by iphindia | Nov 17, 2015 | Blog, Latest Updates
According to the Diabetes Atlas 2006, the number of people with diabetes in India is currently around 40.9 million and is expected to rise to 69.9 million by 2025. Similarly, 118 million people were estimated to have high blood pressure in the year 2000, which is expected to go up to 213 million in 2025.
To address this situation, the Indian government launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS) to 364 districts and Tumkur is one of them.
I want to share my experience of working in Tumkur, one of the rural districts of Karnataka, as part of a research project aiming to strengthen care for hypertension and diabetes in two primary health centers (PHCs) with using available sources.
Link to Bheemaray V M blog’s on BMJ:- Click Here
![Out-of-pocket healthcare payments on chronic conditions]()
by iphindia | Dec 27, 2012 | Latest Updates
Background
The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions.
Methods
A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique.
To Read the full article – Click here
To download the provisional PDF- Click here
![Out-of-pocket healthcare payments on chronic conditions]()
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)
by iphindia | Jan 12, 2012 | Latest Updates, Research, Urban Health Action
The Urban health team had planned to meet officials at government health departments and at hospital superintendents to share our KG Halli area experience and figure out ways to work together. After our first “waiting day” stint in the corridors of government offices, we decided to visit the hospital staff next day. Since our 7 month pregnant community health worker Ms Leela had a problem, we asked her to come to the same tertiary public hospital for checkup
I followed Ms Leela to the door of the OBG outpatient department, where the lady gate keeper stood blocking the way. Normally (so Leela told us) only a ten rupee note is the key, but today took her blocked hands from the door to let us in. She asked only Leela to leave her slippers outside…”Why not me?” I wondered.. “Maybe I didn’t look like poor patient!!” Next Leela went to the nurse who was deciding where the patient should go. Sister pointed towards long waiting line of pregnant women and said “Go there”. That is when I intervened and asked “Why not in the next room where doctors with hardly any patients? She grinned at me and guided me forward.
Now it was Leela’s turn to follow me, I walked towards a doctor who was sitting with another senior, introduced myself as doctor and explained Leela’s problem. After a minute she looked at me..that look was like “Why are you standing here ?”….I continued to stand …after listening to Leela, the doctor said (without looking at me): “ We will see her … The unsaid message was “Why are you still standing here you can go” . I continued to stand…after few minutes looking away she said “ you sit”…I was not sure whether she was addressing me or someone else…. but there were no one around …so I presumed she addressed it to me and decided to sit comfortably on the chair!! She gave me a dirty look when I sat on the chair .. “May be she did not mean her words, I said to myself but this chair does not belong to her you don’t get up”. The senior doctor who was sitting opposite me gave a warm smile…wow that was such a nice feeling ……someone in that outpatient department smiled for the first time!! I decided to ignore that grumpy doctor (by then I had decided that doctor was an insensitive/inhuman lady!! ) and initiate conversation with the senior doctor.
Before I could initiate talk with the senior doctor, medical representatives started coming near her one after the other, and I got no time to talk. I was just observing all the activities around me…in that next 10-15 min..this grumpy doctor had told her students many times to.. “Go see my patient who was in the examination room”…may be she was not happy to see me next to her… but for some reason I stayed put …that gave me more time to observe!! Two incidents diverted my thought process from this grumpy doctor.
A lady with fifth pregnancy requesting help was told “We do not do abortion unless you want to go for permanent sterilization, either Tubectomy or current operation (Laparoscopic sterilization). If you do not agree then you continue with pregnancy”. When she said even her fourth child was not planned, the question rose in my mind whether she had been given information about contraception methods or were the doctors forcing women to go for sterilization because it is the easy option? I know with my experience of working with the Muslim community for some, it is against their cultural belief to undergo sterilization. Only educating about contraceptive methods works for many of them..but are the doctors aware of this and do they have time and patience to explain?
Another incident was more shocking and uncomfortable to witness. The grumpy doctor shouted at a young girl who looked not more than 14-15 yrs sitting quietly in the corner, “Why are you here ? Go out.” This young girl with a dazed look started walking towards this doctor…in the mean while the post graduate student said, “ Madam, her pregnancy test is negative”. But her tummy was saying something…and she was pregnant..5 months confirmed the grumpy doctor!
The next thing was in a loud voice doctor screamed “Who has come with you..you are pregnant, what you want to do?” She turned towards the senior doctor and said “UM” (unmarried) that was the code word!! The very next moment more than 15 pair of eyes…were staring at that young girl…I was trying to read that girls mind..but I failed…may be because her expression was so cold …I felt she did not know what had happened to her. Her sister in law came inside..grumpy doctor had two “VALUABLE” suggestions to make , very matter of fact and devoid of sensitivity.
(1) Carry on with the pregnancy and then give away the baby later….as if it was as simple as giving away book or pen to someone. I asked myself ‘Does she even know what she is suggesting?’.
(2) We can abort if the girl’s guardian, preferably male can come and sign for minor girl.
The sister in law who appeared to be in her later 30’s had no right to do so. ‘Who made this rule?’ I wondered ….I guess doctors decide on case to case basis. It was sad to witness the sister in law pleading with this grumpy doctor “Madam nobody in the house knows, if they come to know it will create lot of problem in the house, I will take responsibility and you please abort.” Her words fell on deaf ears, statues who sat with white coat and stethoscope around their necks with knowledge gained from medical books but lacking common sense or humanity.
A very interesting conversation followed after the young girl and sister in law was shouted at to leave and come with someone elder while I thought ‘30+ is not minor to consider as guardian for that doctor’. The senior doctor said “We didn’t have UM cases for some time, how come suddenly we are getting many cases?” Reply from grumpy doctor was… “May be this is the season”. Then they said “We should also do like private doctors…..…I was finding it hard not to ask what private doctors do? but I said to myself ‘the grumpy doctor who was giving dirty looks now and then will show you the way out, sit quietly’.
But the conversation continued and they revealed that in the private sector if an UM ‘case’ goes, they will not even say she is pregnant…. they will continue treating for anaemia till full term and then say she needs to be operated for some stomach tumor and give away the baby without anyone in the family knowing. By now I was in semi shock! When I heard this, I thought…does this really happen?’ I heard this story for the first time and could not believe my ears. And another thought came ‘Where the medical ethics has gone…Forget about ethics, where has the humanity of the individual gone…may be it is lost in the process of becoming so called white collared DOCTORS!’
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
According to the Diabetes Atlas 2006, the number of people with diabetes in India is currently around 40.9 million and is expected to rise to 69.9 million by 2025. Similarly, 118 million people were estimated to have high blood pressure in the year 2000, which is expected to go up to 213 million in 2025.
