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by iphindia | Nov 18, 2012 | Blog, Latest Updates
This time it was neither KG Halli nor urban health project….but Health Inc…trying to find reasons for social exclusion in Bangalore Rural district.
When we entered 8×8 single room house, Jagadish was lying on the bed. We asked how he was feeling, he pushed bed sheet aside and showed his leg…yes it was badly infected & looked scary and his hospital discharge card said Cellulitis! He said few days ago we went again to private medical college they refused to admit me, then we went to Government Hospital, doctor said nothing can be done..it is too late, so we came back home. I was speechless and ran out of words…just to listen from that 24yr old boy in a calm and composed voice, with no emotions saying I’m waiting for my death! I said to myself.. Is it so easy to accept death?
For a moment I forgot why we were in that house, started making calls to friends and colleagues for help… one of the district surgeon assured to do his best. In the last 2 month, family which is mainly dependent on daily wage had borrowed Rs 40000 for his treatment, admitting him again means one or two family member loosing their wage….where money lenders are already demanding repyment….can they really afford to give time to save Jagadish? After two days I get information that he is yet to reach hospital!!
It must be the frustration, helplessness and poverty forcing people accept things easily as their fate! Is it the fate which is preventing Jagadish from getting care or is our health system failed to provide care for people like Jagadish or access care? Who should be blamed for…is it the tertiary care center which did not consider worth treating him or is it so simple that we blame poverty for everything and record exclusion due to poverty??
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by iphindia | Nov 12, 2012 | Blog, Latest Updates
“Good presentation is very important and I apply this concept”. This is said by one laboratory technician working in a Primary Health Center (PHC). He believes that if he provides his laboratory services in a presentable way, he can earn the trust of the people. “People will come to me and they will not go to private laboratory unnecessarily where they have to pay more for the same kindof laboratory test which I can provide them free of cost”
This he is doing by simply giving the laboratory test report in a format developed by him and using the print copy of that to give report of the patients. Simple thing can make differences. He developed separate format for ANC and separate for other general laboratory test.
He is keeping all daily and monthly chart update. Well maintained registered. Neat and clean laboratory.
While talking to him and observing all these, immediately in my mind I was relating him to my recent experience with private hospitals recording system during my father’s checkup where they gave all medical records of my father in a folder and also while my friend was admitted in a hospital, nurse was visiting her after every two hours, checking her BP, temperature and putting it down in a diagnosis sheet. That time I was impressed and felt good and was thinking why these kinds of services are not available in Government health facilities.
And now when I am relating my experience with this, I am wondering if he is having the knowledge of importance of “good presentation” or good patient documentation. Why not other has this knowledge? Are they do not know its importance and how it will benefit them? Why cannot do they do their bit like him? Is it due to they need training on it? Or they are over burden?
Anyway, I personally realized and learned from him that if I can do my bit by presenting my research work or field experience in a presentable way (through blog, article etc) and share, it can benefit the society to a large extent and also to me
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by iphindia | Oct 30, 2012 | Blog, Latest Updates
Health ‘camps’ are one of the strategies adopted by both government and non-government organizations. This literally means that a team of health professionals ‘camp’ in an area to carry out a limited health intervention. For instance, government organizes sterilization camps for women. Or an NGO organises a diabetes screening camp. Or a private hospital organises a blood donation camp. Unfortunately government pays little attention to the quality of sterilization service and tends to focus on targets. Or there are NGOs which conduct camps just as an activity, which do not yield quality.
KG Halli is one of the 198 wards in the greater Bangalore metropolis with a 45000 population, and we from IPH work with the community to improve the quality of health care in this area. Last year a grass root NGO which is working with the slum inhabitants requested our support in mobilizing the community for an eye camp. To our surprise, it was only screening without any follow up. After the camp, people from the community started asking us whether we would give them any material aid like spectacles and so on. We told them they need to ask the organizers- the hospital which did the screenings. Unfortunately they were advised to purchase the spectacles at their own cost.
Many times, a health camp run by with a private hospital becomes a business gimmick. The poor attend the camp with the aim of free check up and free treatment. When they do not get free treatment or subsidy for treatment they stop follow up. While organizing health camps follow up becomes one of the important ingredient in quality health camps.
Either targeted approach without quality services or an activity without follow up will not improve the health status of the patients and will not develop trust between the community and the NGOs involved in such camps
Therefore we to organize camps and at the same time we cannot ignore offers to organize camps when there is quality in it.
We could not say no to Doctor Santhosh Benjamin from CSI (Christian of South India hospital), when he requested us to ally with them in organizing an eye camp in KG Halli for cataract surgery. We UHT (Urban Health Team) wanted put this opportunity into best use. Hence we planned the eye camp with three phase pre health camp task, actual health camp and post health camp task.
We took up publicity through announcement in different language (Kannada, Tamil and Urdu), besides distribution of leaflets. Our community health assistants announced in three different languages. We had coordination with CSI, BBMP & UHC (BBMP run Urban Health Center), and got permission letter from BBMP to use the UHC premises for the eye camp. We purposely selected UHC to do eye camp, in order to strengthen the link between the government facility and the community. The message was eye camp followed with surgery was free.
The camp program began on time, as a result of two days publicity we were able to mobilize 89 patients. All the patients were registered with their name, address, with contact number for follow up. The activity went up to 3.00 pm. Out of 89, 19 were screened for cataract surgery and were given appointments by the doctor. The appointments dates stretched till 30th of May 2012.
In the midst of the camp the next door CHC (State run Community Health Center) staff wanted to ruin the spirit of eye camp, and went to the CSI doctor to tell her-“This eye camp is waste, the people from this area will never turn up, we have been conducting regular eye camp in CHC, anyway they give address and contact number but will not come”. Josphine (CHA) who followed him gave assurance to the doctor. “Since we are doing home visit and we knew all the patients we will make sure that they visit CSI hospital for surgery”.
However the patients who were asked for surgery did not wait for us to remind them. They promptly visited CSI for surgery. Out of nineteen patients 13 underwent surgery, two were sent back home because one has heart problem (he was asked to get report and letter from his doctor) and another person is diabetic (He was given medicine to control his sugar level). We are following it up with the other four patients. Both Josphine and Nagrathana met CSI doctor to ensure the visit of patients for surgery.
The eye camp program for the community has increased the trust on us and our work. The people from the community are demanding for more such programs.
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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……..
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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……
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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)
When we entered 8×8 single room house, Jagadish was lying on the bed. We asked how he was feeling, he pushed bed sheet aside and showed his leg…yes it was badly infected & looked scary and his hospital discharge card said Cellulitis! He said few days ago we went again to private medical college they refused to admit me, then we went to Government Hospital, doctor said nothing can be done..it is too late, so we came back home. I was speechless and ran out of words…just to listen from that 24yr old boy in a calm and composed voice, with no emotions saying I’m waiting for my death! I said to myself.. Is it so easy to accept death?
