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Our work is in the rural areas of Mahbubnagar District. Mahbubnagar District has the highest rural population (89%) in the Andhra Pradesh. Unfortunately drought is the ever persistent problem for the district and there is a lack of basic infrastructure: public toilets, sewerage and drinking water supply.

 

Cervical cancer kills more Indian women than any other disease. Three-quarters of the world's burden of cervical cancer falls on developing countries such as India.

Late presentation of women with cervical cancer is predominantly due to both inadequate knowledge and lack of effective screening, especially in rural areas.

A search for alternative low-technology screening methods for women in remote, rural regions was instigated in the 1990's. The Institute for Rural Health Studies (IRHS) took part in this process by validating visual inspection of the cervix for cancer using trained village-level health workers.

A full description of this study can be seen here as a WORD document or a PDF document.

Swathi is one of our Community Health Workers, trained by us. She is examining a patient specimen and will write a lab report for our fully-trained paramedics.

This will enable them to treat the patient correctly.

More than 90 percent of patients don't need to be referred to the district hospital or to Hyderabad, the capital city . We have the resources and skills to treat them in the village clinics.

Jayamma is a community health worker; she makes regular visits to households with children and pregnant women. We monitor the growth of all children from birth to 3 years. We also provide an appropriate food supplement to those at risk.

42% of children in India are malnourished. Most of that is borne by rural villagers who have little understanding and even less ability to do anything about it, resulting in stunted growth and susceptibility to illness. Recently, the Prime Minister called it a 'national shame'.

Raghavendra - a fatherless boy - had a rare debilitating and disfiguring tumour which threated to grow upwards into his brain.

A team of doctors representing several specialties tackled his tumour in a corporate hospital which waived the fees for his surgery.

Often, IRHS is able to convince corporate hospitals to look after such complex cases. We have excellent relationships with Hyderabad's many specialist hospitals and their staff.

Both of our clinics have fully-furnished pharmacies carrying nearly 100 essential generic drugs of high quality. On the right is our small travelling pharmacy that can be carried to a home or a mobile clinic.

It is modelled after the old chemistry set used by children in the West.

Jayamma is taking a patient's blood pressure in the reception area of the Dokur clinic.

Every adult patient is monitored for hypertension as this is a major health problem in India. We have a separate hypertension register.

Those diagnosed as hypertensive are routinely treated using appropriate medication. Lifestyle management is also part of the treatment.

Shivaiah, our Senior Paramedic, is examining an x-ray at the Dokur clinic.

The x-ray originally came from a private doctor in Mahbubnagar town, but the patient doesn't know what it tells him and the doctor didn't explain.

He has brought it to us for an explanation and treatment.

This is our very successful 'Traveller's Aid for the Sick' facility at Hyderabad's huge bus station. This woman fell off a bus and has a severe head injury. We found her when our counsellor took his regular turn scouring the platforms for injured or sick passengers.

Each year since 1997, we have helped between 4000 to 5000 travellers - treating them with first aid or getting them to an appropriate hospital. Villagers, unused to city bustle, can often fall prey to unscrupulous touts and misdirected to fake treatments. Many other preventive efforts take place in the centre.

IRHS has frequently engaged in collaborative research with other organisations or carried out independent research in rural areas.

Our research has been funded by such diverse organisations as the Ford Foundation and the United Nations University.

Here an auditor from Unilever Research in the UK is examining results from a study carried out in several villages in the district.

Dr Nitin Rao is a Pediatric Cardiologist. He is examining young Nandini, who suffered from Cardiomegaly (enlarged heart).

This serious condition ultimately resulted in Nandini's death at the age of eleven.

Nandini was actually one of the more fortunate as she had medical care to ease her suffering - many children in rural areas die without ever seeing a doctor.

Shobha is a tribal girl, totally deaf and motherless. Her illiterate father was told about IRHS while a migrant labourer in Mumbai and returned to Hyderabad to see if we would help his daughter.

IRHS used the services of the AYJ National Institute for the Hearing Handicapped to obtain care and a hearing aid for Shobha.

Each Tuesday, clinic staff load clinic equipment in and on top of the van to travel to Kotakadra village in Palamoor Mandal.

This clinic is run from a two-room house (lab and pharmacy) while patients are seen inside a temple compound.

After clinic is finished, the staff have lunch in the temple and follow it with a teaching session led by staff or volunteer doctors.

Life in these impoverished villages isn't all desperation and disease. Here, the women of Dokur village celebrate their Bonalu festival for the goddess Durga.

The pots are filled with a mixture of cooked rice, vegetables and chicken and then offered to the goddess in her temple. Afterwards, everyone gathers to enjoy the meal.

Toddy is generally consumed in good quantities and a good time is had by all.

Dr Pat has worked for more than thirty years in these Mahbubnagar villages and is well-known and much-loved.

Apart from her efforts for early detection of cervical cancer, she also has a special interest in the welfare of widows, who in this patriarchal society are often at a grave disadvantage in their twilight years if their children have moved to urban centres for work.

She is now actively seeking funds to establish a home for those widows who have been abandoned. An effort is being made to contruct an ecological environment using solar energy, water harvesting and a sustainable crèche for income generation.

From time to time, we conduct 'Health Camps' in the tribal villages of Vizag District. This means we take an 8-hour train trip followed by a six-hour jeep ride and then we walk for two hours into the mountains, carrying our kit and medical supplies.

Dr Pat and a paramedic hold a medical camp in a remote tribal village.

With no consultation room, a locally provided bed becomes an examination table.

The villagers crowd around waiting for their turn.

A volunteer, Dr Ruth Torlesse, examines a Konda Dora man with a severe leg infection. She is assisted by IRHS staff, Nathan.

Antibiotics are provided and dressings left behind after teaching his wife how to dress his wounds.

Goitre is common in the mountainous tribal areas due to iodine deficiency in India's mountainous regions and these two Konda Dora ladies are extreme examples.

They were ultimately referred to King George Hospital in Vizag.

This man has come to us because local treatment has failed and he is still ill.

Many tribals believe that one can rid oneself of illnesses by burning the body, and his abdomen has been burned with cigarettes to cure him of his fever.

This is a closeup of the previous patient showing his extensive and disfiguring burns.

He was subsequently treated for his malaria and made a full recovery.

Small areas of the hills can support paddy (rice) cultivation.

These women are scooping up irrigation water for bathing purposes after working in the fields.

Cleft lip and palate are common among rural people due to consanguinous marriages. This Valmiki boy is a severe example.

He was referred to King George Hospital where surgery was done at no charge, although he and his father had to travel 6 hours after a two-hour descent by foot from the mountain.

 

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