two decades of learning. the journey so far ramanamma a v 9 th april, 2012
TRANSCRIPT
Two decades of learning.
The journey so far
Ramanamma A V
9th April, 2012
Different hats at different times
Clinician Public health physician Trainer Advocate
And at all times – a learner
Lakshmi Sabar, 30, lung TB
Bhima Sabar,10Spinal TB
Orissa Supercyclone, 1999, Ersama block
A twisted telecommunications tower, Ersama block, 1999
Bhind district, MP, 2004, outbreak of gastro-enteritis
Morena, immunization catch-up rounds, 2006
Sheopur, immunization catch-up rounds, 2006
ANMs learning about maternal death audit, Guna, MP
Bilaspur district, Chhattisgarh
W
Achanakmar tiger reserve, entry to the core zone
Face to face with all -prevalent hunger, and a high burden of illnesses
Choitram Baiga, 45, Bahaoud village, relocated due to Project Tiger at Achanakmar. Has MDR TB
Suffering from chronic hunger and tuberculosis
Weighs 28.5 kgs Body Mass Index of 10.9,
considered incompatible with life.
Diagnosed in March 2011
Died September 2011
Dhanga Baiga, 55
Raja Baiga, 9 yrs
Also suffers from hunger and tuberculosis
Weighs 10.8 kg Body Mass Index 11.5,
considered incompatible with life
Diagnosed December 2011
Currently on anti-TB drugs and food supplementation from JSS.
The normalization of hunger
on
People living in small places have small problems…
--and thus can do with simplistic care delivered by poorly trained and
inadequately supported staff
Who Needs Tertiary Care?
Urine from a Patient with Blackwater Fever (Falciparum malaria)
Who Needs Tertiary Care?
Patient with a krait bite with ptosis as a sign of envenomation. See here
Who needs tertiary care?
Kiran Baiga, 18, primi with PIH and severe anaemia
3 malnourished children with pus in the chest cavity following pneumonia.
Who Needs Tertiary Care?
Dropped into the fire by older sister who had untreated epilepsy.
Who needs tertiary care?
A child with sickle cell crisis needing blood and pain control
There is therefore an urgent need to train doctors and nurses in peripheral areas to deal with these common conditions,
And to equip the peripheral centres to be able to provide appropriate care before referral.
Massive levels of childhood undernutrition
Poor supplementary feeding; no one to feed the young child; low family income;
family on starvation diet.
Kalyan, 1yr 6mths, 4 kgs
Vishnu Baiga, Chaparwa village.
Sibling care, Bisaunikhar village
Village meeting about creches
The creche worker has her hands full, literally.
Weight for age, all children
2011
44% underweight
2009
56% underweight
Weight for height, all children
2009
26% wasted
2011
10% wasted
2009
26% wasted
2009
26% wasted
2011
10% wasted
2009
26% wasted
2009
26% wasted
2009
26% wasted
2011
10% wasted
2009
26% wasted
2009
26% wasted
2009
26% wasted
2011
10% wasted
2009
26% wasted
2011
10% wasted
2009
26% wasted
2009
26% wasted
2011
10% wasted
2009
26% wasted
2009
26% wasted
2009
26% wasted
2011
10% wasted
2009
26% wasted
Malnutrition in young children can be prevented at the community level
It needs support from Government, however, for food supplementation
Health care costs
Second largest cause of rural indebtedness after agriculture
Each episode of hospitalization pushes 2% of families below the poverty line
Health care expenditure, 2009
Health care expenditure, 2009
There is a huge unmet need for good quality training and appropriate training material
-whether it is for health workers, ANMs, or doctors
Health worker preparing malaria slide, Boirha village
Ramkali, Senior health worker, Bamhni Subcentre, Achanakmar sanctuary
Ready reckoner for drug dosages
Phagni Dai, TBA,Bamhni
Birsa Bai, TBA, Danganiya village
Skill training for TBAs, Achanakmar Sanctuary
Dharmin Bai, Katami, TBA
Discussing conception and contraception
Talking to women about VIA for cancer cervix screening
Who has helped me in this journey?
Family, friends, colleaguesand CMC Vellore