Institute for Rural Health Studies
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Healthcare in the Villages

IRHS runs clinics in two villages in the rural semi-arid tropics of Telangana: Dokur and Kotakadra. These villages are located in Mahbubnagar district.

The majority of IRHS patients are from landless labourer families, who survive on a yearly average of less than a dollar a day and owe far more in debts to money lenders. Malnutrition, a lack of health education and demanding physical labour cause villagers to be particularly vulnerable to health problems.

Each week patients and their families travel from all over the district to receive medical attention at our clinics. Experienced paramedics, healthcare workers and volunteers staff the clinics. As the only reliable healthcare provider within a great distance, they treat a large variety of illnesses and medical conditions. During parts of the year, volunteer doctors spend from 1 - 3 months living in the villages in order to upgrade the medical knowledge of the paramedics.



Village Healthcare Workers

Health workers, trained by paramedics and volunteer doctors and nurses, have important responsibilities both in the clinics and in the communities. In the community they are the institute’s major force for preventive care. The village healthcare workers focus on both the physical and mental well being of women and children. Their duties include:

  • Working with mothers through all stages of pregnancy and childcare;
  • Home visits to families that are unable to visit the clinic;
  • Performing lab tests, maintaining detailed patient records and helping to run the pharmacy.
Paramedics

The paramedics are the keystone of patient care at the clinics. Paramedics are trained by volunteer doctors, they diagnose, treat and manage the patients. The paramedics also work with the city staff by referring patients onwards for specialized treatment. Training local people as paramedics and health workers to serve their own rural areas is a cost effective and sustainable way to offer medical help in areas where there are few viable sources of medical care, i.e., most of rural India. Using urban-based office staff for ‘ready reference’ (which includes a panel of specialists who will answer the questions quickly), the clinic staff are able to offer rural patients the added bonus of backup for unusual situations.

Village Clinics

The clinics are managed by trained local people (paramedics and village health workers) who are trained completely by IRHS and occasional volunteer doctors. The clinic charges a nominal fee of Rs.10 (0.16 USD) for consultation and diagnostics. The medicines dispensed are high-quality, generic and inexpensive. For people who cannot pay this small amount (primarily the elderly and disabled), the services are free. All children are free, irrespective of their economic status, although almost all are poor. The clinics are now visited on average by over 700 patients every month. The conditions seen vary from simple colds and coughs to malignant tumours and severe neurological conditions. Patients from over 150 villages and including neighbouring districts visit the clinics. The clinics are:
  • Staffed by local people;
  • There is an intense focus on training;
  • The staff are patient centred;
  • Close attention is paid to continuity of care;
  • The cost of medicine prescribed from the clinic pharmacy is affordable;
  • The IRHS has a unique system of by appointment referrals to specialists;
  • The state government is examining how the clinics could be used as a model for healthcare provision in rural areas with a population of over 35 million;
  • Organisations in other states have already adopted this clinic model with assistance from IRHS;
  • The IRHS clinic staff monitor government immunization programmes;
  • Staff offer ante and post natal care, they ensure that all women maintain their haemoglobin levels using free iron and folic acid supplements;
  • Women staff offer comprehensive gynaecological care to women, including treatment for all STI's.
Psychiatric Services

IRHS provides the only available psychiatric care in the district. Dr. K. Chandrasekhar Rao, MD, Professor of Psychiatry, ASHA Hospital, Hyderabad, comes to the clinic on a regular basis. On some occasions, he brings students of both psychiatry and psychology to work with him. All medicine is free to patients under his care. Dr Chandrashekhar did his training in psychiatry at NIMHANS, Bangalore. Soon, with Dr Chandrasekhar's assistance, trained psychologists and a psychiatrist will visit local schools to raise awareness of psychiatric and behavioural problems to facilitate early intervention.

Continuing Challenges

The main barrier to developing better healthcare in IRHS village clinics is financial. More resources would allow the clinics to employ more staff and provide more extensive facilities and services. The clinic staff, volunteer doctors and the Institute's city-based personnel are striving to deliver better patient care to improve the standard of living and to reduce villager's debt expenditures on health care, loss of wages and unethical treatment in time to save lives. The IRHS focuses on improving health care in rural Telangana in many ways:
  • Improving diagnosis rates;
  • Conducting a wider variety of lab tests so that the staff can diagnose and treat more patients locally;
  • Developing health education through school visits and drama groups, especially in the fields of reproduction, HIV, hygiene, and nutrition;
  • Encouraging people to come to the clinic early enough to be treated;
  • Breaking down superstitions that are barriers to healthcare e.g. eating dhal (pulses) causes puss in cuts and wounds;
  • Refining the IRHS model for remote and rural clinics and lobbying the state to build simple clinics, run by locally trained paramedics as doctors do not want to serve in rural areas.



IRHS rural clinics see approximately 8,000 patients a year

 



Patients come from 150 different villages, crossing districts and states


Our trained health workers conduct approximately 1000 house visits a year for ante natal, post natal and child care

 

Our clinics are fully staffed with local people

 



Dr. K. Chandrasekhar Rao with a psychiatric patient

 

 

Organisations in other states have already adopted this clinic model with assistance from IRHS