A Pilot Project to Access Care for Rural India
Sanitation and Health, Education in Village communities through improved Awareness and Knowledge of Prevention/Management of Diseases and Health Promotion
The American Association of Physicians of India Origin (AAPI, Drs Thakor G. Patel, Padmini Balagopal and Ranjita Misra) did a study in four rural villages in India and determined that access to care and preventive care was a huge problem along with a high prevalence of diabetes and hypertension. Four studies in rural Alamarathupatti, Samiyarpatti and Pillayar Natham in the state of Tamilnadu and another in the village of Karakhadi, in the state of Gujarat showed villagers had marginalized access to health care and that there were no primary health care centers that could manage the chronic diseases. Seventy per cent of the population in India lives in the villages (700 million people) and the importance of educating and delivering healthcare to this large base of India in its resource-poor settings is an urgent and viable issue. Large-scale efforts to improve general awareness about diabetes, hypertension, cardiovascular disease, its risk factors, and to promote healthy lifestyles, must be undertaken.
In Karakhadi there are about 300 people with hypertension undiagnosed, untreated and probably with no chance of long term management. Dr. Padmini Balagopal called Dr. Patel in the USA with this information. He told her to call the Dean, Dr. Kamal Pathak who sent a van to take care of the people, but this was only temporary as the village is far from Baroda. Inability to get chronic care in the village bothered Dr. Patel who came up with the concept of Sevak, based on his experience with the US Navy Corpsman to address the access to care issue. This is a pilot project to address the shortfalls in the healthcare needs of the villages. This project is modeled on the Independent Duty Corpsman (IDC) in the US Navy. IDC’s are high school graduates interested in health care. They are given 12 months of training and then assigned to Marine Corps units or Navy Ships and are fondly referred to as the “doc”. They provide primary care, look at injuries, manage disasters and also check on the preventive care of sailors along with conducting environmental checks such as humidity, temperature and sanitation. We have adopted this model to help provide health care access in rural India in our Sevak program.
One village per district (26) in Gujarat will be chosen to screen the residents for diabetes, hypertension, obesity, and monitor those with chronic diseases. The project will involve coordinating with the villages and identifying bright individuals with medical and or non-medical backgrounds, one person per village of 1000-1500 population. These individuals will then undergo training to be “Sevak”. Sevaks will screen the village for diabetes, hypertension, monitor high risk population for various diseases and patients with chronic disease who are on treatment, in addition to providing healthy lifestyle education and preventive care. The goal of this project is to create standardized delivery of diabetes and hypertension screening and care in the villages by the Sevak who live there. Once Sevaks are identified they would be brought to Baroda to be trained in the diagnosis and treatment of diabetes, hypertension, and knowledge of symptoms of heart attack, stroke, trauma triage, infectious diseases, kidney diseases, pain and its causes, diarrhea, immunization, sanitation, water purification, efficient chulas(stoves)and how to deliver lifestyle modification education. They will help ensure that patients on TB, HIV, and Malaria treatment take their medicines and patients with diabetes and hypertension come for regular checkups and attend health classes. Pregnant women will be screened for diabetes, hypertension and encouraged to deliver in a hospital or and mornings and evenings to facilitate farmer’s compliance with the checkups. They will be given education in computers and telemedicine. They will be taught to network with other providers, and how to refer cases to Taluka Clinic and District Hospital. Sevaks will maintain a database on the medical problems of the villagers and target the high risk groups for health education and monitoring. A data base of the population as per defined parameters such as demographics, chronic conditions, B.P., weights and any other preventive health compliances such as dates for the various tests (stool guiaic, colonoscopy, PSA, Mammograms, Pap smears etc. and immunizations both for adults and children) will be maintained.
Rural Health in India There is no organized delivery of health care in rural India for all the population. Preventive health care is unavailable in the villages. Clean drinking water is not available to all and the sanitation is not adequate. Immunization though available, does not cover all those who need it. In some villages, there might be circuit riders, who provide only acute care on the days they come. The second level of care is at the rural health clinic where there are no medicines or the care is at best rudimentary. The third level of care is at the district level where there is the availability of better care, however, still without the necessary means to provide full basic care and it is overburdened. The fourth level of care is in the hospitals located in the cities, which are crowded and provide only acute care. Most of these facilities are financed by the government. These facilities are not well staffed or adequately financed. They do not have any provision for screening or preventive care. Life style modification education is not available. Indian villagers very work hard in the farms and lose wages when they travel to another town for care. They need local preventive health care and screening for common diseases such as diabetes and hypertension.
Access to Care in Rural India We need to look beyond doctors for rural access to care by creating a cadre of “Sevaks”. There is a shortage of doctors, but by the use of Sevaks a huge gap in access to care and preventive medicine will be filled. The doctors will be more effectively used in treating patients that need their expertise. Having a Sevak in the village look after the health needs will create healthier and more efficient India. The Sevak concept falls within the Ghandhian principles of “Gram Swarajya”. Medicines, glucometers, BP machines for the pilot project will be provided by AAPI. Continuous monitoring of this project will be carried out by the coordinators of the project. Responsibilities of Sevak Sevaks are in essence complimentary to health care providers and should not be treated as a competitor. Sevaks will make the health care providers more efficient in dealing with diseases that require their expertise. The access to care project may be the only solution to screen and control the high rates of diabetes, hypertension and CAD. This project will be conducted as a pilot in Gujarat before widespread implementation. The training of the Sevaks will be for a period of three months.
Criteria for a Sevak The person should meet the following criteria. He/she must live in the village; has a graduate degree if possible but high school level maybe fine. They can continue to work in the farms but must have the willingness to work in their own community. Girls are acceptable for the program as long as they plan to live in the village for a long time. They will be given training in Baroda for three months (lodging & boarding provided). They should be able to read English, need not be proficient. We are planning to start the first class in March 2010. The pilot program will be for three years with a maximum of five years. As the program is underway, any state or Non Governmental Organization (NGO) can adopt it for the benefit of their state or community. The scope of the problem is so large, it is important to share the lessons leant and benefits of the program as it progresses. The program will be managed by Texas A & M University with the American Association of Physicians of Indian Origin, Baroda Medical College, AAPI (NY-NJ). The program will be reviewed every month to ensure compliance with the standard of care and that the villagers’ health care needs are being met.The principal coordinators for the project will be Thakor G. Patel, MD, Hemant Patel, MD, Padmini Balagopal, PhD and Ranjita Misra PhD.(US), Kamal Pathak, MD, Dean, Baroda Medical College(Ret), Mr. Kirti D. Patel, Bhartiya Seva Samaj and Bina Sengar, Ph.D., Sudarshan Foundation Trust. For any questions please contact: Thakor G. Patel, MD, MACP
Position Chair, Public Health Committee, AAPI Address 10980 Rice Field Place Fairfax Station, VA 22039, USA Phone 703-425-7573 India 09638202360 E-mail firstname.lastname@example.org http://www.moia.gov.in/services.aspx?id1=342&idp=342&mainid=196