Sunday, 19 May 2019

Free medical outreach to Mountanous Somorika community with no access road

Community members receiving medical care during the free medical outreach

Dr Dako Mamudu


I am Dr Dako Mamudu, a family physician based in Lagos metropolis, Nigeria. I am the chief medical director of Dako Medical Centre and also founder and Chief Executive Officer for Dako Foundation for Rural Healthcare and Education. I lead my team to carry out healthcare delivery in remote, rural and difficult to reach communities. 

I was born and raised in a rural community where ninety percent of the houses were roofed with thatch. My empathy for rural healthcare led to the founding of Dako Foundation for Rural Healthcare and Education (Dako Foundation). Dako Foundation is a registered Non-Governmental Organization in Nigeria and it works to improve the living conditions of underserved and difficult to reach communities in Nigeria through education, empowerment, provision of social amenities, public health programmes and direct medical interventions. 

Somorika is an ancient city in Akoko Edo Local government area in Edo North, Nigeria. It is about five kilometers north-east of Igarra in Edo North. It is a community with a wealth of cultural heritage. However, the rocky geographic terrain of this community (several hills that go as high as 1700 feet interspersed at unequal intervals) and the often inaccessible road to the location result in a great inequality in access and provision of healthcare services to people in this location. 

DFRHCE staff going from the residence of the traditional ruler to the health centre where the medical outreach took place.


I lead my team to this mountainous Somorika community for free healthcare outreaches between 2017 and 2018. Members of my team and I climbed several rocks of varying heights in order to get to this community. Our first point of reach was the resident of the community leader. From where we climbed more rocks of varying heights to access the local primary health centre where we carried out the free medical outreach. Similar to my previous missions to rural communities, health care professionals from my team were brought from urban cities of Lagos, Benin City and Auchi to carry out this medical outreach at this community. This was a four day mission and my team consisted of 20 regular staff of the Foundation comprising of doctors, pharmacists, public health experts, nurses, community health extension workers (CHEWs) together with 15 local volunteers. The attending midwife in this facility together with the assistant; a nursing aid also participated in this mission.

DFRHCE outreach team preparing for Somorika mission
DFRHCE staff on the road to Somorika Community, Edo State, Nigeria.
This comprehensive outreach which includes free surgeries is in tandem with the Sustainable Development Goals aimed to ensure healthy lives and promote wellbeing for all at all ages. The outreach activities consisted of community health education and sensitization, general consultation and treatment of endemic diseases, vitamin A supplementation for children and at risk population, mass drug administration of Albendazole to community members, distribution of lifesaving prenatal and post natal vitamin supplements to women of childbearing age and distribution of easy to use water purifying units to households in the community. Hospital equipments were also distributed free to the dilapidating community Primary Health Centre; the only source of healthcare in the community and its environ. The distributed equipments include artery forceps of different sizes, drip stands, hospital beds and mattresses, bedcovers and delivery couch.

Patients who required surgeries were referred to our partner hospital (Dako Medical Centre, Lagos) for free surgeries and follow up. Surgeries performed include breast lumpectomy, emergency caesarian section, and undescended testis (jointly sponsored by Amazing grace Hospital, Dako hospitals and Dako Foundation).

The community leader conducting the DFRHCE staff round his ancestral palace built in 1900.

The community leaders taking the DFRHCE team round the dilapidating infrastructure of the health centre.
Medical consultation for the Community Head of Somorika
Medical examination for optical refraction for patients with refractive errors.
Community members queuing up for registration for treatment.

Children receiving vitamin A supplementation

Over 5,000 rural patients were reached through repeated visits to the community for free medical mission. This is my passion and I am glad to work with a team that share same passion to bring healthcare to the hard-to-reach and underserved communities. 

My mission to take healthcare delivery to the underserved and difficult to reach communities in Nigeria will continue to take us to the underserved and almost forgotten people across communities in Nigeria. In the next edition, I shall publish our outreach work to Okorogbo and Akatakpo in the ‘urban rural’ communities in the heart of Lagos metropolis. Below are some of the images depicting our outreach activities.
_________

Dr. Dako Mumudu MBBS,DFM, is the Chief Medical Director of Dako Medical 

Centre, Lagos, Nigeria and founding Chief Executive Officer, Dako 
Foundation for Rural Healthcare and Education.
Life Member, WONCA

Email: info@dakofoundation.org

Sunday, 7 April 2019

Post flood disaster intervention to victims of flood ravaged areas of Anegbette, Osomegbe and Ekperi Udaba communities of Etsako central local government area of Edo state of Nigeria

 Outreach team work distance into the communities. 
Dr Dako Mamudu 

I am Dr Dako Mamudu, a family physician based in Lagos, a mega city, Nigeria. I am also the founder and chief executive officer of Dako Foundation for Rural Healthcare and Education. I was born and raised in a rural community where ninety percent of the houses were roofed with thatch. The inhabitants of my village and its neighbouring communities were peasant farmers, hunters and petty traders. The only sources of water supply were about half a dozen of deep wells and a stream which was about five kilometers away. The six room block of classrooms in the community primary school which I attended was one of the buildings roofed with corrugated iron sheets. These were the prevailing situation of the communities in the region where I lived. 

Over the years, quality of health care delivery in rural communities has gone from bad to worse in most underdeveloped and developing countries of the world especially Sub Sahara Africa. In Nigeria in particular, the situation is worse in rural, riverine and difficult to reach communities. My empathy for these communities and its people led to the founding of Dako Foundation for Rural Healthcare and Education (Dako Foundation). Dako Foundation is a registered Non-Governmental Organization in Nigeria and it works to improve the living conditions of underserved and difficult to reach communities in Nigeria through education, empowerment, provision of social amenities, public health programmes and direct medical interventions. 

Anegbette, Osomegbe and Ekperi Udaba are parts of the riverine communities in Etsako Central Local Government Area of Edo State, Nigeria where we regularly carry out our activities. The main occupations of the people of these communities are peasant farming and fishing. Together, the population size of all the riverine communities in this local government area is about 250,000. The closest accessible point of good healthcare to these communities is about 50km away and for about six months of the year, there is no access to these communities by road. 

Recently, just like it happened in previous years, tributaries of the River Niger, especially River Alika overflowed their banks (climate change) and swept over the communities; covered their farmlands and swept away their crops. Their homes were covered with water for over two months and they had to take refuge in refugee camps. 

Houses submerged by flood in the affected communities. 
As the flood started to recede, I led a post flood disaster intervention to these communities through Dako Foundation aimed to alleviate the pains inflicted on these communities and its people by the devastating impact of the disaster . Also, this outreach is in tandem with the Sustainable Development Goals (SDGs) SDG 3: to ensure healthy lives and promote wellbeing for all at all ages. 

DFRHCE team at our base station preparing for takeoff for the mission.

Still at the base station; donated clothes awaiting transfer to our work location. 

Health care professionals from my team were brought from urban cities of Lagos, Benin City and Auchi to carry out this medical/social outreach. This was a four day mission and my team consisted of 22 regular staff of the Foundation comprising of doctors, pharmacists, public health experts, nurses, community health extension workers (CHEWs) together with 20 local volunteers. Some health workers from the local health facilities were co-opted to participate in the outreach. 

I have previously carried out some health care missions with Dako Foundation to some of these communities in 2016. The only accessible road to the index communities was through a wooden bridge across a deep flowing river. 

 A Dako Foundation staff guiding the outreach vehicle through a wooden bridge (the only accessible road to most of the communities). 

During the post flood disaster intervention to the communities, myself and my team travelled over 500km from Lagos by road to our local base in Edo North. We then travelled another 35km on a daily basis through a lonely, rough, winding and dangerous road to the only accessible village in the community by road. From here we either walked to the near community or drive across a dangerous wooden bridge across a deep river to the communities. On arrival, we carried out health education and sensitization for community members followed by free medical consultations, prescription and treatment of local prevailing diseases (Figure 6, 7and 8). Also, items distributed include antifungal drugs; clothes; prenatal and postnatal multivitamin supplements for pregnant and lactating women; bread, medicated soaps, toothbrushes and toothpastes. Vitamin A supplementation was given to children and other at risk population (Figure 9). There was also mass drug administration of Albendazole to community members. 
Lactating woman received free drugs distributed by DFRHCE. 

Nursing staff carrying out blood pressure and vital signs measurements after registration.

Community members queue up to get registered for medical consultation 
Distribution of Vitamin A and albendazole to children during the outreach. 



In addition to the above, we distributed easy-to-use potable water sanitizing units with storage tanks to households in the communities (Figure above). This equipment does not require electricity and it is user friendly. It functions in such a way that when it is filled with water, and pressure is applied through the external hand pump, the buildup pressure within the unit drives water flow through the filtration component into its external tap where water is collected and stored in a clean storage. Water that flows through this filtration unit is suitable for drinking. 

Water purifying units distributed to heads of community households.

Overall 5,132 rural members were reached through three targeted visits to the communities for the free medical mission and distribution of relief materials. This is my passion and I am glad to work with a team that share same passion to bring healthcare to the hard-to-reach and underserved communities. I hope to arrange additional interventions to other communities in this locality that were not accessible at the time of this intervention. 

_________
Dr. Dako Mumudu MBBS,DFM, is the Chief Medical Director of Dako Medical
Centre, Lagos, Nigeria and founding Chief Executive Officer, Dako
Foundation for Rural Healthcare and Education.
Life Member, WONCA

Email: info@dakofoundation.org

Sunday, 14 October 2018

Rural island medicine in Minamidaito island, Okinawa, Southwest of Japan


By Ryuichi Ota


I am a young Japanese family physician working in rural areas of Japan. Training for Japanese family physicians has officially started recently, so there is a variety of training systems, though sometimes not always so systematic. I became a physician in Osaka and moved to Okinawa, southernmost part of Japan to become a rural island physician. I have experienced many fruitful things on my island to become a real rural physician. It can be said that rural islands and the citizens educate the physicians. This time, I want to introduce my experience in Minamidatio island, one of the rural islands, as a young rural physician.

I have worked as a young rural physician on a rural Japanese island. It is located in the most southeastern part of Japan. Its name is Minamidaito island, and it is located in Okinawa prefecture. It is about 400 km away from the mainland of Okinawa prefecture. By ship, it may take 14 hours from the mainland. Even if you use an airplane, it may take 1.5 hours. On this island, the population is about 1,400, and most of them work as sugarcane farmers. There is only one clinic without beds appropriated for admission. There is only one doctor, nurse and medical clerk. I went to this distant rural island after finishing my 3-year basic medical residency program, and I have been there for three years now. Is this a rare case in the world? This working style may be controversial in Japan. However, the experience as a young rural physician may affect their future as a physician in an effective way.

The responsibility of a solo physician in a rural island



First, the feeling of responsibility as a physician may increase. For example, on a rural island like my case, a physician has to take care of various kinds of illnesses. All of the patients there have to go to a clinic to get specific care, even if they do not like to go there. The rural physician cannot avoid studying various kinds of medical issues. Emergency cases are especially stressful for rural physicians. At rural island clinics, there are not enough instruments to treat the patients for a long time. The rural island physicians have to transfer their emergent patients to general hospitals on the mainland of Okinawa if they need long admissions or ICU care. However, to transfer the patients, doctor helicopters are needed. It takes 3 hours to reach the distant islands like my island (Ohta & Shimabukuro, 2017b). The rural island physicians must care critical patients until the arrival of the helicopters. The worse thing is, the duration of emergency may depend on the weather. The emergency case in summer was challenging for me. In one day in summer, one patient came to my clinic with the chief complaint of shortness of breath. He voluntarily stopped regular visits to my clinic one year ago. His past medical history was chronic obstructive lung disease. His symptoms had started a few days ago, which gradually exacerbated to the point where he came to the clinic. The vital signs were the blood pressure of 84/40 mmHg, heart rate of 132 beats/min, respiratory rate of 45 breaths/min, oxygen saturation of 79% in ambient air, the body temperature of 37.6 and Glasgow coma scale of E3V5M6 (total 14/15). I listened to his lung sounds, bilateral lung sounds, I diagnosed him with severe pneumonia causing septic shock. Soon, I intubated him and prepared for transportation. However, it did not come at once. This season, Okinawa is attacked by a lot of typhoons, and this year was not rare. This time, one big typhoon was approaching my island, and this prohibited doctor’s helicopter from coming to my island. To make matters worse, the typhoon approached the mainland of Okinawa after passing through my island. As a result, I had to observe this patient with only three members and restricted medical instruments (Ohta & Shimabukuro, 2017b). Without a ventilator, a nurse, a medical trainee, and I performed hourly vital sign measurement and did manual ventilation. Fortunately, his condition was stable with oxygen, antibiotic, and vasopressor. 27 hours after his arrival, he was transferred to a general hospital in mainland of Okinawa.




Diagnostic skills of rural physicians


Also, their diagnostic skills may be improved upon. It is only one physician, and he or she has to diagnose patients with vague symptoms or with certain diseases which they have not experienced yet. They may feel particular pressure and study hard. As they can get a lot of medical information by using the internet and communicate with their senior physicians via a social network, they may be able to approach their patients with various sources of help. For example, when I encountered patients with rheumatoid arthritis following ciguatera poisoning (Ohta, Shimabukuro, & Kinjo, 2017) or with vague bilateral shoulder pain leading to the diagnosis of Parsonage-Turner syndrome (Ohta & Shimabukuro, 2017a), I could diagnose them with literature reviews and my colleagues’ help. Through this process, rural physicians may become competent in diagnosis and inter-physician communication.

Challenge to community-based medical education

Second, a rural island may be a good practical learning situation for medical students and medical residents. They can learn specific things in various medical situations. Through the learning in rural islands, they may learn multiple important issues as physicians. There are many kinds of research to clarify the learning topics in rural areas, especially about community-based medical education (CBME). As learning contents have been shown to depend on the situation, we did one qualitative study to inquire about the learning contents of medical residents in Minamidaito Island. Through this research, we were able to identify four categories: a strong connection among the Islanders, the necessary abilities for rural physicians, islander-centered care, and the differences between rural and hospital medicine(Ohta & Son, 2018). In contrast to hospital medicine, various kinds of learning occurred in deep relationships with the Islanders. Furthermore, we clarified that the learning contents of medical students on this island, as a result, were alike. Rural physicians can learn not only medical issues but also CBME. They may acquire the possibility to become medical educators.

First trial of community-oriented primary care

Third, community-oriented primary care (COPC) should be mandatory in rural islands. Especially, in Minamidaito Island, there is only one physician and a nurse. They are the only medical resources. They have to collaborate with the members of the community to improve community health conditions. There are various stakeholders in the community. Empowering them may drive COPC. The stakeholders may play the central role in community health improvement. For example, public health nurses specialize in community health. They can analyze their communities and find various approaches to improve health conditions there. Their collaboration with medical staff in clinics may improve quality of life. There are two public health nurses on Minamidaito Island, for both pediatrics and older people. The public health nurse for pediatrics is interested in pediatric wheezing because of sugarcane harvesting. Through my collaboration with her, we were able to do a prospective cohort study. As a result, it was discovered that there was some cause and effect relationship between pediatric asthma and sugarcane harvesting (Ohta, Mukoyama, Fukuzawa, & Moriwaki, 2017). Additionally, we make up the specific approaches to diabetic patients on a rural island by using their feelings comparatively. Also, by collaborating with the public health nurses for older people, we were able to increase the opportunities for older people to have a dialogue with each other and share information about their conditions. Through COPC, rural physicians are able to learn the skills for how to approach communities such as leadership and empowerment, and how to analyze and make progress the community condition such as research skills.


The ecology of medical care in a rural island


Besides, an ecology of medical care in clinics is essential for understanding islands’ medical conditions. It is important to know what kinds of symptoms and diseases are common when medical staff inquire into information on epidemiology and do various interventions in communities. Also, the comparison of this data over several years may be useful for knowing the change in the prevalence of medical conditions there. For example, we collected the patients’ data based on International Classification of Primary Care-2 (ICPC-2) between 1990 and 2015(Ryuichi Ohta & Makoto Kaneko, 2017). As a result, in addition to the common cold, the frequency of asthma attack and other chronic diseases increased. This fact might lead to the consideration of the effects of aging population and the deteriorating air pollution. Rural physicians can express their opinions based on precise data and motivate their communities to improve their health conditions.

How to control negative emotion as only one physician in a rural island

At last, rural physicians need effective emotion control. On rural islands of Okinawa, every physician is only one medical staff that can perform medical treatment. They are special there, so rural citizens look at them as a physician wherever and whenever the citizens see the physicians. Additionally, they may feel the negative emotion in interprofessional collaboration. These conditions may lead to the physicians’ stress and negative emotions. Based on our research, rural physicians feel negative emotions in differences in recognition between rural physicians and patients, invasion of professionalism, suppression by one’s role as a rural physician, discordance with multiple occupations, and relationships with unfamiliar hospital physicians(R. Ohta & M. Kaneko, 2017). Also, to relieve negative emotions, time flow, refection, acceptance of islanders’ characteristics, and growth through their role were suggested(R. Ohta & M. Kaneko, 2017). Through rural experiences, physicians may improve their ability to control their negative emotions by recognizing the existence of controlling methods.

Working at rural islands, although there are lots of difficulties for your generation, can give various fruitful experiences for the future. Not related to their foreground carrier, these experiences can make them more balanced physicians and happier than ever.



References

Ohta, R., & Kaneko, M. (2017). Effects of practicing in remote Japanese islands on physicians' control of negative emotions: A qualitative study. J Rural Med, 12(2), 91-97. doi:10.2185/jrm.2934

Ohta, R., & Shimabukuro, A. (2017a). Parsonage-Turner syndrome in a patient with bilateral shoulder pain: A case report. J Rural Med, 12(2), 135-138. doi:10.2185/jrm.2933

Ohta, R., & Shimabukuro, A. (2017b). Rural physicians' scope of practice on remote islands: A case report of severe pneumonia that required overnight artificial airway management. J Rural Med, 12(1), 53-55. doi:10.2185/jrm.2925

Ohta, R., Shimabukuro, A., & Kinjo, M. (2017). Rheumatoid arthritis following ciguatera poisoning: A case report. J Rural Med, 12(1), 50-52. doi:10.2185/jrm.2921

Ohta, Ryuichi, & Kaneko, Makoto. (2017). Health Problems in a Rural Island of Okinawa: Changes Over 25 Years. An Official Journal of the Japan Primary Care Association, 40(3), 143-149. doi:10.14442/generalist.40.143

Ohta, Ryuichi, Mukoyama, Chikako, Fukuzawa, Yasunori, & Moriwaki, Yoshihiro. (2017). Relationship between Pediatric Wheezing Attack Frequency and Sugarcane Harvest Work: Prospective Cohort Study. An Official Journal of the Japan Primary Care Association, 40(1), 21-26. doi:10.14442/generalist.40.21

Ohta, Ryuichi, & Son, Daisuke. (2018). What do medical residents learn on a rural Japanese island? Journal of Rural Medicine, 13(1), 11-17. doi:10.2185/jrm.2950

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Ryuichi Ota is  a Japanese Family Doctor based in a rural remote island. 

Curatorship: Mayara Floss

Sunday, 30 September 2018

Watercolor

Carnaúba dos Dantas - Brazil
Your eyes have
A non-defined color
And, perhaps because of this,
You ​can see the other tones in everything

From the cold gray
Of few shades,
That I coldly plan,
You can identify a small
Sick pink
That motivates my grit

In the green-water lies
That I tell to please you.
You only see the red
Bloody one
That burns me!
You see the invisible notes
With your eyes

Which color, then,
My mother,
Is the soul
That I have mixed
With mine?
__________

Alexandre Dantas is a doctor, teacher and writer. He was born and lived most of his life in one of the driest backlands of Brazil - where he returned 4 years ago, working as a rural doctor. He created the project "A Medicina Rural" on Instagram (@amedicinarural) in order to give visibility to the rural spaces in which he works and voice to the people who live in them.

Sunday, 16 September 2018

Je suis étudiant!

Another intense afternoon at the clinic. Malnutrition and infections are already routine work.

Suddenly arrives a young man of 8 years of age and, well articulated in his words, appears and speaks directly with me, in French: Je suis étudiant!

Son of the arid land of Ambovombe, the little boy tells me about the difficulty in school because he can not see the blackboard. He struggles but has headaches.

He is the only child who attends school for all the children I attended in the entire first week of work. His case was not the priority and seemed absolutely far from our possibilities at the moment. However, #FraternitywithoutBorders was his and his grandmother's only hope

I took a deep breath. I had to do something. And I did...a modified Snellen test was enough to diagnose myopia. Concerned, I tell the translator..."He needs glasses, but we can not offer."

As we have learned in the FWB, we are many united hands working for Love. Dani, my translator and right arm (and left too!) Showed readiness to respond that we had a chance. The next day, we were all going to talk to the priest who had received a mission from the Catholic Church the week before. We introduced the FSF and we got another partner.

A week later, he and his grandmother return to the clinic. Main complaint: a little hand holding a package, a smile that can not be restrained on the lips and a tight hug from anyone who never loses HOPE to see it happen!

Janaina doing the modified Snellen test with the patient during her work 
in Madagascar

Janaine Camargo is a family doctor and works at the NGO Fraternity Without Borders in a rural area in Madagascar


Translated into English by: Bianca Silveira
Posted and Edited by: Ana Júlia Araújo

Sunday, 2 September 2018

Beginning of Success to Reach Health Care to Rural Communities with Extremely Low Resources and Access Problems


Shakuntala Chhabra


Social accountability in health care and medical education has been the hallmark of Kasturba Health Society, Sevagram, which runs Mahatma Gandhi Institute of Medical Sciences, Sewagram in Wardha District of Maharashtra, India. KHS also runs a Nursing School, Nursing College and Kasturba Vidya Mandir (School for children) in the same campus. Institute’s birth is also the consequence of social accountability by none other than Mahatma Gandhi, in the form of a 2 bedded dispensary in 1938 in the village Sewagram where there was a epidemic of Cholera and women and children were finding it difficult to get treatment. The sapling has now grown into a blooming tree with nearly 1000 bedded well equipped, Kasturba Hospital at Sevagram village in the centre of country. Expanding health services to Melghat region in Amravati, Maharashtra, is another step towards social accountability in health and education. The step was taken in view of rural communities sufferings.

In view of the problems of high maternal, perinatal, infant and child morbidity / mortality step was taken to help rural community. So government of India and Government of Maharashtra were approached with the proposal for Mother and Child / Multispecility Hospital at Utawali, but delays in the system were worrisome. So it was decided to do whatever was possible. Agriculture land was bought more than dozen no objections were procured and plans of hospital as expansion of existing institute in the nearly district was planned.

Fortunately a Mumbai based charitable trust “Shri Brihad Bhartiya Samaj” came forward with the generous donation for the building and major equipments for the proposed hospital. Before this hospital could be built a beginning was made on first January 2012 by alterations / additions in the existing building of a minihospital constructed by KHS, Sevagram some years back where a physician and ophthalmologist deputed by KHS were working. A make shift birth area, operation theatre for caesarean section, hysterectomy and other surgeries was done. Other needed changes were made in the building and equipments / instruments were procured. In the existing guest house in the campus, alterations and additions were made so that the health teams could stay for 24/7 for emergency services. A nearby hut was converted into kitchenette, dining area cum office. A mini-library and online Maharashtra University of Health Sciences library were made available for every one to remain updated. Sports too were arranged and mobile phones and televisions to make the life of health providers in the hilly forestry region with access problems little easy and to try to reduce the general reluctance of health providers to work in the region. Now since Feb 2016 a reasonably well equipped. Multispeciality Dr. Sushila Nayar Hospital in Utawali has come up with basic facilities available in much better way with reasonability comfortable place for the health provider team in the building. A building with 4 flats and some land have been procured in the vicinity keeping in mind needed accommodation during the development.

With the guidance, support and help of KHS/MGIMS, Sewagram the team of Obstetrician – Gynaecologist, Paediatrician, Anaesthetist, Physician, Medical Officers, Interns, Administrative Officer, Nurses with other paramedical staff have been managing emergencies and day to day problems in outpatient, inpatient and operation theatre, 24/7 days. While paramedical administrative staff has been exclusively appointed, doctors are deputed in rotation from head quarter, the medical institute in the near by district, a dozen doctors are always available. Author as officer on special duty with support of management and a big number of colleagues at base institute are trying since beginning their best, from buying agriculture land to health services now in a reasonably equipped hospital. Caesarean sections, minor and major gynaecological surgeries are being performed in addition to normal and instrumental births. Everybody is trying to give his/her best with whatever available in the given circumstances with limited resources. The very first caesarean section was performed on 21st January, 2012, mother and baby discharged healthy in a week. The first hysterectomy with removal of a uncommon cancer of ovarian tumor ‘Struma Ovari’ performed on 15 February, 2012 and the woman doing well, 6 years. Now services for prevention of blindness complete eye care are also being provided.

Everybody is trying to give his/her best with whatever available in the given circumstances with limited resources.

There is good understanding and cooperation between Sub District Hospital Primary Health centres of Government of Maharashtra and our centre.

While trying to do whatever we could, we have had many challenges, many practical difficulties and have also realised that though. nutrition, anaemia, poor health, are responsible for many problems, their causes are deep, in the social and economical conditions, in the nonavailability of food, in ignorance, when the food is available, gender bias, unemployment, addiction and many other issues. Hindrances also include lack of awareness, lack of resources to seek services at health facilities and their own faith concepts of traditional healing, beliefs and disbeliefs. Sometimes making the patient stay in the hospital for her own good or her child’s good is a tough job, testing the patience, the best of counselling skills and dedication. 

We realized within months of opening the hospital unless Community based services, community motivation, mobilization and behaviour change, were done not much was going to change. So a step was taken in this direction way back in Feb 2013, just a year after starting the services. Now seven nurse midwives provide community based antenatal services, advocacy about intranatal, postnatal, neonatal care in the villages. We started with 52 villages in February 2013 and 13 more were added from July 2013, a total of 65 till recent past. Later 35 more have been added from April 2016 and 40 more in August 2017, making a total of 140 villages. The team visits villages 5 days a week. Medical officers posted under Rural NGO posting scheme of the Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha used to run Community Based health clinics in these villages with the nurses, in rotation while services at base hospital at Utawali. However the current rules of postgraduates medical admissions with national eligibility examination, no medical officers are available. Some laws for some good spoil other good work. So interns of the Institute in the near by District at Sewagram  are posted in rotation for 15 days, task shifting. So while each NM visit their assigned village, once in a month, doctors run clinic in assigned villages by covering 7 villages in one visit by one doctor. Things will change. It needs some time before awareness will come in the tribal population and their many unlisted social and economical issues are really addressed.  


Now seven nurse midwives provide community based antenatal services, advocacy about intranatal, postnatal, neonatal care in the villages.

Diagnostic cum therapeutic camps have been made annual event. First camp was held in March 2012 with 226 patients, February 2013 the number was 1036, in 2014 February it was 1107, in 2015 it was1883 and 2016 it was 2197. In 2017 attempts were made to help differently abled and 216 needy were help. In 2018, 3872 Surgeries have been performed on camp days and left over cases are operated within days of camp, some at Utawali and complicated at the institute at Sewagram. Camp for Cleft lip Cleft Palate was also conducted in December 2014. Attempts are being made to help Elderly women and elderly men too for diagnosis and therapy of illnesses, including noncommunicable diseases, (Hypertension, Diabetes and Cancers) vision problems. Research was done with help from US based Global Health through Education and Service, (GHETS) Indo Canadian Institute from Canada. Now Mumbai based philanthropists including Jan Kalyan Trust help in services for elderly. Research about ‘Abortions’ under Indian Council Of Medical Research, New Delhi Disability Detection program was done and Aids, including Wheel chairs provided to nearly 225 people. Now beginning has been made for trying to make adolescent, young school drop outs learn skills to become self sufficient, with support from Jan Kalyan Trust Mumbai. Camps for cataract surgery are being done. 

Research is being done about effects of Bio-fuel mass on health of family specially mothers and new born with plans for providing and Chimneys related to Agriculture status and malnourishment, low body mass index, Anaemia, Vit A deficiency etc. There are plans for Family Life Education Program for Adolescents, Preconception literacy and care also, finding how Wellness can be created for them.


Presently the biggest need is of finances so that in the reasonably equipped, furnished hospital, free services can be provided to the real poor, especially mothers and babies in emergencies. It is not possible for KHS, Sevagram to provide free services to everyone without support. Though services are provided to everyone, who reports, irrespective whether the patient can pay or not, it is not possible to Declare free services due to lack of resources. Also financial support is needed for providing children the needed nutrition at home till the time they are in a position to become self sufficient. Major issues are also awareness of many things, access issues and safe water, working on their beliefs and disbeliefs.
____________________________________

Shakuntala Chhabra is an meritus Professor - Obstetrics Gynaecology, Chief Executive Officer - Woman Child Welfare, Officer Special Duty - Dr. Sushila Nayar Hospital, Melghat. In addition to DGO, MD, Diploma - Advanced International Maternal Health Sweden, Certificate Courses- Maternal Child Health, U.K, Problem Based Learning- Netherlands, others- Logistics Management, Teaching Training, Human Resource Management etc. Receive the awards: FIGO’s Distinguished Community Emergency Obstetrics, Best Teacher, MUHS, Nashik. Short term WHO Consultant, Technical Consultant, Technical Temporary Advisor - WHO. Supervisor for SIDA. Member of Women’s Health Task Force, Network TUFH, USA. Member of World Rural Health Council 2018. Special Interest- Maternal health, Social Obstetrics, Gynaecological cancers, Health Professionals education.

Curated by Ana Júlia Araújo and Mayara Floss