Call it the light at the end of the tunnel, or the pure relief that comes when the hoped-for, unexpected unfolds; but the urban health team experienced the adrenaline rush that goes with all this on August 8th at KG Halli’s community centre as we gathered for the first meeting with the health providers in the ward.
As the community links have strengthened over time, the household survey has moved steadily and imperceptibly into home visits, and contacts with schools and sanghas have regularised. The challenge was now to rope in the doctors in the area, both public and private providers on whom the 40 thousand odd people living there depend on for their health needs. Our initial meetings had revealed around 25 practitioners in the clinics and 4 hospitals, with a wide range of training from Allopathy to Ayurveda to Unani, and including alternative healers using natural remedies, a physiotherapist and counsellor.
Over the last two weeks we had met most of these practitioners and explained the direction our research was taking. We also invited them for a meeting at the community centre in Vinobhanagar, at the heart of ward no 30. Interestingly, we received no negative response; everyone said they would try to come, and the time was fixed for 3pm-4pm, as best suited the doctors. This, despite the fact that the fasting of Roza has begun for the predominantly Muslim community.
At the IPH end, now started fairly intense preparations for this event. For the team it was the first time we were trying to explain our work to the doctor community. Even for the public health specialist, “action research” needs explanation, and the “platform” sounded nebulous to our own ears as we rehearsed. But the process of preparing for this meeting was such a joy and a challenge. Upen had put the skeleton of the survey results onto powerpoint, but as we progressed, discussing what we wanted to convey to the audience, the presentation came together. The red thread was kept tight by Thriveni , little details came from Amrutha , I brought in a story for perspective and Antu, Nagaratna, Leelavathi and Josephine brought the raw power of their field experiences, which we practised to a polished 30 minutes.
Munna came in with all the arrangements for the meeting (including the photo credits!) and by 2.30 pm we were awaiting our guests. We had already swallowed our disappointment when, over the weekend, our good friend and colleague from the UHC, Dr. Anantalakshmi had informed us that she had been transferred and could not attend. The other government centre, the CHC had also a prescheduled meeting, but Upen and I decided to make one last effort to meet Dr. Mangala, the doctor in charge. We were richly rewarded in that a young doctor Dr. Shweta was deputed to come, overcame her reservations and arrived at the meeting.
At this point, between 3 and 3.20 pm I must confess to having kittens, as we waited ….and waited….and waited. But soon, they started trickling in and by 4 pm we had seven guests, seated comfortably on the mats, and we closed the door on the pouring rain flooding the balcony, and started to share. It was remarkable how intense the meeting was, how carefully the practitioners listed to the team’s findings, and towards the end, how interactive the session became. The community workers voices had that note of passion and truth and their confidence had the audience listening. Equally remarkable were the guests, from the wisdom and hope of Dr. Aftab , to the clinical expertise of Dr. Kulkarni, the participation was complete. Dr. Shweta stayed on well past her working hours with great attention and interest, her husband who came to pick her up was kind enough to wait until past 5 pm. The presentation had focused on the findings of the survey, but the discussion took off, and as someone commented, we were all on the same page………….improving health care, concern for the poorest, how to share expertise and resources………..these were the topics around which the talk revolved.
Some very encouraging quotes from both the meeting and the IPH debrief later, may give you a sense of what transpired.
… “ I never thought it would happen at 3 pm……….but the meeting was much better than expected”
…. “ Even if few people came, it gave us the chance to get to know them and talk with ease”
…. “ Now that we know we have all these resources available , we can actually make health care happen for the community”
….. “ We must have meetings like this every month, they are very informative”
….. “ It was a suuuper meeting!!”
….. “ There is lots of work ahead , but that was the point of all this, is it not?”
So where do we stand today? Surely able to answer our colleagues who have been asking with understandable impatience “Will you ever get a platform?”….in the affirmative. And ready to take the first step which is always the beginning of every journey, however long.
ವಾರ್ಡ ಸ೦ಖ್ಯೆ ೩೦ರಲ್ಲಿ ನಾವು ಸುಮಾರು ಎರಡು ವರುಷಗಳಿ೦ದ ಕೆಲ್ಸ ಮಾಡುತ್ತಿದ್ದೇವೆ, ನಮ್ಮ ಗುರಿ ಸಮುದಾಯದ ಆರೋಗ್ಯದಲ್ಲಿ ಗುಣಮಟ್ಟ ತರುವುದಾಗಿದೆ. ಈ ವಾರ್ಡನಲ್ಲಿ ಭಾರತಮಾತ ಸ್ಲ೦ ಇದೆ, ಅಲ್ಲಿ ಒ೦ದು ಅ೦ಗನವಾಡಿ ಸಹ ಇದೆ. . ನಾವು ಕೆಲಸ ಮಾಡುವ ಸ೦ದರ್ಭದಲ್ಲಿ ಆ ಅ೦ಗನವಾಡಿಯು ಸರಿಯಾಗಿ ಕೆಲಸ ಮಾಡುತ್ತಿಲ್ಲ ಎ೦ದು ಗೊತ್ತಾಯಿತು.ಮಕ್ಕಳು ಸಹ ಆ ಕೇ೦ದ್ರಕ್ಕೆ ಸರಿಯಾಗಿ ಬರುತ್ತಿರಲ್ಲಿಲ್ಲ, ಬದಲಾಗಿ ಅಲ್ಲೆ ಪಕ್ಕದಲ್ಲೆ ಗ್ರೇಸ್ ಸ೦ಸ್ಥೆ ನಡೆಸುತ್ತಿದ್ದ ಅ೦ಗನವಾಡಿಗೆ ಮಕ್ಕಳು ಹೋಗುತ್ತಿದ್ದರು. ಅ೦ಗನವಾಡಿ ಸಹಾಯಕಿ, ಅ೦ಗನವಾಡಿ ತೆರದು ನ೦ತರ ಅಕ್ಕಪಕ್ಕದಲ್ಲಿ ಮಾತನಾಡುತಾ ಕಾಲ ಕಳೆಯುತಿದ್ದರೆ, ಟೀಚರು ಸುಮಾರು ೧೧.೩೦ಕ್ಕೆ ಬ೦ದು ಶಾಲಾಪೂರ್ವ ಚಟುವಟಿಕೆಯನ್ನು ಮಾಡದೆ ಕೇವಲ ದಾಖಲಾತಿಗಳನ್ನು ಬರೆದು ಮನೆಗೆ ಹೋಗುತ್ತಿದ್ದರು. ಮಕ್ಕಳಿಗಾಗಲಿ, ಗರ್ಭಿಣಿಯರಿಗಾಗಲಿ ಪೌಷ್ಟಿಕ ಆಹಾರಗಳನ್ನು ಸಹ ಕೊಡುತ್ತಿರಲ್ಲಿಲ್ಲ. ಅ೦ಗನವಾಡಿಯ ಪಕ್ಕದಲ್ಲೆ ಕಸಕಡ್ಡಿ ತ೦ದು ಹಾಕುತ್ತಿದ್ದರು ಅದಕ್ಕೆ ಏನು ಕ್ರಮ ತೆಗದುಕೊ೦ಡಿಲ್ಲ. ಅ೦ಗನವಾಡಿಯೊಳಗೆ ಇರುವ ಆಹಾರಗಳು ಹೆಗ್ಣಗಳ ಪಾಲಾಗುತ್ತಿತ್ತು.
ಅ೦ಗನವಾಡಿಯು ಸಮುದಾಯದ ಅವಶ್ಯಕ ಸೌಲಭ್ಯವೆ೦ದು ನಮಗೆ ಅನಿಸಿತು ಹಾಗಾಗಿ ಇಲ್ಲಿನ ಪರಿಸ್ಥಿತಿಯನ್ನು ಬದಲಿಸಬೇಕೆ೦ದು ನಾವು ಟೀಚರೊ೦ದಿಗೆ ಸುಮಾರು ಸಲ ಮಾತನಾಡಿದೆವು, ಆದರೇನು ಅ೦ಗನವಾಡಿ ಸುಧಾರಣೆ ಆಗಲಿಲ್ಲ. ಟೀಚರು ತನ್ನ ಸಮಸ್ಯೆಯನ್ನೆ ಹೇಳುತ್ತಿದ್ದರೆ ವಿನಃ ಆ ಸ್ಲ೦ನಲ್ಲಿ ಮಕ್ಕಳು ಸೌಲಭ್ಯಗಳಿ೦ದ ಎಷ್ಟು ವ೦ಚಿತರಾಗುತ್ತಿದ್ದರೆ೦ದು ಕಿ೦ಚತು ಭಾವಿಸಿಲ್ಲ. ನಾವು ಅವರ ಸಮಸ್ಯೆಯನ್ನು ಸಹ ಅರ್ಥಮಾಡಿಕೊ೦ಡೆವು, ಆದ್ರೆ ಅವರು ಒಬ್ಬ೦ಟ್ಟಿಗರು ಮತ್ತು ವಿಧವೆ ಎನ್ನುವುದು ಬಿಟ್ಟರೆ ಬೇರೆ ಸಮಸ್ಯೆಗಳೇನು ಇರಲ್ಲಿಲ್ಲ. ಯಾವಾಗ ಅವರೊ೦ದಿಗಿನ ಮಾತು ಪ್ರಯೋಜನವಾಗಲ್ಲಿಲ್ಲ ಅವರ ಅಧಿಕಾರಿಗಳಿಗೆ ೨-೩ ಸಲ ಬರವಣಿಗೆಯ ಮುಲಕ ವಿಷಯ ಮುಟ್ಟಿಸಿದೆವು.ಅವರು ಸಹ ಯಾವುದೇ ಕ್ರಮ ತೆಗೆದುಕೊ೦ಡಿಲ್ಲ. ನ೦ತರ ಸಮುದಾಯದವರೊ೦ದಿಗೆ ಮಾತನಾಡಿದೆವು. ಸಮುದಾಯದವರೊ೦ದಿಗೆ ಮಾತನಾಡುವಾಗ ಮತ್ತೊ೦ದು ಹೊಸ ವಿಷಯ ಬೆಳಕಿಗೆ ಬ೦ತು, ಒಟ್ಟು ೪೦ ಹೆಣ್ಣು ಮಕ್ಕಳನ್ನು ಭಾಗ್ಯಲಕ್ಷ್ಮಿ ಸೌಲಭ್ಯದಿ೦ದ ವ೦ಚಿತರಾಗುವ೦ತೆ ಮಾಡಿದರು ಈ ಭಾಗ್ಯಲಕ್ಷ್ಮಿ…. ಟೀಚರು. ಇದರ ಬಗ್ಗೆ ನಮ್ಮಲೇ ಚರ್ಚೆಗಳಾಯಿತು ಮತ್ತೊ೦ದು ಸಲ ಅ೦ಗನವಾಡಿ ಟೀಚರ ಹತ್ತಿರ ಮಾತನಾಡುವುದೆ೦ದು ನಿರ್ಧರಿಸಿ ಅವರಿಗೆ ಮತ್ತೊ೦ದು ಅವಕಾಶ ಕೊಟ್ಟೆವು. ಅವರು ಸುಧಾರಿಸುವ೦ತೆ ಕಾಣಲ್ಲಿಲ್ಲ ನಮಗೆ ಅದೆ ಸಮಯದಲ್ಲಿ ಅದೃಷ್ಟವಶಾತ ಹೊಸ ಶಿಶು ಯೋಜನ ಅಧಿಕಾರಿ ಬ೦ದಿದ್ದು ಅವರು ನಮ್ಮೊಬ್ಬ ಸಹೊದ್ಯೋಗಿಯ ಸ್ನೇಹಿತರಾಗಿದ್ದು ಒ೦ದು ರೀತಿಯಲ್ಲಿ ಸಮುದಯಕ್ಕೆ ಅನುಕೂಲವಾಯಿತು. ನಾವು ದಾಖಲಾತಿಯೊ೦ದಿಗೆ ಅವರನ್ನು ಭೇಟಿಯಾದೆವು, ಪರಿಸ್ಥಿತಿಯನ್ನು ಅವರೆ ಬ೦ದು ನೋಡಿ ನ೦ತರ ಕ್ರಮ ತೆಗದುಕ್ಕೊಳ್ಳಬೇಕೆ೦ದು ಅವರಿಗೆ ಹೇಳಿದೆವು.
ಹೇಳಿದ೦ತೆ ಅವರು ಅ೦ಗನವಾಡಿಗೆ ೧೦ ಗ೦ಟೆಗೆ ಬ೦ದರು. ಅವರಿಗೆ ಅ೦ಗನವಾಡಿಯು ಯಾವ ಸ್ಥಿತಿಯಲ್ಲಿದೆ ಎ೦ದು ತಿಳಿಯಿತು, ನ೦ತರ ಮಹಿಳೆಯರೊ೦ದಿಗೆ ಗ್ರೇಸ್ ಕೇ೦ದ್ರದಲ್ಲಿ ಸಭೆ ನಡೆಸಿದರು, ಸಮುದಾಯದೊ೦ದಿಗೆ ಮಾತನಾಡಿದರಿ೦ದ ಅ೦ಗನವಾಡಿ ಟೀಚರಿ೦ದ ಎನೆಲ್ಲಾ ಸಮಸ್ಯೆಗಳಾಗುತ್ತಿದೆ ಎ೦ಬುದು ಅವರಿಗೆ ತಿಳಿಯಿತು. ಎ೦ದಿನ೦ತೆ ಆ ದಿನವು ಟೀಚರ್ ೧೧ ಗ೦ಟೆಗೆ ನೇರವಾಗಿ ಸಭೆ ನಡೆಯುತ್ತಿದ್ದ ಗ್ರೇಸ್ ಕೇ೦ದ್ರಕ್ಕೆ ಬ೦ದರು. ಲೇಟಾಗಿ ಬ೦ದದ್ದಕ್ಕೆ ಅವರ ಅಧಿಕಾರಿ ಕಾರಣ ಕೇಳಿದರು ತಕ್ಷಣ ಉತ್ತರ ನೀಡದೆ ಸ್ವಲ್ಪ ಸಮಯದ ನ೦ತರ ತನಗೆ ಆರಾಮ ಇರಲ್ಲಿಲ್ಲ ಎ೦ದು ಹೇಳಿದರು (ಹುರುಳಿಲ್ಲದ ಉತ್ತರ). ಟೀಚರನ್ನು ನೋಡುತ್ತಿದ್ದಾಗೆ ಸಮುದಾಯದವರು ರೇಗಾಡಲು ಶುರು ಮಾಡಿದರು- “ಇಷ್ಟು ವರುಷಗಳಿ೦ದ ಅ೦ಗನವಾಡಿ ನಡೆಸುತ್ತಿದ್ದೀಯ ಯಾವುದಾದರು ಒ೦ದು ಮಗುವಿಗೆ ನಿನ್ನಿ೦ದ ಅನುಕೂಲವಾಗಿದೆ ಎ೦ದು ಹೇಳು ನೋಡೋಣ”? ಇದಕ್ಕೆ ಅವರ ಹತ್ತಿರ ಉತ್ತರವಿರಲಿಲ್ಲ. ಸುಮಾರು ಸಮಯ ಚರ್ಚೆಗಳಾಯಿತು, ಅ೦ಗನವಾಡಿ ಟೀಚರ್ ತಮ್ಮ ನಡವಳಿಕೆಯನ್ನು ಸಮರ್ಥಿಸಿಕ್ಕೊಳ್ಳಲು ಸಮುದಾಯವರ ಮೇಲೆ ಗೂಬೆ ಕೂರಿಸುತ್ತಿದ್ದರು, ಆ ಸ್ಲ೦ನ್ ಲೀಡರ್ ಅವರನ್ನು “ನೀವು ಹೊರಗೆ ಹೋಗಿ ಇದು ನಮ್ಮ ಸಮಯ ನಿಮ್ಮ ಸರ್ ಹತ್ತಿರ್ ನಾವು ಮಾತನಾಡುತ್ತೇವೆ ಎ೦ದು ಹೇಳಿದರು”. ಸಮುದಾಯದವರು ಈ ಅ೦ಗನವಾಡಿ ಟೀಚರ ನಮ್ಗೆ ಬೇಡ ದಯವಿಟ್ಟು ಬೇರೆ ಟೀಚರನ್ನು ನಮಗೆ ಕೊಡಿ ಎ೦ದು ಒಮ್ಮಲೆ ಕೇಳಿಕೊ೦ಡರು.ಅದರ೦ತೆ ಆಗಲಿ ಎ೦ದು ಅಧಿಕಾರಿಗಳು ಒಪ್ಪಿಕೊ೦ಡರು.
ಸಧ್ಯದಲ್ಲಿ ಒ೦ದು ಒಳ್ಳೆಯ ಟೀಚರನ್ನು ಕೊಟ್ಟಿದ್ದಾರೆ, ಆದರೆ ಅವರು ಡೆಪ್ಯುಟೇಷನ್ ಮೇಲೆ ಬ೦ದ್ದಿದ್ದಾರೆ, ಆದಾಗ್ಯು ನಾವು ಈ ಅ೦ಗನವಾಡಿಗೆ ನಿರ೦ತರವಾದ ಟೀಚರ ಬೇಕೆ೦ದು ಅನುಸರಣೆ ಮಾಡುತ್ತಿದ್ದೇವೆ.ಅದಕ್ಕೆ ಅಧಿಕಾರಿಗಳು ಒಪ್ಪಿ ಮು೦ದಿನ ಅಭ್ಯರ್ಥಿಗಳ ಆಯ್ಕೆಯಲ್ಲಿ ಹೊಸ ಟೀಚರನ್ನು ಕೊಡುವುದಾಗಿ ಭರವಸೆ ನೀಡಿದ್ದಾರೆ.
ಹಿ೦ದಿನ ಟೀಚರ್ ಸ್ವಲ್ಪ ಮಟ್ಟಿಗೆ ತನ್ನ ನಡವಳಿಕೆಯಲ್ಲಿ ಬದಲಾವಣೆ ಮಾಡಿಕೊ೦ಡಿದ್ದರೆ ೪೦ ಹೆಣ್ಣು ಮಕ್ಕಳು ಭಾಗ್ಯಲಕ್ಷ್ಮಿ ಸೌಲಭ್ಯದಿ೦ದ ವ೦ಚಿತರಾಗುತ್ತಿರಲ್ಲಿಲ್ಲ…., ಕೊನೆ ಪಕ್ಷ ಈ ಸ್ಲ೦ನ್ ಮಕ್ಕಳು ಸಾಕ್ಷರರಾಗಿರುತ್ತಿದ್ದರು…. ಸ್ವಸಹಾಯ ಗು೦ಪು ಅಥವ ಸ್ತ್ರೀ ಶಕ್ತಿ ಗು೦ಪುಗಳಿ೦ದ ಹೆಚಿನ ಮಹಿಳೆಯರು ಆರ್ಥಿಕವಾಗಿ ಸಬಲರಾಗಿರುತ್ತಿದ್ದರು…..
-Munegowda C.M, Amrutha and UHP team
11 July began like any other Monday in KG Halli, meant to be a quick review of the last week and a plan for the one to come, but unfolded otherwise. We were interrupted by a phone call from Bharatmata slum; and another, and a third, until it became clear that we needed to be there soon. The information was that Juliet who had gone underground since her last ANC check-up, had surfaced, and the entire community was on the alert. They had seen our team go to unusual lengths trying to track her, and wanted to help.
So three bus stops and fifteen minutes later all five of us reached Ms. Pakyamary’s place and I met the young woman for the first time. Of indeterminate age, the right side of her face twisted and swollen with an infected tooth, she seemed the epitome of fear and misery. Juliet is well under five feet and looks as though a mild breeze will blow her away. Under the ‘dupatta’, the small swelling of her belly is barely visible, and surrounded by a group of loud and angry women, she was led to the small Jesus and Mary shrine nearby. A feature of this urban area are the small Christian, Hindu and Muslim shrines, where the old and infirm sometimes rest and shelter.
One more day in the field – and a million more questions
The first minutes were volatile, with the voices of many angry women creating a raucous backdrop to a highly charged scene. Ms.Pakyamary herself, a powerful local leader was loud in her accusations, asking why Juliet had “run away” and proved so elusive. She , of the soft voice became totally silent, when faced with all the questions. Finally, everyone departed, the local ladies to their chores, two team members for school permissions and two others for medicines and antibiotics for our patient. Antu and myself stayed on, and we tried to gently question and piece the story of the last two months together. Extracting information from this young woman was a huge challenge. We listened,cajoled,advised, entreated, listened some more…….. in a vain attempt to understand her actions.
It appears that this young lady is truly abandoned, she does not know where her mother is, her brothers are incommunicado (no one would admit to knowing them when enquiries were made in the area) and her equally young husband is addicted to drugs. She said her mother-in law fed her dosas this morning and told her to leave the house ……..
When faced with the question of what to do next, she seemed really clueless, at a term pregnancy with an intra –uterine growth retardation, and severe anemia, strangely uncaring but very fearful of the future. From bursting into tears and begging Antu to stay with her in hospital to stubbornly refusing to go back home, we had glimpses of a young child who has never known security and been driven by fear from one life-event to the next. She has spent much of her young life on the road, I suspect. Finally she agreed to wait there while we bearded the lion in the den…….her mother in law who had already given the team a mouthful.
This stalwart, mother of eleven children ( “I have buried five of them”) also appears of indeterminate age, albeit older than Juliet. Life is clearly an immense struggle, a drunken husband lolls on the bed, crying over the loss of the last child who was stabbed in a brawl two months ago, and her voice rings true as she describes the hard work and hunger that haunt her days as a rag picker. She is a survivor; when she speaks, I can see where the Tamil films get their salt –of-the-earth heroines from. After sometime as she repeats herself and her outrage at Juliet’s behaviour, it turns surreal and I am not sure if this is art imitating life or vice-versa. Here is a woman who has very strong ideas on “mariyadaya” –respect- and the fact that women must do their bit…… “I give her little work” she says, “not like I had to do when I was expecting my first child”……..And her eyes fill with unshed tears “ I lost one daughter, she is like another –see I have saved hundred rupees even hidden from my husband, for her delivery”….. “ But how can she go out and claim I do not care”……The ego is hurt, that despite all she has been maligned.
Finally, after much listening and some persuasion, she agrees to look after Juliet if we talk to her.
And this is where we lost the thread. We descended back to the shrine thinking we had “fixed it”. Juliet started out accepting but once her mother in law entered with the accusations, she turned the offer away. “ I will go to my Anni”……an older brother’s wife who has not featured in the story till now. A figment of her imagination? Is she clutching at straws?
And we are left wondering afresh at our definitions of health – not merely the absence of illness, but the state of physical, mental and social well being – and their relevance in our daily work. How supremely satisfying it is to say ‘holistic care’ or ‘cradle to grave’ and then be given pause to think just because a young and very lost woman wandered into our life by becoming pregnant.
Tomorrow the team is going back to ask if she would like to deliver in an institution that might extend care in such a case as this. If they find her…………..
Is Juliet’s fear of going to a health provider justified?
Are health providers sensitive to an unusual patient like Juliet ?
Let us explore the Issues further
Juliet is 13 years old and married to Narayana who is 15 years old. She lives in a congested small house in Bharathmata slum. She was detected as pregnant in the month of January by Dr.Roopa/ Dr.Thriveni . As a follow-up task Anthu and the Community Health Assistants (CHA) have been repeatedly motivating her to undergo antenatal check up (ANC) but she has never yielded to suggestions given by our team. Whenever our team visited the slum they consistently motivated her but unfortunately it was similar to watering a barren land. Somehow she would always escape from our sight. To avoid our suggestions or accompanying her to the hospital there would be an answer that she was not at home, she had gone to her mother’s place etc.
We would discuss her in our review meeting and feel helpless of being unable to motivate her. We were in dilemma whether to give up or pursue her to visit the urban health center. At that point Anthu said –“No I will take her to the hospital”.
Anthu was spurred into action, along with Josephine she took Juliet to the public health maternity home. Taking Juliet to the hospital was not an easy task. Anthu and Josephine reached Bharathmata slum at 9.45 am and waited till 11.30 am to meet Juliet and lure her into accepting to visit the hospital. Even on that day Juliet played the same tricks, unwilling to attend the hospital. After an hour of restless waiting Josephine went to her home to fetch her. She found her at home completely disconcerned about her health and need to go to the hospital. After long hour of convincing, Josephine and Anthu took her to the hospital.
When they arrived at the hospital it was 12.30 pm, past registration time and the hospital staff refused to take her in. After explaining their effort in motivating her to have ANC, the nurse agreed to allow her in. She was taken to the registration counter and later to the nurse for general check-up. Here the nurse collected general information about her family, marriage and occupation of her husband. When the nurse realized Juliet was 14 years old she made fun of her saying “What is your age, do you want a pregnancy at this age?” the rest of the staff started laughing at this remark. In addition, while gathering this information, the tone of the nurse was authoritative and insulting, this behaviour of all the staff made Juliet feel as though she had done something wrong. When Josephine felt the situation was getting out of hand, she intervened to tell them “Please do not insult and laugh at her, with great difficulty we have brought her for ante natal check up”.
Meanwhile she had completed blood and urine test including BP and weight check-up. All the results showed her to be a high risk patient (wt is 34kg, BP100/60, HB is 8.0gm). Later she was taken to the doctor for further checkup. The young interns visiting the maternity Centre realized this was a risk pregnancy and refused to do further check-up. Juliet waited for the senior doctor, who referred her to Bowring or Ambedkar for further tests like scanning and PPTCT.
Either a teenage pregnancy, or adult pregnancy, the responsibility of the public providers requires sensitive attitude at least towards unusual patient like Juliet. An insulting attitude of the public health staff induces fear among teen agers to get ANC. My perspective is strongly supported by Juliet’s view about the hospital and its staff. She told us that she was scared of going to the hospital since she had heard that they would be rude towards teenage pregnancy. With this attitude how can one expect the community to have trust in public health providers?
On one hand there is the community with no trust in public health services, and on the other handwe have public health providers with de-sensitized behaviour towards the community. This is a huge challenging for us.
Not how, but we are constantly exploring the ways and means of building the trust between the community and the public health providers!!!!!!!!!!
Institute of Public Health
The Bharathmatha slum community was facing a huge garbage problem. There was incomplete garbage collection in the area which had given rise to multiple health problems to the community. The IPH team working in the urban health project decided to meet health inspector to discuss this issue and find solutions to help the community at KG halli.
During our meeting with the health inspector, he explained that there were issues with the timings of garbage collection in the area. The garbage collectors (Pourakarmikas) would come early in the morning, when it was inconvenient for the community to hand away the garbage to them.
As a follow-up of this, the IPH team decided to bring the community representatives and the municipality of the area together for a discussion. A meeting between 40 community representatives and BBMP senior health inspector Mr.Rayappa was arranged.
During this interaction, community members articulated the problems they were facing in respect to garbage collection. These problems were that the Pourakarmika workers would come only once in a week and days when these workers would not come the garbage would be thrown outside.
Addressing their problems, the health inspector promised that 2 pourakarmikas will be posted for the area. He also promised that he would ensure that the garbage will be collected twice a day. Further ahead, he requested the community members to handover the garbage to pourakarmikas and not through it outside.
In the same meeting, the community representatives brought up other issues which they were facing on an everyday basis in the locality. These problems were improper cement road, inadequate water supply, bad drainage facility, and many others. Responding to these issues, the health inspector Mr.Rayappa proposed that in the forthcoming month a meeting including community members, representatives from BWSSB,( Bangalore water supply and Sewage Board) AE,( Assistant Engineer) MLA(Member of legislative assembly) and Councilor will be planned. This meeting would provide a platform for the community to interact with higher officials and put forth their grievances to be addressed by all.
One of the objectives of the urban health project is to facilitate a process to bring the community and government officials together on one platform. This activity would motivate the community members to discuss their problems and grievances directly and we anticipate this to be heard and addressed by the government representatives positively.
Blog posted by : Munegowda C.M.
The most exciting day of my undergraduate life at medical college was the day when I put the stethoscope on a patient’s chest and asked ‘can you take a deep breath’. Through the years at college, life completely revolved around patients and their diseases. In fact, our introduction to clinical medicine focused on comprehensive details that a student was expected to procure from patients during the course of history taking and clinical examination. To fare well in exams we were instructed to examine as many cases as possible and memorize exhaustive details of the innumerable diseases infecting people and populations.
The wait for us, would always be for an exotic disease like Kawasaki disease or a Marfan’s syndrome. The early morning walks, cancelled classes and evening tea times, would be filled with excited discussions on eliciting a particular murmur or a classical sign of the rare disease. Word would spread around and the spot light would suddenly dawn on patients infected with the rare diseases. Herd of students would bombard the patient with never ending questions trying to match the disease features to that as mentioned in ‘Harrison’ or ‘Bailey and Love’.
Looking back today, I try to reflect upon what I learnt 10 yrs ago. The search was always for something that was new, unknown and unheard of. I wonder how different would have been my learning if I was taught to ask patients some fundamental questions like ‘how far did they had to travel to reach hospital? Or ‘how could someone who struggled to earn 3 meals a day was able to pay medical bills running in thousands’ and ‘in quest of becoming healthy, how poor had they become?’.
From Reorientation of Medical Education (ROME) scheme in 1977 which aimed at developing medical doctors for the rural poor to the Vision of Medical education in 2015 which envisages creating a basic doctor, physician for first contact of urban and rural community, I see major changes. These have been mainly on the duration of the course, the curriculum and the delivery of the subjects. In every effort to transform medical education, the larger objective has always been to expose the medial undergraduates to the community, to provide insights into field realities of the country. But the conversion of this objective into action has been only through posting them into rural health facilities, sometimes during the course and some as interns.
What would multiple pages of a case sheet with in-depth information of the disease mean to a woman who is wondering what went wrong with her healthy son, the only earning member of the family?. She runs from pillar to post in a completely unfamiliar environment trying to follow and fulfill every instruction of a busy doctor, who cannot devote few minutes to explain why her son was so much in pain. I wonder which subject or part of medical life sensitizes medical students to the pain, sufferings, fears and anxiety of patients and their families.
The focus of medical education needs to shifted from treating the disease to treating the patient. While signs, symptoms, investigations and treatment are all vital, the situation and the context of a patient’s life are most fundamental to understand and internalise.
I am constantly in search of students who while can rattle out causes of maternal deaths, can also ask questions like why did the ANM discriminate the mother while providing ANC care? Why was the medical officer attending to private practice during duty hours? Why did the health facility fail to provide ambulance when it was most required?
I wonder when the search will ever come to an end.
Blog by: Dr. Kavya R