July to September 2023

 A comfortable three months. Patients turning up as usual. Monsoon cooled the country side, but the rains were minimal, our area rapidly going into the Deficient zone and soon large deficient - 39% to - 60%.

September saw welcome rains, about 15 cm in a matter of a week - cheers to all. Brought much needed relief.

However, the farmers have taken a hit. All the rain fed crops -Ragi, Groundnuts withered away due to the lack of rains. There was no flowering of the groundnuts. One odd brave plant pushed a flower out, only to be defeated by the lack of moisture. A real sad sight.

3908 patients accessed the RHC

3883 BPL patients

Children 53/75 and Elderly 355/243

Kartik

April 2023 to June 2023

 A hot summer ahead as April heats up

2400 patients came to the Health Centre,

2387 BPL patients

Children 31/33 and Elderly 238/188

With the Exam season on, the kids are busy studying. The exams being scheduled for May in AP. 

The RHC was busy in April.

May was our vacation.

VACATION

This time. we kept the RHC functional - the pharmacy was kept open; A nurse and 1 admin staff were there to check out the patients.

Nurses were given a protocol to follow, for the patients coming in. In case of doubt, they would Teleconsult with the doctor on duty who gave them appropriate instruction.

Worked well and the patients were happy that they were able to get a refill of their medicines.

October 2022 to March 2023

 October to December 2022

The RHC saw 3233 patients: 

Children: 63 (M); 55 (F) - all primarily from the RHC

Elderly: 215 (M); 243 (F)

Adults: 1126 (M); 1451 (F)

BPL Patients: 3149 

The recovery from COVID is slow but steady. 

Patients are generally happy, farm work is progressing, and the air of doom has abated.

DOT Glasses

Jayesh Patel, from the UK had visited the Health Centre in December 2022
His daughter and her friend, initially spent a week with us understanding a Rural Health set up, the problems faced by below poverty line rural populations, the impact on their health, affordability of treatment etc.

Jayesh had brought some kits of ready to use Spectacles: https://www.dotglasses.org/  
After an initial training at the RHC, the glasses were taken to the Panchayat Office at Thettu Village. The ASHA workers and ANMs motivated the population to come and get their eyes checked. About 20 pairs of glasses were given out.

The remaining boxes are being used at the RHC

The Kits Being Unpacked

The KIT 

An elderly gentleman getting his eyes tested

Testing in progress

Proudly wearing his new spectacles

The team

January 23 to March 23

This was a cold winter, quite a bit of rain too. A number of elderly came down with Pneumonia, exacerbations of COPD etc. Quite a few saw their last winter, their children came back to let us know about their passing. 

Though death is inevitable, there is always a sadness in the passing away of a life, particularly for some who have been our patients for many years.

The RHC saw 3544 patients: 

Children: 52 (M); 50 (F) - all primarily from the RHC

Elderly: 329 (M); 271 (F)

Adults: 1314 (M); 1528 (F)

BPL Patients: 3510

Nebulisation for a COPD with exacerbation

Wondering what we did for Asthmatics before Inhalers, Rota halers, Nebulisation became widespread. In the old days, Adrenaline injection were the main stay of treating Acute Asthmas. It's been ages since one has resorted to Deriphylline Drip etc.

A better understanding of lung function, asthma mechanism and newer drugs has really helped.

July to September 2022

 This is normally the busiest period - the sowing is done; farm work is restricted to de-weeding and pest control. The festive season is still a few weeks away.

TOTAL: 4148

Adults: 4148 (1534:1787)

Children: 119 (60:59)

Elderly: 708 (419:289)

The crowds are more manageable now. Governmental initiatives have made a difference to doorstep health care delivery

Jan to March 2022

 As the COVID epidemic waned, public services resumed. Most importantly the APSRTC bus service to villages restarted. This helped patients easily access the RHC. The curbs on gatherings were also removed, schools restarted and all this meant we saw an uptick in the number of patients accessing the RHC.

TOTAL: 3949 - slowly approaching the monthly pre COVID Figures of 1500 per month

Children: 105 (52 M : 53 F), Elders: 692 (407 M: 285 F)

Adults: 3152 (1452 M : 1700 F)

The COVID pandemic has had an impact on mental health too. A number of students had trouble readjusting to school / college after the long lay off. Difficulties in concentration, restlessness, somatization were all common symptoms. Counselling helped a great deal. A few of the students needs short courses of Anti Depressants.

Adults were similarly affected. Loss of income, loss of crops, working children being laid off all played a part. For many of them, they had exhausted all their coping strength over the years. Faces wore a sense of hopelessness. Many of them needed Anti Depressants and a lot of encouragement. The hope came back as the restrictions were removed, providing much needed income to the families.

Lets hope that the COVID pandemic peters out and is limited to small outbreaks only

October to December 2020

As the corona pandemic waned, the patients started coming back to the RHC. There was still no public transport. Hitching a ride on motorcycles, hiring an auto who brought them through the check posts, the patients cam back for testing, medicines and most importantly meeting the doctors.

3587 patients accessed the RHC - about 50% of our earlier workload.

Majority of them had income levels less than 48000 pa

A simple meal for a villager. Plastic serves myriad functions. It is easy to use, cheap and TOXIC. However, the alternative is carrying steel vessels, which adds to the weight of water.

WOUND DEBRIDEMENT

 at the Outpatient. Because of the Corona, most of these are being done in open air - 

true FIELD CONDITIONS

       

Wound Debridement in the Open air

 

An old man with a Diabetic Foot Ulcer getting a new pair of orthotic footwear. This service has helped our patients to no end.

HELPING HAND

A little girl, helping out her grand father. The elderly person has Parkinson's Disease making it difficult for him to do his day to day tasks. 

His grand daughter was the epitome of patience and empathy as she helped him navigate the crowds, roll up his  sleeves and wait for the medicines

          

        

The proud mother is a Type I Diabetic. We have seen her through at the RHC from age 12, i.e 10 years. She graduated and works as a teacher.
HATS OFF to the young man for marrying her knowing full well that she is a Diabetic and will be on Insulin lifelong.
We had a long chat with the groom, his parents and the girl's parents prior to finalizing their marriage

  

CORONA MASS TESTING AT THE RHC

AT REST

 

July to September 2020

 As the COVID scythes its way across the world, our little valley was not spared too. A smattering of positives in the surrounding villages. Most had mild symptoms. The PHC staff, ANMs and ASHA workers took good care, ensuring quarantine of the affected persons. So also the Village Volunteers who contributed their mite to ensuring the safety and welfare of their villages. All have recovered and are back to their normal lives.

Our patient load has been a steady 40 - 50 patients daily. This is a far cry from our normal daily load of 120 - 130. Lack of transport and fear of COVID are the 2 prime factors. Our numbers tell the story. This has affected our finances. Income has dropped quite a bit.

TOTAL PATIENTS: 2960

Under 15s: 45 - 29,  Over 65s: 531: 449, Adults: 936:970

Through the lockdown - April to June 2020

The experiences and learnings of the last three months need to be documented for successive generations of health care professionals.

COVID 19 has made us look anew at  disease epidemiology, progression, pathogenesis and management protocols. All of us, HCPs, have been involved in trying to understand, contain and control this pandemic. To a large extent we have been groping in the dark trying to understand this virus. Theories propounded only to be debunked in a few short weeks. 

To me it is reminiscent of the way humanity grappled with Cholera, Typhoid, Small Pox and Plague in the late 19th and early 20th century. It is only from the mid 1950s were we able to get a handle on infectious diseases. When I read accounts of past epidemics, I sometimes wonder how people could have been so stupid and not followed what we, today consider as basic tenets of hygiene, wound care etc!

I am sure that 30/40/50 years down the line, Health Care Professionals will laugh at the way we handled the COVID pandemic and feel the same way.

What has definitely improved is possibly personal hygiene - washing hands, feet before entering home, not shaking hands, maintaining a distance etc. 

However as time goes on, there has been an acceptance that this disease is not going away in a hurry. We have to learn to live with this and protect ourselves to the extent possible.

Patients have been trickling in through the lockdown, finding someway of accessing the RHC. There is a sense of trust and faith in the RHC. Many youngsters just come to collect medications for their grandparents or elders in their village. A coming together of the community, helping each other; something which has not been prevalent last many years.

Total Patients: 1383 (Our normal monthly attendance is about 1500 patients)

The majority of them (1355 patients) earned less than 48000 pa.

Children accounted for 26 and elders 385.

SOME PHOTOGRAPHS

Patient Screening at RHC, the masked staff of the RHC

Getting Ready

Screening

Staff waiting for the patients

PATIENTS - Patience is the name of the Game

 

Orderly queues outside the RHC. Distancing maintained

  

Waiting for her turn

An elderly couple with their daughter in law

 

Relaxing on his tricycle!

A shoulder to lean on - much needed

Medicine distribution

   

Waiting for Medicines

 

Food for the Soul

 

The open air eatery run by this couple

A tree falls

An old Peepul tree more than 70 years old, died. Successive droughts had battered it and then possibly a fungal attack on its roots, withered the tree from inside. The tree had to be brought down before strong winds uprooted it.

Thats for Now Folks

Syncretism

Reaching out, helping out has been part of humanity since time immemorial. It is only of late that we have started getting self absorbed in our own selves and become self centred - looking after our own interests at the cost of humanity itself
In such a situation it was hear warming to see an old lady being escorted to the RHC by her neighbour - who is not a relation to ger at all.
The old lady is from Nimanapalle, a small town about 10 km from Madanapalle. Ever since her husband passed away a few years ago, she has been living in Madanapalle with her elder sister. The elder sister herself is paralysed following a stroke. Both these old ladies get a monthly pesnion of INR 2000 from the Government.
Their neighbour, looks after them, cooks for them, helps in household chores etc - and this notwithstanding the fact that the old ladies are Hindus and the one looking after is a Muslim

One can see the staring eyes and expressionless facies of possible Parkinsons

July to September 2019

June was hot and dry, towards the nd of July the rains picked up. August was better and as we approached the end of the third week of September, we had good rains and from being deficient rainfall we are now on par. Everyone is mighty thrilled with the bounty of the gods.
The groundnut crop is doing well. The farmers say that the size as well as number of nuts per plant is good. They hope to get a good price for that
So also the tomatoes which have shot up. The spread of rainfall was good and so the crop was good. As they say one persons bounty is another's misery. Floods had washed out tomato crops elsewhere so the farmers in our region had a better price. How I wish that there could be an even distribution of farm income.
Patient Data
Total: 6553
Children: Males: 301; Females 336
Elderly: Males 887; Females 679
Adults: Males: 2042; Females 2308

Having an extra hand in Dr Anandhi has definitely reduced the stress and the fatigue!!!
Cheers

April - June 2019

Wow its been hot. In the last 20 years never seen temperatures continuously above 41 C. Sapped us thoroughly. As an emergency measure put shade nets over the waiting area and got 2 air coolers to alleviate the suffering of the patients who have to wait for hours as we ploughed through the crowd. Frayed tempers, exhaustion, irritability all in equal measure. What a relief it was for all of us when the vacations rolled by - a much needed break.
Back to work on 01 June and back to work. The heat abated a bit but the rains have stayed away.

Patient Data
Total: 3823
Children: Males: 99; Femakles 118
Elderly: Males 556; Females 433
Adults: Males: 1283; Females 1334

cVEDA Project
Children at play drawing and colouring as they wait their turn for the assessments. This was a great way to engage the kids through the long questionnaires.

A Young Baby

A 3 month old baby presented to the RHC with signs of Congestive Heart Failure due to a congenital heart problem. We successfully resuscitated the baby here and then admitted at a secondary care centre. After the baby stabilised, he was referred to Krishna Institute of Medical Sciences, Hyderabad. He was operated there by Dr Anil Kumar, Paediatric Cardio Thoracic Surgeon and his team, under the aegis of Arogyashree medical scheme. The baby has made an excellent recovery. God Bless the team at KIMS, Hyderabad.
 

                                                                         







  

Jan to March 2018

Winter stayed on for quite a while, a blessed relief.
A conscious decision was made to try and reduce the numbers of patients accessing the RHC daily. We found that well off patients and patients from far towns and cities were thronging the RHC for treatment of Diabetes as well as Thyroid disorders. The loads were becoming too much to handle. We started sending back patients as well as giving appointments.
However the aged, those with complications were given priority to be seen that day itself.

Most afternoons, I find it increasingly difficult to focus on what the patients are saying, registering their ailments and then try and find appropriate remedies for them. There, would,  possibly be some, not so appropriate treatment as a consequence of fatigue. However what we ensure is that the basic medications are correct. For example dose adjustment for diabetics, diet advise, foot care are not compromised upon. Aches and pains, dyspepsia are possibly given short shrift!

6706 patients accessed the RHC during this period
Children (less than 15) M 242 : F 264
Elderly ( more than 65) M 747 : F 709
Adults: M 2190 : F 2554

Income - less than 48000 pa : 6563 and more than 48000 143

Jan to March 2017

Wow its hot, March has been sizzling. Temperatures upwards of 38 Celsius and working in the heat in the mid afternoons - phew!!! Patients sit uncomplainingly

Lots of patients: 6968 of them, with the majority earning less than 48000 pa.
475 children below the ages of 15 and 981 elderly patients.

The drought has also affected the earning capacity. The effects of demonetisation are slowly fading though.

April promises to be hot as well

The year past saw us cover 22742 patients, an increase of 5% from the last year. Quality affordable outpatient medical care is so much needed. Almost 95% of illnesses could be treated at an outpatient level. The need is to have dedicated doctors and staff in rural areas. I frankly do not see it happening given the way our medical education is structured.

 This young girl had an extra orbital pseudo tumour which caused ptosis of the left eye. She was operated at Hyderabad and is slowly recovering.

 This old lady, with Hypertension, Stroke and Diabetes makes a trek of almost 40 km to reach the RHC. She has to change 3 buses to reach. We were able to help her with some transportation charges so is now able to hire an auto. She comes once in 4 months for a review.

 Young man with Congenital Hypothyroidism. Mis diagnosed and Mistreated - literally abandoned by his parents. Slowly brought under control. I suspect that he has other endocrine deficiencies too.
















Diabetic feet are so common - lack of foot care, injuries due to bare foot walking, poor nutrition all add up to this debilitating condition. Loss of earning capacity adds to the woes of the patients.

Throngs of patients. This was at 1700 having seen an OP of 180 patients

This young girl with type 1 Diabetes - is an aspiring state Basketball player. She made it up to the semifinals in the recently conducted nationals at Rajnandgaon. However she could not make the cut. Wondering whether her illness precluded her selection. 

She is well controlled on Insulin and has excellent parental support.

That's all for now folks. Looking forward to a break in May

March 2015

Clear skies, warm nights and increasingly hot days. Summer is here and rather quickly. The trees are withered and all the leaves fallen off. Looks like a hot summer ahead. There is already talk of El Nino doing the rounds. Wonder what it augurs for our monsoon? 
The media has stopped reporting H1N1. Maybe the real issues will surface, but one doubts it as malnutrition, Diabetes, Hypertension are not headline grabbing stuff. 
The heat does not seem to affect the inflow of patients however. The crowds seem to have increased. Wonder where they get their money from with crop failures and no work?  

Total Patients: 2293 (Annual Total 2014 - 15: 19650, Annual Total 2013 - 14: 19477)

Below 15 years - Male: 125; Female: 120
Above 65 years - Male: 99; Female: 88
Adult: Male: 877; Female: 984

Income (₹) Distribution

Below 12000: 1364
 12001 - 24000: 737
 24001 - 36000: 108
36001 - 48000: 51
Above 48001: 33

February 2015

Clear skies, cool nights and mornings, a little bit of dew in the early hours, spring is here and a few new leaves. As yet nature has not indicated how the monsoon might be. 
A quite month, but for the H1N1 scare which seems quite misplaced, if one looks at the absolute numbers. More people die of TB, Malaria and other so called common illnesses and yet the media continues to write about this "new" disease!!!! Wonder how long the media interest will last. The response of the Min of Health has been graded and well thought out, No knee jerk reactions.

Total Patients: 1700

Below 15 years - Male: 97; Female: 89
Above 65 years - Male: 74; Female: 76
Adult: Male: 647; Female: 717

Income (₹) Distribution

Below 12000: 1032
 12001 - 24000: 538
 24001 - 36000: 63
36001 - 48000: 36
Above 48001: 31

January 2015

The new year has dawned clear and bright. It was warm over the new year but cooled dramatically after that for a few days. Not a hint of a cloud. 

This is also the time for Sankranti - the harvest festival. Quite subdued this year with the lack of rains. The long wait for the monsoon has begun. One hope that this year at least we get bountiful rainfall

Total Patients: 1714

Below 15 years - Male: 92; Female: 82
Above 65 years - Male: 65; Female: 64
Adult: Male: 700; Female: 711

Income (₹) Distribution

Below 12000: 1238
 12001 - 24000: 361
 24001 - 36000: 63
36001 - 48000: 35
Above 48001: 17

December 2014

Well the North East Monsoon fizzled out. A few drops here and there and that's it. This year we have had just 25 cm of rainfall. Migrations from the villages to the cities has started and of course most bore wells are dry. The South West monsoon is still 5 months away. Wait and see, hope and pray. 
Though we had a fair number of patients, we found that many of them were opting not to do testing or asking to cut down on the number of investigations or drugs prescribed. For example - a Diabetic with myalgia who would benefit from Calcium and D3, but could not afford it, was prescribed only Oral Antidiabetic drugs. Such examples are many. Also patients are postponing doctor visits, simply because of the costs involved.

Total Patients: 2161

Below 15 years - Male: 120; Female: 114
Above 65 years - Male: 89; Female: 104
Adult: Male: 838; Female: 896

Income (₹) Distribution

Below 12000: 1324
 12001 - 24000: 688
 24001 - 36000: 75
36001 - 48000: 42
Above 48001: 32

November 2014

I have been away for almost two months, tied up with various domestic issues. Spent time in Chennai.
The RHC reopened 2nd week of November and a few patients started dropping by.
The constant refrain was the lack of rains and the hardships it has caused
Hoping that the North East Monsoon will at least bring some rains. Its also become quite cold in the nights.Always wonder how the poor survive!

Total Patients: 751

Below 15 years - Male: 64; Female: 63
Above 65 years - Male: 52; Female: 47
Adult: Male: 275; Female: 250

Income (₹) Distribution

Below 12000: 522
 12001 - 24000: 162
 24001 - 36000: 30
36001 - 48000: 21
Above 48001: 16

October 2014

The vacations are due soon, the RHC will close for Deepvalli in the 3rd week of October. The number of patients has come down, possibly due to the lack of rains and also the fact that the RHC closes.
End October is also when the investigators for the Controlling Hypertension in Rural India (CHIRI) a multicentric study meet in Hyderabad to discuss progress and future plans

Total Patients: 1316

Below 15 years - Male: 77; Female: 55
Above 65 years - Male: 69; Female: 68
Adult: Male: 502; Female: 545

Income (₹) Distribution

Below 12000: 805
 12001 - 24000: 416
 24001 - 36000: 51
36001 - 48000: 25
Above 48001: 19