TRIBAL HEALTH INITIATIVESittilingi, Tamil Nadu, India

Experiences in training Para-medical Workers

Dr. Lalitha Regi

Presentation at ARSICON2008

Wardha

Helping tribals heal themselves……

Invocation

To the tribal Gods who protect our people

Sittilingi Valley …..enveloped by the Kalrayan and Sitheri hill ranges

Sittilingi and the Avalur valleys have 21 hamlets which are home to about 10,000 people of whom 95% are tribals

Need of the area Remoteness – nearest referral centre was

100km away No “modern” facilities Staff need to understand and empathise

with the tribal population Villagers need to feel comfortable with

health care providers

Selection Initially looked for

educated girls – 8th Std Now we send out

information – applicants have a written test on basics of language and mathematics; then interview

Selection based on aptitude, attitude, region, income levels

6th batch in progress

Health Worker Training

Caring , respect and shared concern

Balance classes with practical work

Training – general principles Design according to the need of the area Emphasize student’s role as educator How things are taught is more important than

what is taught Caring , respect and shared concern Balance classes with practical work Understand social causes of ill health Make people more self reliant and less

dependant on institutional health care Participatory training

HWs’ manage most of the Hospital

•See Out patients 4 days a week

•Conduct deliveries and assist surgeries

•Manage Ward and emergencies

Deliveries & Neonatal Care

Advanced Neonatal care

About 30 deliveries a month and 3 - 5 for neonatal care per month

Surgical Work

About 20 – 30 surgeries every month including emergencies .

Surgical training·       1. How to do basic dressings

·       2. Injuries – how to examine, clean, debride and do the suturing if needed.

·       3. Check ante-natals, monitor and assess labour and conduct deliveries including some of the abnormal deliveries like breech delivery

·      4. Examine and do incision and drainage of abscesses

       5. Surgical removals of small swellings like sebacious cyst, lipomas etc.

·       6. Local anaesthetic blocks, giving and managing of drugs like ketamine and thiopentone

7. Manage spinal blocks and intra-operative management of general anaesthesia

Surgical Training

Simple surgical procedures like cysts and other swellings

Surgical Training

Dressings, I & Ds

Assisting Major surgeries

Anaesthesia training

General Anaesthesia

Spinal Blocks

Community Health

Health Workers now plan and implement the Community Health Program

Health Care at the doorstep – postnatal care

Field Clinics

Health education is the key

LaboratoryTechnician

Basic tests we taught – practical & theory Biochemistry & maintenance – other hospitals Government recognised lab – TB & HIV Seniors train juniors and we check – 5 have skills All Health Workers learn basics TB/HIV – Government uses our lab as an example

X-ray/ ECG technician

1. Theory taught by us2. Practical learnt in large hospital1. Seniors train juniors , theory we teach 2. 5 Health Workers know

Pharmacy

Drug names and actions taught – to all Basics of dispensing taught – to all Stock keeping and ordering – one person

specialises, one assistant

Advantages/Disadvantages

•Brings down workload

•Treatment inexpensive

•Knowledge passed onto community

•Increased confidence & self esteem

•Gives us time to look into other problems in the community

LEGAL PROBLEMS !!!?Non – Recognition from other hospitals

Achievements No maternal death – 5 years Infant mortality – from 147/1000 to 32/1000 Malnutrition – down by 50 % Antenatal mothers check up – from 11% to 95 % Almost 100% completion of treatment in TB Hospital attendance from our area – decreased from

50 % to 20%

Tribal Hospital – Staff patternNon tribals

3 doctors 1 Administrator

Locals 14 Health Workers 2 Lab Techs 1 X-ray tech 2 Pharmacists 3 Admin assts 2 Drivers 7 HW trainees

That formal education is mandatory to do health care is a myth

Help people heal themselves…..

References Health for all-Alma Ata declaration and

after-N.H.Antia The Alma Ata declaration and goal of

health for all-David Werner Health Care in India ‘a profile’-Devraj Chauhan,N.H.Antia,Sangita Kamdar

Thank you

For more information check out

www.tribalhealth.org