At the end video Hunar Ghar coordinator Deepak sits with a patient to ask him about his experiences with the mobile clinic. Next month, we plan on a full survey of all patients so we can include the needs and perspectives of the community as much as we can in the style, type and manner of health care they receive.
The latest monthly mobile clinic, hosted by Bakhel and provided by the Global Hospital & Research Centre in Mount Abu, happened last Sunday. This month we were visited by 64 patients. This is down on the number of patients we usually see – more than 100 every month – but there is currently a lot of work in the fields as people prepare for harvest, or fertilise all their cotton.
There have now been 4 mobile clinics, and each one successful. It is becoming know that this is a regular and reliable form of finding healthcare, something the Bakhel community has perhaps never had before.
Except there is one problem
The word in the field is that lots of people don’t want to use it. Odd, no? – free reliable healthcare from trusted and caring doctors brought right to the door step; who wouldn’t want to use that?
The first person is someone that has multiple illnesses or suffers chronically. Although the doctor makes, for example, TB referrals, the mobile clinic service is not equipped to deal with many chronic illnesses, and these are sometimes the most threatening diseases to a lot of people in Bakhel. The clinic also only come once a month, so there is no chance of further consultation say two weeks after seeing the doctor – making diseases that cannot be treated with a few days pills and tablets harder to address. Pills and tablets are also the only things that the clinic is equipped to dispense. In the village there is a general low interest in pills – they want injections, and they can’t get these at the mobile clinic. They want injections because they see these as treating more serious diseases – something we have seen the mobile clinic is less able to do.
Another person that isn’t going to come may be a woman with health issues. Most mobile clinics it is a male doctor who comes, which presents immediate issues. The doctor also operates out of the back of the van you can see in the video above – and the cluster of people you can see outside it are all patients waiting in line – there is absolutely no privacy or patient confidentiality.
So what can be done?
The Hunar Ghar team and I had a discussion about this after the clinic. We decided that there were some simple things we can do to improve the situation, and there are some longer term changes that we will need to find a way to work out. Next month we are going to ask the doctor to sit in a private room in the house behind, so people can speak more openly. We are going to tell each female patient that if they prefer they can speak privately to Vishnu Priya, a female from the Hunar Ghar team. She will then relay information to the male doctor, so the female patient will be able to discuss issues she might not have wanted to to a male doctor. In the long term we can advocate for a female doctor to come.
Understanding chronic illnesses is a bigger problem. In April we did a complete health survey of the village. In this 5 major diseases were identified. These corroborated with those we thought were the major diseases, but now we have hard evidence to demonstrate it. In every mobile clinic sine them we’ve been noting down the prognosis of every patient. This last clinic we also wrote down the prescriptions given. What we will do is compare the major diseases identified in the health survey with the most commonly treated illnesses in the mobile clinic. It is my feeling, from scanning through the data, that the two do not align. This means that the best health service the Bakhel community have access to doesn’t address the most common (and pressing?) illnesses – clearly work needs to be done.
The mobile clinic is a wonderful addition to the right to access quality and reliable healthcare by the Bakhel community. It is a pleasure to work with a dedicated and caring team, and this sentiment has been echoed by the Hunar Ghar staff, who see how the doctor treats every patient with kindness and care – not common for the Bakhel community. Most importantly, it is the Bakhel community themselves that have noted that the doctor is good and giving them good attention.
Next steps
With this now in place and running smoothly, we can now bring together the Health Partnership team again – the Global Hospital, the RNT Medical College, Hunar Ghar, the Bakhel Primary Health Clinic and the Bakhel Community to work out what our next steps will be for 2013, to continue to improve access and use of quality health care for the Bakhel community, and make best use of our most knowledgeable people – the Bakhel community – to help improve health service in other places too.