Rural Health Success Stories

noreply@blogger.com (Bianca Cadore Morás) — Sun, 25 Oct 2020 23:40:00 +0000

Photo of one of the landscapes the autor encounters during her attendances

Written by Melina Branco Behne

Translated into english by Bianca Cadore Morás
Reviewed by Carolline Paggi Montemezzo

Posted by Bianca Cadore Morás

(Portuguese below)

I'm a doctor from the city hall of Francisco Beltrão (PR, Brazil) and I work only with bedridden patients, including the rural area ones. These patients are, with no doubt, the ones I like to work with more. They are the most polite ones, the ones that are more grateful for the medical appointments.

We can't always do the best medical appointments, since we depend on environmental conditions like hygiene and lighting, but I'm sure we can always get the best laugh, the best conversation and the best coffee. They are patients that are grateful even for the minimal thing you do.

And, the landscapes we come across to until arriving at the patients's houses are wonderful. It pays off for the flat tire because of the holes on the road. For me, the best part of medicine is the attendance in rural areas.

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About the author:

Melina Branco Behne, born in Pato Branco in Paraná. I studied in a private school all my life and also graduated in a private college, I dared to change my family's principles and think about the others and nature. I'm seen as nuts by my family for it. I'm a woman, a feminist, a lesbian, all tattoed and a plant lover. I'm also a public employee at Francisco Beltrão in Paraná.

Original text in Portuguese:

Foto de uma das paisagens que a autora encontra durante as suas consultas

Escrito por Melina Branco Behne

Traduzido para o inglês por Bianca Cadore Morás
Revisado por Carolline Paggi Montemezzo
Postado por Bianca Cadore Morás

(Em inglês acima)

Sou médica da prefeitura de Francisco Beltrão (PR) e atendo apenas os pacientes acamados da cidade, incluindo os da área rural. Os pacientes da área rural são, sem dúvidas, os que mais gosto de atender. São os mais educados e os mais gratos pelo atendimento.

Nem sempre conseguimos realizar o melhor atendimento, pois dependemos das condições do ambiente/ paciente, por exemplo, nem sempre a iluminação ou a higiene são adequadas, mas com certeza é a melhor risada, a melhor conversa e o melhor café. São pacientes que ficam agradecidos com o mínimo que você faz para eles.

E as paisagens até chegar nas casas são maravilhosas. Paga qualquer pneu furado por causa do buracos. Para mim, a melhor parte da medicina é o atendimento em área rural.

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Sobre a autora:

Melina Branco Behne, nascida em Pato Branco no Paraná. Estudei em escola particular a vida toda e fiz faculdade particular também, ousei mudar os princípios da família e pensar nos outros e na natureza. Sou vista como a doida da família por isso. Mulher, feminista, lésbica, toda tatuada e amante das plantas. Servidora pública de Francisco Beltrão no Paraná.

The Amazon Ulcer

noreply@blogger.com (Bianca Cadore Morás) — Tue, 28 Jul 2020 22:24:00 +0000

Photo of the panorama view

Written by Danuta Ramos Duarte

Translated into english by Carolline Paggi Montemezzo
Reviewed by Andressa Cavalcante Paz e Silva

Posted by Bianca Cadore Morás

(Portuguese below)

A little more than a month working with the indigenous health in the Kayapo territory I can say that I already lived a lot. Here, everyday is like a week and the work is continuous and exhausting. In the last day I had the immeasurable opportunity to meet a folk, his culture and his comprehensions of body-health-sickness. I'm learning too much from Kayapo's people and it's really sad to me that the first picture of their territory that I share on social media is this one.

Today I needed to take a sixteen year-old pregnant girl, by helicopter to the town, because of the imminent maternal-fetal death risk. When the plane was taking of, the panorama view revealing itself was like a wound open into the earth. A bleeding ulcer, a death threat, endorsed by the most disastrous government in fighting the COVID-19 worldwide. The Earth moans and cries everyday because men's greed.

Narubia Werreria usually says that everybody have indigenous blood, or in the veins or in hands.

This government is swimming in blood.

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About the author:

Danuta Ramos Duarte, born in the riverside of Araguaia in a little town of Tocantins state called Araguatins. She studied in a public school, graduated in medicine at a public university, Universidade Federal de Tocantins. Danuta is a person in love with people, nature and also with people’s natures. Granddaughter of a babaçu coconut cracker and an ecologist of Bico do Papagaio, daughter of a teacher, a feminist that dares to love another woman. A resident in Family and Community Medicine for SES-SC, a member of GT Rural from Brazilian Society of Family and Community Medicine (SBMFC).

Original text in Portuguese:

Foto do garimpo

Escrito por Danuta Ramos Duarte

Traduzido para o inglês por Carolline Paggi Montemezzo
Revisado por Andressa Cavalcante Paz e Silva
Postado por Bianca Cadore Morás

(Em inglês acima)

Há pouco mais de um mês trabalhando com saúde indígena no território Kayapo e posso dizer que já vivi muita coisa. Aqui cada dia vale uma semana e o trabalho é contínuo e exaustivo. Nos últimos dias tive a imensurável oportunidade de conhecer outro povo, sua cultura e sua compreensão de corpo-saúde-adoecimento. Estou aprendendo muito com os Kayapó e me entristece que essa seja a primeira foto do seu território que compartilho nas redes.

Hoje precisei levar uma jovem gestante, de apenas 16 anos, de helicóptero para a cidade, pois o risco de vida materno-fetal era iminente. Ao levantar voo, o garimpo se revela como essa ferida aberta na Terra. Uma úlcera sangrante, uma ameaça de morte, chancelada pelo governo mais desastroso no combate à COVID-19 mundialmente. A Terra geme e chora todos os dias pela ganância dos homens.

Narubia Werreria costuma dizer que todos temos sangue indígena, ou nas veias ou nas mãos.

Este governo está nadando em sangue.

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Sobre a autora:

Danuta Ramos Duarte, nascida na beira do Araguaia numa pequena cidade do Tocantins (Araguatins). Estudou em escola pública, formada em medicina pela Universidade Federal do Tocantins, apaixonada por gente e pela natureza e pelas naturezas das gentes. Neta de quebradeira de coco babaçu e do ambientalista do Bico do Papagaio, filha de professora, feminista e que ousa amar uma mulher. Residente em Medicina de Família e Comunidade pela SES-SC, membro do GT rural da SBMFC.

Family Medicine that is not in the books

noreply@blogger.com (Bianca Cadore Morás) — Sun, 31 May 2020 22:57:00 +0000

Photo of a mask hanging in front of a rainy day, taken by the author

Written by Karine Kersting Puls

Translated into english by Bianca Niemezewski Silveira

Posted and edited by Bianca Cadore Morás

(Portuguese below)

The residency ended. Finally, the idealized life of a family physician was about to begin, but it wasn't just anyone. It was not in any specialty. It was not at anywhere. It was the one as a physician, family physician, family and community physician in a rural city. And the dream began. And the plans started. Staff meeting. Planning. Agenda management. Knowing the territory. Knowing people. Bonds. Touch. Take care. Two weeks: that was the time. Two weeks for such a virus to emerge and catch dreams, plans, expectations, curiosities, take everything on the way and change the route. Change the known. To change. Pandemic. Individual protection equipment. Do not touch. Do not hug. It is no longer allowed to share the mate. Do not shake hands. Examine what is necessary. Do what is necessary. Do not leave if not necessary. Pandemic. Fear. Confusion. Standstill. Action.Make the contingency plan. Isolation. Take the test. And that idealization became reality - not the idealized reality, but the true one. And the real world has shown that reinvention is daily. Family and community physican. She learned that being a family and community physician goes beyond books. It goes beyond the residency. It goes beyond idealization. She learned that a family and community doctor is a reinvention, flexibilization, a daily action in the balance between doing and not doing. She learned so young that in order to be a family and community physician, a pandemic must be orchestrated in the midst of a non-idealized rural community.

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About the author:

Karine Kersting Puls is a family doctor in the interior of Rio Grande do Sul (Brazil), member of Rural Seeds and WONCA Working Party on Rural Practice.

Original text in Portuguese:

MFC que não está nos livros

Foto de uma máscara em frente a um dia chuvoso, tirada pela autora

Escrito por Karine Kersting Puls
Traduzido para o inglês por Bianca Niemezewski Silveira
Postado e editado por Bianca Cadore Morás

(Em inglês acima)

Terminou a residência. Finalmente a tão idealizada vida de médica ia começar, mas não era qualquer uma. Não era em qualquer especialidade. Não era em qualquer lugar. Era aquela como médica, médica de família e comunidade, médica de família e comunidade em uma cidade rural. E o sonho começou. E os planos começaram. Reunião de equipe. Planejamentos. Gestão da agenda. Conhece o território. Conhece as pessoas. Faz vínculo. Toca. Cuida. Duas semanas: esse foi o tempo. Duas semanas para um tal de vírus surgir e pegar os sonhos, os planejamentos, as expectativas, as curiosidades, pegar tudo que tinha pelo caminho e mudar o trajeto. Mudar o conhecido. Mudar. Pandemia. EPIs. Não toca. Não abraça. Não compartilha mais o chimarrão. Não aperta a mão. Examina o necessário. Faz o necessário. Não sai se não for necessário. Pandemia. Medo. Confusão. Paralisação. Ação. Faz o plano de contingência. Coloca em isolamento. Faz o teste. E aquela idealização se tornou realidade - não a realidade idealizada, mas a de verdade. E o mundo real mostrou que a reinvenção é diária. Médica de família e comunidade. Aprendeu que ser médica de família e comunidade vai além dos livros. Vai além da residência. Vai além da idealização. Aprendeu que médica de família e comunidade é uma reinvenção, uma flexibilização, uma ação diária no equilíbrio entre o fazer e o não fazer. Aprendeu tão jovem que para ser médica de família e comunidade tem que se orquestrar uma pandemia em meio a uma comunidade rural não idealizada.

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Sobre a autora:

Karine Kersting Puls é médica de família e comunidade no interior do Rio Grande do Sul (Brasil), membro da Rural Seeds e do conselho do WONCA Working Party on Rural Practice.

On social isolation in a Brazilian rural community

noreply@blogger.com (Bianca Cadore Morás) — Thu, 30 Apr 2020 01:10:00 +0000

Photo of the author at the health support center of Coelhos

The place’s abandonment held me strongly.
And kept my eye throughout all life.

Everything I knew after was full of abandonment.

There wasn’t in the place a way of running off.

We were inventing ourselves through

the path of new words.

We were a piece of an insect on the floor.

That’s why our delight was unseeing the world.

(Manoel de Barros, Free Translation)

Written by Mariel Hespanhol Torres

Translated into english by Cibelih Hespanhol Torres

Posted and edited by Bianca Cadore Morás

Reviewed by Mayara Floss

(Portuguese below)

I am lucky to be a Family Medicine resident in Amarantina. People say it received this name because it made some Portuguese remember his homeland, Amarante. They also say it is a district of Ouro Preto, a Brazilian historic city, but whoever was born in Amarantina frequently expresses his objection: “Ouro Preto is only about climbing up-and-down the hills! For God’s sake! And what about the cold…?” etc. etc. An Amarantinense sees himself as an Amaratinense – not Ouropretano.

Amarantina, just like Amarante, has a landscape way more appropriate to vegetable farming than it’s stony neighbors. Because of that, it has grown in both size and economic importance after Ouro Preto's great hunger, in the 18th century. More recently, the inhabitants have increased in order to sustain the mining operations in Itabirito, the closest city. Agriculture is not the main labor activity anymore, and the old village has become a district with more residents than the small towns in danger of extinction in Minas Gerais. However, the ways of life, the local culture and the distance from the big centers with their variety of services characterize the rurality of Amarantina. Each day I learn a little more about the consequences of being rural for the health of its population.

In times of COVID-19, one particular remark made me think about the vulnerability of populations living in the countryside, such as Indigenous People, Quilombolas and Local Communities. The deeper we go in the rural communities, attending in supporting units or visiting the families, the more we get the sensation that this new disease is only one more bad news coming from the capital. In the countryside we have leishmaniasis, Chagas, dor nas juntas (popular expression for arthralgia), stomach burn, sugar in the blood, and the most diverse diagnosis given by benzedeiras and raizeiros, the communities’ healers… But Coronavirus? This one has not yet been included in many people’s vocabulary. And not just because of its novelty. Using WhatsApp as a Telemedicine tool has shown us that the countryside is not a synonym of lateness – but this is a subject for another story.

I believe that the fear of being infected by SARS-CoV-2 is lacking in the same proportion that the personal protective equipment, public services, access roads and citizens’ rights also lack. Through an individual perception of risk, always illogical and subjective, the barriers of access seem to be barriers of protection. If the public policies are not present, why should the virus be? Therefore, rural communities do not take precautionary measures, so estimated by urban population. The paradox of such a situation is exposing a population already so neglected – not to mention, of course, the health professionals whose scholarship does not immunize them against human irrationalities.

I hope the arrival of COVID-19 in Brazilian countryside will remind us that, even considering how essential biomedical science is at this moment, the health-disease process is still socially determined. Taking the experience from Amarantina, may we learn that, where social and political isolation were already a rule, a false sensation of safeness can be shared between users and professionals of health services. Self-awareness, cultural competence and advocacy will be as important as the measures indicated in official protocols.

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About the author:

Mariel Hespanhol Torres was raised in the bush and learned to like the little things on the ground. People belonging to abandonment move her: as much as the superb little things (paraphrasing Manoel de Barros). She is currently a resident of Family Medicine at UFOP in Amarantina, a district from Ouro Preto/MG.

Original text in Portuguese:

Sobre o isolamento social em uma comunidade rural

Foto da autora na Unidade de apoio de Coelhos

O abandono do lugar me abraçou de com força.

E atingiu meu olhar para toda a vida.

Tudo que conheci depois veio carregado

de abandono.

Não havia no lugar nenhum caminho de fugir.

A gente se inventava de caminhos com

as novas palavras.

A gente era um pedaço de

formiga no chão.

Por isso o nosso gosto era só de

desver o mundo.

(Manoel de Barros)

Escrito por Mariel Hespanhol Torres

Traduzido para o inglês por Cibelih Hespanhol Torres
Editado e postado por Bianca Cadore Morás

Revisado por Mayara Floss

(Em inglês acima)

Tenho a sorte de ser residente de Medicina de Família e Comunidade em Amarantina. Dizem que ela recebeu esse nome porque lembrou a algum português sua terra natal, Amarante. Dizem também que é um distrito de Ouro Preto, mas quem é de lá faz questão de expressar sua oposição: "Ouro Preto é só sobe-e-desce, Deus me livre! E que frio! etc. etc.". Um amarantinense se sente amarantinese, não ouropretano.

Amarantina, assim como Amarante, tem uma paisagem bem mais convidativa ao cultivo de hortaliças do que seus vizinhos de pedra. Por conta disso, cresceu em tamanho e importância econômica após a grande fome de Ouro Preto, no século XVIII. Mais recentemente, a população residente tem aumentado para sustentar a mineração em Itabirito, o município mais próximo. A agricultura já não é a principal atividade laboral e o antigo povoado se tornou um distrito com mais habitantes do que as pequenas cidades mineiras ameaçadas de extinção. No entanto, os modos de vida, a cultura local e a distância dos grandes centros com sua variedade de serviços caracterizam a ruralidade de Amarantina. A cada dia aprendo mais sobre as implicações disso para a saúde de sua população.

Nesses tempos de COVID-19, uma observação em especial me faz pensar sobre a vulnerabilidade dos povos do campo, da floresta e das águas. Quanto mais "fundo" vamos no rural, seja para atender nas unidades de apoio ou para fazer visitas domiciliares nos sítios e povoados, maior é a sensação de que essa doença nova é só mais uma notícia estranha e lamentável que vem da capital. Na roça tem mosquito palha, barbeiro, dor nas juntas, impinge, queimação, açúcar no sangue, os mais diversos diagnósticos de benzedeiras e raizeiros... Mas coronavírus? Este ainda não entrou no vocabulário de muita gente. E não é simplesmente por ser novidade. O Whatsapp como ferramenta de Telemedicina tem nos mostrado que o rural não é sinônimo de atraso – mas isso é assunto para outro relato.

Acredito que falta o receio de contaminação pelo SARS-CoV-2 na mesma proporção que faltam os Equipamentos de Proteção Individual, os serviços, as estradas, os direitos de cidadania. Na percepção individual de risco, ilógica e subjetiva, as barreiras de acesso parecem ser também barreiras de proteção. Se o Estado não chega, por que o vírus haveria de chegar? Assim, não são tomadas as medidas de precaução pelas quais as populações urbanas zelam tanto. O paradoxo de tal viés é tornar ainda mais suscetível uma população que já se vê negligenciada. E ele também contamina a nós, profissionais de saúde, cuja escolaridade não nos torna imunes às irracionalidades humanas.

Espero que a chegada do COVID-19 nas zonas rurais do Brasil faça lembrar a todos que, por mais fundamental que seja a ciência biomédica neste momento, o processo saúde-doença segue sendo socialmente determinado. Que possamos aprender com o causo dos amarantinenses que, onde o isolamento social e político já era regra, uma falsa sensação de segurança frente a problemas globais pode surgir em usuários e trabalhadores da saúde. Autoconhecimento, competência cultural e advocacy serão tão importantes quanto as medidas que constam nos protocolos oficiais.

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Sobre a autora:

Mariel Hespanhol Torres foi criada no mato e aprendeu a gostar das coisinhas do chão. Pessoas pertencidas de abandono a comovem: tanto quanto as soberbas coisas ínfimas (parafraseando Manoel de Barros). Atualmente é residente de Medicina de Família e Comunidade pela UFOP em Amarantina, distrito de Ouro Preto/MG.

Rural telehealth against the coronavirus

noreply@blogger.com (Bianca Cadore Morás) — Sun, 22 Mar 2020 14:23:00 +0000

Photo with the Araucaria trees in Santa Terezinha

Written by Danuta Ramos Duarte

Translated into english, posted and edited by Bianca Cadore Morás

Reviewed by Mayara Floss

(Portuguese below)

Being a doctor in a small town, in the middle of Santa Catarina state in Brazil, with a population of nine thousand people, imposes some challenges. But my small town has a secret name: Santa Terezinha. To get here from the coast we have to cross narrow streets amid Brazil’s Atlantic rainforest, trees called araucarias and small plantings.

The road is rough, full of hills and valleys, with rivers crossing the forest to become waterfalls. Little unpaved roads connect the districts, holding an area of approximately 450 miles.

The people who live here sustain themselves basically with farming, as the plantation of tobacco, corn and soybean are the most frequent crops. They are rural workers, little farmers descended from European migrants who took refuge here during the World War II, finding in Brazil a home beside the nazi horror. They’re polish-descendants (self-titled “polacos”), ucranians and germans who carry strong family traditions: the boundaries between public and private is lost among social relations.

At the chimarrão (mate tea) reunions in the evening, they gossip about the lives of everyone in the community with great detail – a scene capable of provoking an unpleasant sense of invasion of privacy but at the same time a growing feeling of belonging and reception among them.

To care the population, we have three Primary Healthcare Unities with healthcare teams, and other three supporting stations in more distant locations.

A lot of people living in remote areas don’t even have access to phone lines, having trouble coming to our basic care unities because of the miles between us. In realities like this, the telehealth is an essential tool to reach the people that can’t easily come for health facilities.

Fortunately, the internet and the radio are modern resources already consolidated in most homes, are helping us to reduce the distances.

So, as an educational health strategy, we are using Whatsapp and the community radio line to inform people about the coronavirus and the changing on rural basic care units working routine, since we’re attending only priority groups, emergencies and respiratory syndromes. The town provided an official telephone number as an open communication channel with the community. Besides that, the community health agents – who live in the neighborhood – spread the official information in their area of coverage, since they already have Whatsapp groups with the people they visit.

Instead of what we might think, most of Brazilians, as well as the people from Santa Terezinha, live in rural areas and traditionally put great confidence in the word of doctors and public authorities.

We use this confidence to reinforce the need of social isolation to withhold the pandemic of coronavirus which is getting close to us, many times we are going against what the federal government is, irresponsibly, preaching in their recent statements.

Educating the population, promoting autonomy and critical thinking, really saves lives.

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About the author:

Original text in Portuguese:

Telemedicina rural contra o coronavírus

Foto com as araucárias de Santa Terezinha

Escrito por Danuta Ramos Duarte

Traduzido para o inglês, editado e postado por Bianca Cadore Morás

Revisado por Mayara Floss

(Em inglês acima)

Ser uma médica num pequeno município, no interior de Santa Catarina, de 9 mil habitantes, impõe seus desafios. Mas minha pequena cidade tem nome sagrado: Santa Terezinha. Para chegar do litoral até aqui passamos por estradas estreitas ladeadas por mata atlântica, araucárias e pequenas plantações.

O terreno é acidentado, cheio de morros e vales, com riachos entremeados na mata, formando cachoeiras. As estradinhas de terra estreitas conectam os distritos, abrangendo uma área de aproximadamente 720 quilômetros quadrados.

O povo que aqui vive se sustenta basicamente da atividade agrícola, sendo a plantação de fumo, milho e soja as culturas mais frequentes. São trabalhadores rurais e pequenos agricultores e agricultoras, descendentes de migrantes da europa, aqui refugiados durante a Segunda Guerra, que encontraram no Brasil um lar ante o horror nazista.

São descentes de poloneses (autodenominados "polacos'), ucranianos e alemães, de tradição fortemente familiar: os limites entre o público e o privado se diluem nas relações sociais.

Nas rodas de chimarrão ao entardecer toda a vida da comunidade é discutida e recontada aos detalhes - cena capaz de provocar uma desagradável sensação de invasão da vida particular, ao passo que faz nascer o sentimento gostoso de acolhimento e pertencimento à comunidade.

Para atender a população, temos 3 postos de saúde com equipe saúde da família, com outros 3 postos de apoio nas áreas mais afastadas da sede.

Muitas pessoas em suas localidades não têm acesso a rede de telefonia e enfrentam dificuldade de acesso aos postos devido às grandes distâncias. Em contextos como este, a telemedicina é ferramenta essencial para alcançarmos as pessoas que não alcançam os serviços de saúde com facilidade.

Felizmente a internet e o rádio são recursos modernos já consolidados em grande parte dos lares dessa gente resistente, nos possibilitando reduzir as distâncias.

Então, como estratégia de educação em saúde, estamos usando o whatsapp e a rádio comunitária para informar as pessoas sobre o coronavírus e as mudanças na rotina das UBS e postos de saúde rurais, já que estamos atendendo apenas grupos prioritários, emergências e síndromes respiratórias. O município forneceu um número de whatsapp oficial como canal aberto de comunicação com a comunidade. Além disso, as agentes comunitárias de saúde, que moram nas localidades, repassam as informações oficiais para as famílias da sua área de abrangência, pois já possuem grupos de whatsapp com as pessoas que atendem.

Ao contrário do que possamos acreditar, a maior parte dos brasileiros, tais como os terezinhenses, vive em zonas rurais e tradicionalmente depositam grande confiança na palavra de médicos e autoridades públicas.

Nos valemos dessa confiança para reforçar a necessidade de isolamento social para impedir que a pandemia chegue até nós, indo, muitas vezes, em contramão do que governo federal tem apregoado irresponsavelmente, nas suas declarações mais recentes.

Educar a população, promovendo autonomia e criticidade, salva vidas.

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Sobre a autora:

How did we find Rural Medicine? By Matt and Sue Masel

noreply@blogger.com (Paola Veiga) — Thu, 29 Aug 2019 00:04:00 +0000

Free medical outreach to Mountanous Somorika community with no access road

noreply@blogger.com (Mayara Floss) — Sun, 19 May 2019 11:54:00 +0000

Community members receiving medical care during the free medical outreach

Dr Dako Mamudu

I am Dr Dako Mamudu, a family physician based in Lagos metropolis, Nigeria. I am the chief medical director of Dako Medical Centre and also founder and Chief Executive Officer for Dako Foundation for Rural Healthcare and Education. I lead my team to carry out healthcare delivery in remote, rural and difficult to reach communities.

I was born and raised in a rural community where ninety percent of the houses were roofed with thatch. My empathy for rural healthcare led to the founding of Dako Foundation for Rural Healthcare and Education (Dako Foundation). Dako Foundation is a registered Non-Governmental Organization in Nigeria and it works to improve the living conditions of underserved and difficult to reach communities in Nigeria through education, empowerment, provision of social amenities, public health programmes and direct medical interventions.

Somorika is an ancient city in Akoko Edo Local government area in Edo North, Nigeria. It is about five kilometers north-east of Igarra in Edo North. It is a community with a wealth of cultural heritage. However, the rocky geographic terrain of this community (several hills that go as high as 1700 feet interspersed at unequal intervals) and the often inaccessible road to the location result in a great inequality in access and provision of healthcare services to people in this location.

DFRHCE staff going from the residence of the traditional ruler to the health centre where the medical outreach took place.

I lead my team to this mountainous Somorika community for free healthcare outreaches between 2017 and 2018. Members of my team and I climbed several rocks of varying heights in order to get to this community. Our first point of reach was the resident of the community leader. From where we climbed more rocks of varying heights to access the local primary health centre where we carried out the free medical outreach. Similar to my previous missions to rural communities, health care professionals from my team were brought from urban cities of Lagos, Benin City and Auchi to carry out this medical outreach at this community. This was a four day mission and my team consisted of 20 regular staff of the Foundation comprising of doctors, pharmacists, public health experts, nurses, community health extension workers (CHEWs) together with 15 local volunteers. The attending midwife in this facility together with the assistant; a nursing aid also participated in this mission.

DFRHCE outreach team preparing for Somorika mission

DFRHCE staff on the road to Somorika Community, Edo State, Nigeria.

This comprehensive outreach which includes free surgeries is in tandem with the Sustainable Development Goals aimed to ensure healthy lives and promote wellbeing for all at all ages. The outreach activities consisted of community health education and sensitization, general consultation and treatment of endemic diseases, vitamin A supplementation for children and at risk population, mass drug administration of Albendazole to community members, distribution of lifesaving prenatal and post natal vitamin supplements to women of childbearing age and distribution of easy to use water purifying units to households in the community. Hospital equipments were also distributed free to the dilapidating community Primary Health Centre; the only source of healthcare in the community and its environ. The distributed equipments include artery forceps of different sizes, drip stands, hospital beds and mattresses, bedcovers and delivery couch.

Patients who required surgeries were referred to our partner hospital (Dako Medical Centre, Lagos) for free surgeries and follow up. Surgeries performed include breast lumpectomy, emergency caesarian section, and undescended testis (jointly sponsored by Amazing grace Hospital, Dako hospitals and Dako Foundation).

The community leader conducting the DFRHCE staff round his ancestral palace built in 1900.

The community leaders taking the DFRHCE team round the dilapidating infrastructure of the health centre.

Medical consultation for the Community Head of Somorika

Medical examination for optical refraction for patients with refractive errors.

Community members queuing up for registration for treatment.

Children receiving vitamin A supplementation

Over 5,000 rural patients were reached through repeated visits to the community for free medical mission. This is my passion and I am glad to work with a team that share same passion to bring healthcare to the hard-to-reach and underserved communities.

My mission to take healthcare delivery to the underserved and difficult to reach communities in Nigeria will continue to take us to the underserved and almost forgotten people across communities in Nigeria. In the next edition, I shall publish our outreach work to Okorogbo and Akatakpo in the ‘urban rural’ communities in the heart of Lagos metropolis. Below are some of the images depicting our outreach activities.

_________

Dr. Dako Mumudu MBBS,DFM, is the Chief Medical Director of Dako Medical

Centre, Lagos, Nigeria and founding Chief Executive Officer, Dako

Foundation for Rural Healthcare and Education.

Life Member, WONCA

Email: info@dakofoundation.org

Post flood disaster intervention to victims of flood ravaged areas of Anegbette, Osomegbe and Ekperi Udaba communities of Etsako central local government area of Edo state of Nigeria

noreply@blogger.com (Mayara Floss) — Sun, 07 Apr 2019 15:00:00 +0000

Outreach team work distance into the communities.

Dr Dako Mamudu

I am Dr Dako Mamudu, a family physician based in Lagos, a mega city, Nigeria. I am also the founder and chief executive officer of Dako Foundation for Rural Healthcare and Education. I was born and raised in a rural community where ninety percent of the houses were roofed with thatch. The inhabitants of my village and its neighbouring communities were peasant farmers, hunters and petty traders. The only sources of water supply were about half a dozen of deep wells and a stream which was about five kilometers away. The six room block of classrooms in the community primary school which I attended was one of the buildings roofed with corrugated iron sheets. These were the prevailing situation of the communities in the region where I lived.

Over the years, quality of health care delivery in rural communities has gone from bad to worse in most underdeveloped and developing countries of the world especially Sub Sahara Africa. In Nigeria in particular, the situation is worse in rural, riverine and difficult to reach communities. My empathy for these communities and its people led to the founding of Dako Foundation for Rural Healthcare and Education (Dako Foundation). Dako Foundation is a registered Non-Governmental Organization in Nigeria and it works to improve the living conditions of underserved and difficult to reach communities in Nigeria through education, empowerment, provision of social amenities, public health programmes and direct medical interventions.

Anegbette, Osomegbe and Ekperi Udaba are parts of the riverine communities in Etsako Central Local Government Area of Edo State, Nigeria where we regularly carry out our activities. The main occupations of the people of these communities are peasant farming and fishing. Together, the population size of all the riverine communities in this local government area is about 250,000. The closest accessible point of good healthcare to these communities is about 50km away and for about six months of the year, there is no access to these communities by road.

Recently, just like it happened in previous years, tributaries of the River Niger, especially River Alika overflowed their banks (climate change) and swept over the communities; covered their farmlands and swept away their crops. Their homes were covered with water for over two months and they had to take refuge in refugee camps.

Houses submerged by flood in the affected communities.

As the flood started to recede, I led a post flood disaster intervention to these communities through Dako Foundation aimed to alleviate the pains inflicted on these communities and its people by the devastating impact of the disaster . Also, this outreach is in tandem with the Sustainable Development Goals (SDGs) SDG 3: to ensure healthy lives and promote wellbeing for all at all ages.

DFRHCE team at our base station preparing for takeoff for the mission.

Still at the base station; donated clothes awaiting transfer to our work location.

Health care professionals from my team were brought from urban cities of Lagos, Benin City and Auchi to carry out this medical/social outreach. This was a four day mission and my team consisted of 22 regular staff of the Foundation comprising of doctors, pharmacists, public health experts, nurses, community health extension workers (CHEWs) together with 20 local volunteers. Some health workers from the local health facilities were co-opted to participate in the outreach.

I have previously carried out some health care missions with Dako Foundation to some of these communities in 2016. The only accessible road to the index communities was through a wooden bridge across a deep flowing river.

A Dako Foundation staff guiding the outreach vehicle through a wooden bridge (the only accessible road to most of the communities).

During the post flood disaster intervention to the communities, myself and my team travelled over 500km from Lagos by road to our local base in Edo North. We then travelled another 35km on a daily basis through a lonely, rough, winding and dangerous road to the only accessible village in the community by road. From here we either walked to the near community or drive across a dangerous wooden bridge across a deep river to the communities. On arrival, we carried out health education and sensitization for community members followed by free medical consultations, prescription and treatment of local prevailing diseases (Figure 6, 7and 8). Also, items distributed include antifungal drugs; clothes; prenatal and postnatal multivitamin supplements for pregnant and lactating women; bread, medicated soaps, toothbrushes and toothpastes. Vitamin A supplementation was given to children and other at risk population (Figure 9). There was also mass drug administration of Albendazole to community members.

Lactating woman received free drugs distributed by DFRHCE.

Nursing staff carrying out blood pressure and vital signs measurements after registration.

Community members queue up to get registered for medical consultation

Distribution of Vitamin A and albendazole to children during the outreach.

In addition to the above, we distributed easy-to-use potable water sanitizing units with storage tanks to households in the communities (Figure above). This equipment does not require electricity and it is user friendly. It functions in such a way that when it is filled with water, and pressure is applied through the external hand pump, the buildup pressure within the unit drives water flow through the filtration component into its external tap where water is collected and stored in a clean storage. Water that flows through this filtration unit is suitable for drinking.

Water purifying units distributed to heads of community households.

Overall 5,132 rural members were reached through three targeted visits to the communities for the free medical mission and distribution of relief materials. This is my passion and I am glad to work with a team that share same passion to bring healthcare to the hard-to-reach and underserved communities. I hope to arrange additional interventions to other communities in this locality that were not accessible at the time of this intervention.

_________

Dr. Dako Mumudu MBBS,DFM, is the Chief Medical Director of Dako Medical
Centre, Lagos, Nigeria and founding Chief Executive Officer, Dako
Foundation for Rural Healthcare and Education.
Life Member, WONCA

Email: info@dakofoundation.org

Rural island medicine in Minamidaito island, Okinawa, Southwest of Japan

noreply@blogger.com (Mayara Floss) — Sun, 14 Oct 2018 13:23:00 +0000

By Ryuichi Ota

I am a young Japanese family physician working in rural areas of Japan. Training for Japanese family physicians has officially started recently, so there is a variety of training systems, though sometimes not always so systematic. I became a physician in Osaka and moved to Okinawa, southernmost part of Japan to become a rural island physician. I have experienced many fruitful things on my island to become a real rural physician. It can be said that rural islands and the citizens educate the physicians. This time, I want to introduce my experience in Minamidatio island, one of the rural islands, as a young rural physician.

I have worked as a young rural physician on a rural Japanese island. It is located in the most southeastern part of Japan. Its name is Minamidaito island, and it is located in Okinawa prefecture. It is about 400 km away from the mainland of Okinawa prefecture. By ship, it may take 14 hours from the mainland. Even if you use an airplane, it may take 1.5 hours. On this island, the population is about 1,400, and most of them work as sugarcane farmers. There is only one clinic without beds appropriated for admission. There is only one doctor, nurse and medical clerk. I went to this distant rural island after finishing my 3-year basic medical residency program, and I have been there for three years now. Is this a rare case in the world? This working style may be controversial in Japan. However, the experience as a young rural physician may affect their future as a physician in an effective way.

The responsibility of a solo physician in a rural island

First, the feeling of responsibility as a physician may increase. For example, on a rural island like my case, a physician has to take care of various kinds of illnesses. All of the patients there have to go to a clinic to get specific care, even if they do not like to go there. The rural physician cannot avoid studying various kinds of medical issues. Emergency cases are especially stressful for rural physicians. At rural island clinics, there are not enough instruments to treat the patients for a long time. The rural island physicians have to transfer their emergent patients to general hospitals on the mainland of Okinawa if they need long admissions or ICU care. However, to transfer the patients, doctor helicopters are needed. It takes 3 hours to reach the distant islands like my island (Ohta & Shimabukuro, 2017b). The rural island physicians must care critical patients until the arrival of the helicopters. The worse thing is, the duration of emergency may depend on the weather. The emergency case in summer was challenging for me. In one day in summer, one patient came to my clinic with the chief complaint of shortness of breath. He voluntarily stopped regular visits to my clinic one year ago. His past medical history was chronic obstructive lung disease. His symptoms had started a few days ago, which gradually exacerbated to the point where he came to the clinic. The vital signs were the blood pressure of 84/40 mmHg, heart rate of 132 beats/min, respiratory rate of 45 breaths/min, oxygen saturation of 79% in ambient air, the body temperature of 37.6 and Glasgow coma scale of E3V5M6 (total 14/15). I listened to his lung sounds, bilateral lung sounds, I diagnosed him with severe pneumonia causing septic shock. Soon, I intubated him and prepared for transportation. However, it did not come at once. This season, Okinawa is attacked by a lot of typhoons, and this year was not rare. This time, one big typhoon was approaching my island, and this prohibited doctor’s helicopter from coming to my island. To make matters worse, the typhoon approached the mainland of Okinawa after passing through my island. As a result, I had to observe this patient with only three members and restricted medical instruments (Ohta & Shimabukuro, 2017b). Without a ventilator, a nurse, a medical trainee, and I performed hourly vital sign measurement and did manual ventilation. Fortunately, his condition was stable with oxygen, antibiotic, and vasopressor. 27 hours after his arrival, he was transferred to a general hospital in mainland of Okinawa.

Diagnostic skills of rural physicians

Also, their diagnostic skills may be improved upon. It is only one physician, and he or she has to diagnose patients with vague symptoms or with certain diseases which they have not experienced yet. They may feel particular pressure and study hard. As they can get a lot of medical information by using the internet and communicate with their senior physicians via a social network, they may be able to approach their patients with various sources of help. For example, when I encountered patients with rheumatoid arthritis following ciguatera poisoning (Ohta, Shimabukuro, & Kinjo, 2017) or with vague bilateral shoulder pain leading to the diagnosis of Parsonage-Turner syndrome (Ohta & Shimabukuro, 2017a), I could diagnose them with literature reviews and my colleagues’ help. Through this process, rural physicians may become competent in diagnosis and inter-physician communication.

Challenge to community-based medical education

Second, a rural island may be a good practical learning situation for medical students and medical residents. They can learn specific things in various medical situations. Through the learning in rural islands, they may learn multiple important issues as physicians. There are many kinds of research to clarify the learning topics in rural areas, especially about community-based medical education (CBME). As learning contents have been shown to depend on the situation, we did one qualitative study to inquire about the learning contents of medical residents in Minamidaito Island. Through this research, we were able to identify four categories: a strong connection among the Islanders, the necessary abilities for rural physicians, islander-centered care, and the differences between rural and hospital medicine(Ohta & Son, 2018). In contrast to hospital medicine, various kinds of learning occurred in deep relationships with the Islanders. Furthermore, we clarified that the learning contents of medical students on this island, as a result, were alike. Rural physicians can learn not only medical issues but also CBME. They may acquire the possibility to become medical educators.

First trial of community-oriented primary care

Third, community-oriented primary care (COPC) should be mandatory in rural islands. Especially, in Minamidaito Island, there is only one physician and a nurse. They are the only medical resources. They have to collaborate with the members of the community to improve community health conditions. There are various stakeholders in the community. Empowering them may drive COPC. The stakeholders may play the central role in community health improvement. For example, public health nurses specialize in community health. They can analyze their communities and find various approaches to improve health conditions there. Their collaboration with medical staff in clinics may improve quality of life. There are two public health nurses on Minamidaito Island, for both pediatrics and older people. The public health nurse for pediatrics is interested in pediatric wheezing because of sugarcane harvesting. Through my collaboration with her, we were able to do a prospective cohort study. As a result, it was discovered that there was some cause and effect relationship between pediatric asthma and sugarcane harvesting (Ohta, Mukoyama, Fukuzawa, & Moriwaki, 2017). Additionally, we make up the specific approaches to diabetic patients on a rural island by using their feelings comparatively. Also, by collaborating with the public health nurses for older people, we were able to increase the opportunities for older people to have a dialogue with each other and share information about their conditions. Through COPC, rural physicians are able to learn the skills for how to approach communities such as leadership and empowerment, and how to analyze and make progress the community condition such as research skills.

The ecology of medical care in a rural island

Besides, an ecology of medical care in clinics is essential for understanding islands’ medical conditions. It is important to know what kinds of symptoms and diseases are common when medical staff inquire into information on epidemiology and do various interventions in communities. Also, the comparison of this data over several years may be useful for knowing the change in the prevalence of medical conditions there. For example, we collected the patients’ data based on International Classification of Primary Care-2 (ICPC-2) between 1990 and 2015(Ryuichi Ohta & Makoto Kaneko, 2017). As a result, in addition to the common cold, the frequency of asthma attack and other chronic diseases increased. This fact might lead to the consideration of the effects of aging population and the deteriorating air pollution. Rural physicians can express their opinions based on precise data and motivate their communities to improve their health conditions.

How to control negative emotion as only one physician in a rural island

At last, rural physicians need effective emotion control. On rural islands of Okinawa, every physician is only one medical staff that can perform medical treatment. They are special there, so rural citizens look at them as a physician wherever and whenever the citizens see the physicians. Additionally, they may feel the negative emotion in interprofessional collaboration. These conditions may lead to the physicians’ stress and negative emotions. Based on our research, rural physicians feel negative emotions in differences in recognition between rural physicians and patients, invasion of professionalism, suppression by one’s role as a rural physician, discordance with multiple occupations, and relationships with unfamiliar hospital physicians(R. Ohta & M. Kaneko, 2017). Also, to relieve negative emotions, time flow, refection, acceptance of islanders’ characteristics, and growth through their role were suggested(R. Ohta & M. Kaneko, 2017). Through rural experiences, physicians may improve their ability to control their negative emotions by recognizing the existence of controlling methods.

Working at rural islands, although there are lots of difficulties for your generation, can give various fruitful experiences for the future. Not related to their foreground carrier, these experiences can make them more balanced physicians and happier than ever.

References

Ohta, R., & Kaneko, M. (2017). Effects of practicing in remote Japanese islands on physicians' control of negative emotions: A qualitative study. J Rural Med, 12(2), 91-97. doi:10.2185/jrm.2934

Ohta, R., & Shimabukuro, A. (2017a). Parsonage-Turner syndrome in a patient with bilateral shoulder pain: A case report. J Rural Med, 12(2), 135-138. doi:10.2185/jrm.2933

Ohta, R., & Shimabukuro, A. (2017b). Rural physicians' scope of practice on remote islands: A case report of severe pneumonia that required overnight artificial airway management. J Rural Med, 12(1), 53-55. doi:10.2185/jrm.2925

Ohta, R., Shimabukuro, A., & Kinjo, M. (2017). Rheumatoid arthritis following ciguatera poisoning: A case report. J Rural Med, 12(1), 50-52. doi:10.2185/jrm.2921

Ohta, Ryuichi, & Kaneko, Makoto. (2017). Health Problems in a Rural Island of Okinawa: Changes Over 25 Years. An Official Journal of the Japan Primary Care Association, 40(3), 143-149. doi:10.14442/generalist.40.143

Ohta, Ryuichi, Mukoyama, Chikako, Fukuzawa, Yasunori, & Moriwaki, Yoshihiro. (2017). Relationship between Pediatric Wheezing Attack Frequency and Sugarcane Harvest Work: Prospective Cohort Study. An Official Journal of the Japan Primary Care Association, 40(1), 21-26. doi:10.14442/generalist.40.21

Ohta, Ryuichi, & Son, Daisuke. (2018). What do medical residents learn on a rural Japanese island? Journal of Rural Medicine, 13(1), 11-17. doi:10.2185/jrm.2950

__________

Ryuichi Ota is a Japanese Family Doctor based in a rural remote island.

Curatorship: Mayara Floss

Watercolor

noreply@blogger.com (Mayara Floss) — Sun, 30 Sep 2018 21:18:00 +0000

Carnaúba dos Dantas - Brazil

Your eyes have

A non-defined color

And, perhaps because of this,

You can see the other tones in everything

From the cold gray

Of few shades,

That I coldly plan,

You can identify a small

Sick pink

That motivates my grit

In the green-water lies

That I tell to please you.

You only see the red

Bloody one

That burns me!

You see the invisible notes

With your eyes

Which color, then,

My mother,

Is the soul

That I have mixed

With mine?

__________

Alexandre Dantas is a doctor, teacher and writer. He was born and lived most of his life in one of the driest backlands of Brazil - where he returned 4 years ago, working as a rural doctor. He created the project "A Medicina Rural" on Instagram (@amedicinarural) in order to give visibility to the rural spaces in which he works and voice to the people who live in them.

Je suis étudiant!

noreply@blogger.com (Anonymous) — Sun, 16 Sep 2018 21:41:00 +0000

Another intense afternoon at the clinic. Malnutrition and infections are already routine work.

Suddenly arrives a young man of 8 years of age and, well articulated in his words, appears and speaks directly with me, in French: Je suis étudiant!

Son of the arid land of Ambovombe, the little boy tells me about the difficulty in school because he can not see the blackboard. He struggles but has headaches.

He is the only child who attends school for all the children I attended in the entire first week of work. His case was not the priority and seemed absolutely far from our possibilities at the moment. However, #FraternitywithoutBorders was his and his grandmother's only hope

I took a deep breath. I had to do something. And I did...a modified Snellen test was enough to diagnose myopia. Concerned, I tell the translator..."He needs glasses, but we can not offer."

As we have learned in the FWB, we are many united hands working for Love. Dani, my translator and right arm (and left too!) Showed readiness to respond that we had a chance. The next day, we were all going to talk to the priest who had received a mission from the Catholic Church the week before. We introduced the FSF and we got another partner.

A week later, he and his grandmother return to the clinic. Main complaint: a little hand holding a package, a smile that can not be restrained on the lips and a tight hug from anyone who never loses HOPE to see it happen!

Janaina doing the modified Snellen test with the patient during her work
in Madagascar

Janaine Camargo is a family doctor and works at the NGO Fraternity Without Borders in a rural area in Madagascar

Translated into English by: Bianca Silveira
Posted and Edited by: Ana Júlia Araújo

Beginning of Success to Reach Health Care to Rural Communities with Extremely Low Resources and Access Problems

noreply@blogger.com (Mayara Floss) — Sun, 02 Sep 2018 15:01:00 +0000

Shakuntala Chhabra

Social accountability in health care and medical education has been the hallmark of Kasturba Health Society, Sevagram, which runs Mahatma Gandhi Institute of Medical Sciences, Sewagram in Wardha District of Maharashtra, India. KHS also runs a Nursing School, Nursing College and Kasturba Vidya Mandir (School for children) in the same campus. Institute’s birth is also the consequence of social accountability by none other than Mahatma Gandhi, in the form of a 2 bedded dispensary in 1938 in the village Sewagram where there was a epidemic of Cholera and women and children were finding it difficult to get treatment. The sapling has now grown into a blooming tree with nearly 1000 bedded well equipped, Kasturba Hospital at Sevagram village in the centre of country. Expanding health services to Melghat region in Amravati, Maharashtra, is another step towards social accountability in health and education. The step was taken in view of rural communities sufferings.

In view of the problems of high maternal, perinatal, infant and child morbidity / mortality step was taken to help rural community. So government of India and Government of Maharashtra were approached with the proposal for Mother and Child / Multispecility Hospital at Utawali, but delays in the system were worrisome. So it was decided to do whatever was possible. Agriculture land was bought more than dozen no objections were procured and plans of hospital as expansion of existing institute in the nearly district was planned.

Fortunately a Mumbai based charitable trust “Shri Brihad Bhartiya Samaj” came forward with the generous donation for the building and major equipments for the proposed hospital. Before this hospital could be built a beginning was made on first January 2012 by alterations / additions in the existing building of a minihospital constructed by KHS, Sevagram some years back where a physician and ophthalmologist deputed by KHS were working. A make shift birth area, operation theatre for caesarean section, hysterectomy and other surgeries was done. Other needed changes were made in the building and equipments / instruments were procured. In the existing guest house in the campus, alterations and additions were made so that the health teams could stay for 24/7 for emergency services. A nearby hut was converted into kitchenette, dining area cum office. A mini-library and online Maharashtra University of Health Sciences library were made available for every one to remain updated. Sports too were arranged and mobile phones and televisions to make the life of health providers in the hilly forestry region with access problems little easy and to try to reduce the general reluctance of health providers to work in the region. Now since Feb 2016 a reasonably well equipped. Multispeciality Dr. Sushila Nayar Hospital in Utawali has come up with basic facilities available in much better way with reasonability comfortable place for the health provider team in the building. A building with 4 flats and some land have been procured in the vicinity keeping in mind needed accommodation during the development.

With the guidance, support and help of KHS/MGIMS, Sewagram the team of Obstetrician – Gynaecologist, Paediatrician, Anaesthetist, Physician, Medical Officers, Interns, Administrative Officer, Nurses with other paramedical staff have been managing emergencies and day to day problems in outpatient, inpatient and operation theatre, 24/7 days. While paramedical administrative staff has been exclusively appointed, doctors are deputed in rotation from head quarter, the medical institute in the near by district, a dozen doctors are always available. Author as officer on special duty with support of management and a big number of colleagues at base institute are trying since beginning their best, from buying agriculture land to health services now in a reasonably equipped hospital. Caesarean sections, minor and major gynaecological surgeries are being performed in addition to normal and instrumental births. Everybody is trying to give his/her best with whatever available in the given circumstances with limited resources. The very first caesarean section was performed on 21st January, 2012, mother and baby discharged healthy in a week. The first hysterectomy with removal of a uncommon cancer of ovarian tumor ‘Struma Ovari’ performed on 15 February, 2012 and the woman doing well, 6 years. Now services for prevention of blindness complete eye care are also being provided.

Everybody is trying to give his/her best with whatever available in the given circumstances with limited resources.

There is good understanding and cooperation between Sub District Hospital Primary Health centres of Government of Maharashtra and our centre.

While trying to do whatever we could, we have had many challenges, many practical difficulties and have also realised that though. nutrition, anaemia, poor health, are responsible for many problems, their causes are deep, in the social and economical conditions, in the nonavailability of food, in ignorance, when the food is available, gender bias, unemployment, addiction and many other issues. Hindrances also include lack of awareness, lack of resources to seek services at health facilities and their own faith concepts of traditional healing, beliefs and disbeliefs. Sometimes making the patient stay in the hospital for her own good or her child’s good is a tough job, testing the patience, the best of counselling skills and dedication.

We realized within months of opening the hospital unless Community based services, community motivation, mobilization and behaviour change, were done not much was going to change. So a step was taken in this direction way back in Feb 2013, just a year after starting the services. Now seven nurse midwives provide community based antenatal services, advocacy about intranatal, postnatal, neonatal care in the villages. We started with 52 villages in February 2013 and 13 more were added from July 2013, a total of 65 till recent past. Later 35 more have been added from April 2016 and 40 more in August 2017, making a total of 140 villages. The team visits villages 5 days a week. Medical officers posted under Rural NGO posting scheme of the Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha used to run Community Based health clinics in these villages with the nurses, in rotation while services at base hospital at Utawali. However the current rules of postgraduates medical admissions with national eligibility examination, no medical officers are available. Some laws for some good spoil other good work. So interns of the Institute in the near by District at Sewagram are posted in rotation for 15 days, task shifting. So while each NM visit their assigned village, once in a month, doctors run clinic in assigned villages by covering 7 villages in one visit by one doctor. Things will change. It needs some time before awareness will come in the tribal population and their many unlisted social and economical issues are really addressed.

Now seven nurse midwives provide community based antenatal services, advocacy about intranatal, postnatal, neonatal care in the villages.

Diagnostic cum therapeutic camps have been made annual event. First camp was held in March 2012 with 226 patients, February 2013 the number was 1036, in 2014 February it was 1107, in 2015 it was1883 and 2016 it was 2197. In 2017 attempts were made to help differently abled and 216 needy were help. In 2018, 3872 Surgeries have been performed on camp days and left over cases are operated within days of camp, some at Utawali and complicated at the institute at Sewagram. Camp for Cleft lip Cleft Palate was also conducted in December 2014. Attempts are being made to help Elderly women and elderly men too for diagnosis and therapy of illnesses, including noncommunicable diseases, (Hypertension, Diabetes and Cancers) vision problems. Research was done with help from US based Global Health through Education and Service, (GHETS) Indo Canadian Institute from Canada. Now Mumbai based philanthropists including Jan Kalyan Trust help in services for elderly. Research about ‘Abortions’ under Indian Council Of Medical Research, New Delhi Disability Detection program was done and Aids, including Wheel chairs provided to nearly 225 people. Now beginning has been made for trying to make adolescent, young school drop outs learn skills to become self sufficient, with support from Jan Kalyan Trust Mumbai. Camps for cataract surgery are being done.

Research is being done about effects of Bio-fuel mass on health of family specially mothers and new born with plans for providing and Chimneys related to Agriculture status and malnourishment, low body mass index, Anaemia, Vit A deficiency etc. There are plans for Family Life Education Program for Adolescents, Preconception literacy and care also, finding how Wellness can be created for them.

Presently the biggest need is of finances so that in the reasonably equipped, furnished hospital, free services can be provided to the real poor, especially mothers and babies in emergencies. It is not possible for KHS, Sevagram to provide free services to everyone without support. Though services are provided to everyone, who reports, irrespective whether the patient can pay or not, it is not possible to Declare free services due to lack of resources. Also financial support is needed for providing children the needed nutrition at home till the time they are in a position to become self sufficient. Major issues are also awareness of many things, access issues and safe water, working on their beliefs and disbeliefs.

____________________________________

Shakuntala Chhabra is an meritus Professor - Obstetrics Gynaecology, Chief Executive Officer - Woman Child Welfare, Officer Special Duty - Dr. Sushila Nayar Hospital, Melghat. In addition to DGO, MD, Diploma - Advanced International Maternal Health Sweden, Certificate Courses- Maternal Child Health, U.K, Problem Based Learning- Netherlands, others- Logistics Management, Teaching Training, Human Resource Management etc. Receive the awards: FIGO’s Distinguished Community Emergency Obstetrics, Best Teacher, MUHS, Nashik. Short term WHO Consultant, Technical Consultant, Technical Temporary Advisor - WHO. Supervisor for SIDA. Member of Women’s Health Task Force, Network TUFH, USA. Member of World Rural Health Council 2018. Special Interest- Maternal health, Social Obstetrics, Gynaecological cancers, Health Professionals education.

Curated by Ana Júlia Araújo and Mayara Floss

On my Skin

noreply@blogger.com (Anonymous) — Tue, 19 Jun 2018 20:47:00 +0000

On my Skin

She opened the door of the health unit almost sensing something that morning. In the Rural Health Unit, about 100 kilometers away from the nearest reference center. A newly appointed doctor....and the farmers of the region saw in those hands a ray of hope. "The doctor listens to us."

Maybe this was the beginning of a cry about the future on her face. When she was in the office with another patient, somebody knocked the door, "Doctor, please come fast". The nurse was already gloved, a woman in great pain, laboir pain. Upon touching down the cervix, it was 5cm dilated. Fetal heartbeat flickering and Ineffective contractions.

Labor without progression was sensed. Oxytocin, orientations, everyone entering the small emergency room. Got everyone out of there to take a deep breath and called the 911.

"The ambulance can only get there in two hours, it is in another displacement." The calculation was not difficult... Two hours to come plus two hours to cover the 100km made 4 long hours. Can we handle it? Will the baby be born before that? We ask for priority, but the whole state needs priority.

Deep breathing, medications, salines, change of position, but still it is only 6cm of dilation in the first hour. The Fetal Heart Beat slowed down. They call the ambulance. "I need it for now." It doesn't arrive.

It did not come, it did not happen, it did not progress and it was not born.

Some colleagues would say, "it is her fault that she chose to work where she has no recourse". But is there a way to have a hospital in the countryside? To have an anesthetist team in the middle of the green of the corn? To have a team with obstetrician? Pediatrician? There, where the soy is planted?

Several will condemn "it is the doctor's fault, who went there," but would the unborn child stop herself being born or would the mother stop going into labor because they were in the countryside? Would the countryside stop existing just because there are no qualified professionals in it?

The baby was not born, the baby did not survive. Everyone hears the fetal heartbeat fade away without recourse, no training, no legislation, no doctor adequately trained for more than 60% of Brazil's population living in rural areas. While the ambulance did not arrive, a sigh, a tear.... A fatality? Could we have avoided this?

From birth to mourning. To err is human, to kill and to die is human too. But a doctor in the rural area without training is inhumane.

Warm regards,
Mayara Floss

Review by: Nisanth Menon
Translated into English by: Bianca Silveira

Posted and Edited by: Ana Júlia Araújo

Link to Portuguese text: http://balsa10.blogspot.com/2018/05/na-minha-pele.html?q=mayara+floss

Mayara Floss is a young doctor working in a rural area: Cunha Porã (SC), Brazil. She Co-creator of project 'Health Education League'. She is the creator of the Rural Family Medicine Café to provide a forum to discuss Rural Health – a forum for students, young doctors and experienced professors and GPs from all world. She is the student representative of the WONCA Working Party on Rural Practice. She also co-created with Pratyush Kumar the project 'Rural Health Success Stories' and writes a weekly blog of Popular Education, Arts and Health - the Ferry Street of 10.

Ruralices

noreply@blogger.com (Mayara Floss) — Wed, 02 May 2018 11:57:00 +0000

Amber Wheatley and Mayara Floss

The experimental short movie produced by Mayara Floss and Amber Wheatley called "Ruralices" received the award for best original background at the FISFA - International Short Film & Arts Festival during the 15th WONCA World Rural Health Conference, New Delhi with voice of Amber Wheatley and the music of Lucio Yanel and sonoplasty by Mayara Floss.

"My first job as a junior doctor in South West Wales involves a 1 hr and 15 min journey by bus from my apartment in the city centre to the hospital in Llanelli. My colleaguess often commented on how difficult it must be because the public transport in Wales, particularly the most western you go, is notorious for having problems. Make no mistake this is absolutely true but it also provided me with two unique opportunities; 1) I took the same bus as the people living in the community so I understood all too well the issues of getting to hospital when you relied on public transport and 2) I got to watch the sunrise every morning as I moved from an urban setting to a suburban setting. During my commute I had more time than at any other point in the day to be alone with my thoughts and take it what was going on around me. I also used this time to catch up on reading, writing and social media. Before medical school I wrote songs and poetry in my spare time but medical school seemed to kill all my creativity. I was slowly starting to reclaim it when one day looking at a photo from the Ruralices instagram page, I was overcome with inspiration. Dr Mayara Floss started the Ruralices page to capture and share images of the daily life of a rural doctor. Each of the pictures I knew held a story and that story inspired these poems". - Amber Wheatley

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Amber and Mayara are Young Doctors and ambassador of Rural Seeds. They are committed and passionate about rural health, arts and writing.

Healthcare in Kerala : My observation

noreply@blogger.com (BestPhysicianInPatna) — Sun, 19 Nov 2017 09:13:00 +0000

....having stayed in kerala during my graduation , I found Kerala to be a society full of paradoxes, rather hypocritical to an extent.

Whereas on the one hand you have the best literacy rates and the wow health standards at par with the developed world, on the other you have almost near zero entrepreneurial ventures no industry very limited opportunities of employment outside the government .

One of the highest suicide rates in the country and almost all families have an earning member overseas/outside kerala sending in the dough.

On the one hand female literacy rates are the highest in the country on the other ladies venturing outside their home after sundown were looked down upon,

On the one hand you have the matriarchial society on the other hand ladies are not allowed in the sabrimala temple ( a place of worship in Kerala)

Whereas on the one hand you will not find any coolies on the railway stations but a good chunk are manual labourers in the society.

Whereas you will find them to be admitting to be less than willing to do anything yet their professionalism specially in healthcare is beyond compare, their dedication , zeal and commitment unparalleled.

Health standards were achieved in my opinion because of exemplary societal acceptance of the role of the ladies in the healthcare field specially in the domain of Nursing and teaching.

Whereas men folk ventured to search for employment opportunities beyond Kerala, i.e in the Gulf, America, Europe, or even in other indian states,the women folk continued to manage the native front and ensured education and good healthcare to their children.

As a result even though the governmental expenditure on health was trivial, the out of pocket healthcare was flourishing.

Nothing succeeds like success! once they had carved out a place for their state in the health standard arena they took upon themselves on a war footing as a matter of immense pride to keep it that way and once achieved the government too started to patronise the healthcare in a bigger manner.

If you have travelled through Kerala you would realise that it is an urban village from the northern most district (Kasarkode) to the southern border (Thiruvananathapuram)with almost universally similar facilities all over.

This was probably due to a paradigmal shift by the policy makers regarding resource allocation to local governing bodies called panchayats around 1996, where almost 40 percent of the states available funds were at the disposal of these local bodies for capacity building and development, as per local needs.

Open door policy viz for education in english and hindi ensured education to kids that was utilisable beyond kerala, at the same time not letting go their tradtional cultural traditions i.e mohiniattam, kathakkali, and their gaanamelas,

Notwithstanding what the world said they continued to use coconut oil for cooking relying on their cultural wisdom,only now the entire world is marketing virgin coconut oil for cooking and as cure for some forms of dementia.

Coconut,coffee,cardamom and rubber which were their cash crops peculiar to the weather there continued to attaract world attention because despite all the mechanisation most of these crops continued to be grown traditionally and had their quality and genepool maintained.

Traditionally they eat parboiled rice which is now emerging as a recommendation for diabetics.

With the IT revolution the beauty of kerala became popular and Kerala an important destination for medical tourism specially for the Maldivians and the Lankans. like begets like !! once the dollars started trickling in the industry veterans pumped in even more to ensure world standards.

So,what probably started as a mundane chore of life evolved as the feather in the cap of the nation leave alone Kerala .

Regards

Dr Hemant Saluja

Strong determination is half battle won

noreply@blogger.com (Anonymous) — Sun, 22 Oct 2017 07:17:00 +0000

It gives me immense pleasure to share my feelings from a few days ago. Being born as a girl and growing into women is so challenging. Also nature and almighty gave boon to becoming a mother; most prestigious designation! But the journey is not easy.

Menarche is a very sensitive turning point in every girl's life. I happened to visit a rural area few days ago and with the help of an NGO we conducted a health checkup camp specially for girls and women from ages 8 - 60 years. We started from younger girls and tried to talk in most simple form so that they could feel free to express themselves.

Besides general health problems, most had issues associated with menstrual cycle. To our surprise, majority were not using sanitary napkins, but using clothes! It gave rise to health issues they felt ashamed to discuss.

During camp we showed short animation movies about adolescent health as mass media has better impact. These girls and women were convinced that spending little on sanitary napkins will help in contributing towards positive health. We tried to inculcate in their mind that along with spending on clothes and jewelry, they should save little to be spent on sanitary napkin. They all promised to do so from coming months.

Also elderly ladies complained of anemia and general ill health like backache, hypothyroidism and diabetes. They were advised regular health checkups at district hospital and to take medicines on regular basis.

Many women gave history of very early hysterectomy. This is a practice I have noticed very often in peripheral area when poor women undergo hysterectomy at early age for trivial issues because they lack proper health education and are forced to undergo hysterectomy by wrong professionals. They are thus exposed to osteoporosis and other hormonal imbalances for the life time.

The camp concluded with the message of using sanitary napkins on regular basis, regular health checkups and sharing health issues with community workers for betterment of women’s health; also plans to start a small scale industry for sanitary napkins at a cost which community can afford.

All endeavours need lots of planning, capital and proper implementation. But as said "strong determination is half battle won". Look forward to contribute to womanhood in most positive way. Proud to be a women..Proud to be a mother!

Dr. Sonia

Rural Family Doctor

noreply@blogger.com (Mayara Floss) — Sun, 08 Oct 2017 15:23:00 +0000

Mayara Floss

Taking care of the patients in the countryside was my way of coming back to rural. I planted tobacco when I was young and today I try to support patients to stop smoking.

Brazilian South, Jul / 17

The children raising children

noreply@blogger.com (Mayara Floss) — Sun, 24 Sep 2017 15:35:00 +0000

When it comes to rural medical practice in Uganda, one of the things that fascinates me is the alarming teenage pregnancies. This leads me to a story of one of my patients who came to the health facility I work in (Kapelebyong health center 4, located eastern rural part of Uganda), a 16 year old girl with her mother in law. (Yes her mother in law, its crazy!!) They came to the facility with the complaint of failure to carry pregnancy, ever since she got married 2 years ago (It means she got married when she was 14 years!!). It had been her 3^rd time miscarrying her pregnancy. And this time they decided to come to the hospital for guidance.

When I first saw them I thought it was a mother who had escorted their daughter to hospital for a consultation. But she spoke out and said this girl is failing to conceive. I was very disturbed, It was already running in my mind that this is a child and marital issues should not be in her mind. In fact by what I could see she needed to go to school or she needed to be in school. Her family had already handed her over as a wife to her boyfriend who is also 16 years but he was in school at the moment. (In this rural area boys are usually favoured to continue with their education because in their understanding when a girl marries she joins the other family leaving her old family behind, so any investment in her would be a waste of time!!) This angered me more because I knew the parents probably made her marry earlier so as to secure a bride price mainly because of the financial situation they have at home.(Poor families are more likely to marry off their daughters earlier to get bride price and this is just so sad!!)

But given the situation it is a rural area in Africa where the community still thinks educating a girl child is useless because she anyway leaves the home and gets married into another home. And marriage comes with a bride price.

Of course I advised them to come back to the facility the next time they get pregnant. Starting a battle with them and nullifying the marriage was out of my jurisdiction as a medical doctor in a rural area guided by cultural norms.

But this comes to the main issue, many children in the rural area I work in are raising other children. It is sad but I have seen girls as young as 14 years of age getting pregnant. Sometimes the mother and child come to hospital to give birth at the same time. And it becomes worse because by 20 years, most of these girls have given birth to at least 2 children. So you can imagine when they are 30 years of age? In fact by 30 most of the women have at least an average of 8 children!! This is really sad.

Of course as a rural doctor we have started outreach programs to schools encouraging children to remain in school especially girls. But it has come under a lot of pressure and still many girls are also being put under pressure by other girls (their own peers) who already have children of their own. They usually ask questions like, “why are you wasting time? Do you want to spend all your time in school?”

It is a sad situation but the trend is now showing that a young mother is more like to bring the sick child to hospital more often than an older mother.

It is a battle we are fighting quietly. I am really interested to know if this happens in other countries. Any one who can share with me what they are doing to save their rural girls???

Me with some of the rural children of the young mothers on an outreach!

SOME OF THE OUTREACHES ENCOURAGING CHILDREN TO REMAIN IN SCHOOL. ESPECIALLY THE GIRLS..

I am Dr. Etonu Joseph, Junior medical doctor from Uganda 29 years of age, I've been practicing for 2 years in a rural area in Uganda in a county called Kapelebyong county. I Started my work when I was 26 years old in the facility. Iam the only doctor there covering the health of 89,000 people. Being a very rural area very few doctors attempted to work there but so far i am the one who has lasted the longest in the facility..The people I serve are the humble indigenous rural people of Karamoja and also Kapelebyong county..I graduated in 2012 at the University of St. Petersburg Pavlov,the Russian Federation. But i started working in this rural area in late 2014. I ride a motorcycle to work because the roads are soo bad in the rains that sometimes it rains on me! BUT I LOVE MY WORK and I have learnt a lot from the people I serve.

Simplicity

noreply@blogger.com (Mayara Floss) — Sun, 10 Sep 2017 13:30:00 +0000

Fábio Schwalm

Home visit in the late afternoon
Hi Dona Ana, how is going the hemodialysis
She responds:
Well, at first it was difficult, I had a bad time ... now I'm fine ... I spend the four hours praying
while I pray
And eating?
Better now I can eat more
And how can we help?
She hold a list in her hands:
What is Damascus?

__

Fábio Schwalm is a Brazilian rural family physician. He works in Brazilian South in a city called Barão. He is learning to write and grew in a rural area working in the smoke farm.

The day that I dealed with death peacefully

noreply@blogger.com (Mayara Floss) — Sun, 27 Aug 2017 18:40:00 +0000

Andressa Cavalcante Paz e Silva

“When the rain falls down / What brings it back? / Opens the resurrected cloud / From white to black / It's a second birth / For dying skin / In my coffin...”

(My coffin - Jon Foreman)

I’ve been thinking a lot about this story. Maybe, for some people, it couldn’t be a “Success Story” because in the end the patient dies. But, as a wise once told: In life, it is the journey that matters. So, I’m going to tell you a rural success journey story.

My story begins with a young girl going to a home medical visiting in a little rural area called Curuá, in Baixo Amazonas, north of Brazil. This girl was attending Medicine classes for four years in a College School in Rio Grande do Sul, a state located on the opposite side of Curuá, south of Brazil. However, this story is not about her. This story is about the day she understood the real meaning of Rest in Peace. This girl is me.

It started out with a “Hi, good morning, mrs. Maria. Have you called out for our visit? Let me see how Mr. Manoel is going.” and them the medical interview continued.

-Thank you for being here, doctor, he is not so well. He can’t speak anymore and It is being pretty difficult for him to walk. Also, he is refusing to eat since the day he had this strong diarrhea.

- Oh, and how was this diarrhea, mrs. Maria? You see if he is suffering of pain? Tell me more about it. - The student asked.

- It was last week. It’s been 5 days since the only episode. Oh and those black stools were so so smelly as I’d never had seen!! And in the last two days he is totally constipated. We tried so hard to give him food… We even tried to lay down some pasty food and in his lips and mouth, but the only thing he wants is water and sleep. We are trying so hard to give him the medications another doctor prescribed us, as well as those nutritional supplements. Now he isn’t suffering of pain, but we are worried about inappetence.

Mr. Manoel, an elderly man aged 77, was clearly dehydrated, hypotensive (80x40mmHg) and in the neurological exam we found out Glasgow 10. When we touched his belly during the abdominal exam, his face showed heavy pain. In our hypothesis we conclude that maybe Mr. Manoel was having an upper digestive hemorrhage.

Unfortunately (or fortunately), the medical conduct wasn’t totally accepted by the family. First, we suggested moving the patient to Santarém, a place with a hospital, in which he could do exams to confirm the bleeding and treat specifically. Nevertheless, the logistic for all transportation stuff and maintenance of the patient and the family in Santarém was really difficult.

Actually, even if there were no problems at all, Mr. Manoel’s family had already decided he would die at home. “We can’t send him to Santarém… A couple of weeks ago when he was a little better he said that If we ever try to send him to another place instead of here, he would come to haunt us after his death for sure!” - they said. In summary, the elderly man was medicated with some Oral Rehydration Solution and referred to the doctor of the city, as I was only in an observership. This experience was really different and meaningful for me. The empowerment of that family caught my attention and I started to think about empowering my parents and my relatives to understand the finite of life and to embrace palliative care too. Mr. Manoel get better in the consequent day after drinking the oral rehydratation solution, but after two days he died at the crack of dawn.

So, I’ve been thinking a lot about this story. Maybe, for some people, it couldn’t be a “Success Story” because in the end the patient dies. But, as a wise once told: In life, it is the journey that matters. I guess Mr. Manoel’s journey through death was peaceful and I guess he will not come back to haunt his family.

Photo by: Keith Dalmon Ferreira

Andressa Paz is a Medicine Student living in the South of Brazil. She loves listening to stories and rural ones are her favorite. She had her first contact with rural and remote Medicine in Kat Kalen - Haiti and then in brazilian Amazon area

The Elderly Lady and her Chicken

noreply@blogger.com (Mayara Floss) — Sun, 13 Aug 2017 15:15:00 +0000

Dr. Etonu Joseph

It was a usual day on the ward in the rural facility I work in (kapelebyong Rural Health Center,in north eastern Uganda), as I was doing a ward round. Like other normal days it is characterised by children having malaria and usually I review them to make sure the dosages are right and they receive the right treatment.

This particular day I noticed a chicken walking through the ward and of course I was furious(given that infection control is very important) why would a chicken be moving through the ward. Then I chased it out. The African local chicken are quite fast and of course it got away.

Surprisingly after sometime I noticed the same chicken coming back to the ward. This time I asked the nurse on the ward what was wrong with the chicken.

She then revealed to me that the chicken is for one of the elderly patients on the ward. “It has even laid eggs and it must be trying to come back to lay another one”, the nurse added!!!

This made me even angrier. How can a chicken just want to lay eggs in a hospital!!!

I matched to the patient with my eyebrows up and I noticed next to her was an old sink that was not in use, with a box and about 11 eggs. The chicken had already laid 11 eggs!!! I asked her in shock, ‘’why is your chicken laying eggs in the ward?” She replied to me, I was admitted to be in hospital for 2 weeks and unfortunately I stay alone at home. This is the 3rd time my chicken is laying eggs and the 2 previous times I wasn’t home to protect it from the neighbours who stole all the eggs. I am not willing to take any chances this time so I have decided to carry the chicken to hospital with me this time, she humbly replied. I told her that unfortunately chicken are not allowed to live in the hospital next to patients because it could cause diseases and she just kept quiet. She looked at me in confusion as to why the doctor wouldn’t understand her concern.

She put me in a dilemma I couldn’t send this lady back home because we needed to monitor her meds and it was unfortunate that she stays at home alone and all her children had moved to the city, like most of the elderly women.

We ended up having to organise for her a separate empty room to be with her chicken.

I am still wondering whether it was the right decision. What would you do in the same position?

Above you can see the eggs in the broken sink!!

Above you can see the patient’s bed!! Next to the sink!! With the chicken seated on the eggs below!!

Its just God's miracle, we are just medium...

noreply@blogger.com (Smruti haval) — Sun, 02 Jul 2017 11:00:00 +0000

Hello friends.Me Dr.Suhas and my wife Dr. Prerna are specialist by degree but generalist by choice.We both have humble rural background and upbringing.Hence after our post graduation we moved to rural set up for practice as we believe we have many dues towards society and community who helped us to be a good doctor.

In rural peripheral setup you have a new day new challenge.There are many stories till now in one year.

But the most interesting one is the 28 year female diagnosed with unexplained infertility for 8 long years. She was investigated & treated at several Super speciality setups at Mumbai, Pune, Nasik, Malegaon, Aurangabad.

She even underwent multiple times for diagnostic laparoscopy, hysteroscopy, IUI, IVF & her male partner was also treated for low sperm count in last 8 years but failed every time. Spent lacs of rupees for treatment but every time result was unsuccessful. Husband being rickshaw driver, due to mental frustration gave up hope on for not being able to become a father.

Interesting fact is that the couple was none other than our hospital staff worker's son & daughter in law.

After we started practice in rural setup, the staff told the story about her son & daughter in law. The couple meanwhile consulted us. Selective investigations were done as all the previous investigations were normal. We studied the case very thoroughly and with help of expert opinion of Dr. Prerna the patient conceived within a month. Her UPT came positive for the first time.

The happiness which we saw on her face was priceless. After proper care of thorough 9 months pregnancy she delivered a male child on 23/4/17. Staff worker's son literally cried with happiness. He told us that we are everything for him. And we told him its just God's miracle, we are just medium...

Author

Dr. is Dr.Suhas Pawar is (MS Gen.Surgeon) and his wife Dr.Prerna Pawar MBBS,DGO.They run a rural hospital named Saibaba Hospital, Satana,Nashik. Both belogs to humble rural background and are passionate to provide all super speciality services to rural people in there own community.This shall reduce there trouble to cope up with city urban life.

The police protection

noreply@blogger.com (Mayara Floss) — Sun, 21 May 2017 13:13:00 +0000

Dr. Etonu Joseph

It was a usual afternoon at Kapelebyong Health center 4,in Uganda, like everyday during my work I see all patients with different conditions.Some of them are brought by a policeman and this would be because of assault or even rape sometimes.But this day had i saw a police officer,a gentleman well built and strong sitting in the waiting area waiting to see me. As usual because I knew he had other day duties. I allowed him into my doctor's room. I expected him to be accompanying the usual cases of rape or violence but was I wrong.

Entering the room he closes the door behind him and he sat down. So i asked him "What can I do for you?" He replied it is I who needs help, "yesterday night I was attacked by my wife and she was bitting me with her teeth" He showed me all the bite marks on the hands and the back. I felt for him because 1st of all he is a Man! And also a police man. And being in the village many men usually beat their wives and sometimes they injure them so badly. But it was very humbling to notice this policeman keeping himself calm. And he did not beat his wife(Being physically strong He didnot even fight back). I advised him to get help for his wife because he was not safe living with her.

But it got me suprised that if a policeman can seek for help on the abusive nature of his wife.Then that means he loves her and it could also mean that he respects the rule of law.But it also got me thinking as we call police for help, who helps the police when they are in trouble..?

Isolation

noreply@blogger.com (Mayara Floss) — Sun, 14 May 2017 16:00:00 +0000

Caruaru - Mayara Floss @ruralices

Mayara Floss

I need to call Emergency.

There is an emergency in the rural unit.

"But doctor, there's no phone."

Caruaru 02/17

Mayara Floss

Undergraduate student of medicine at Federal University of Rio Grande (FURG) - Brazil. She Co-creator of project 'Health Education League'. She is the creator of the Rural Family Medicine Café to provide a forum to discuss Rural Health – a forum for students, young doctors and experienced professors and GPs from all world. She is the student representative of the WONCA Working Party on Rural Practice. She also co-created with Pratyush Kumar the project 'Rural Health Success Stories' and writes a weekly blog of Popular Education, Arts and Health - the Ferry Street of 10.

Parsimony

noreply@blogger.com (Smruti haval) — Sun, 26 Feb 2017 08:00:00 +0000

Dr.B.C.Rao

I got trained in the old school of thought as far as patient care is considered. There were several dos and don’ts that were dinned into our heads. Some of these were don’t prescribe an expensive drug when an alternative cheaper one is available. The other is don’t investigate unless absolutely necessary. Always listen to the patient then proceed to examine and always try and come to a clinical conclusion. If you have to confirm do the minimum lab and other tests. When you are in doubt get another opinion.

These principles have stood me and my patients in good stead over the years and saved us lots of headache and money. But occasionally it has backfired to give an example or two.

I am against routine annual medical examinations and investigations to all and sundry and with valid reasons.I consider these a waste of money. But when there is a definite indication to screen a high risk patient I do order the required tests.

In this case the a young man’s company does many tests as a part of the employee benefit and an electrocardiogram is one of them. He knows that I am against routine screening for heart disease in low risk groups and the youngster was one such.He reluctantly came and apologetically asked me to have a look at the reports.The company and done many tests which included an ECG.

The ECG was abnormal. Though the rhythm was alight the rate was very high. Even if one gives margin to the fear of doctors and machines many have with the resulting increase in the heart rate, this kind of increase was a cause for concern.The report just said sinus tachycardia and the physician who signed it had not bothered to see the patient. There was also a marginal increase in the levels of thyroid hormone.On talking to him I realised he had lost weight, had been having some diarrhoea and when I examined him he had a heart rate of 130 beats per minute. A repeat test for thyroid function revealed he had increased activity of thyroid gland and this was duly treated.

Had he not done the annual tests would he have come to see me? Probably not immediately but would have because he was concerned with his loss of weight. He would have come much later when treating him may have become tougher than it did.

Another patient this time a friend of mine, who by nature a thrifty sort of a fellow [there is a very thin line between thrifty and miser].He tries his best avoid consulting me [read paying me]. He also treats himself with some success. He had symptoms of hyper acidity a year ago and as his usual antacid failed to help he sought my attention and I advised him to take a course of different class of anti acid drugs and get back after six weeks. He got better and did not get back to see me. When I met with him on the golf course he said he was well but once in a way he has to take the medicine. This worried me as at his age one should not have recurring symptoms like this. As the golf course is not the ideal place for a professional consultation, I asked him to see me in my chambers. This he did when his wife came to see me, he sort of hitched a ride.

I found he has been taking the medication prescribed and managing.Though there was nothing much detected on physical examination I told him to get an endoscopy done to have look at what his stomach looks like [this meant going to the hospital and getting a flexible tube thrust down the throat right up to the stomach, a not very pleasant procedure but was needed]. He said alright and went away. He did not go to the hospital. He came three months later with worsening of symptoms. I had no doubt about the diagnosis. He had cancer of the stomach and further tests including the endoscopy showed the cancer had spread all over. He does soon after.

Looking back I feel guilty for not having insisted that he get the tests done.I could have told his wife and she would certainly have succeeded in getting the tests done.Would he have survived had the tests been done six months earlier? Yes he would have.

There is a saying that you can take the horse to the water but you cannot make it drink it. Sometimes it is difficult to force the issue. But difficult or not I should have done it and he would have probably few more years of life. Now I am carrying this burden and it will be with me and his face will keep coming to haunt me, may be, till I die.

Another patient and another time. This person was a medical shopper. He saw many doctors and I was one of them. He had painful sensations on the skin of his thighs extending down to the calves. Only sensory involvement of pain sensation carrying nerve fibers may be due to many causes and cancer is one of them. He was a smoker and on testing he was found to be a diabetic. I was happy because diabetic neuropathy is very common and good control of diabetes will help. He was told the diagnosis. He appeared happy that a cause was found and went with the diet sheet and prescription. For three months I did not see him. When he did come he had with him records of three other doctors, one of them a homeopath. His diabetes was under control but his neuropathy [pain] had worsened. A neurologist who had seen him had done a scan of his spine and brain with no abnormality. Now he also had weakness and loss of weight which was attributed to diabetes. What is this patient’s illness?

I expressed my worry about cancer to the patient and told him to get a PET scan [an expensive test but will reveal cancer activity] of his whole body. After much deliberation and visit to another doctor [fortunately he too advised the same] this test was done. A tumor was found in the patient’s intestine [ceacum]!

Though nearly six months had elapsed from the onset of pain in region far removed from the place where the cancer was, it was found to be operable. The patient lived few more years but died due to recurrence.

Here again if we had forced him to do this test and the diagnosis had been done early, may be, he would have lived his normal span of life. All of us [many doctors whom he went to] thought that diabetes is the cause when all the time it was cancer. This episode too has remained in my memory but does not haunt me as the other one does.

Despite this experience I stick to the principle of investigating only when necessary. But as you can guess, I have started forcing and even threatening them with dire consequences if they don’t follow my advice. Once bitten twice shy that is what I have become.

Medicine is in many ways, a cruel profession. You may be right 99 times out of 100 but you remember the 100th because willy nilly you were responsible. And to the patient who suffered it is 100 percent.

Author

Dr. B.C. Rao is 73 year old family doctor with varied interests.He is still in active practice though only for limited hours now.He actively guide young aspirants of family practice.