Sunday, 2 October 2016

Newer technologies and rural health

 Dr.Smruti Mandar Nikumbh-Haval

With new updates in world of bioengineering many firms are introducing various patient friendly gadgets which help them in monitoring of health issues. But in most of the rural areas these techniques are beyond reach. Reasons could be cost, literacy rate, education level to monitor them, maintainace, service centers, easy availability etc. 

 But a primary care physician can judge the need of such techniques well for community. These can bring a welcome change in community health services. He/she should try to search and use them for improvement of rural health. Urban or rural good patient health care should be the aim of every primary care physician. 

Today I will share my experience of one such technology came across few months back. It’s named as Continuous Glucose Monitoring System (CGMS).This is a new technology in market for monitoring of glycemic control of patient over period of 14 days continuously without causing much discomfort to patient. 

I got introduce to this during one of the workshop I attended. One of my colleague there who was type I diabetic using it smoothly to control his glycemic variables. I quite liked that so I searched for the company that provided that in India. My main hurdle was my rural back group .To convince marketing fellow was a task as he was bit reluctant to come to our place, share a demo and training. I assured him that I will personally take him to the venue and arrange transport. Then with lot of yes/no he agreed. One more (?) Bribe I offered him was discovery of an undiscovered market place which will help him in his promotion. That clicked well to him I guess. :-P. 

 We got our demo and I soon mastered the skill. We now have used it on more than 7 patients and it really helped them in their treatment plan modification. My patient range was also variable /we used it in post CABG, post angioplasty, uncontrolled diabetic patients and brittle diabetes cases. We got excellent details from that monitoring. We also ask patient to keep a food consumption chart to correlate readings of glucose levels. 

 We document hypoglycemia unawareness, false alarms of hypoglycemia/ Hyperglycemia, Dawn’s phenomenon. With these variables we could modify there treatment plan and make their life bit stress free as symptoms are gone or in control. This time we know a concrete reason. The patient satisfaction was immense. 

 CGMS really document it better and helps in monitoring of glycemic control. We even saved one patient who was having recurrent severe hypoglycemia and need of Insulinoma workup. With careful history, glucose monitoring and treatment adjustments things are in control, major operative or multiple investigations and psychological stress got saved. 

The only factor that hampers its routine use in rural population of India is cost of device. But I am hopeful in near future it will come down. In primary care one should learn to balance technology and its need as treatment option. We should not depend too much on them. Clinical judgment is a priority. Additional tools like these should be used to improve clinical outcome. 

Brief Description about the author
Dr Smruti Mandar Haval  (Dr. Smruti Subhash Nikumbh);  M.B.B.S.D.N.B. (Family Med),M.N.A.M.S.,P.G.D. Diabetology  & Geriatric Med; Certified International Diabetic Educator by Project Hope & International Diabetes Federation (IDF) USA; Consulting Physician in Family medicine, Diabetology, Preventive Cardiology, Thyroid disorders  & Geriatric Medicine; C.E.O. Sukarmayogi Publishers, Sankeshwar Dist: Belgaum, Karnataka; Assistant Professor, Department Family Medicine, USM-KLE IMP,Belgaum


Area of practice- Sankeshwar, Dist – Belgaum,Karnataka. Epidemiology of your area in brief: It’s an semi rural area covering more than 50 km radius including many villages. Its USP is it’s an border area connecting borders of Maharashtra and Karnataka which makes it an multiethnic area. Common chronic health diseases are diabetes, hypertension, asthma, hypothyroidism etc.

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