Sakharshet Public Health Center and the Sub-Center

I genuinely feel fortunate to have been able to visit the Sakharshet Public Health Center and the sub-center in the village.  India faces many health challenges, which include illnesses, such as diarrhea, hepatitis, typhoid, worms, measles, malaria, tuberculosis, whooping cough, and HIV/AIDS; and it was inspiring to see how the devotion of medical staff is at the core to India overcoming such obstacles.  Their commitment is evident and deserves credit when one discusses India’s medical successes such as the decrease in infant mortality, decrease in waterborne diseases and vaccination of children.  Furthermore, in both facilities, I was able to witness the genuine efforts made to bring the poorest of the population affordable quality health care and it was inspiring.

The free services provided were: immunization, deliveries, post-natal care, child care, family planning, treatment against dog and snake bites, basic laboratory services for the diagnosis and treatment against leprosy, tuberculosis, malaria and HIV/AIDS, referral services, eye check-ups, safe water supply, basic sanitation, prevention and control of locally endemic diseases, collection and reporting of vital statistics, and education about health. 

Challenges

The Public Health Center’s and the Sub-Center’s obstacles are that they are understaffed, lack infrastructure, high infant mortality rate, malaria, and the high population density.  First, the lack of manpower is a problem in rural India as most doctors prefer to work in urban areas because 80% of health facilities are concentrated there.  This is a dilemma because approximately 74% of India’s population lives in rural areas.  In other words, the distribution of doctors and medical resources is unequal, as the majority is located in urban areas.  

Secondly, the lack of infrastructure and resources is a major obstacle.  For example, statistics are manually collected because there is no electricity for 7 hours a day on average.  Also, the implementation of computers would not be feasible at this point in time because nurses will have to be trained to use computers, which will take them away from their work.  Additionally, financial resources are considered inadequate to supply such services, which makes it difficult for doctors to make necessary improvements.  For instance, the center is too small for all the patients they help to on a daily basis because it was built in 1962.  It was not built to attend to the needs of so many individuals, but insufficient capital makes expansion problematic. 

Fourth, the high infant mortality rate was daunting for the medical officer because he witnessed the deaths of over 100 infants in a year.  Fortunately, this average was significantly reduced to approximately 20 deaths a year due to his commitment, by providing pre-natal health care and by decreasing anemia in mothers by providing them with free iron tablets.  They also weigh infants, under the age of 6, to ensure that they are not malnourished.  Importantly, if the child is malnourished they are provided with protein and iron rich foods.  Furthermore, despite the lack of capital, significant progress regarding child mortality has occurred.

Fifth, being able to physically see the gambusia fish tank was gratifying.  Before this class I never heard about this fish and how it is the most effective method against malaria as they eat mosquito larva.  Sixth, the high population density is a major challenge because the Medical Officer is supposed to take care of 25,000 people, but he is actually responsible for the health of 37,000 people, which makes it difficult to provide everyone with the services they deserve. 

Achievements

The Public Health Center’s and the Sub-Center’s achievements are tremendous.  Despite all of the impediments, they have decreased the prevalence of both waterborne diseases and infant mortality, are close to eradicating polio, and their sterilization and vaccination efforts have been fruitful, to name a few.  Firstly, both centers operate according to Indian Public Health Standards (IPHS), which ensures optimal expert care at affordable prices.  Secondly, it is ingenious that villagers donate land and the government constructs the centers because it shows the commitment of both parties to promote health.  Thirdly, I think it is brilliant that the tribal nurse is compensated when she refers patients, for services such as sterilization and institutional deliveries, because it is an incentive that benefits her and the patient.

Fourth, the decrease in waterborne diseases, such as polio, typhoid, and diarrhea, is a major achievement because they claim 1.5 million lives annually and account for 80% of illnesses in India.  Advantageously, the center educates locals about the diseases that thrive in unclean water and chlorinates all 94 wells have decreased the toil that waterborne diseases has.  Fifth, India has almost completely eradicated polio, which is phenomenal.  According to World Health Organization standards countries need to make sure that there are not any new cases of infection for a span of 3 years.  In other words, if there are no new case of polio for 3 years, India can declare that they have eliminated it. 

Sixth, this center has surpassed the goals for sterilization, which are 74 for women and 8 for men.  Due to culture, women are more willing to undergo the surgery because they do not want their husbands to feel less masculine.  However, the strong relationships the doctors and nurses have with the villagers encouraged more men to willingly undergo sterilization.  Educational camps were set up for villagers where family planning was promoted.  They were taught that smaller families were more beneficial because there is less strain for resources such as food, medicine, and education.  The government provides monetary incentives for men and women who undergo the surgery and gives subsidized housing to families with no more than 2 children.  Furthermore, sterilization has been so effective because this issue was tackles via education, monetary compensation and reparations through housing.

Seventh, India’s immunization program has been successful because approximately 94% of children have been vaccinated free of charge.  I assert that this is a tremendous investment because it is a preventative measure.  Importantly, since 70% of India’s population lives in rural areas, this achievement would not be possible if it were not for the efforts of public health staff.  Nurses travel to each home in order to vaccinate all children.  Brilliantly, vaccines are kept cool as they are submerged in carriers with ice because the heat can render them ineffective.  Eighth, they have a pharmacy in both centers, which is genius because patients can conveniently obtain affordable medication without having to waste time or money traveling to a pharmacy.

Ninth, waste disposal bins were color coordinated, which is clever, because the separation and disposal of medical waste needs to be done properly.  Tenth, rural and tribal people have their own health practices and believe that diseases are caused by hostile spirits or by the breach of some taboo.  Fortunately, fewer villagers are seeking remedies through traditional priests and are utilizing the public health centers.  This was a major issue because treatable illnesses worsened since a trained medical officer was not consulted.  Significantly, this shift was possible because the medical personnel are committed to the health of the individuals they serve.  They have developed relationships with everyone in the village.  Additionally, the idea that free or inexpensive services are of lesser quality has deterred.  Villagers are realizing that they can get the same, if not better services, at a public facility because the staff are trained, have standards they follow and are open 27 hours a day 7 days a week.

Eleventh, deliveries are preferred by doctors and nurses or midwives.  There are at least two certified personnel present for deliveries in case there are complications.  Then the women are usually hospitalized for 48 hours after the birth to monitor her health and the health of the baby.  Interestingly, women are compensated 400 rupees a day, for 10 days, if they deliver in the medical facility because they live in inaccessible areas, have high risk pregnancies, and/or lack access to a telephone or electricity.  Significantly, this program has drastically reduced the average infant mortality rate.  Lastly, it was phenomenal to discover the medical officers’ reason behind working with villagers.  I admire his yearning to contribute to society by seeking an occupation with purpose.  He asserts that working as a medical officer has been a valuable experience for him.

The sub-center is the peripheral outpost of the existing health delivery system in rural areas.  Centers are manned by one multipurpose health worker and generally cater to 5,000 residents.  However in hilly, tribal and backwards areas they attend to 3,000 individuals.  The nurse’s role at the sub-center is limited to mother and child health, family planning, and immunization.  She has been working at the sub-center since 1994 and is supposed to attend to 3,000 people, but she actually caters to over 6,000.  Inspiringly, she has polio, which physically inhibits her, however her commitment to her patients is rooted in her desire to provide quality and affordable health care to others, because she does not want anyone to suffer as she does with polio.  Amazingly, despite her physical handicap, her sub-center is one of the best in the region.  I assert that the efforts of the medical staff in rural India are phenomenal.  They have been agents for change that have improved the health status of thousands of Indians.  However, in order to further improve the quality of rural life the gap between the biomedical model and the socio-cultural model need to tighten.