Ria Das | January 21, 2016

Gaps in rural healthcare: What I learnt during my immersion

“No matter how intricate the circuit or the drug design is… you need the finger touch to unleash the magic.”

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This was exactly how I felt looking at the health provider’s urge to provide a service against all odds in the absence of resources, during my immersion for the BIRAC SIIP (Social Innovation Immersion Programme) at Villgro. SIIP is designed to immerse its innovators for six months followed by a year to develop from ideation to further stages of proof-of-concept and prototyping in the domain of Maternal and Child Health. This has been one of the best developmental stages in my life till now. The immersion phase allowed me to travel across the varied geographies of our beautiful nation. During my travel I saw how human resource pushes the limits to touch the maximum number of lives.

My team and I visited the B.R. Hills Tiger Reserve in Southern Karnataka, Thrissur in Kerela, Jhalawar and Sawai-Madhopur in Rajasthan and Tertiary Healthcare setting in Tamil Nadu. We met people at all levels associated with the provision of healthcare facilities and learnt about their ‘jugaad’, struggles and happiness.

It was 26 km, where we had to travel up in the tiger reserve hills from the PHC at the foothills, where small communities of tribes resided in small villages called Podus. Gumbahalli PHC being one of the best of its kind was also NABH accredited. Every staff member was equally passionate about his/her work. The PHC was set amidst a farm, tailoring school and an orchard. The community of people didn’t seem to be confused by the workflow directions and every wall was well decorated with all kinds of information that people read.

The visit to see a Mobile Health Unit was remarkable too. We saw how the medicines were arranged in van cabinets and also assembled together in cardboard boxes, despite some difficulties of digging out the medicines. The health workers made sure they knew the best possible scenario of the patients who came to take over-the-counter drugs. They were well aware of the days of MHU, which denotes the significant work by ASHA and ANM sisters.

We were privileged to accompany Doctor Nagaraj S. Bhadrashetty, of Gumbhalli PHC, during an MHU visit to a location that lacked electricity and mobile network. The doctor and the health worker unloaded cartons of medicines, registers, sphygmomanometers and thermometers. We all travelled to reach the Anganvadi through tall cornfields. The health worker had a massive load on his shoulder and the 75-year-old doctor did not stop for a moment even as he was telling us about the current challenges in providing healthcare to the community. In the scorching sun, the fields and cardboard boxes were dry, but this might not be the case during rainy seasons, the health worker told us.

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At the tertiary level healthcare setting, there was a different set of challenges. Some places didn’t have even the last in the chain of health providers, the ASHA worker, leading to higher cases of stillbirths and miscarriages.

Doctors at the centres talked about the adjustments they had to make to deliver maximum care. They tape the probes – ideally supposed to be clipped on a finger – to a baby’s foot, so as to pick up the vitals measured for heart and pulse rate. Blood pressure measuring cuffs are generally not available or existing modern facilities are not very reliable for new-borns. There’s a similar problem with the use of pulse oximeter. Size-related issues were seen in phototherapy sessions, where the eye masks were not able to cover the baby’s eyes completely.

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In Rajasthan, amidst the dry lands and thorny paths, we met ANM and ASHA sisters working hard to do their best. In some villages, health providers and the community acknowledged talked about safety issues. With high crime rates and alcohol abuse in some communities, it becomes challenging for healthcare workers to function safely and effectively. We also saw women in labour being carried in cots over several kilometres to a pickup point from where the ambulance could reach her to take her to the hospital. And two days post-delivery, discharged new mothers had to make the same trek back, by foot this time. The cot carriers are community people bridging the gap of health provision.

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Across India, there were a lot of cultural and behavioral practices influencing the health status of the community, more so in the case of pregnant mothers and newborns due to their compromised immunity – open defecation, poor diet, unnecessary fasts, not bathing, not wearing shoes, worm infestation, accepting babies in old clothes, not seeing the necessity of medical intervention, and alcohol abuse.

This immersion had me thinking, how a product has multiple users and a broken chain, if not repaired, will deliver negative outcome. I realized no matter how sophisticated a solution is, it might not work in a particular setting and in particular hands that have their own advantages and disadvantages. But I was happy to see people genuinely devoted to their work, who want to make a difference and are keen to learn more. And so I too am now working towards making some changes in the healthcare of a mother and a child.