by iphindia | Dec 8, 2011 | Blog, Urban Health Action
It is more than, two months since, I had an opportunity to stay overnight in a tertiary government hospital in Bangalore. This is the storey of what I observed that night at a labor ward. It was a night of the August 23, 2011. If the nurses and doctors had listened to the crying would-be mother that night they might have prevented the death of a child.
I arrived at the hospital around 10 pm. Dr.Upen and myself were there to play the role of family for Juliet, a young lady (rather a girl) from KG halli with risk pregnancy brought to this hospital for delivery. She had no support from her in-laws. Our worry about her risk delivery flew away as doctors assured that she would deliver normally.
As the Juliet was taken inside the labour ward, we were waiting eagerly thinking what will happen, and when will they break the news. We waited for almost three hours. Later at 12.30am a staff nurse called over mike,” who are the Juliet’s relatives? Get the cloth to wrap the child”. Upen and I ran towards labour ward with the cloth and gave it to the helper. She asked me to accompany her to sign on the form before handing over the child to us. I had never come across such situation in my life before, holding and caring the child. I happily transferred this responsibility to Upen, who accompanied the helper, singed the form, and came out with the child, I saw a male baby in his hands.
The people around us were very cooperative. Some of the women sympathized with Upen and helped him in wrapping the new born properly. The baby was very quiet and slept till morning without disturbing us. The baby was separated temporarily from the mother since the mother was given drips inside the ward that had no facility like cradle, for the baby. Beds were arranged on the either side of the ward entrance so that mothers can be put temporarily on these beds before shifting them to the post natal ward.
There are enough places for the family members to stay near the labour ward. Only women were allowed to stay near the labour ward. Every now and then helpers would chase the men away from there. But my colleague Dr. Upen was excused as the baby was happily resting on his lap.
I had nothing to do but wait till morning to ensure that both mother and the baby get shifted safely to the ward. I was observing what all was happening there. I felt I was in crowded and noisy place. Staff nurse was calling the name over the mike “who are Geetha’s relatives?”, “who are the relatives of Nagamma? “etc. Family members were running fast with the cloth to sign the paper and get the baby.
The pregnant women who were waiting to deliver were walking from one end of the hospital corridor to the other end. Some of them were inside the labour ward. Some of them were screaming loudly due to pain. In the midst of all these a pregnant woman caught my attention. I was watching her from the time I have entered the hospital. She suddenly used to come out from the labour ward, would ask for water to drink, would walk the corridor and would again go inside the labour ward. She was repeating it continuously.
I could understand her behaviour that she was trying to control crying from labour pain. She was very anxiously asking her husband, mother-in-law and mother, “Ma why I am not yet delivering? For how long I need to bear this pain? Why don’t you tell the doctor to do cesarean? I think I may die due to the pain, ma please…………………. tell the doctor”. Her mother-in-law went inside to tell the staff nurse about her daughter-in-law’s wish. But she shouted at her and asked her to go out. The helpless lady came out with unhappy face. Her situation was difficult as she was neither able to console her daughter-in-law nor convince the doctor.
Around 5.30 am this lady burst out with loud cry, as she could not tolerate the pain. One can see blood stain on her dress and she was repeatedly telling her mother-in-law about blood spot, in turn; her mother-in-law was reporting it to the nurse. But it seems to be a futile exercise by the family members as the nurse did not care to take this incidence to notice.
Meanwhile Juliet was shifted to the ward with the baby. We both (Upendra and myself) were waiting to hand over the responsibility to Nagrathna, our colleague working in KG halli. While leaving hospital by around 8.30am, I met the same family and noticed no progress in the situation I saw at night. They were so helpless and asked for help, I was thinking how to help them. Suddenly I remembered the names and phone numbers of doctor in-charge displayed on the board near labor ward. I told them that they can talk to an authority and get the work done.
Afternoon I went to meet Juliet and her family members to motivate them to stay with her on that night in the ward. At that time, I met the husband of the lady whom I was observing since last night crying out in pain. As soon as he saw me tears started rolling down from his eyes. He said – “Madam as you suggested I called the doctor. Doctor asked the duty doctor to attend immediately, they did it, and they took our signature saying there is some problem with the baby. After five minutes, doctor came out to say that we have lost the baby. If they would have listened to us, and lent an ear to my wife’s cry we would have gone back home with the live baby”. Gentleman said “I do not think the child died after five minute; maybe it was dead before seeing the world”.
How to justify the behaviour of the nurse/doctor?
Is it the power of knowledge that makes them to refuse the request made from the women or family members? It is like “I know what do, you do not know anything”?
– By Amrutha
by iphindia | Dec 1, 2011 | Blog
Context – Monthly taluk meeting of all government medical officers (MOs) in the taluk. The MOs were asked for their suggestions to strengthen the health services in their taluk.
Among various issues raised, one issue was about the lack of obstetric services at the taluk. In the past 7 months, there have been only 305 deliveries at the PHC level and 85 deliveries at the Taluk Hospital. This, against an expected 2,500 deliveries. This means that the rest of the 2000 women have delivered either at the district hospital or at private nursing homes. The MOs provided some insight into this situation.
The ANMs at the SCs were very good in delivering women. Some of them would conduct 10 – 20 deliveries in a month. But suddenly, now the ANMs have been told not to deliver at the SC and that all the patients have to be sent to primary health centres (PHCs). So this has created a lot of problems for the patients. “We should have recognised their competencies and skills and allowed those who can conduct deliveries to continue, rather than centralising everything.” One of the MOs
At the PHC, there is only one MO and one ANM. Usually neither stay at the primary health centre as the facilities are very limited. There are no quarters usually. Where there is a quarter, there is no running water, no toilet facilities and no good schools nearby for the children. So the staff do not want to admit a patient for delivery, lest they have to stay back after 4 pm. So they refer these patients to the nearest facility – the 24 x 7 PHC.
The 24 x 7 PHC is expected to provide nursing services round the clock. It usually has one MO and 3 staff nurses (SN). These SNs are on continuous 8-hour duty, for 7 days a week. If any of them fall sick or have to take leave, then the other two have to manage by doing 12 hours duty. Naturally they find it difficult to handle any complicated deliveries, as it means a lot of tension for them. Rather they prefer to refer any ‘complicated cases’ to the taluk hospital (TH).
This is made worse by the patients, who want a definite answer to their question – “can you handle this delivery here? Will you guarantee us a healthy mother and child?” Since this guarantee is not possible, and since the threat of mob attack if there is any poor outcome is a reality, the nurses prefer to refer the patient.
And the last straw for the PHC staff is the maternal death audit. They are terrified about this and clearly state that the “doctors and the nurses do not want to take a risk. Better to refer the patient, than get caught up in the unnecessary problems of audit and the public humiliation that we experience.”
At the TH, there is only one obstetrician. He / She is expected to provide out-patient services from 9am to 1pm. And is then invariably asked to go for a laproscopic camp in some PHC area. After that he returns to do night duty. Which means that he is off on the next day. And for the next four nights, when other specialists are on night duty. While a surgeon can easily handle a medical or an orthopaedic patient, they have limited skills to manage an obstetric patient. This is because they have specialised in surgery, not obstetrics. It is like expecting a plumber to build a door. Or an engineer to argue a case in court. So any obstetric patient who lands at the taluk hospital on a day or period when the obstetrician is not on call is then referred to the next level, i.e. the district hospital. While TH specialists are able to handle non-obstetric cases, they are not willing to take the risk of managing a delivery. “We are in between the mob and the maternal audit. Why should we take any risk? All we have to do is refer the patient. Now with ‘108’ ambulance services, this is not a problem. So patient is happy and the doctor is happy.”
Maternity ward in India
What about the expenses for the patient and the government? A trip to the district hospital by 108 ambulance means that the government has to spend Rs 45 per km for this referral. Not to mention the burden on the district hospital. And of course the patient has to pay for a lot of indirect expenses, like transport, food, etc. There was no answer to this question. The implicit message was ‘– as long as it is out of my area (facility), then I am not bothered. I should not get into trouble.’
Various recommendations for solving this problem were provided, ranging from building the capacity of ANMs to manage deliveries, to increasing the staff at PHCs and 24×7 PHCs and THs. One suggestion that kept coming was – why not centralise all deliveries at the Taluk Hospital, employ 3 obstetricians and 3 anaesthetists and provide all obstetric services there. When challenged about the difficulty in getting obstetricians and anaesthetists, one suggestion that came up was whether the TH could make a panel of local private obstetricians and anaesthetists and call them when necessary. “One obstetrician full time may not be possible as it takes a long time to recruit and then if this one person leaves, we are back to the same situation.” However, a panel of specialists (similar to the practices of private nursing homes) may be feasible. If one doctor is not there, we can call the next on the list. This way, the government only has to reimburse the services of these private specialists, without taking the burden of recruiting them etc.
The other suggestion that came up was to use this money to incentivise the government obstetrician for every LSCS conducted at the TH. This will encourage optimum use of resources plus will be an incentive for the obstetrician. “Why should I work for 35,000 pm, while a junior and less experienced obstetrician recruited on a contractual basis gets 70,000 pm. If you give me that 70,000, I am willing to put in the extra effort to provide all the necessary services. And I do not have to go to the private nursing home, conduct deliveries to earn 3000 per delivery. I will have the peace of mind that I am not breaking any rules” – an obstetrician at the TH.
So it is not surprising that less than 20% of the pregnant women in this district are delivering at the most appropriate level and facility. The rest of them have to weather the problems of multiple referrals, uncertainty of services and finally meet the costs of all this.
![ತಟಸ್ತ ಹೃದಯಗಳ ನಡುವೆ ಸ್ಪಂದಿಸುವ ಹೃದಯ]()
by iphindia | Nov 4, 2011 | Blog
ಭಾರತದಲ್ಲಿ 1986 ರಲ್ಲಿ HIV -ಸೋಂಕನ್ನು ಪತ್ತೆ ಹಚ್ಚಲಾಯಿತು, 25 ವರ್ಷ ಕಳೆದರು ನಮ್ಮ ದೇಶದಲ್ಲಿ HIV -ಸೋಂಕಿತರ ಬಗ್ಗೆ ಇರುವ ಕಳಂಕ ಮತ್ತು ತಾರತಮ್ಯ ಅಷ್ಟೇನೂ ಕಡಿಮೆಯಾಗಿಲ್ಲ, ಇದಕ್ಕೆ ಸಾಕಸ್ಟು ಉದಾಹರಣೆಗಳಿವೆ, HIV-ಯಿಂದ ಗಂಡ ಮರಣಹೊಂದಿದ ವಿದವೆಯನ್ನೂ ಮನೆಯಿಂದ ಹೊರಹಾಕುವುದು ಗ್ರಾಮವನ್ನು ಬಿಡುವಂತೆ ಒತ್ತಾಯ ಮಾಡುವದು, ಮಕ್ಕಳುನ್ನು, ಶಾಲೆಯಿಂದ ಹೊರಗೆಹಾಕುವುದು ಅಥವಾ ಶಾಲೆಗಳಿಗೆ ಪ್ರವೇಶ ಸಿಗದೆಇರುವದು. ಇವೆಲ್ಲವು ಕಳಂಕ ಹಾಗು ತಾರತಮ್ಯಗಳಿಗೆ ಕೆಲವು ಊದಾಹರಣೆಗಳು.
ಈ ರೀತಿಯ ಘಟನೆಗಳು ಎಷ್ಟೋಬಾರಿ ನಾವು ವಾರ್ತ ಪತ್ರಿಕೆಗಳಲ್ಲಿ ಹಾಗು ನಿಯತಕಾಲಿಕೆಗಳಲ್ಲಿ ಓದುತ್ತಿರುತ್ತೇವೆ ಹಾಗೂ ನಮ್ಮ ಕಣ್ಣುಮುಂದೆ ನಾವು ಮಾಡುವ ಕೆಲಸದ ಕ್ಷೇತ್ರಗಳಲ್ಲಿ (ಆರೋಗ್ಯ್ ಹಾಗೂ ಇತರೆ ಕ್ಷೇತ್ರ) ನಡೆದರೂ ಸಹಾ ಅಸಹಾಯಕತೆಯಿಂದ ನೋಡುತ್ತಿರುವ ಪ್ರಸ೦ಗಗಳು ಉಂಟು.
HIV-ಸೋಂಕಿತರಲ್ಲಿ ಕಳಂಕ ಮತ್ತು ತಾರತಮ್ಯಕ್ಕೆ ಸಿಲುಕಿ ಇಹಲೋಕ ತ್ಯೆಜಿಸಿದವರಲ್ಲಿ ಕೆಲವರಾದರೆ ಇನ್ನೂ ಕೆಲವರು ಆರ್ಥಿಕವಾಗಿ ಹಿಂದುಳಿದಿದ್ದು ಅವಕಾಶವಾದಿ ಕಾಯಿಲೆಗಳಿಗೆ ಬಲಿಯಾಗಿ ಸೂಕ್ತ ಚಿಕಿತ್ಸೆ ಸಿಗದೆ ಸತ್ತಿರುವುದು೦ಟು. ಇದಕ್ಕೆಲ್ಲಾ ಕಾರಣ ಅವರಿಗೆ ಸೂಕ್ತ ಸಮಯದಲ್ಲಿ ಸೂಕ್ತ ಮಾಹಿತಿ, ತಿಳುವಳಿಕೆ ಹಾಗು ಚಿಕಿತ್ಸೆ ಸಿಗದಿರುವದು. ಸರಿಯಾದ ಸಮಯದಲ್ಲಿ ಸರಿಯಾದ ಮಾಹಿತಿ, ತಿಳವಳಿಕೆ ಹಾಗೂ ಚಿಕಿತ್ಸೆ ದೊರೆತಿದ್ದರೆ ಎಸ್ಟೋ HIV-ಗೆ ಸ೦ಬದಿಸಿದ ಸಾವುಗಳನ್ನು ಮತ್ತು ಆತ್ಮಹತ್ಯೆಗಳನ್ನು ತಪ್ಪಿಸಬುಹುದು ಎಂಬುದಕ್ಕೆ ಈ ಕೆಳಗೆ ಎರಡು ನಿದರ್ಶನಗಳನ್ನು ನೀಡಲಾಗಿದೆ
ಗುಬ್ಬಿ ತಾಲೂಕಿನ ಒಂದು ಹಳ್ಳಿಯ HIV- ಸೋ೦ಕಿತ ಮಹಿಳೆಗೆ ಮೊದಲ ಹೆರಿಗೆ ಸಿಜೇರಿಯನ್ ಆಗಿತ್ತು. ಕೆಲವುದಿನಗಳು ನ೦ತರ ಮತ್ತೆ ಅವಳು ಬಸುರಿ ಎ೦ದು ತಿಳಿದು ಬಂತು, ಆಗ ಆಲ್ಲಿಯ ವೈಧ್ಯಾಧಿಕಾರಿ ಮತ್ತು ಕಿರಿಯ ಆರೋಗ್ಯ ಸಹಾಯಕಿ ಅವಳಿಗೆ ಸಲಹೆ ಮತ್ತು ಆಪ್ತಸಮಾಲೋಚನೆ ನಡೆಸಿ ಅವಳನ್ನು ಗರ್ಭಪಾತ ಮಾಡಿಕೊಳ್ಳುವಂತೆ ಮನವೊಲಿಸಿದರು, ಕಾರಣ ಅವಳು ತುಂಬಾ ನಿಶಕ್ತಳಾಗಿದ್ದು, ಎರಡನೇ ಮಗವನ್ನು ಹೆರುವ ಪರಿಸ್ತಿತಿಯಲ್ಲಿ ಆಕೆ ಇರಲಿಲ್ಲ. ಆದರೆ ಅವರ ಸಲಹೆ ಆ ಮಹಿಳೆಯ ಮೇಲೆ ಯಾವುದೇ ರೀತಿಯ ಪರಿಣಾಮ ಬೀರಲಿಲ್ಲ.
ಆದರೆ ಕಿರಿಯ ಆರೋಗ್ಯ ಸಹಾಯಕಿ ತನ್ನ ದಿನನಿತ್ಯದ ಕೆಲಸವಾದ, ಮನೆಯ ಭೇಟಿಗೆ ಹೋದಾಗೆಲ್ಲಾ ಸತತವಾಗಿ ಆ ಗರ್ಬಿಣಿಯ ಮನೆಗೆ ಭೇಟಿನೀಡಿ ಅವರ ಯೋಗಕ್ಷೇಮ ವಿಚಾರಿಸುತಿದ್ದರು, ಅವಶ್ಯಕತೆಇದ್ದಾಗ ಸೂಕ್ತ ಸಲಹೆ ಮತ್ತು ಮಾಹಿತಿಯನ್ನೂ ಆಕೆಗೆ ಹಾಗೂ ಮನೆಯವರಿಗೂ ನೀಡುತಿದ್ದು, ಅಲ್ಲದೆ ಹೆಚ್ಚಿನ ಚೆಕ್-ಅಪಗಾಗಿ ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆಗೆ ಕಳಿಸುತ್ತಿದ್ದರು. ಗರ್ಬಿಣಿಗೆ 8 ಮತ್ತು 9 ತಿಂಗಳು ತುಂಬಿದಾಗ ತಿಂಗಳಿಗೆ ಎರಡು ಸಲ ಮನೆ ಭೇಟಿನಿಡಿ ಅವರ ಯೋಗಕ್ಷೇಮವನ್ನು ವಿಚಾರಿಸುತ್ತಿದ್ದರು ಹೆರಿಗೆ ಸಮಯಕ್ಕಿಂತ ಮೊದಲೆ ಹೆರಿಗೆ ನೋವು ಕಾಣಿಸಿಕೊಂಡಾಗ ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆಗೆ ಕರೆದುಕೊಂಡು ಬಂದರು. ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆಯಲ್ಲಿ ಅವರದೆಯಾದ ಹಲವು ಕಾರಣ ಮತ್ತು ಸಮಸ್ಯೆಗಳಿವೆ ಅದನ್ನು ಮು೦ದಿಟ್ಟುಕೊಂಡು ಆಸ್ಪತ್ರೆಯ ಸಿಬ್ಬಂದಿಗಳು ಆ ಮಹಿಳೆ HIV- ಸೋಂಕಿತಳೆ೦ದು ಹೇಳಿ ಪ್ರವೇಶ ನಿರಾಕರಿಸಿದರೂ ಕೆಲವು ಸಮಯದ ನಂತರ ಪ್ರೋಗ್ರಾಮ್ ಆಫೀಸರ ಸಹಾಯದೊಂದಿಗೆ
ಆ ಗರ್ಭಿಣಿಗೆ ಆಸ್ಪತ್ರೆಯಲ್ಲಿ ಪ್ರವೇಶ ದೊರೆಯಿತು, ಬೆಳಗಿನಜಾವ ಆ ಗರ್ಭಿಣಿ ಯಾವುದೇ ತೊಂದರೆಯಿಲ್ಲದೆ ಗಂಡು ಮಗುವಿಗೆ ಜನನ ವಿತ್ತಳು. ಆದರೆ ಜನಿಸಿದ ಕೆಲವೆ ಗಂಟೆಗಳಲ್ಲಿ LBW(Low birth Wight) ಕಾರಣದಿಂದ ಮಗು ಮರಣಹೊಂದಿತು.
ಇನ್ನೊಂದು ಉದಾಹರಣೆ ಸಹ HIV- ಸೋಂಕಿತ ಮಹಿಳೆಗೆ ಸಂಬಧಿಸಿದ ವಿಷಯ. ಅದೇ ಗುಬ್ಬಿ ತಾಲುಕಿನಲ್ಲಿ ಮಹಿಳೆ ಗರ್ಭಿಣಿ ಆಗಿದ್ದಾಗ ರಕ್ತ ಪರೀಕ್ಷೆಗೆ ಹೋಗುವಂತೆ ಕಿರಿಯ ಅರೋಗ್ಯ ಸಹಾಯಕಿ ಕೆಲವು ಸಲಹೆ ಹೇಳಿದರು ಸಹ ಆಕೆ ಹೋಗಿರಲಿಲ್ಲ ಹೀಗಿರಲು ಗರ್ಭಿಣಿಗೆ 9 ತಿ೦ಗಳು ತುಂಬಿತು , ಈ ಸಂರ್ಬದಲ್ಲಿ ಕಿರಿಯ ಅರೋಗ್ಯ ಸಹಾಯಕಿ ಮದುವೆಗೆ೦ದು ಒಂದು ತಿಂಗಳು ರಜೆಯಲ್ಲಿದ್ದರು. ಆಶಾ ಕಾರ್ಯಕರ್ತೆಯ ಸಹಾಯದೊಂದಿಗೆ ನಿರಂತರ ಅನುಸರಣೆ ಮಾಡುತಿದ್ದರು ಹಾಗಾಗಿ ಮಹಿಳೆಗೆ 9ನೇ ತಿಂಗಳು ತುಂಬಿದಾಗ ಕಿರಿಯ ಅರೋಗ್ಯ ಸಹಾಯಕಿ ಹಾಗು ಆಶಾ ಕಾರ್ಯಕರ್ತೆಯ ತಾವೇ ಸ್ವತಃ ಆ ಮಹಿಳೆಯನ್ನು ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆಗೆ ಕರೆದುಕೊಂಡು ಹೋಗಿ PPTCT ಕೇಂದ್ರದಲ್ಲಿ ಹಿವ್- ಪರೀಕ್ಷೆ ಮಾಡಿಸಿದಾಗ , ಆಕೆಯು HIV- Postive ಎ೦ದು ಬಂತು, ಇದರೊಂದಿಗೆ ರಕ್ತಹೀನತೆಯಿಂದ ನರಳುವದಾಗಿ ತಿಳಿದುಬಂತು. ಸೂಕ್ತ ಸಮಯದಲ್ಲಿ ಅವಳಿಗೆ ರಕ್ತ ನೀಡಿದ್ದರಿಂದ, ಆಕೆಗೆ ಹೆರಿಗೆಯೂ ಸಹಜವಾಗಿ ಆಗಿದ್ದು ತಾಯಿ ಮತ್ತು ಮಗು ಕ್ಷೇಮವಾಗಿದ್ದರೆ.
ಸರಕಾರದ ನೌಕರರು ಎಂದಾಕ್ಷಣ ಸರಿಯಾಗಿ ಸೇವ ನಿಡುವುಲ್ಲಾ ಎಂಬ ಅಭಿಪ್ರಾಯವನ್ನು ಕಿರಿಯ ಅರೋಗ್ಯ ಸಹಾಯಕಿ ಸುಳ್ಳಾಗಿಸಿರುವದು ಈ ಎರಡು ನಿದರ್ಶನಗಳಿಂದ ಕಂಡು ಬರುತ್ತದೆ, ಅವರು ರಜೆಯಲ್ಲಿ ಇದ್ದರು ಸಹ ಆಶಾ ಕಾರ್ಯಕರ್ತೆಯ ಸಹಕರಂದೊದಿಗೆ ಒಂದು ಅಪಾಯದ ಹೆರಿಗೆಯನ್ನೂ ಹಾಗೂ ಒಂದು ಮಗುವು HIV-ಸೋಂಕಿಗೆ ಒಳಗಾಗುವುದನ್ನು ತಪ್ಪಿಸಿದ್ದಾರೆಂದರೆ ತಪ್ಪಾಗಲಾರದು.
ಇಂದು ಸರಕಾರ ವಿಷೇಶವಾಗಿ ವೈಧ್ಯಕೀಯ ತಂಡಕ್ಕೆ HIV- ಸೋ೦ಕಿತ ಮಹಿಳೆಗೆ ಹೆರಿಗೆಮಾಡುವಾಗ ವೈಧ್ಯಕೀಯ ತಂಡಕ್ಕೆ ಯಾವುದೇ ರೀತಿಯ ತೊಂದರೆಗಳು ಮತ್ತು ಅಪಾಯ ಬರಬಾರದೆಂಬ ಉದ್ದೇಶದಿಂದ ಉಚಿತವಾಗಿ HIV-ಹೆರಿಗೆ ಕಿಟ್ ಎಂದು ಕೊಡುತಿದ್ದು ಇವುಗಳನ್ನು ಎಲ್ಲಾ ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆಗಳಲ್ಲಿ ಸಿಗುವಂತೆ ಮಾಡಿದೆ. ಇದರ ಸದುಪಯೋಗ ಎಲ್ಲಾ ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆ ಸಿಬ್ಬಂದಿಗಳು ಪಡೆದುಕೊ೦ಡು ಕಿರಿಯ ಅರೋಗ್ಯ ಸಹಾಯಕಿಯಂತೆ HIV-ಸೋಂಕಿತ ಗರ್ಭಿಣಿಯರನ್ನು ಅಪಾಯದ ಹೇರಿಗೆಯಿ೦ದ ರಕ್ಷಿಸಬಹುದಲ್ಲವೇ.
ಎಲ್ಲಾ ಆರೋಗ್ಯ ಸಿಬ್ಬ೦ಧಿಗಳು ಈ ಮೇಲಿನ ಕಿರಿಯ ಆರೋಗ್ಯ ಸಹಾಯಕಿಯ೦ತೆ ಇರುವುದಿಲ್ಲ ಎಲ್ಲಾ ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆಗಳಲ್ಲಿ HIV-ಸೋ೦ಕಿತ ಗರ್ಭಿಣಿಯರಿಗೆ ಸರಿಯಾಗಿ ಚಿಕಿತ್ಸೆ ಸಿಗುತ್ತಿಲ್ಲ. ಆಸ್ಪತ್ರೆಗಳಲ್ಲಿ ಇನ್ನೂ ಸಹ ಕಳ೦ಕ ಮತ್ತು ತಾರತಮ್ಯ ಇದೆ. ಕಿರಿಯ ಆರೋಗ್ಯ ಸಹಾಯಕಿಯ೦ತೆ ಸ್ಪಂದಿಸುವ ಹೃದಯಗಳಿದ್ದರೆ ಇದ್ದರೆ ಎಷ್ಟು ಉತಮ್ಮ……..
ಅದನ್ನೆಲ್ಲಾ ಮರೆತು HIV-ಸೋ೦ಕಿತ ಮಹಿಳೆ ಹೆರಿಗೆಗಾಗಿ ಜಿಲ್ಲಾ ಆಸ್ಪತ್ರೆಗೆ ಬಂದಾಗ ಅವಳಿಗೆ ಸೂಕ್ತ ಚಿಕಿತ್ಸೆ ನೀಡದೆ ಆ ಮಹಿಳೆಯನ್ನೂ HIV-ಸೋ೦ಕಿತಳೆ೦ದು ಹೇಳಿ ಇನೊಂದು ಆಸ್ಪತ್ರೆಯ ರಸ್ತೆಯನ್ನೂ ತೋರಿಸುವದು ಎಷ್ಟು ಸೂಕ್ತ ???,
-By Bheemaray
by iphindia | Oct 16, 2011 | Blog
On 12th April 2005, the National Rural Health Mission (NRHM) was launched in India with a goal towards reforming and strengthening the basic health care delivery system of the country. Out of the many innovations under the program, a new cadre of district and block program managers were introduced into the health system of the country.
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by iphindia | Sep 29, 2011 | Blog
For decades, the country has been striving towards decreasing the burden of Tuberculosis (TB) on its population. The introduction of Directly Observed Treatment Strategy (DOTS) through the Revised National Tuberculosis Control Program (RNTCP) was expected to bring about a major change in controlling the disease. In spite of many efforts, the indicators of TB fail to impress. Failure of adherence to the DOTS program and discontinuation of the treatment is attributed as an important cause for the current state of the disease. Linda, a friend of ours describes her experience with Tuberculosis, DOTS program and importance of completing the treatment.
I was down with typhoid in March 2011. During that time I noticed a swelling below my jaw, towards the left side. The swelling did not subside even after a couple of weeks. It was diagnosed to be lymphocytes, that is TB of the lymph nodes. A particular physician advised me to get the lump removed surgically. In fact the surgery was fixed for the next day. Then the doctors at Institute of Public Health (IPH), Bangalore referred me to another doctor for second opinion. The second doctor advised me to start TB medicines under Government of India DOTS Program. So I went and got myself registered for the program in Primary Health Unit in Cox Town, Bangalore. The staff their immediately started me on medicines and assigned me to a Social Health worker close to my house. A box containing the medicines of my full course was given to the health worker. I had to go regularly to her and pick up my medicines. She wrote my name on the box and kept a complete record of the medicines issued.
Initially when started my medicines I started feeling very weak and had severe pain and tingling sensation all over the lower part of my body mostly my legs. The pain was so severe I could not even move about. The swelling also increased rapidly and I was losing weight rapidly. I was feeling really frustrated and depressed. The doctors at IPH counseled me regularly and encouraged me to continue the course. My husband and my son also were very supportive. After a couple of months the swelling started reducing. I started feeling normal and started gaining weight. I still have 5 more weeks of treatment. I feel perfectly normal and have no swelling at all.
I would like to stress that the Government DOTS Program is most effective. I would advise people with TB to go undergo Government DOTS Program and not to private practitioners. The quality of the medicines is excellent although it is completely free of cost. I would also like to add here that to bounce back to good health, one needs to complete the entire DOTS course.
– LINDA DANIEL
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by iphindia | Sep 10, 2011 | Blog
Forest department officials at task to ensure uninterrupted GANESHA procession
The last month had been Ramadan, and many practitioners of the Islamic faith could not make it to the meeting. Now it was the turn of Ganesha, that ‘remover of all obstacles’ and what we had not forseen, was that today the idols would be taken in a procession to the nearby lake for ‘immersion’. Entry into the area found forest department staff pruning the gulmohars in front of KG Halli police station in preparation for the large trucks that would pass in the evening. A fairly skilled task, made more challenging by the continuous traffic that passes beneath. Was this, one wondered, the BBMP team involved in the environmental health of the area?
Quite startling were the number of Ganesha idols on the main Tannery road- at least seven 12-14 foot idols with music systems in trucks; each with more than a dozen speakers piled on and blaring music at mind boggling decibels. Another potential area of intervention for environmental health? There was clearly a competitive streak with the traditional ‘aarthi’ vying with Kannada, English and of course Bollywood’s latest – “Sheela ki jawani” ! Noticeably absent were people, these main- road idols seemed to the viewer /listener to provide entertainment to passers-by.
A woman attempting to calm drunken men with a bucket of water
Entering the side road to the Centre we found three smaller pandals , put up by families or groups; again providing music at ear shattering decibels. So we shut all doors and windows in order to hear each other (and the doctors we were trying to call on the phone) and conceded the choice of the day had been a mistake. But every time a balcony door opened we were inevitably drawn to the drama unfolding outside in the corners of the street. In one pandal, men were dancing, inebriated, uninhibited and to the embarrassment of their womenfolk. Three policemen on duty sat comfortably in chairs to the side of the pandal and watched indifferently as a woman brought a bucket of water and doused her husband in an effort to stop the display. A child was caught in the circle of dancing men and had to be pulled out, crying bitterly. Finally when a passing scooter was halted and the driver heckled, the batons came into view and raised voices were heard. At this point a CHA said “This is how the fights start, last year a man lost his hand in the brawl !” Yet 20 feet down the road, the dancing young children emitted a completely different energy, exuberance with the innocence of childhood. Everywhere, the boys danced. One wondered if the girls wanted to.
IPH team and health providers in KG Halli at a meeting
Meanwhile we strategized and waited. And after numerous phone calls , four private providers braved the chaos on the roads, and came to the meeting. Four more would have come, but they stayed back to treat injuries or could not come through the procession. We tried the government facilities, both had emptied of staff by midday, as transport to go home would be a nightmare. Again, despite the numbers being few, we were struck by the interest and attention these practitioners displayed to the sharing from the IPH team. The CHAs were already sounding more confident and interestingly, this time they spoke in the Dakkhini- Urdu so typical of the area! As we got a chance to interact closely with the providers, we were also able to assess individually, the probable areas of interaction that they might involve themselves in. From describing the state of the bakeries using child labour in the Vibhuthipura area to offering to help with Urdu translations of appropriate health messages, it was clear from the exchanges that the practitioners are not limiting themselves to treating colds and coughs, or examining lungs and livers. There was also the interest in the centre, how it runs and where collaboration in following up with government departments might be useful.
Luckily the Ganesha in “our” lane was sent on his journey to the waters by 2.30pm, so the meeting was conducted in relative peace. By the time we wound up and travelled home it was later than usual, the mind filled with jumbled images linked to health …….alcohol and stress , gender, the role of ritual in social inclusion, youth and political dynamics in the urban settings, being some of them.
On the ground, yet another step had been taken towards the elusive platform for ward no 30.
