As a researcher, this was another day of visit to KG Halli in our long series of interactions with the community, but this particular visit was critical from research and humane point of view. I had gone to to meet three women who had lost their babies recently. I was a bit apprehensive to go and talk with them though they had expressed interest to meet me. This was perhaps e my previous experience of feelings of helplessness when a woman had broken down narrating her story in a similar situation and the research team could only console her at that time.
I followed Leela (the community health assistant) to Ms Shagufta’s house in KG Halli. We got a warm welcome and we all sat on a mat on the floor. After an initial chat, she gave me a plastic carry bag with many sheets of paper in it. The ultrasound report stated intrauterine death (IUD). On further questioning, Mrs Shagufta shared that she had been to the nearby Maternity Home and the doctor had advised her to go to “big hospital” but she along with her husband took the decision to wait for two days and then see…… She visited the same doctor after two days, but it was too late!!! One wonders, if the baby could have been saved if the reason for referring to the bigger hospital was explained to the mother? or the consequence of delaying visit to “big hospital” was communicated properly?? Do the doctors in public hospital
have so much time considering the work load?? Or should they be spending few minutes if the case is complicated? Not sure where and what went wrong but the end result was one life was lost which was preventable!
We walked through the Bharathmatha slum and reached Ms Vimla’s house. Her house was a contrast to the surrounding area that was neat and things in the house were well-arranged.. While talking I could feel her frustration when she said in-spite of doing everything what the doctors had suggested, I lost my baby! This happened in one of the private medical colleges/hospitals, where she went for regular antenatal care (ANC) visit—that too every 15days as advised by the doctors for monitoring her blood pressure. All she knew about the reason for baby’s death was that due to her high blood pressure the baby was choked to death. She attributes the sudden rise in her blood pressure at that time to witnessing the death of women in labor opposite to her ……this in a way raises questions about the atmosphere women deliver which is supposed to be the one of the best moments of their life!! Are the concerned staffs in the labor ward even aware of the impact of this situation on women in labor pain? ………….I had no exact answer when she asked why did my baby die after half an hour of birth?
With many un-answered questions for possible reasons for death of babies, we walked to Ms Salma’s house. Met this young charming girl sitting next to her first child….her sister in law joined us….whom we knew very well so the talk went smoothly……it was obvious that this young mother had terrible experience while in the labor ward…..in one of the secondary public hospitals in Bangalore. She said she was shouted at for going there while in labor and was told “if things go wrong we are not responsible”…It is difficult to understand whether secondary hospitals should concentrate more on referred cases/complicated cases or on ANC? Or is this a way shying away from responsibilities and accountability?? To add to this, money was demanded by the aaya….she was repeatedly slapped during the process of delivery….constantly and repeatedly told not to scream if she did so the baby would die…finally it reaches a stage where the aaya sits over her chest to “PUSH” the baby. The out-outcome of all this torture was a still birth!! She had lot of praise for the doctor’s attitude but she said it was nurse and aays who were rude …but are the doctor not supporting this kind of behavior by not addressing and turning a blind eye to it ? Or are they helpless to address this? Is this not part of basic quality of care? The young mother goes through this stressful experience and lives with guilt of killing her own baby by screaming and she shared her decision that -“ I will NEVER go to hospital for delivery”. This time I had an answer to her question – the baby did not die because you screamed while in labor pain! Though I did not have immediate answers in the first two episodes, I feel that sharing the ‘unresolved’ and ‘unaddressed’ issues and concerns of the community would go a long way to actually resolve them and prevent future deaths.
Please note: Names are changed to protect privacy.
IPH (Institute of Public Health) & ITM (Institute of Tropical Medicine) are partners in the Health Inc project. Werner Soors elaborates on the development of the SPEC-by-step tool for layered analysis of social exclusion in health. Tanya Seshadri shares a practical example where the tool is pre-tested on the preliminary data of an ongoing RSBY (Rashtriya Swasthaya Bima Yojna) WHO-Alliance study.
Date: 18th August 2011
The full presentation can be downloaded here (3Mb)
Part 1 The twinned concepts of social exclusion/inclusion
We introduce the concepts of social exclusion, specifically social exclusion in health, and the interaction of social exclusion and inclusion. For the latter, the Indian example of reservation serves as an example.
Part 2 Development of the SPEC-by-step tool
We develop the SPEC-by-step tool: a generic, structured checklist to provide guidance for analysis of social exclusion in social health protection programmes. We take you through each level and step of the tool.
Pre-testing the SPEC-by-step tool on an existing dataset
We exemplify the SPEC-by-step tool as an eye-opener by starting to apply it on the preliminary data of an ongoing RSBY WHO-Alliance study. (A cautionary note: preliminary unclean data is utilised for this example to understand application of this tool and is not related to the ongoing RSBY WHO-Alliance study)
Articles in BMC journals are listed in PubMed and archived at PubMed Central.
National policies recommending routine iron supplementation. Understanding factors associated with receipt of iron in the field could help optimise implementation of anaemia control policies. Thus, we undertook 1) a cross-sectional study to evaluate iron supplementation to children (and mothers) in rural Karnataka, India, and 2) an analysis of all-India rural data from the National Family Health Study 2005-6 (NFHS-3)
ISSN 1471-2458
Article type : Research article
Submission date : 31 January 2011
Acceptance date : 3 August 2011 Publication date : 3 August 2011
The Institute of public health hosted a group of 10 Maastricht University students on an Exposure visit to India program.
The students were participants of the Honours International program at Maastricht university.
The 3 week program from July 11 – July 28 2011 focused on exposing the students to the health system of the country.
The program was directed to equip students with better skills, knowledge and practices about inter country public health sceneries with special focus on the differences between multiple health care systems and also the regional and cultural perspectives.The prime component of the program were exposure to field visits. The students were also provided with theoretical framework/background to link the observations made in the field, much better.
The main topics covered under the program were health care system in India, social determinants of health, communicable and non communicable diseases, child and maternal health care in India, health service organisation, community health and health care financing in India.
Researchers from IPH along with wildlife scientists from National Centre for Biological Sciences, Bangalore and James Cook University in Australia studied the effects of poor malaria care in in and around Pakke Tiger Reserve area in Arunachal Pradesh specifically on wildlife conservation efforts in the area. In a paper published in Biological Conservation, they try to understand how malaria affects services such as park protection in such areas. A policy brief has been prepared based on the findings.
Where hunting pressure is high, anti-poaching efforts are often crucial for protecting native wildlife populations in nature reserves. However, many reserves suffer from inadequate support and provisioning of staff, especially in developing nations. In Pakke Tiger Reserve in northeastern India, we found that malarial infection is a serious hindrance for front-line patrolling staff that limits the time they can spend in the field. We assessed the consequences of malaria both for local people and park staff in the general region and its indirect effects on wildlife protection. To accomplish this we compiled data from annual epidemiological records of malaria, the number of malaria cases and associated mortality, financial costs, and loss of time spent patrolling. Over a 4-year period (2006–2009), the majority (71%) of forest department staff in Pakke Tiger Reserve suffered from malaria. Malaria treatments cost park managers nearly 3% of their total budget and caused a net loss of 44,160 man hours of anti-poaching effort. The government forest and health departments involved in the employment and health of park staff have separate missions and responsibilities, yet our findings show that a multi-disciplinary approach to conservation is essential to avoid overall systemic failure.
Highlights
► We examined the effects of malaria on anti-poaching staff and its consequences for park protection. ► We focussed particularly on protected areas in northeastern India that suffer from significant wildlife poaching. ► Malaria had a measurable impact on the health of forest department staff, park budgets, and anti-poaching efforts. ► Simple, short-term measures, such as the distribution of insecticide-treated nets, reduced infection rates among park staff. ► An ultimate solution is to improve health services and ensure better coordination between forest and health services.
Article type Research article
Authors : Velho N, Srinivasan U, Prashanth NS & Laurance WF
