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 . . .

Ragi Dishes

As part of the Project on Community Based Adaptation towards Climate Change, we are trying to re-introduce usage of finger-millets and popularise it in our communities. 

Below are an array of food stuffs which used to be common in homes of rural India till few years back . . . 
 

Ragi porridge

 

Thoppa Roti

Chilka Roti

Mohan Bhog

Ragi Laddoo

Ragi Laddoo

Ragi Khichdi 

Ragi Idlis

Anarasa (also in the right)

 

Madwa Halwai

Madwa Poori

Ragi Puttu

I shall be posting the recipes of each of the items in the coming days . . .

Disabled in rural India

Last week’svisits to the villages have been to look at the work that has been going on as part of our Community Based Rehabilitation of the Disabled.

Below are few of the major aspects about the disabled in rural India which sets them apart from their counterparts in towns and cities.

1.       The hardworking villagers in the rural parts of the country do not have much time to think about the disabled in their communities. The classic story is that of our enquiry about the number of disabled in our nearby villages and our staff replying that it would be a surprise if we cross a single digit number. Now, after the end of a survey, the number stands at over 800. I still have reasons to believe that we’ve still some more numbers to count.

2.       The disabled are thought of as being an aberration in the community. Therefore, no thought is given about any of their welfare. Many of the villages we visited, the villagers were quite inquisitive about the reason why we were interested in the disabled. According to them, the normal people in the village had so much of issues with poverty and under-development that the disabled who are of no apparent use was of not much of a value.

3.       The worst group of sufferers are the mentally challenged. There are lot of beliefs and myths associated with psychiatric illness. One wretched practice is that of marrying off the mentally challenged with the belief that it would make them well. It was heart-wrenching to see them being made to perform like jokers in few of the villagers.

4.       In impoverished communities as ours, the very thought of getting some money in the form of a disability pension is quite music to the ears of many a family. However, the benefit hardly reaches the beneficiary. Rather it is used off by the other members of the family.

5.       The mortality rates of the disabled are quite high. The village headman (mukhiya) who took us around had a child who died few years back. And death within the disabled populations is well accepted. It’s rather seen as grace for their lives.

6.       One major cause of disability is birth asphyxia caused by home deliveries. In fact the mukhiya’s child appeared to have cerebral palsy as a result of birth asphyxia. I wonder if someone can do a study on the burden of birth asphyxia caused by home deliveries in the community. When birth asphyxia happens and the baby dies, nobody bothers as it is deemed that the baby was weak (kamjor) and therefore it was good that the baby did not live and suffer for the rest of his/her life.

7.       In the midst of all these, there are isolated amazing stories of the disabled being able to stand on their own feet. There was this young man in the village we visited last week, who was disabled because of polio. But, he was quite motivated, hard-working and was into dairy business. He had his own vehicle which he used to ferry milk from the village to the nearby town.

The final word – The disabled in rural India hardly finds any acceptance, leave alone any sort of support from their fellow human beings. There is a lot to be done to mainstream them into the society. Considering into fact the healthcare issues in rural areas which are yet to be well taken care of, it may seem quite a tough and humongous task.

However, I’m encouraged by the efforts that our team has been able to put through in reaching this marginalized group. We value your prayers, support and advice. 

The Village Visit

Few days back, I had the opportunity of doing visits to few villages as part of our community health projects. It is not that I do not visit villages regularly. These village visits were quite different as I had the opportunity to walk through an entire village after quite a long time.

As is the custom, my colleague and I went straightaway to the village headman’s (mukhiya) house as soon as we reached the village. After exchanging pleasantries, we got into the serious discussion about the issue of people with disabilities for whom we had made the visit. 

I shall write about this in another of my posts.

The mukhiya was from a caste which is designated as backward. He got the opportunity of being elected as the mukhiya because the panchayat had the status of being a reserved panchayat where only a person from the backward caste could be elected.

What I would like to portray here is my walk from the mukhiya’s house to the government run village play school (anganwadi).

The mukhiya’s house was very close to the main road. However, his immediate neighbours were all people who were deemed as that of a higher caste. It was obvious that most of these people did not want to do anything with the mukhiya.

Cursory glances went up as we walked through this ‘high caste street’. There was no word uttered. Contrary, there were murmurings going on mainly between the womenfolk who were sitting in the courtyards of their homes.

The next street belonged to people of another caste whose major occupation was dairy farming. However, here the mukhiya had people asking him very sarcastically about the work he was doing. There were women asking him if there was some new government scheme in the pipeline. The tone and mannerisms did give away the mistrust they had on him.

The anganwadi was in the area where another caste was dominant.

I enquired about the Harijans - the supposedly lowest caste. Gandhiji gave them the name Harijan which means God’s people.

One of the men pointed to clump of thatched houses a bit distance away from the anganwadi.

Previous experience has taught us that it may not be wise to rush to this group. The problems would be the maximum here. But, almost the whole of any rural Indian village do not consider them humans. We would visit these houses at a later time.

Other than the caste system, one more aspect which concerned me . . .

The filth and dirt in the streets was appalling. One of the villagers commented that if it rains it becomes worse. Of course, the situation was worst in the area where the dairy farming caste was living. Conditions were perfect for the outbreak of an epidemic of any water borne disease. It would be a miracle if nobody got malaria in the entire village every week. And of course, the worst part . . . there were no toilets. It was open air defecation all around.

Any good things . .. …

There were televisions and music systems in quite a few houses. There were jazzy bikes parked in front of few houses. There was a sort of serenity and peace in the whole place although the divisions within the community was obvious. 

It is not uncommon to see romantic depictions of rural Indian vistas portrayed in many avenues.

However, I’m sure that what is depicted above is not an uncommon scene in many of our villages.

(Apologies for no snaps from the visit in this post. This is because of feedback about villagers not being comfortable about outsiders taking snaps. There is regular talk about the press and NGOs taking snaps from villages and using it for nefarious purposes. The snap given above is that from another village) 

Communications. . . Cut Off from the outside world . . .

The whole of last week has been a nightmare for us . . . In addition to the challenges we have with electricity, we also have problems with our communication lines . . .

We've been almost cut off from the rest of the civilized world . . . Almost all the cell phone networks had failed and the ensuing road repair going on has ensured that the phone lines and the internet broadband connections are also regular snapped . . . 

And therefore, the drop in the number of posts in my blog. . . The hospital has been quite busy and we've had enough sick patients to write about . . . but, because of no connectivity, nothing has been possible. 

Quite a lot of us depend on the BSNL network for our cell phone connections. . . The network has been dead for almost the last 10 days. . . and we have no clue on when the network will be back. We get Airtel connections from a tower which is about 2 miles away . . . but, the connections are not very strong, but we have identified certain locations within the campus where we get good network. 

For me, I also do possess an Airtel connection and I get the best network when I keep the phone dangling on a cloth-hook and now I am connected to the internet through Airtel. Another place where I get a good connection is under the Banyan tree near the mess . . . and many a time, as I try to walk up and down while talking to someone I need to be careful that the network stays good. . .and I do not stray beyond the area of good connectivity.  

Of late, Reliance has good network and I've got a connection for my wife. But, again, we've realized that there are quite a lot of areas within the campus where the connectivity becomes zero. I continue to depend on the BSNL and Airtel connections. . . 

Now, you can imagine how difficult it is going to keep multiple connections . . . However, the cell phone manufacturers have also kept themselves in business by manufacturing phones which can carry multiple SIM Cards. . . I carry one which provides space for 2 SIM Cards. Recently, my engineer has got hold of a machine which provides space for 4 SIM Cards. . .  

It was only couple of days back, a dear friend of mine suggested that I talk with one of the Cell Phone companies who could provide some sort of a low cost equipment which would give us uninterrupted connectivity to us within the hospital campus. Of course, our neighbours would also benefit from the same. I'm not sure on where to start . . . 

Later, as I discussed this with few of my staff, I understood that there had been some efforts made earlier. . . but had not yielded much results . . . 

Therefore, I would like to invite anybody with the right connections to help us get in touch with any of the mobile companies . . . What I can assure you is at least 100 connections from within our institution . . .  So, guys from Vodafone, Tata Indicom and Idea, do you want to be part of the little good that we try to do in this part of rural India ? ? ? 

Malignancies Cont'd. . .

After the story I wrote about KD who had a extensively invasive oral cancer we had been having quite a number of patients with malignancies who came to OPD. Although most of them look quite bizzare, just wanted to draw your attention to an unmet need for care for cancer patients in rural India.

12 year old boy with a biopsy proven soft tissue malignancy of the chest wall musculature who has been running from hospital to hospital for some sort of treatment. We were not equipped to treat it and we ultimately referred him to the Department of Oncology, Banaras Hindu University Medical College. It has almost been a year since the swelling started the size of a pea. I wonder if it is too late to do anything. The boy had quite a number of files of consultations at various centres – but none of them venturing into a definite treatment.     

40 year old man with history of oral ulcers who came from almost 200 kms away in Bihar. I just could not understand why he did not go to a higher centre at either Gaya or Banaras which is nearer to his home. The lesion was quite invasive with the cheeks perforated at 2 places.

50 year old lady from one of our nearby villages who had an ulcer of the tongue. Surprisingly, a well known superspeciality teaching centre in a nearby city refused to entertain the possibility of malignancy. However, the family decided to take a second opinion where a biopsy was done which confirmed squamous cell carcinoma. The family wants to take the patient for treatment at either Mumbai or CMC, Vellore.

50 year old man with the history of a swelling of the right tonsil for the last 15 years which has started to bleed since the last 2 months. I’m definite that there is malignancy. He has requested for a referral to CMC, Vellore.

Murder of the voiceless - abortions in rural India

I just finished counseling a 22 year old lady who we unwittingly diagnosed to be pregnant. She is not yet married, but has a boyfriend. She came yesterday with features which were very suggestive of an early pregnancy with a severe urinary tract infection.

We had repeatedly asked her if there was a chance of her being pregnant and she had vehemently denied of any possibility. Today morning, Nandamani who reviewed her for a vague discomfort of the lower abdomen took her in for ultrasound and found her to have a 7 week fetus. Not an uncommon event in many hospitals.

Nandamani called me in to deal with the crisis. The girl was already in tears and then confided that she had sexual relations with her boyfriend about couple of months back and she had never thought that it could end up such. Very familiar statements for me and Nandu. We get to hear it almost every month.

The issue was on how to deal with it. The girl had a very easy solution. 'I'll abort it'. After sometime we talked with the boy over the phone and he was also very cool about taking a decision to abort. I was very uncomfortable about how fast they had made such a decision.

'Murder planned so easily. Not a hint of remorse in the young voices.'

I know I'll face the brunt of many by making such a statement. The institution of marriage is breaking all over the world. Questions are being asked about the very fabric of it's institution.

However, what I'm more concerned is the cold blooded killing of the unborn. The unborn are most probably the most voiceless of all the people in this world. Recently, I read an article in 'The Hindu' which has put it quite well.

As told by the Dr Ronald, it is very common to see girl babies being killed all over the country. However, the killing of the innocents for sexual freedom is not something which is prevalent only in the West. It is very much present even in remote areas of third world countries such as ours.

The girl is an adult. She took the decision not to tell about the pregnancy to her parents. After a whole lot of counselling, she has still decided to go ahead with the abortion. Tomorrow, the boy has promised to come. Kindly pray that I can convince them to go ahead and have the baby.

However, as I pen this, I'm very much aware of the umpteen number of abortions which take place in very unhealthy and unsterile environments all over the world and more in rural areas of Asia and Africa which is a major challenge to maternal healthcare. There are no easy answers but to kill off unborn babies without any reservations is not the best choice.