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TRIBAL HEALTH INITIATIVESittilingi, Tamil Nadu, India
Experiences in training Para-medical Workers
Dr. Lalitha Regi
Presentation at ARSICON2008
Wardha
Helping tribals heal themselves……
Invocation
To the tribal Gods who protect our people
Sittilingi Valley …..enveloped by the Kalrayan and Sitheri hill ranges
Sittilingi and the Avalur valleys have 21 hamlets which are home to about 10,000 people of whom 95% are tribals
Need of the area Remoteness – nearest referral centre was
100km away No “modern” facilities Staff need to understand and empathise
with the tribal population Villagers need to feel comfortable with
health care providers
Selection Initially looked for
educated girls – 8th Std Now we send out
information – applicants have a written test on basics of language and mathematics; then interview
Selection based on aptitude, attitude, region, income levels
6th batch in progress
Health Worker Training
Caring , respect and shared concern
Balance classes with practical work
Training – general principles Design according to the need of the area Emphasize student’s role as educator How things are taught is more important than
what is taught Caring , respect and shared concern Balance classes with practical work Understand social causes of ill health Make people more self reliant and less
dependant on institutional health care Participatory training
HWs’ manage most of the Hospital
•See Out patients 4 days a week
•Conduct deliveries and assist surgeries
•Manage Ward and emergencies
Deliveries & Neonatal Care
Advanced Neonatal care
About 30 deliveries a month and 3 - 5 for neonatal care per month
Surgical Work
About 20 – 30 surgeries every month including emergencies .
Surgical training· 1. How to do basic dressings
· 2. Injuries – how to examine, clean, debride and do the suturing if needed.
· 3. Check ante-natals, monitor and assess labour and conduct deliveries including some of the abnormal deliveries like breech delivery
· 4. Examine and do incision and drainage of abscesses
5. Surgical removals of small swellings like sebacious cyst, lipomas etc.
· 6. Local anaesthetic blocks, giving and managing of drugs like ketamine and thiopentone
7. Manage spinal blocks and intra-operative management of general anaesthesia
Surgical Training
Simple surgical procedures like cysts and other swellings
Surgical Training
Dressings, I & Ds
Assisting Major surgeries
Anaesthesia training
General Anaesthesia
Spinal Blocks
Community Health
Health Workers now plan and implement the Community Health Program
Health Care at the doorstep – postnatal care
Field Clinics
Health education is the key
LaboratoryTechnician
Basic tests we taught – practical & theory Biochemistry & maintenance – other hospitals Government recognised lab – TB & HIV Seniors train juniors and we check – 5 have skills All Health Workers learn basics TB/HIV – Government uses our lab as an example
X-ray/ ECG technician
1. Theory taught by us2. Practical learnt in large hospital1. Seniors train juniors , theory we teach 2. 5 Health Workers know
Pharmacy
Drug names and actions taught – to all Basics of dispensing taught – to all Stock keeping and ordering – one person
specialises, one assistant
Advantages/Disadvantages
•Brings down workload
•Treatment inexpensive
•Knowledge passed onto community
•Increased confidence & self esteem
•Gives us time to look into other problems in the community
LEGAL PROBLEMS !!!?Non – Recognition from other hospitals
Achievements No maternal death – 5 years Infant mortality – from 147/1000 to 32/1000 Malnutrition – down by 50 % Antenatal mothers check up – from 11% to 95 % Almost 100% completion of treatment in TB Hospital attendance from our area – decreased from
50 % to 20%
Tribal Hospital – Staff patternNon tribals
3 doctors 1 Administrator
Locals 14 Health Workers 2 Lab Techs 1 X-ray tech 2 Pharmacists 3 Admin assts 2 Drivers 7 HW trainees
That formal education is mandatory to do health care is a myth
Help people heal themselves…..
References Health for all-Alma Ata declaration and
after-N.H.Antia The Alma Ata declaration and goal of
health for all-David Werner Health Care in India ‘a profile’-Devraj Chauhan,N.H.Antia,Sangita Kamdar
Thank you
For more information check out
www.tribalhealth.org