Community Health

AIMS & OBJECTIVES

With the prevailing ‘misconceptions’ and attitudes of people in the society regarding essential aspects of health and nutrition, Peaceful Society decided to have a concrete initiatives on Health for a year with monthly follow up health check ups and health talks in the year 1987. Dr. Poornima N. Usgaonkar kindly agreed to pay one visit every month.

WORK PROCESS

The first health camp was held at Bandora-Goa & was attended by 25 children along with their mothers from poor community. A talk on “worm infestations” was given. Medicines required were prescribed and guidance towards nutrition was given since Anemia was prevalent with many cases of faulty feeding. Same Children attended the next follow up camp and it was obvious that the medicines prescribed were not bought and there was no much change in the health status of the children. So, for the third camp medicine samples with deworming medicines, certain antibiotics, cough syrups, iron supplements, calcium supplements samples brought from own clinic (“Usgaonker’s Children Clinic”) & were given to the patients as indicated. Most of the mothers were very happy since they could not get the exact benefit of the camp except for listening to the health talks, they could not buy the medicines prescribed as they did not get cooperation from the husbands. Subsequently, at every camp there was a health talk to start with, on separate topics and slowly the impact could be felt specially in deworming of the children. Earlier there were hundred queries about the deworming. Misconcepts prevailing in the older generations were coming in the way but with every camp the confidence between doctor and patients became stronger and slowly the advices were accepted on the first instance. The deworming trend began which was an outcome of proper explanations on hazards of worm infestations, exact method of medication which again was a very important factor since improper way and inadequate medicine would disturb worms, and create false impression on the patients about deworming. As for other medicines, though medicines were given after proper scrutiny, a little percentage of patients had their doubts about the expiry dates and all fancy doubts about medicines and avoided the camps initially. But to our surprise, over a period of time they were the most regular patients later on and the camps became a pleasant work with wholehearted participation of patients. Subsequently Peaceful Society partially bought medicines for the camps.  On completion of one year, on the demand from the public it was continued further and from 1990 it was shifted to Dhaknewada, Madkai, once Peaceful Society had shifted their office there. Initially the numbers of patients were not under control but later it was restricted to 25-30 per camp with their mothers. The mothers also received attention and their health problems were looked into, they were given iron, calcium supplements, deworming medicines and specific medicines for existing illnesses.

Interceptions did occur due to personal health problems. But soon the camps were resumed on recovery and Subsequently, since Sept. 1998, separate doctors for women were requested for their assistance in the check ups. During every visit, weight recording, examination in details, advice, Rx for the condition is given and records are maintained. Information regarding various health problems given during the camps and cases are picked up and demonstrated for better compliance.

Stress laid on different aspects regarding Health: –

NUTRITION

Health talks on nutrition at various ages of a child from antenatal period; new born stage; infancy, childhood and adolescence are given from time to time. Breast-feeding of the

children by mothers was stressed upon.  Because if the breast-feeding is not done or the mother doesn’t yield milk then the children may suffer from severe protein energy malnutrition, kwashiorkor etc. Therefore supplementary food in the form of powdered milk was supplied to the children with joint efforts of Usgaonker’s Clinic and Peaceful Society. Other deficiencies like iron, calcium etc. were taken care of by supplying regular iron and calcium tonics. The mothers were given calcium and iron supplements, too. Mothers’ nutrition was taken care with advices on proper ways of nutrition and importance of nutrition during pregnancy and lactation. Cerelac packets samples given to us by company on request were supplied regularly and the effect could be seen from the weight gain of the children. Cases of kwashiorkor were followed up under proper nutrition and their deficits were completely taken care. Advice on preparation of food items from locally available grains, vegetables & fruits is being given. Photographs, whenever possible were taken before and after treatment, showing the effect of proper management. Peaceful Society supplied eggs and milk for some period of time and pamphlets on nutrition for infants and children were distributed.

WORMS

A number of lectures with the emphasis on health problems caused by worms and the methods of preventing worms and treatment were delivered to give an impact on the mothers that worm removal is not hazardous which was a misconception for years. Pamphlets on prevention of worm infestations provided by Pfizer Co. were distributed. Removal of worms under certain seasons was a misnomer prevailing. This was effectively taken care and the de-worming treatment was streamlined and the people ultimately accepted it in such a pleasant way that every 3 months they take the medicines and come on their own for deworming purpose. The improvement in the health conditions is appreciable and the mothers could get convinced about the good effects of deworming and the initial resistance from the mothers passed away after a few months. The first camp in Madkai after deworming reported around passage of 200 worms and above by each child, the story now is 2-3 worms at the most. No admissions to the private hospitals or Goa Medical College as was indicated by their discharge summaries from the respective hospitals and showed a total nullification of such types of admissions caused by different worm problems. Pfizer Company gave their utmost cooperation for timely deworming by their supply of Combantrin syrup and tablets for years. This was a major achievement of the camps, which still Continues.

SCABIES

During the initial stages a number of cases with scabies were seen, but by regular and timely treatment and lectures on methods of prevention of scabies and detailed care during scabies indications, it was almost totally eradicated. The advice on care of the clothes and public cleaning of clothes during consecutive camps helped to stress all such factors and with the demonstration of the cases to all the attendants the topic was well understood and the women were very receptive and followed the advice properly, resulting in total absence of cases of scabies during recent camps.

FUNGAL INFECTIONS

Considerable number of mothers had Paronycheal abscess with fungal infections of nails of fingers and toes as well as skin of hands and feet due to constant contact with water during household and field work. A thorough local treatment with systematic treatment was given to them with detailed instructions about care to prevent such infections like importance of keeping the hand and feet dry during and after working. They were also informed about the fungal infections caused due to the use of damp clothes, undergarments, etc. There was a marked improvement in the condition and many were relieved of these painful conditions and awareness was created about maintaining dryness of hands and feet. The patients were supplied with anti-fungal lotions, ointments and powders that were brought from Usgaonker’s Children Clinic samples. At present awareness is already present to ask for medicines in the start of the disease.

 

TUBERCULOSIS

The children since being diagnosed regularly could be grouped out from their weights. The inability to gain weight in spite of nutritional improvements, removal of other infective conditions etc. and those other children with persisting respiratory complaints in spite of timely treatment and treatment for eosinophilia etc. were grouped out for investigations and they were investigated for tuberculosis, with blood tests, PPD and X ray chest, PPD test was done in own clinic with readings on 3rd day taken there in the campus. X ray chest were done at Amey X-ray Clinic, Ponda and blood tests were done at Patholab, Ponda by Dr. R. A. D’costa. The cases found positive were started on treatment. Later to screen the contacts, a survey was conducted in various parts of Madkai by the Tuberculosis Department and Peaceful Society with sputum examinations and the positive cases were given treatment by the TB Department with follow up carried out by Peaceful Society. A case of TB spine, some cases of primary complex, progressive primary complex were the cases found in children which were treated adequately with the help of ID hospital Ponda-Goa, in addition to samples brought from Usgaonker’s Clinic.

 

IMMUNIZATION

The immunization record of every patient is kept in the books and timely reminders are given for boosters and subsequent immunizations, if required. Talks on importance of immunization and the Vaccinations, are given from time to time, which could help those who could afford private treatment. MMR Vaccinations were given at Usgaonker’s Clinic free of cost for the needy patients. Pamphlets containing information on schedule of immunizations are distributed from time to time.

 

BLOOD GROUP DIRECTORY

Blood Group is a very important factor in certain health conditions and prior knowledge of an individual’s blood group is very useful and helpful tool in situations like Blood Donation, Blood reception and Prevention of certain blood group incompatibilities in the newborn e.g. Rh incompatibility, ABO incompatibility.

If blood group of mother is Rh –ve and baby is +ve or if mother is O and baby A or B, then such incompatibilities can occur.  If prior to pregnancy, the blood group is known, it helps to prevent neonatal jaundice due to incompatibility or manage it timely, to prevent complications of brain. Anti D Injection can be given soon after birth if mother is Rh –ve. Therefore Awareness of this blood group is very essential and camp was held to –

1)    Issue cards to individuals including children for the sake of a record of blood groups.

2)    Blood group directory for donation of blood in case of emergency. With this aim a blood grouping camp was arranged.

A blood grouping camp was held on 27th Feb. 1998 with the help of Dr. R.A. D’costa from Ponda where blood grouping was done and a directory is maintained with blood group cards supplied to the people with their photographs. Dr. D’costa arranged the required material along with reports, syringes, slides, and reagents free of cost. Dr. R.A. D’costa gave a talk on blood grouping and blood transfusion. Peaceful Society supplied the photographs.

 

PAP’S SMEAR

For early detection of Cancer Cervix of uterus, a camp for women above 40 was done with pap’s smear with the help of Dr. Sudha Vaidhya, ID hospital and Goa Medical College, Pathology Department.

 

Subsequently, for the sake of proper examination and treatment of women, Dr. Sudha Vaidhya and Dr. Smita Usgaocar, were requested to do the check up every month from September 1998.

 

DENTAL CHECK UP

Dr. Chhaya Bandodker Practising dental surgeon from Ponda did dental check up with talk on oral hygiene on 24th Sep. 1998.

Mega Camp with all specialities was held on 29th May 1998 with consultants in medicine (Dr. Lalana Bakhale, physician), (Dr. Sudha Vaidya, Gynaecologist), (Dr. Bandekar, Ophthalmologist), (Dr. Santosh Usgaonker, Paediatrician). 140 patients were examined and those requiring further follow up were called in respective Clinics for further management at free of cost. Dr. Uday Kerkar & Dr. Ghanshyam Mardolkar also contributed for the camp.

 

EYE CHECK UP

Dr. Bandekar did eye check up and Peaceful Society supplied spectacles to the patients.

 

SAFE MOTHERHOOD DAY

“Safe motherhood day” was celebrated on 20th July 2001, jointly with Public Health centre under the guidance of Dr. M. Mohandas.

FIRST AID BOXES

First aid boxes containing Scissors, towel, nail-cutter, antiseptic cream, lotion, cotton, gauze, adhesive tape, toothbrush, paste etc. were supplied to each family with proper detailed instructions, to mothers for how and when to use each item.

Certain special cases like a perforated eardrum was operated by Dr. Acharya, ENT Surgeon, from Madgaon, free of cost. Patients with congenital heart defects, epilepsy, mental retardation etc. were given special treatment jointly by Usgaonker Clinic & by Peaceful Society.

 

HEALTH TALKS

During every health camp a health talk on different health problems and prevalent misconceptions regarding infective diseases, worms, immunization, nutrition, care during pregnancy, care of the newborn, care during adolescence, health problems in the rainy seasons, tips towards family health, hygiene, rabies, measles mumps, tetanus, chicken pox, anaemia, calcium deficiency, nutritional deficiencies, mental health, jaundice, malaria, tuberculosis, fungal infections, were given from time to time.

Information materials distributed from time to time on malaria, worms, nutrition, immunization, rabies, scabies etc.

 

DIFFICULTIES ENCOUNTERED

Beginning of the camps was a tough encounter to overcome certain fixed concepts prevailing.

→  Purpose of health camp was not understood.

→  Mothers also could not buy necessary medicines, so samples were distributed and later Peaceful Society arranged the required medicines.

→  Doubts about medicine samples – expiry dates etc.

→  Inadequate medications – overcome in course of time by persuasive attempts of teaching the importance of adequate medications and removal of false fears.

→  Faulty attitudes of the elderly – were timely taken care with assurance and subsequently accepted with practical experience.

 

SOCIAL STIGMAS

Tuberculosis was and is taken, as a social stigma. Even today, more public the issue is made more difficult is the cooperation. So the matter is tackled in a different way without making it public, with personal advices, and management. Assurance about the cure after proper treatment and ways of prevention of spread are stressed upon.

 

SPECIAL CASE STUDIES

I.             Potts spine – Mast. Raju Gaude presented with febrile convulsion with fever OFF and ON, put on anti-convulsants developed a painful swelling on the thoracic paraspinal region. He was referred for investigations at ID hospital. X-ray spine revealed koch’s lesion at T3 – T4 – level. He was started on a course of anti TB Rx, completed the full course and recovered completely, no convulsions thereafter.

II.           A.S.D – A care of acyanotic congenital heart disease, from Bandora followed up at the campus. ECG was done at private clinic free of cost. X-ray chest at Amey X-ray clinic revealed primary complex, received full course of Rx from Usgaonker’s Children Clinic samples + Peaceful Society sponsored meds – Recovered completely, now 20 years old.

III.        Eczyma – Sheetal Gaude from Bandora a case of eczema legs, scalp, face followed up at the camps was referred to Dr. Mallya, skin specialist, Margao, received treatment and with regular follow up examination and instructions recovered completely.

IV.        Kwashiorker – Protein energy malnutrition with hair changes, skin changes, due to faulty feeding followed up at the camps. Milk powder from Usgaonker’s Children Hospital at subsidised rate bought by the Peaceful Society and supplied free of cost to the patient with proper feeding instructions, recovered fully.

V.          Mentally – Retarded

a.   Sangeeta: – complete cerebral palsy following Encephalitis – followed up at every camp was treated with Neurocitam, encephabol supplied regularly by the company samples on request, oral hygiene care, Vitamin E, Vitamin A, B’plex regularly given, oral antiseptic lotions and toilet training instructions showed marked change in condition, no drooling of saliva, presence of social smile and could recognise, physiotherapy taught and was followed to some extent improved muscular activity quite a bit. Succumbed to respiratory infection later.

b.   Olga Gomes – Another mentally retarded, followed up at every camp had attained menarche and had epilepsy, repeated urinary infections, proper instructions on personal hygiene and timely treatment for urinary infections in addition to neurocetam, encephabol showed improvement in the condition. Anti-convulsants were continued after EEG.

VI.        A case of Perforated ear drum – with chronic suppurative otitis media – infection was controlled and surgery of repair of ear drum was performed by Dr. Acharya ENT Surgeon from Margao, free of cost on personal request. Maximum co-operation of the surgeon was available.

VII.     V.S.D – Mrinal Naik a case of V.S.D was diagnosed at GMC was followed up regularly during the camps, with ECG done at Usgaonker’s Children Clinic free of cost, Echo at Dr. Colaco Margao and respiratory infections were timely treated to prevent sub-acute bacterial endocarditis. Regular follow up X-rays, ECG & Echo done. Child has good growth, no repeated respiratory infections and is studying with normal physical activities even sports games.

VIII.   Cleft Palate – Leena Naik a case of Cleft Palate was advised surgery but due to parental scare did not opt for surgery.

IX.        DUB – Gokul Gaude a case of Dysfunctional uterine bleeding was referred to Dr. Sudha Vaidhya and then sent to GMC for further investigations where treatment was given and it was controlled.

X.           Umbilical granuloma – was diagnosed at the camp and cauterisation was done in the clinic free of cost.

XI.        Fancom’s Syndrome a primary complex – 10 months old diagnosed at GMC followed up at camps, and then in private clinic free of cost, X-ray chest done in pit, antikoch’s medicines supplied from private clinic samples. Got mediclaim done from GMC to be referred at Manipal

XII.     Adenoids Chronic tonsillitis – followed up at camps referred to GMC for tonsillectomy adenoidectomy

Fears: – Parents of a child having Cleft Palate, in spite of assurance and volunteering of surgery free of cost were not ready for surgery, out of fear of complications. Certain facilities offered were not taken by a few due to fears.

 

All critical cases of children under follow up who need admissions and other subsequent medical care are looked after by Usgaonker’s Children Clinic and Hospital and neonatal care unit by Dr. Purnima & Dr. Santosh Usgaonker absolutely free of cost right from the beginning of the camps till today.

 

CONCLUSION

Though with initial difficulties which were subsequently overcome with time and patience, a bond has been built up over a period of years and though it looks purely a supply of medicines at every camp, they are still the most needed medicines which are supplied if not for which the health could not be maintained to this present level, which obviously is devoid of hospitalisations with advanced health problems, caused due to variety of the causes already listed above and are being taken care from time to time with definitely a confident cooperation from mothers whose health also is taken care adequately. It is still a pleasure to work in the same manner since one can enjoy the cooperation of the mothers, which is most important base for any further projects.

 

WAY FORWARD

So far with due tackling of the notorious situations and concepts the camps are comparatively a smooth flow and with this further bold steps can be taken up towards newer affordable immunizations not available in Govt. Health Services. Regular Pap’s smear testing every year or so, Ophthalmologic check up of children, ENT check up of children, IQ testing, introduction of yogas, pranayama, suryanamaskars which will help to overcome variety of health problems, more so mental fitness a bad need of the time to overcome present stress.

 

Report :-  Dr. (Mrs.) Purnima N. S. Usgaonker