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Sunday, August 21, 2011

Is Primary health care possible through Siddha

On an informal discussion a senior Indian Administrative Service officer with firm conviction of the efficacy of Traditional Medicine asked me if it is possible to provide primary healthcare to all residents of a settlement with Indian Traditional Medical systems. Earlier having applied for a project to Dept. of AYUSH under Public Health Initiative scheme to implement Primary Health Care through ISM for migrant workers and displaced community and the project still bending for a long time in spite of being considered as a good initiative, I replied in the affirmative. She mentioned that under corporate Social Responsibility of the Public Sector Finance Organization she heads CTMR will be given a grant towards the cost of medicines and for promoting Home Herbal Garden, but after an year it’s the responsibility of the organization to make the people understand and agree that ISM approach will reduce frequency of illness and reduce health expenditure. CTMR grabbed the opportunity and wrote a proposal and submitted to Tamilnadu Industrial Investment Corporation. The Chairperson Mrs. Sheela Rani chungath invited CTMR to make a small presentation about the project to the Board of Directors of TIIC. The board readily agreed and on 20th August, exactly a year ago the grant was given on the inaugural day of the Siddha Health Centre in Chinnandikuppam a fisherman colony.

Once it was decided to launch such a programme next started a discussion among the volunteers of CTMR on the location. It emerged that the Centre should be in a settlement of a marginalized society not very far from the city so that it could be closely monitored as it is a pilot project on Public health through Siddha. With prior experience in interaction with fisherman community and their secluded lifestyle from mainstream due to their vocation, basically depended on the coast line and odd working hours and the recent losses they suffered in TSUNAMI, it was decided to start in Neelangarai, Vetuvankeni area. The Posh neighborhood of the rich was little frightening, whether we will be able to get a place. Then came the memory of the Place for health centre available with Catalyst trust at Chinnandikuppam. A Telephonic call was made to its chairman and consumer rights activist Mr.Desikan. He readily agreed to provide the place but also cautioned that the Siddha doctor from Kelambakkam PHC was supposed to visit twice a week but it did not materialize. He also said an allopathy doctor visits every day for a short while and the community participation is not very encouraging. The nearest Siddha facility was Govt dispensary at Adayar – 15 kms away or Kelambakkam 22 kms away. For Hospitalization it is 30 kms to National Institute of Siddha or Anna Hospital, Anna Nagar.

We decided to do a survey of the colony on the awareness about Siddha or any other traditional medicine and utility pattern of health care. Dr.Murugesan, Dean of NIS and Dr. M.Meenakshisundaram readily agreed to send their PG students and internees. CTMR physicians along with the 15 carried out a door to door survey and found the awareness level to be 10% and actual utilization at 3%. This worried us more as if this is the situation where two major hospitals and four teaching institutes exists what would be the status in rural Tamilnadu.
We decided to Organize the Inaugural meeting as an awareness meet and Mrs. Sheela Rani in her conventional way made a very impressive passionate speech in a language of the common man connecting with them. There were more men from the community with little participation from women. So we thought women may not avail this facility. But once we run the centre we realized that men were reluctant as they felt Siddha medicines will not go well with non-vegetarian diet and their alcohol consumption. More interactions in informal group discussion were held to dispel the fears and it was explained to them Non-veg in general is not a barrier to Siddha medicine and alcoholism is any way bad irrespective of the system and in fact taking hepatoprotective drugs of Siddha will reduce the burden of alcohol intake for the vital organs.

Then the procurement of medicines. A list of medicines were drawn based on the essential drug list of the Dept. of AYUSH and due consideration was given to select cost effective alternatives so that the project is sustainable. Due care was taken to include herbal medicines and essential herbo-mineral drugs so that adverse drug reactions were minimal. IMPCOPS procedure of providing institutional membership was delayed but their dealer agreed to provide medicines at same cost and promised just in time delivery. It was a different story that IMPCOPs revised the price of certain key drugs like Thiriphala churanam by 40 % and therefore quantum of drugs that could be purchased with the grant came down for the same value.

Our volunteers went home to home to create awareness about the system and the services rendered by the centre. Dr. Priyadarshini and Dr. S. Rajkumar were the regular doctors and Dr. Padmapriya visited initially every friday till Dr. Priyadarshini got complete understanding. Dr. Priyadarshni had to leave after eight months due to personal reasons and Dr. Indhumathi joined the team. I must acknowledge each of them meticulously maintained medical records and in fact Dr. Rajkumar underwent training on software for AYUSH medical record keeping and analysis.
Then we also extended the services to velankadu a village between Thiruporur and Thirukalukundram , a displaced persons belonging to dalit community settlement colony as many of them had no regular job or land holding and a poor health history. This was done every fortnight and an educated person in the village was trained and given a simple kit of siddha medicine for fever, diarrhea, common cold and scorpion sting.

Analyzing the data after one year, All members of the village are now aware of siddha and simple plant remedies. Now they try steam inhalation, fomentation, use of adhatoda decoction made at home fenugreek and asafetida for abdominal spasm. About 90 % have a health card of our centre and for majority of them Siddha Health centre has become the first contact for condition like fever, head ache, common cold, sinusitis, Acid-peptic diseases, diarrhea, muscular sprain, anemia, post-natal care, scabies wounds in children and many other conditions. About 40% have become well after one or two visit while 20 % keep coming for routine check of Blood pressure etc and only 10% have dropped out. Though minimal level of cleansing therapies and external therapies are being carried out in the centre further infrastructure is required. In all now 1100 patients (Absolute number and not number of patient visits) are availing the facility. The Cost of medicine dispensed so far is close to Rs 1,50,000 which works out to Rs 137 ( Rupees One hundred and thirty seven per patient per annum) including conditions like anemeia for which at least a month treatment is required.

Since on every visit the medicines required for treating the episode is given – say for 3 -7 days depending on the condition and for conditions like NIDDM one month medicine is given the patients are not forced to frequent the clinic which prevents loss of absenteeism from their vocation. More so the time of the centre so flexible as the large chunck come to the centre between 12 Noon to 2.30 P.M after completing sale of fish in the market.

  • Siddha could definitely be a solution to fulfill primary health care needs of a community.

  • Cost of Treatment with Siddha is certainly low with judicious choice of drugs combined with proper adoption of dos and don’ts

  • Maintaining a proper medical record is possible when patients numbers are limited to 30/day per doctor- though during initial period this may be difficult- a volunteer support may be required.

  • There is a need to make Siddha available in every place which will definitely improve utilization

  • News about the centre in English newspaper though has created awareness among others but has not helped reach the target population but has generated interest among others to think of supporting such interventions

  • Excepting on Sundays and National holidays this centre was never closed as some other physician was deputed
    CTMR team is grateful Mrs Sheela Rani Chungath for the motivation and TIIC and others for the support. The informal leaders of the community and volunteers who took part in the health survey.

1 comment:

V.Karthikeyan said...

Amazing write up Dr. Thirunarayanan. Very happy to hear the news. Let God Almightly help your noble cause improve further.

V. Karthikeyan,