Dr Patricia Bidinger, MS, PhD

Director, Institute for Rural Health Studies

Rural Maharashtra in 1977

– a long way from Hyderabad and a world apart

Rural villages:

Food, nutrition and medical care in Maharashtra & Andhra

In Maharashtra, food, nutrition and medical care exceeded that in

the state now known as Telangana

Diets were more varied and were more nutritionally balanced;

babies were fed earlier and with better food

Proximity to effective medical care was better, as well

A welcome to India……

• Poor roads

• Few buses

• Few Primary Health Centres

• Dedicated, but frustrated doctors

• Inadequate supply chains (or impractical)

• Inadequately trained paramedical staff

• Little comprehension on the part of the villager

• Epidemics at regular intervals

Andhra Pradesh rural life…..

• Extreme poverty as seen in low weight, etc.

• Malnutrition including all classic signs and symptoms

• Childhood diseases were ever present

• Lack of clean water

• Advanced stages of non communicable diseases

• Fear of leaving the area for help or assistance

• And much, much more……

In the villages……….

• The rural ANM from the village perspective:

Irregular appearances

Frequently found in the large farmers’ houses

Made demands on the villagers

Lack of explanation by ANMs and..

Lack of comprehension by the villagers

Early government immunization

• The RMP

• Frequently, he was the 2nd or 3rd generation

• He didn’t discriminate

• He extended credit in time of need

• And he always gave the patient something

But what was always there?

Good and effective changes have been legion:

More and better PHCs with greater facilities

Better trained personnel at all levels

Asha workers now in existence and bridging gaps

Anganwadis are accepted and utilized

Effective immunization

Better government hospitals at all levels

Health care today…..the government

We see RMPs and some ‘quacks’:

1. Acting as marketing agents for corporate hospitals

2. Giving grossly inadequate amounts of antibiotics.

3. Endangering lives with copious amounts of steroids

4. Offering endless ‘drips’ to all and sundry.

Yet something is lacking……

A few reasons:

• Few qualified doctors actually listen to patients

• Fewer yet actually examine their patients

• The RMP is nearby and is easily accessible

• He has long experience sounding ‘sincere’

• His marketing connections/skill reduce the time to

accessing health care

• The poor, labor family feels less of a barrier

• The RMP is affordable as most rural villagers are in

debt for dowry and previous private healthcare

Why do villagers choose to use RMPs?

There are solutions, but they will require a bold

approach and a willingness, in part, to combat the

Indian Medical Association (IMA).

The following slides will demonstrate three ways of

combating some of our problems in rural health care

and the enabling ethical access to higher level health

care.

Join me on my journey……….

Improving medical care for villagers….

We are an NGO in Telangana, India

• IRHS (Institute for Rural Health Studies) was founded in 1981 to serve the population of the South Indian state of Telangana.

• IRHS‘ mission is to ensure access to primary through tertiary healthcare for the poor rural population

• IRHS is using an innovative integrated network of healthcare provision – in rural villages and in the state’s capital Hyderabad

Hyderabad

We provide healthcare services for the rural poor.

• We run two health clinics in a remote area of Mahbubnagar district

• There, we treat on average 200 patients/week

• All these patients would otherwise have limited or no access to healthcare

• The health clinics offer comprehensive primary care services (including lab investigations, counseling and specialist gynecology services) and have pharmacies

• Cases that require specialist care are taken to Hyderabad by our team where we help them through our Travellers’ Aid service

The Cervical Cancer Programme is unique in its

approach.

Our Cervical Cancer Programme ...

... screens women in rural areas for cervical cancer

(outreach teams of nurses and an outpatient clinic

inside the Mahbubnagar District Hospital).

… diagnoses and treats early cervical cancer lesions

using visual inspection methods followed by cryotherapy.

… refers more advanced cases to specialist care in

Hyderabad’s Institute of Oncology.

… educates women about the causes of the disease.

Cervical cancer is the

leading cause of death for

women in India (estimated

70.000* deaths/year)* Ferlay J, Bray F, Pisani P, Parkin PM. Globocan 2000: Cancer incidence,

mortality and prevalence worldwide. IARC Press, 2001.

The Cervical Cancer Programme is expanding.

•The State Commissioner of Health and Family Welfare

has asked us to duplicate our successful cervical cancer

screening programme in other district hospitals.

•We are looking to one day run similar projects across

the entire state.

•We have begun training ANMs from two remote, rural

districts. Our second unit will soon be opening in the

Nagarkurnool District Hospital.

•The Commissioner has also proposed we replicate our

approach for early detection of breast and oral cancers.

We provide health education in a variety of settings.

•We teach health education in village schools to increase health awareness for the children in rural areas.

•Children in large, government-run school nearby are also benefitting from our health education classes.

•Classes for teenage girls are held each Friday evening in our Dokur clinic.

The Travellers’ Aid for the Sick program facilitates

specialist services for the rural poor in Hyderabad.

• Picks up poor patients arriving

at Hyderabad’s (state capital)

biggest bus stations

The Travellers’ Aid for the Sick Team in Hyderabad...

• Receives referral cases from

our own rural health clinics at

the bus stations

Ensures that patients

• access quality services in Hyderabad, using

government facilities where possible

• are informed and taken care of while in Hyderabad

• receive consistent treatment over longer periods of

time by organizing follow-up appointments

• ensures patients receive their treatment by paying for

bus fares, medicines, lab tests, food and other

expenses during treatment in Hyderabad

Patients from rural areas are often illiterate,

extremely poor and incapable of finding their

way through Hyderabad‘s complex medical

system

Cervical Cancer Control Project,

Mahbunagar District Hospital

Mahbubnagar

Inst. for Rural Health Studies Dokur Clinic

Dokur village, Devarkadra mandal

Mahbubnagar District

Contact or call us: Dr. Pat Bidinger

pdbidinger@ruralhealthindia.org

Cell: 9848535366

Landline: 040 2338 4472

Come visit us and see for yourself…..

Thank you for listening

www.ruralhealthindia.org