Village Medical Camp

Quite a many public health experts think of a one time medical camp as a waste of resources. However, we get invited many a time by organizations to conduct medical camps in villages. 

I usually oblige. The prime reason being that I need to have a very good relationship with the organisations who call us for these camps. The other reason being that many patients who need surgeries are identified and referred. However, experience says that very few of them turn up. 

But, the major reason for going for a camp is that we doctors get a hang of what is happening in the communities only if we go for such camps. 

Last week we had a medical camp was in a remote village in Chinia block of Garhwa district.

My quick notes about the place – 

- The impoverishment of the area strikes you. There were only about a dozen people who had an average physique. Almost all the women were poorly built and nourished. 

- There is a high incidence of hypertension. We calculated about 40 newly detected patients with high blood pressure in the crowd of about 400.

- There is a high incidence of cataracts. The fact that the elderly are quite disabled by cataract is comfortably ignored. Very few families were bothered about it. The attitude was that they are old anyway and therefore there is hardly a need to worry about their sight. They only want some medicine to be put and we found it difficult to convince the families that these elderly would benefit from a simple surgery. And we were doing it free. Of the 40 odd patients whom we referred, only one turned up for free surgery.

- Another striking aspect which was also seen in camps we did earlier was the high incidence of corneal opacities in the young. Most of them were secondary to trivial injuries to the eye.

Of the above, the most worrying . . . the relatively high incidence of hypertension in rural communities. With the amount of follow up that non-communicable diseases such as hypertension warrant, they could spell the death knell for quite a lot of our agrarian populations.

The quite a few number of strokes we get in NJH is good enough proof.

 
I wonder how serious we are about the morbidity and mortality that non-communicable diseases can do to agriculture economies . . .

Geriatric Care . . . cont'd

The elderly lady sitting in front of me in the medical camp couple of days back in a village near Panki was the epitome of all what stood for geriatric care in rural India.

The rugged creases on her face and forehead would have been the delight of any professional photographer. She had such an artistic expression of the ruggedness of the countryside.

Then I looked carefully into her face. Both her eyes were glazed, caused by hypermature cataracts. I wondered how long she has been blind. I looked more carefully. In addition to the cataracts, she had pterygium in both her eyes.

Then I noticed that she was feeling her surroundings with her hands. I was having the glass of 

Sprite which was on table while she was helped to the patient’s chair by one of the volunteers.

As I helped her hands on to the table, I was horrified to see that both her hands were stiff from the shoulder down. The elbows were bent and fixed at an obtuse angle. The muscles had obviously wasted away. I asked her about her hands. Small pox . . . that was the answer.

The best thing I could do was to help her out with her cataract. However, the volunteers told me that she had come alone. They could not trace anybody who knew her. Tracing her home could take some time as people from more than 50 villages had come for this medical camp.

I wrote on her case sheet. - Bilateral cataract. However, no relatives to help with decision.

I gave her some multivitamins. And, a dosage of deworming medicine.

She got up to take leave. She wanted to know if she got some medicine. I told her I have written some. She was happy. She gave me a toothless smile . . . very similar to the one that a baby gives you when you give her a cuddle.

And as she stood up, I was horrified to find out that she was bent over. She had  a very bad spinal gibbus. It needed quite an effort from her to change her position. 

I once again asked the volunteer to ask her about her relatives. She had overheard me. She waved her hand and told me that nobody bothers about her. So, there was no point in asking that.

A very simple condition like a cataract was a major challenge for her. We were ready to treat her, provided she had someone to take care of her during the peri-operative period.

The sad state of our society where the elderly find themselves at the margins with nobody to turn to for help says quite a lot. 

(The snap used in the post is not that of the lady mentioned in this post. This has been googled.)

Medical Camp, Panki

Couple of days back, we had a medical camp at Panki. One of the major strategies at NJH over the last decade has been networking with like-minded non-governmental agencies, churches and para-church organisations. 

The partners for today's medical camp was the Calvary Gospel Mission and the Wycliffe Bible Translators. 

Snaps from the event . . .

People waiting for their turn

Another snap of the camp site

Dr. Kumudh seeing a patient

Mr. Arun and nursing students dispensing the medicines

Ms. Meghala and Mrs. Julita helping out with registrations

It started to rain. And the people waited patiently

Another view of the crowds

The team getting ready to return to NJH

The statistics . . . we saw over 350 patients. A team of 12 staff including 2 doctors participated. 

We're quite interested in the diagnosis of patients who came to the camp. I shall put up more information in a later post.

RSBY Medical Camp . . .

Couple of weeks back, I was informed about the program of holding a medical camp in Satbarwa by RSBY. I had been quite vary of medical camps since I had been part of quite a lot of them. They are quite good for bringing in publicity. From a public health point of view, I'm not sure of how useful they are except for a chance for screening populations for chronic diseases like hypertension or diabetes. 

On asking the concerned staff on what the objectives are - I was informed that it is basically to screen patients for elective surgeries. I was not much impressed. However, did not want to discourage the RSBY staff. And it was first one I was doing in the name of RSBY and also after I came back after my post-grad. And I thought of giving it a good try - with all inputs from the hospital put in. The Community Health Department made quite an effort.

Following are the snaps from the camp. We got quite a lot of patients - totalled about 150. We had 3 doctors at the place including Dr Isac Jebaraj, an orthopedic consultant from the Christian Medical College, Vellore who was visiting us along with a batch of 2nd year Medical Students.

Getting the place ready

The ophthalmology team

Registration

Everybody . . .

Drs. Isac Jebaraj (white shirt), Nandamani (blue shirt) and Titus (yellow shirt)

Lessons learnt at the end - 

1. Medical camps are a waste of time especially for hospitals like us which have quite a regular crowd.  At least when they are arranged like this without much of a targeted approach. Lately, I realized that even hospitals such as Apollo has dropped their camp approach for valvular heart diseases.

2. Providing constant and regular service is more important in healthcare rather than mass efforts such as medical camps. 

3. We never got any surgical patients. Most the patients were those with backaches and vague complaints. Like most medical camps I've been to, most of the patients appeared to have come because there was a doctor available for free consultations and some free medicines.

Well, this post would not be complete without the mention of some small drama that happened. We had been told about the camp for almost a week. The venue was all decided and we were given the responsibility of publicity, which we did quite well. However, on the day before the camp, I received a phone call from the RSBY DPM saying that they were thinking of changing the venue. 

The venue surprised us - a newly opened private hospital about 1 km beyond Satbarwa. It was outrageous. I wondered what they were up to. I expressed our unwillingness to go and sit at a private hospital. I told them that I would not have any problem having the camp in the local government subcentre or the new primary health centre almost nearing construction. 

After being stubborn about this, they finally relented and agreed for the original venue.


Well, for a status update, since we were empaneled (March 2012), we've already treated 100 odd patients as in-patients and 570 patients in out-patients under the scheme. And do remember, we must be one of the very few hospitals in Jharkhand who does not charge registration and consultation fees for outpatient care for RSBY card-holders.


The challenge remains payments from the insurance provider - so far we've only received about 120,000 INR out of the 250,000 claimed (only claims submitted 21 days back) . . .  We hope that payments would be a bit more fast . . .We're already making extra investments for the poor - but payback is becoming tough. Do remember the 50,000 INR we lost because of free outpatient registration and consultation. And expenses for medical camps such as the one I described . . .And all these in a space of not even 3 months . . .