THE MEDICAL MOBILE UNIT
The Medical Mobile Unit (MMU) has 15 scheduled camps every month over 8 days, catering to the population of approximately 80 villages. The unit has the services of a lady doctor, a general physician, a lab technician, an X-Ray technician and a nurse cum pharmacist. Services provided are X-Rays, ECG, drug dispensation, laboratory tests for blood and sputum and family planning services. Over the past six months of its operation, the MMU has greatly added to the reach we have had to bring clinical services to some of the very remote villages in Okhalkanda Block of Naiintal District and support our community health program. It is also covering a large gap in the delivery of antenatal services that the government is unable to provide comprehensively.
To see hospital services data please see the attachment below titled CURATIVE HEALTH DATA
The Pindari health camps of Aarohi started in September 2009, a result of the efforts of our dear friend Pankaj Wadhwa. The bi-annual camps aim to provide basic but essential health care services and spread general health awareness in government schools largely bereft of teachers. These villages lie scattered on the trek route to the Pindari, Sunderdhunga and Kafni glaciers. They lie between altitudes of 2000 to 3000 m above sea level, and a good ten hours of a tough trek through mountain terrain from the road head, which itself is eight hours of difficult driving from our village headquarters in Satoli. A total of 9 camps have been done over the past 6 years. The focus now is on growth monitoring of some 200 children in 5 schools. Six monthly records of height and weight are done along with a complete medical and dental check-up. The medical team deworms the children and gives Vit A and Calcium supplements. Volunteers help conduct awareness sessions on personal hygiene and cleaning campaigns are conducted in the villages. Village out-patient care is conducted for the ill seeking treatment.
Our research in the energy sector has been driven by the need to improve the crude stoves and methods used in the region to heat homes and cook food, using wood as fuel. On average women spend 2-3 hours every day collecting fuel wood and in the Okhalkanda Block of Nainital District - our target area – the stoves used are virtually the same as those used by cave men. These burn wood inefficiently and fill the house with hazardous smoke which, after a lifetime of inhalation, causes compromised respiratory function and early death. In 2010 we started the construction of 'Improved Chullahs' (smokeless stoves). The focus was on reducing the amount of inhaled smoke in the house, especially by women and children. Over the last three years we have constructed 401 smokeless chullahs and this has been a period of intense learning for the community, the masons and us. We struggled with different designs as well as getting women to understand maintenance of these chullah and the benefits of a smoke-free home. We teamed up with ARTI (Appropriate Rural Technology Institute) of Pune and also brought in a much more scientifically designed chullah that used a fixed mold, allowing little room for error in construction. However an end-of-phase evaluation found that only 116 or 29% of chullahs were working and used well. The rest were either not in use or had been broken. An analysis of the situation revealed that the main reason for non-compliance was the mouth of the chullah. It was too small to puff the standard-sized `roti’ (Indian flat bread). Many women chose not to adapt and reverted to their old smoky chullahs. Another key reason was not a very aggressive follow up by the masons’ team, resulting in clogging of flue pipes with soot and smoking the house.
To see the Energy Project data please see the attachment below titled CHULLAH REPORT.
Greetings from Himalayas! We are happy to report 3 months of work of our community health project involving extension to 35 more villages in the Okhalkanda Block of Nainital District. A new office has been set up in Patlot and 12 new health supervisors hired. Concomitantly, we also launched the Mobile Health Clinic in July, a joint venture with the Government of Uttarakhand. This has brought succor to 500-600 additional patients in extremely remote villages. The mobile clinic is equipped with a lab, and X-Ray machine. We await bureaucratic clearance for use of the ultrasound machine, also part of the mobile clinic.
Three of our smokeless chullah (improved cookstove) masons went to ARTI (Appropriate Rural Technology Institute), Pune for an exposure and training on different technologies for cooking and heating for rural areas.
We hope you find the attached report informative. Should you have any questions at all please do not hesitate to contact me (firstname.lastname@example.org).
With warmest regards,
Dr Sushil Sharma
Dear Aarohi supporters,
Greetings from Himalayas! It was in April I had written to you last. The past three months have been as enthralling as ever and we have been doing some vital groundwork for phase III of our health project, also called ‘Arogya Phase III’. As you already know our health work focuses on the ‘mother and child’. To complement our main work, our secondary objective is to address issues of (to a limited extent albeit)- women hygiene, sanitation, clean drinking water, promoting smokeless cookstoves or chullahs and addressing social taboos. Funded by Sir Dorabji Tata Trust, by the end of Arogya phase III we would have covered 105 villages in the remote Okhalkanda Block- a region where no other organization has undertaken health related work so far.
Hope you find the attached report informative. Should you have any questions at all please do not hesitate to contact me (email@example.com).
With warmest regards
REDUCE INFANT & MATERNAL MORTALITY IN THE HIMALAYA: January - March 2014
1 COMMUNITY HEALTH
After conducting a baseline survey in 15 villages, we started collecting information from the 35 villages in which we will be working in the first year. The villages are Okhalkanda Malla, Okhalkanda Talla, Khansyu, Chyurigaad, Pokhari, Kulori, Putgaon, Reekhakote, Tanda, Surang, Sui, Jamraadi, Takura, Karayal, Rekuna, Tushraad, Paitana , Ramela, Putpudi, Bhadrakot, Herakhan, Dewli, Kalaagar, Kwerala, Gargadi Talli, Gargadi Malli, Galni, Teemar, Chamoli, Jhadgaon Malla, Jhadgaon Talla, Saal, Badoun, Thalaadi and Bagor.
Highlights of the past 3 months work with the community
1.1 Exposure visit
From 18-23rd January Aarohi health staff visited Jan Swasthya Sahyog (JSS), a voluntary, non-profit and registered society founded by a group of health professionals committed to developing a low-cost and effective health program that provides both preventive and curative services in the tribal and rural areas of Bilaspur district in Chhattisgarh. The objective of the visit was to gain exposure to JSS’ activities. Those of note that Aarohi would consider replicating or adapting to their own work environment, include:
-meetings in which creative learning materials are used to raise the awareness of adolescent girls of issues such as personal hygiene and menstruation
- forming self-help groups amongst local villagers to address health or social issues
- organising fairs at the local market to spread awareness of health and social issues
- providing supplementary food when giving medicine to patients to boost their immunity
- colored thermometers for illiterate health workers to identify if a person is running a fever and provide medicine with the help of diagrams.
1.2 Training Camp
Dr. Ramani Atkuri, a consultant, trained senior Aarohi staff and trainers on Ante natal care, Post natal care, Neonatal care, sepsisin neonatal, nutrition, malnutrition, diarrhoea and growth monitoring. The training took place from 26th-30th of January and occurs twice a year as a means of updating Aarohi’s staff’s knowledge.
1.3 Health Management information System (HMIS) training
Mr. Ganga Singh and Mr. Nain Singh trained the 13 Aarohi health supervisors on HMIS tools that they use in the field. Sessions focussed on how to use HMIS tools and their importance for the project – the recording of essential data in progress reports, daily activity schedules, and child growth monitoring charts. This provides a refresher for most supervisors and is a necessary introduction for new supervisors.
1.4 CommCare Programme
Since March 2013 Aarohi has been running a pilot project using an innovative job aid tool for mobile health workers. The tool is a free, open source mobile phone application that Aarohi developed in conjunction with Dimagi Inc, an American not-for-profit. Ten Accredited Social Health Activists (ASHAs) have tested the application in the Okhalkanda Block of Nainital district in their door-to-door ‘safe motherhood’ educational visits to families. The results have been a win-win-win, benefiting the women and families to whom the health awareness work is targeted, the ASHAs themselves as well as their managers. The novelty of a multimedia questionnaire using sounds and images on a mobile phone sustains the interest of the woman interviewed as well her whole family allowing the ASHA to provide health awareness more effectively to her target groups. The mobile-phone application questionnaire also ensures that the AHSA does not forget to transmit crucial information during her health education exchange with the women and their families. The application is a lighter and more efficient way for the ASHA to record and manage the information she collects (rather than recording it all into countless paper notebooks) from each visit. Given that the data is automatically uploaded onto a cloud server each time that the ASHA has internet access, real-time information becomes available to managers allowing evidence-based change to strategies in order to respond to needs. The availability to managers of the information on the interviews conducted by ASHA also makes remote supervision far easier. In light of the positive results of the pilot, Aarohi intends to expand its use of the application to all health workers in the area and make it available for use by other organisations.
1.5 ASHA selection
Aarohi’s proposal to train ASHAs in Okhalkanda Block was approved by the Uttarakhand Health and Family Welfare Society, the state government body. This training, which will start in April 2014, will supplement and provide key additional information and skill not covered by government training. Aarohi thus looks forward to receiving better-quality data from the ASHAs who have been trained; indeed they are the only people collecting such data at the grass-roots level.
During the reporting period, Aarohi identified ASHAs in Aarohi intervention villages who will each be paid Rs. 500 per month and who will benefit from Aarohi’s training and mentoring.
Mother and Child Data*:
Aarohi health supervisors are in the process of weighing all children aged 0-5 years in the project areas and have identified malnourished and severely malnourished children. Further advice on diet is being provided to mothers.
Health supervisors are also visiting all pregnant women in the project areas and encouraging them for undergo regular antenatal checkups.
TOTAL NO. OF VILLAGES: 35
TOTAL POPULATION: 17,379
ELIGIBLE COUPLES: 613
NO. OF PREGNANT WOMEN: 82
LACTATING MOTHERS: 54
CHILDREN (0-6 MONTHS): 97
CHILDREN (6 MONTHS- 1 YEAR) 27
CHILDREN (1-3 YEARS) 414
CHILDREN (3-6 YEARS) 341
* The data is incomplete due to the fact that we had a few supervisors who had quit their jobs and therefore no information was collected from the villages in their absence.
Mobile health care monitoring comes to a Himalayan village
Just 23 years old, Keshvi represents the typical mountain woman whose life is defined by relentless house work from morning till dusk, poor education and marginalized social status. Keshvi is all of this but a lot more as well. She has been working as an ASHA (Accredited Social Health Activist) in her village Galni, Okhalkanda Block for over two years now. When Aarohi started working in village Galni for the first time, not many women were open to work as health workers. They did not have the time to do anything but housework. Keshvi would have been one of those women as well if her father in law did not encourage her to take up the role. Since then, there has been no looking back for her. Not long after she joined as a health worker, the VHNSC (Village Health, Nutrition and Sanitation Committee) recruited her as an ASHA- Keshvi’s commitment to her work and potential to grow had not gone unnoticed.
During the second phase of the Aarohi Arogya Project when the Commcare application was introduced, Keshvi joined as one of the mobile users. In the beginning she found it challenging to work with a mobile phone as she had never used one before. While the other workers were literate enough to read the instructions and were aware of how to use a mobile phone, Keshvi, a school dropout in class 5, could not use one. Taking it as a challenge, she started learning how to operate a mobile phone first and then how to operate the Commcare application. In just three months, she was able to operate the application without any problems.
Today Keshvi is the best mobile user we have under the Commcare programme for maternal and childcare. She updates and collects information from the village on a regular basis. She even does her own basic troubleshooting regarding the application or the phone.
Keshvi has proven that all one needs to use the Commcare application is just the will to learn.
2 CURATIVE HEALTH
2.1 Routine clincial services based out of hospital in Satoli continued with a fair increase in surgicak wiork done through monthly mulit-specialty camps.
TOTAL PATIENTS TREATED 1158
VILLAGES COVERED 49
SPECIALIST CAMPS HELD 4
PATIENTS TREATED IN SPECIALIST CAMPS 460
SURGERIES PERFORMED 41
ULTRASOUNDS PERFORMED 63
DENTAL CAMPS HELD 2
DENTAL PATIENTS TREATED 67
2.2 Mobile Medical Unit (MMU)
Aarohi signed a contract in October 2013 with the Government of Uttarakhand to reactivate the first Medical Mobile Unit that ran in Uttarakhand until 2012. The reactivated MMU will improve the reach of Aarohi’s clinical services to remote areas in the districts of Nainital and Almora. It will be staffed by a General Physician, a Lab Technician, an X-Ray Technician, a Nurse and a Pharmacist. Specialists and a Radiologist will be made available for 25% of the camps. The MMU will be capable of conducting ultrasounds, X-Rays, ECG, distribution of drugs, blood tests, sputum exam for Tuberculosis and will provide immunisation and family planning services.
The MMU which was lying idle at the Birla Institute of Applied Sciences has been transferred to Aarohi. After inspection of the equipment, the vehicle was taken to Haldwani for repair. The unit will next be sent to Delhi for major repairs and servicing. It should be functional by 1st May.
The beginning stage of the third phase of our project that is largely funded by Sir Dorabji Tata Trust Mumbai, included a baseline survey which was completed in November and involved randomly selected 15 villages and 430 households from Okhalkanda Block. The villages covered were – Paijaina, Dalauj, Kotla, Kafli, Tanda, Putgaon, Sakalwar, Patrani, Bhumka, Thushrar, Takura, Kotli, Baramdhar, Reekhakot and Soude. The data collected is currently being analysed.
Highlights of 3 months of continuation work with the community were:
- Dr. Ramani Atkuri, a consultant under the project conducted a training workshop at Satoli from the 8th -11th of October 2013. She helped in preparing a roadmap for trainers, shortlisted activities that need to be done in the first year and reviewed schedules for reporting and feedback, baseline survey and monthly schedules for supervisors. She also conducted practical training for the supervisors on Haemoglobin testing and taking Blood Pressure.
- Training for the building of smokeless chullahs (improved cooktoves) was conducted by Mr. Saulunkhe from ARTI, Pune from 18th- 20th of October 2013 in Khansyu. The villages- Putpudi, Ramaila and Galni were identified from in and around Khansyu and Karayal and training were given to the masons on how to build the chullahs. Follow up was also done on the chullahs that were built in the past to identify the issues faced by the users using the chullahs. The houses using chullahs have had an immediate decrease in smoke inside the house and have also reported a reduction in consumption of wood.
- A training workshop on mental health was conducted at the Aarohi office in Khansyu by Dr. Mukesh Shah. He gave training to the supervisors on identifying common mental conditions with signs and symptoms of each condition.
Regular monthly meetings were conducted with the health supervisors for planning and the sharing of work done and also on discussions about field related problems.
Mother and Child issues
The health supervisors are in the process of weighing all children in the age group of 0-5 years in the project areas and have identified the malnourished and severely malnourished children. Further advice on the diet is being provided to the mothers.
All pregnant women in the project areas are also being visited and ante natal checkups are being done.
Data on both will be obtained by January 2014.
VHSC (Village Health and Sanitation Committee) meeting
Twelve meetings of the VHSC were conducted. Issues taken up were regular supervision and monitoring of the ASHAs, their incentives, bank accounts, balance funds with the VHSC, other health related issues of the village and roles and responsibilities of VHSC.
- Commcare is a cell phone based application that aims to enable the community health worker at the field level to provide better and more efficient care while also enabling better coordination as well as monitoring and evaluation of the community health program.
- The program is running as per schedule and regular reporting and troubleshooting is performed on a scheduled basis. We have got the permission to scale up our operation by increasing the number of the mobile app users. Dimagi will be supporting us in capacity building and funding for the purchase of more cell phones.
Mobile Medical Unit:
- Aarohi has signed a contract with the Government of Uttarakhand to reactivate the first Medical Mobile Unit to be used in and around the District of Nainital.
- The mobile van will help us to improve the reach of clinical services to remote areas in the districts of Nainital and Almora.
- The van will cover around 50-55 villages in the two districts every month and these are areas where Aarohi already runs its community health program.
- The medical unit will have the services of a general physician, a lab technician, an X-Ray technician and a nurse cum pharmacist. Specialists will be made available for 25% of the camps.
- The unit will be capable of conducting ultrasounds, X-Rays, ECG, distribution of drugs, blood tests for malaria, sputum exam for tuberculosis and family planning services.
A detail of patient care at the Aarohi hospital is reflected below:
TOTAL PATIENTS BENEFITED 1366
TOTAL VILLAGES COVERED 45
SPECIALIST CAMPS HELD 4
PATIENTS TREATED IN SPECIALIST CAMPS 109
TOTAL SURGERIES DONE 7
TOTAL ULTRASOUNDS DONE 28
DENTAL CAMPS HELD 2
TOTAL DENTAL PATIENTS TREATED 141
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