತ್ತು ಮನೆ ಭೇಟಿ ಮಾಡಿ ಮರಳಿ ಮನೆಗೆ ಬಂದು ೧೬ ಕಿಂತ ಹೆಚ್ಚಿನ ರೆಜಿಸ್ಟರಗಳ ನಿರ್ವಹಣೆ ಮಾಡುವುದು ತುಂಬಾ ಕಷ್ಟ. ಅಲ್ಲದೆ ವಿವಿಧ ಕಾರ್ಯಕ್ರಮದ ಮೇಲಿನ ಅಧಿಕಾರಗಳು ಪ್ರತಿತಿಂಗಳು ಒಂದಲ್ಲಾ ಒಂದು ವರದಿ ಸ್ವರೂಪದಲ್ಲಿ ಹೊಸ ಬದಲಾವಣೆ ಮಾಡಿ, ತತಕ್ಷಣ ವರದಿ ಸಲ್ಲಿಸುವಂತೆ ಕೇಳುತ್ತಾರೆ, ತತಕ್ಷಣ ವರದಿ ಸಲ್ಲಿಸುವದು, ಅದರಲ್ಲಿ ಹೊಸ ಸ್ವರೂಪದ ವರದಿ ಸಲ್ಲಿಸುವುದು ತುಂಬಾ ಕಷ್ಟದಕೆಲಸ.
ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ ಬಂದನಂತರ ಪ್ರತಿ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಗಳಿಗೆ ರೂ: ೧೦,೦೦೦ ಮುಕ್ತ ನಿಧಿ ನೀಡುತ್ತಿದ್ದು, ಆ ಹಣವನ್ನು ಉಪ ಕೇಂದ್ರಗಳ ಸಣ್ಣ-ಪುಟ್ಟ ದುರಸ್ತಿ. ಅನಿರೀಕ್ಷಿತ ಅವಶ್ಯಕ ಘಟನೆಗಳಿಗೆ ಮತ್ತು ತಕ್ಷಣದ/ತುರ್ತು ಔಷಧಿ ವೆಚ್ಚವನ್ನು ಪೂರೈಸಲು ಹಾಗೂ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಕ್ಕೆ ಬೇಕಾಗುವ ಸಣ್ಣ-ಪುಟ್ಟ ಸಲಕರಣೆಗಳ ಖರೀದಿಗೆ ಈ ಹಣದಿಂದ ವೆಚ್ಚಮಾಡಬಹುದು. ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ ಅಡಿಯಲ್ಲಿ ಪ್ರತಿ ಉಪ ಕೇಂದ್ರಗಳಿಗೆ ರೂ ೧೦,೦೦೦ ನೀಡಿರುವದು ತು೦ಬಾ ಸಂತೋಷದ ವಿಷಯ ಆದರೆ ಈ ಹಣದಲ್ಲಿ ಯಾವುದೇ ಹಣ ವೆಚ್ಚ ಮಾಡಬೇಕಾದ್ದಲ್ಲಿ, ವೆಚ್ಚಮಾಡಬೇಕಾದ ಚೆಕ್ ಮೇಲೆ ಗ್ರಾಮ ಪಂಚಾಯತಿಯ ಅಧ್ಯಕ್ಷರ ಸಹಿ ಇರಲೇಬೇಕು, ಪ್ರತಿ ಕಿ.ಪು.ಆ.ಸ ತಮ್ಮ ವೃತ್ತಿಗೆ ಸಂಬ೦ದಿಸಿದ ಎಷ್ಟೋ ಮುಖ್ಯ ಕೆಲಸಗಳನ್ನು ಬದಿಗಿಟ್ಟು ಈ ಒಂದು ಸಹಿಗಾಗಿ ಮೂರ ರಿಂದ ನಾಲ್ಕು ಬಾರಿ ಗ್ರಾಮ ಪಂಚಾಯತಿಯ ಅಧ್ಯಕ್ಷರ ಮನೆಗೆ ಅಲೆದಾಡಬೇಕಾಗುತದೆ, ಈ ಒಂದು ಓಡಾಟದಲ್ಲಿ ತಮ್ಮ ಅಮುಲ್ಲ್ಯವಾದ ಸಮಯ ವ್ಯಯವಾಗುತ್ತಿದೆ ಎಂಬುದು ಕಿ.ಮ್. ಆ. ಸಹಾಯಕಿಯರ ಅಭಿಪ್ರಾಯ.
ಎಂ,ಸಿ,ಟಿ,ಎಸ್(ತಾಯಿ ಮತ್ತು ಮಗುವಿನ ಟ್ರ್ಯಾಕಿಂಗ್ ವ್ಯವಸ್ಥೆ) ಮತ್ತು ಎಚ್,ಎಮ,ಆಯ್,ಎಸ್ (ಆರೋಗ್ಯ ನಿರ್ವಹಣಾ ಮಾಹಿತಿ ವ್ಯವಸ್ಥೆ) ಗಳನ್ನೂ ಪರಿಚಯಿಸಿ ಸುಮಾರು ೩-೪ ವರ್ಷಗಳು ಕಳೆದರೂ ಕೂಡಾ ಇವಗಳು ಇನ್ನು ಮುಖ್ಯವಾಹಿನಿಗೆ ಬರುತ್ತಿಲ್ಲಾ ಏಕೆ ಎಂದು ಕಾರಣ ಹುಡುಕುತ್ತಾ ಹೋದರೆ; ಕೆಲವು ಕಿ.ಪು.ಆ.ಸಹಾಯಕಿಯರು ಇನ್ನು ಸಮುದಾಯ ಆಧಾರಿತ (Community based) ಅಥವಾ ಸೌಲಭ್ಯ ಆಧಾರಿತ (Facility based) ಕೇಂದ್ರಗಳ ವರದಿ ವ್ಯವಸ್ಥೆಯ ಅರಿತುಕೊಳ್ಳುವ ಗೊಂದಲದಲ್ಲಿ ಕೆಲವರು ಇದ್ದರೆ ಇನ್ನು ಕೆಲವರು ಎಂ,ಸಿ,ಟಿ,ಎಸ್ ಅಂತಹ ತಂತ್ರಜ್ಞಾನಕ್ಕೆ ಮೊಬೈಲ ಮೊಲಕ ವರದಿ ಸಲ್ಲಿಸವುದರಲ್ಲಿ ಪರದಾಡುತ್ತಿದ್ದಾರೆ, ಹಳೆ ತೆಲಮಾರಿನ ಕೆಲವು ಕಿ.ಮ.ಸಹಾಯಕಿಯರು ಕಾರ್ಯಕ್ಷೇತ್ರ ಭೇಟಿ ಮತ್ತು ಮನೆಯ ಬೇಟಿ, ಆಪ್ತಾಸಮಾಲೋಚನೆ ಹಾಗು ಹೆರಿಗೆ ಮಾಡುವದು, ಇತ್ಯಾದಿ. ಹೀಗೆ ಆರೋಗ್ಯಕ್ಕೆ ಸಂಬದಿಸಿದ ಇತರೆ ಚಟುವಟಿಕೆಗಳಲ್ಲಿ ನೈಪುಣ್ಯತೆ ಹೊಂದಿದ್ದು, ಆದರೆ ಎಂ.ಸಿ.ಟಿ.ಎಸ್ ಅಂತಾ ಹೊಸ ತಂತ್ರಜ್ಞಾನಕವನ್ನೂ ತಿಳಿದುಕೊಳ್ಳಲು ಹಾಗು ಅದಕ್ಕೆ ಸಂಬ೦ಧಿಸಿದ ಕೆಲಸ ನಿರ್ವಹಿಸಲು ಪದೆ-ಪದೆ ಇನ್ನೊಬ್ಬರಿಂದ ಸಹಾಯ ಕೇಳುವುದು ಪ್ರತಿ ಕಿ.ಮ.ಸಹಾಯಕಿಯರಿಗೆ ಮುಜುಗರದ ಸಂಗತಿಯಾಗಿದೆ.
ತಾಯಿ ಮತ್ತು ಶಿಶು ಮರಣ ಸಂಭವಿಸಿದಾಗ ಕಿ.ಮ.ಸ ಮನೆಗೆ ಹೋಗಿ ವಿವರವಾಗಿ ವಿಚಾರಣೆ ನಡೆಸಿ ಮೇಲಾಧಿಕಾರಿಗಳಿಗೆ ವರದಿ ಮಾಡಬೇಕಾಗಿರುವುದು ಕಿ.ಮ.ಸ ಕರ್ತವ್ಯ. ಆದರೆ ವಿಚಾರಣೆ ನಡಸಲು ಪದೆ-ಪದೆ ಅವರ ಮನೆಗೆ ಹೋದಾಗ, ಆ ಕುಟ೦ಬದ ಸದಸ್ಯರು ಹಾಗು ನೆರೆಯ ಜನರು ಕಿ.ಮ.ಸಹಾಯಕಿಯರನ್ನು ತಪ್ಪಾಗಿ ಭಾವಿಸುತ್ತಾರೆ. ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಗೆ ಸರಕಾರದಿಂದ ಹೆಚ್ಚಿನ ದುಡ್ಡು ಸಿಗಬಹುದು, ಆದರೆ ಆ ದುಡ್ಡುನ್ನು ಫಲಾನುಭವಿಗಳಿಗೆ ಕೊಡುತ್ತಿಲ್ಲಾ ಎಂದು ಸಂಶಯ ವ್ಯೆಕ್ತಪಡಿತ್ತಾರೆ. ಕಿ.ಮ.ಸಹಾಯಕಿಯು ಕ್ಷೇತ್ರದಲ್ಲಿ ತಮ್ಮ ಕರ್ತವ್ಯಗಳನ್ನು ಸರಿಯಾಗಿ ಮಾಡಿದ್ದರೂ ಸಹ ಯಾವುದೋ ಕಾರಣಾಂತರಗಳಿಂದ ಯಾವಾಗಲಾದರೂ ತಾಯಿ ಅಥವಾ ಶಿಶುಮಣರವಾದಾಗ, ಇಲಾಖೆಯ ಮೇಲಾಧಿಕಾರಿಗಳು ನಡೆಸುವ ತಾಯಿ ಹಾಗು ಶಿಶು ಮರಣದ ವಿಚಾರಣೆ (Maternal & Infant death Audit ) ಸಂದರ್ಭದಲ್ಲಿ ತಪ್ಪು ಎಲ್ಲಿ ನಡೆದಿದೆ? ಯಾರಿಂದ ನಡೆದಿದೆ? ಯಾತಗೋಸ್ಕರ ನಡೆದಿದೆ? ಎಂಬುದು ವಿಚಾರಿಸದೆ ಎಲ್ಲವು ಕಿ. ಮ. ಆ. ಸಹಾಯಾಕಿಯರದೆ ತಪ್ಪಿನಿಂದಲೆ ಯಾಗಿದೆ ಎಂದು ಅಪರಾಧಿ ಸ್ಥಾನದಲ್ಲಿ ನಿಲ್ಲಿಸಿ ಜನರ ಮುಂದೆ ನಿಂದಿಸುತ್ತಾರೆ. ಎಷ್ಟೋ ವರ್ಷಗಳಿಂದ ಕಿ.ಮ.ಆ.ಸ ಆರೋಗ್ಯ ಇಲಾಖೆಯಲ್ಲಿ ಸಾಕಷ್ಟು ಸೇವೆ ನೀಡುತ್ತಾ ಬಂದಿದ್ದರೂ ಆ ಸೇವೆಗೆ ಕೂಡ ಪರಿಗಣನೆ ಕೊಡದೆ, ಯಾರೋ ಮಾಡಿದ ತಪ್ಪಿನಿಂದಾಗಿ ಕಿ.ಮ.ಆ.ಸ. ನಿಂದನೆಗೆ ಒಳಗಾಗಭೇಕಾದ ಸಂದರ್ಭ ಉಂಟಾಗಿದೆ ಇದರಿಂದ ಬಹಳ ದುಃಖವಾಗುತ್ತದೆ ಎಂಬದು ಒಬ್ಬ ಹಿರಿಯ ಆರೋಗ್ಯ ಮಹಿಳಾ ಸಹಾಯಾಕಿಯ ದುಃಖದ ಮಾತುಗಳು.
ಈ ಎಲ್ಲಾ ಸಮಸ್ಯಗಳಿಗೆ ಪರಿಹಾರವಿಲ್ಲವೇ? ಯಾವ ರೀತಿಯಾಗಿ ಈ ಸಮಸ್ಯೆಗಳಿಗೆ ಪರಿಹರಿಸಿ ಪ್ರತಿ ಕಿ.ಮ.ಆ,ಸ ವೃತ್ತಿಯಲ್ಲಿ ಗುಣಾತ್ಮಕತೆ ಕಾಯ್ದುಕೊಳ್ಳಲು ಹಾಗು ಪ್ರೇರಣೆಯುತವಾಗಿ ಕೆಲಸ ನಿರ್ವಹಿಸಲು ಹೇಗೆ ಸಹಕಾರ ನೀಡಬಹುದು: ಎಲ್ಲಾ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಕ್ಕೆ ನಿಯಮದ ಪ್ರಕಾರ ಸಮಾನ ಜನಸಂಖ್ಯೆಯ ಹಂಚಿಕೆ ಅಥವಾ ಪುನಃಸ್ಸಂಘಟನೆ, ಪ್ರೇರಣೆ ಆಧಾರಿತವಾದ ಮೇಲ್ವಿಚಾರಣೆ, ವಿವಿದ ಕಾರ್ಯಕ್ರಮಗಳಿಗೆ ತಕ್ಕ೦ತೆ ನಿಯತ ಹಾಗು ಚೈತನ್ಯದಾಯಕ ಗುಣಮಟ್ಟದ ತರಬೇತಿ, ಪ್ರಸ್ತುತ ಸಲ್ಲಿಸುತ್ತಿರುವ ವರದಿ ಪದ್ದತಿಯಲ್ಲಿ ಬದಲಾವಣೆ, ಉತ್ತಮ ಕಾರ್ಯನಿರತ ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಯನ್ನು ಗುರ್ತಿಸಿ ವಾರ್ಷಿಕವಾಗಿ ತಾಲೂಕು ಮತ್ತು ಪ್ರಾಥಮಿಕ ಆರೋಗ್ಯ ಕೇ೦ದ್ರಮಟ್ಟದಲ್ಲಿ ಸನ್ಮಾನಿಸುವುದರ ಮುಖಾ೦ತರ, ಪ್ರಸ್ತುತವಾಗಿ ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಯರು ಎದುರಿಸುತ್ತಿರುವ ಸಮಸ್ಯೆಗಳು ಪರಿಹರಿಸಿ, ಅರೋಗ್ಯ ಕಾರ್ಯಕ್ರಮಗಳು ಯಶಸ್ವಿಗೆ ವಿಷೇಶವಾಗಿ ಗುಣಾತ್ಮಕ ಕಾರ್ಯಕ್ರಮಗಳ ಅನುಷ್ಟಾನಕ್ಕೆ ನಾ೦ದಿಹಾಡಬಹುದು.
by iphindia | Apr 16, 2012 | Blog
The Urban health project ofInstitute of public health has begun working in KG Halli since 2009. When we came to the area, our first action was mapping all the health facilities in ward no 30. As we did the mapping we found two government facilities in the area. One was the urban health center which comes under BBMP and mainly focuses on the RCH Preventive programs and the RNTCP. Another one was the Primary health center, which is under the Karnataka state and family welfare wing. Interestingly these two physical structures share a common wall but one had to jump it informally to get to the other side. Psychologically this wall could not be crossed, as the health centre staffs are answerable to different bodies- state and corporation.
As the days moved on we noticed that near the PHC, new big posh buildings were being built. Somewhere in 2009, we heard news that this PHC had been upgraded into a CHC- Community health center. Months later, one of the new buildings started being used. As patients had been lining up in long queues in the hot sun, particularly during the Chikangunya epidemic, and the existing PHC size was insufficient, an interim agreement had been reached. Without the official inauguration, one building would be used for examining outpatients.
Meanwhile the posting of doctors remained frequent and unpredictable. For a while there was a string of specialists and rumor was that it would be a functioning trauma centre. Happily this idea was thought through and discarded and for much of the two years -2010 and 2011, a senior administrator with four interns managed the outpatient care, in the newly inaugurated, well lit OP building.
However, an operation theater had been constructed and we waited with bated breath to see how it would be put to use. For some time we had been campaigning for a sorely needed maternity center for the area. It appears that our prayers were heard, because, finally they posted a senior lady doctor in charge. However a team was still necessary and they had only one staff nurse on board.
Once the gynecologist Dr. Mangalagowri had taken then charge, things moved faster. She also realized the need, but the final hold up was in hiring the ‘D’ group staff.
We also put in a word with local Councilor to push for hiring the necessary staff, but unfortunately our councilor also remained unsuccessful.
The fully provided-for labor room should lose this new and unused look soon!”
At last, on 15th march 2012 we had news that the labor ward action is in action. The Community health center has now become a 24×7 health service. Now the community can access the maternity facility without any time limit. Dr. Mangalagowri said within a month two deliveries have been conducted and requested the urban health team to spread this news across ward.
A walk down Tannery road at 10 pm is like walking down any other big street in Bangalore at 7pm. Like the jaws of a aging man, dark gaps where the bike workshops punctuate the shining rows of shops, many with brightly lit interiors, the city seems to swallow one up. I notice most of the people walking the street are men; the rare family, but as a single unaccompanied woman, I do not draw many glances. This is a world where anonymity is the norm. People are very occupied, earning their living. Every street corner has a hole in the wall eatery with the owner dishing out hot chicken wings from a frying hot ‘kadhai’. Large neon signs in every colour advertise “goodies” of all kinds, from clothes to shoes to accessories to ….and here we have it…. to medicines. As I strolled along, three large, glass- fronted pharmacies caught my attention, the window displays abundantly showcasing expensive and (to my mind), unnecessary products. The vitamins of old have been successfully replaced by “sugar-free” and equivalent products meant to lull the obese patient into the ‘soft’ pill option.
It is well known that many hospitals have their own pharmacies – convenience for the patient being the supposed rationale. By extension, the small clinics often have a drugstore next door. However, by a strange twist, the unstated, unpalatable truth is that the drugstore has the clinic and therefore the doctor. So it was with a great sense of curiosity that I wandered into the newly built 15 bedded hospital adjacent to the large glass fronted pharmacy. I had met the Managing Director , a twenties- something doctor when the hospital opened an hour ago, but community feedback was that it had not really take off. So I was surprised to see three patients in the ’emergency’ ward, all on ‘glucose drips’ , two of these being children. I caught sight of two ‘duty doctors’ identifiable by their stethoscopes and slightly preoccupied air. Evidently the beds are slowly filling up, although there is no permanent staff in place.
