Thursday, 24 August 2017

With the community

I haven't written in a while. Today I had to write for several reasons. Mainly because I realised how my new place of work and study is influencing my mind and way of thinking. I've been asked to keep a daily log during the entire course of my fellowship in HIV medicine at SVYM, Viveka Memorial hospital, Saragur which started a week ago. I'm glad that'll make me write regularly so that I jot down the crazy amount of thoughts and learnings I'm experiencing in SVYM before I forget a few of them. Also I believe writing brings clarity and forces one to learn things in detail. So what was different that compelled me to write?
I had duty in the mobile health unit (MHU) today. This is a service 5 days a week from our hospital where a doctor and a field worker goes to around 8 haadis each day (different ones fixed each day) in a van which has drugs to treat some common ailments. It's a concept which I had previously come across even at the hospital at BR hills about which I've already written. The tribal settlements were called podus at BR hills while they are named haadis here. So this mobile health unit is an operation that sounds simple but is quite extensive and wonderfully insightful in terms of how much effort is being put by many people to bring about outcomes that are beyond treating the diseases.
Briefly this is how it works in our setup:  (I still have to learn about the logistics in detail)
A field worker is given the responsibility of few haadis.So all the people in those haadis are his/hers. He/she'll take care and know about almost everyone from their place. He visits them, gets information regarding the number of eligible couple, pregnant ladies, neonates, infants, their immunisation status, the number of TB patients whether suspected, or on treated or completed treatment. Finds out about the problems if any, that they are facing related directly or indirectly to their health and socio-economic condition. Be it their job, or getting their ration/ aadhar card. So before the MHU actually reaches their haadi on their respective days, the field worker would know who should be paid attention to by the doctor. When we go in the MHU van, a siren is played to which some people come to discuss their ailments and get treated. But there are people who would be sleeping unwell and would reveal only when we go to their home and ask "yellaru channagidira?" (meaning is everyone okay?). Like my friend who was here from the US had rightly pointed out that hospital is for the people who are willing and can approach health care facility,camps are for the people who can't approach the health care facitlity and MHU is for the people who won't seek health care. :D So we take a round and ask people randomnly about their health and try to pull in people to the van not to abduct them but just to keep them healthy.
What I realised today is -
  • SVYM has and is building a bond with the community it is working with through various means and MHU is one big operation that is facilitating this, especially for the tribal community who are resistant to approaching a health care facility or personnel without that bond and trust. "With" being highlighted because this is the exact same word that one of the founders used while discussing with a well wisher  the other day. About how SVYM is not working for the people but with the people. 
  • I was eager to see and was able to follow up the patients I'd seen in our hospital and keep a track of how they are doing even if they weren't coming for follow up.
Also we were taught during our community posting during UG times to take a detailed history regarding the conditions that led a person to develop a disease. But here we can witness the person in his actual living environment, in his daily routine. The water he/she is consuming, the food a mother is feeding an undernourished child daily, the kind of defecation practice one is following, in real without the need of questions. In this way we can understand why some conditions if not all, we term as "preventable events" occur.
For example, today we found a pregnant lady smiling. She basically approached the van because she was having pain in her lower abdomen since the past one week. So I asked her a basic question of how many months old was her pregnancy. She giggled and confronted that she didn't know and thought it had been 7 months and that her husband knew. Then I asked her to get her mother card suspecting that she hadn't had enough ANC visits. So she came back hiding the card in her veil. She had probably visited just once to a PHC, maybe to get the card and so only Hb , weight and blood grouping was written. Somehow she was immunised with 2 injections of TT one in the PHC and the other in our MHU itself. No scan done. Not screened for HIV/HbsAg/VDRL as every pregnant lady is. She was smiling all the while until I started probing her to tell me why she hadn't visited for Ante natal care or for ultrasonography to know the health status of her growing baby. She had tears in her eyes and told us how her husband barely has money left over after pouring it all into liqour. He is least interested to share the responsibility in taking care of his  baby or carrying wife. She had no parent and her only brother was elsewhere working. So she was completely dependent on her husband for money and care. So we gave her 50 rs asking her to take the bus this Sunday to our hospital in Saragur and give us a call so we could get the investigations and scanning done. We had to ask her to hide the money and our phone numbers safe from her husband. I know this is not a sustainable gesture but this is all I could do to get her to come to the hospital. This made me wonder how many such mothers are out there who haven't approached us because everyone wouldn't have a complaint of pain abdomen like she did but they would have a careless husband who's addicted to drinking or simply doesn't care.
Probably this is one of the background details I'll not forget the next time I'm about to shout at a lady when she approaches us in labor but with an empty mother card or with no scans or with uncontrolled BP.

So MHU concept is trying and definitely lessening this burden of shadowed people and preventing complications.