BACKGROUND MATERIALS FOR THE MEETING 'LISTEN AND LEARN SESSIONS : PRIMARY CARE AND OUTREACH
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- Title
- BACKGROUND MATERIALS FOR THE MEETING 'LISTEN AND LEARN SESSIONS : PRIMARY CARE AND OUTREACH
- extracted text
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RF_COM_H_102_SUDHA
4/11/2019
learning from primary care experiences
SJMC/ SOCHARA- 1971-2019
St. John's Medical College
Phase 1963 -1983
Listen and learn sessions: Primary Care and
Outreach Experiences
12th April 2019
Dr. Ravi Narayan,
Community Health Advisor
Sueiet) lor Community Awareness, Research and Action
The Elusive goal of Medical Educatio
n in
India - 1946 onwards
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st. John’s Medical College
Aims and Objectives
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- Aimsand Objectives ofSJMC lOAn
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form doctor5
doctoi characlcri2cd
a
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KB jsaiVAsM''*
dXto'’°“'‘irl’CCT’ C°IIeBC "'l,crein- education regulater"'
• ’ Perf‘;cts’the whole aggregate of human life, physical
sp.ntua!, mtellectual, morai, individual, domestic aiJI social >
Most Rev. Angelo Fernandes, CBCI
A Dilemma of all medical colleges:
What type of doctor should we produce?
A JOURNEY THROUGH HISTORY:
KEY DOCUMENTS FOR THE SECOND
__ ______
hl
DECADE
PT---- ------- -
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CBCI Report - 1977
Cor Unum Document
1977
ACHARA 1973
1
4/11/2019
The First Decade - 1963 - 1973A Perspective Report to CBCI -1977
Re-orienting Medical Education
WHAT'S WRONG?
> Too much stress on curative medicine - little or non in
preventive and social aspects
> Too hospital and specialist oriented
f No community orientation
> Foreign text books/ experience bias
good academic standards and departments
• Indcntified and appointed academic, well qualified and
❖EZhshed Sta7Vith " AI1 India backgr°-d (-en state, in ,976)
Esubhshed a selection procedure process which involved
quahK.ng examination marks, entrance test, psychological
tests and interview.
°
❖Strong emphasis on student formation and facilities-hostel
. '•‘t,l l'^ch.qda|nly,ethics teaching, tu,Orship scheme, etc
• Good Umvers.ty examination results on an average - 80 to 100%
results and many university medals
• clinical departments
rrarch r"’m
ver-v
HOWTO SET IT RIGHT?
From Cadaver and Clinical orientation to community orientation
Introduct.on to sociology,anthropology,economics,statistics
' Commun.ty Health Centre, postings during internship
£spifa|inVOlVCmCnt in hea,th CarC <ldivcr7 bc/°"d caching
- "<■-
trrr.Ti niCChaniS,nS ^Wished - CBCI Society and EC
stucten s vl'T
§CC CamP rCSP°nSe in 1971
,nterns &
■ tudents which was inspiring and greatly appreciated.
Inspiration: Refugee Camp 1971
What sort of health Professional would you like to be?
J
Documentation of local knowledge and experience
Experiments in lowcost appropriate health care
General practice orientation and integrated teaching
z Incentives for rural work
Source: Narayan.R, 1972 - 1974
RECOMMENDATIONS OF THE REVIEW COMMISSION
on the 1st decade (May 1973)
.
^^1
Papersand Dissertation on Medical Education Reform
( Dr. Ravi Narayan,.Registrar, SJMC, 1972-74
Q
medical Education relevant. A student’s point of view
.
LOOKINGTOTHE FUTURE
.
v Orientation to teaching in rural health.
<• Explore setting up of community extension services and
orientation courses
Bond scheme to make students work in rural areas
y Greater perceiii«ige of religious sisters as students
❖ Social commitment to be enhanced
- Ascertain commitement of students to social service at
selection
teachers with missionary zeal for community
health and willing to work part time in such community
situations and able to inspire students in this direction
. increase alumni serving in non urban areas a sign of
achieving objectives.
Experimentation in Community
Orientation at St. John’s - 2nd Decade
1973)nJ°Urna OfPreventiveaud Social Medicine,Vol 4, June
□ Making Medical Education Relevant to the needs of the
society : A student point of view
(Indian Journal of Medical Education,Vol XI, No 2 &3, Aproep, I 7/2)
•
( quoted in Park's Text Book - 12''- Edition in Chapter on Sociology!)
□ Trends in undergraduate Medical Education in India :
Training Doctors for Community Health Services.
(Dissertation for Diploma in Tropical Public Health,
University of London, June 1973)
—Xu
Swiirr CortiHtifftfiy
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2
4/11/2015
initiatives in community outreach
SERVICES IN THE SECOND DECADE-1
The Pontifical Council Cor Unum , 1976
THE NEW ORIENTATION OF HEALTH SERVICES
COMMUNITY PROJECTS
Mallur Health Cooperatives,SiddlaghataTaluk
> Siluvepura Health Centre , Hessaraghata
PrXT)1 HeaIth Pr°jeCt’ DOmmaSandra (SBI
- Dommasandra Health Centi:re
- Mugalur Health Centre
- Bidraguppe Health Centre
-Yadavanahalli Health Centre
- Huskur Health Centre
> Urban Health Centre, Shantinagar
Cm’ " ,^1' tast ,h‘’ ,l-a'cn <’ too far
removed from the loaf
in<l l,i”n"rs ■" ‘he health field
by
initiatives in community outreach
SERVICES IN THE SECOND DECADE-II
COMMUNITY BASEDTRAINING
> Rural internship in Mallur, Siluvepura
Oornmasandra, Mugalur, Huskur, Bidraguppe,
and Yadavanahalli
& 11 ’
'■>
I »— 4- « .
I
•
Broadening the Horizon
4/Sa X
fa mL,
—A''
>i m. ftp A.
• •.uv. llauIp in Iea piantatioi
'ns in Coonoor,
Anamalais, Wynad, Munar. (Ross
Institute unit
and CLWS-UPASI Partnership.)
> Rural orientation program for medical
yv *
stu ents-/nurses in Dommasandra (ROP)
Epidemiological projects in rural centres
SoCrAL AxALVtrtl
• "j'i
•^X'MHWvaAl Sc.lHCf]
•'otM-ruTiciT
rcocosv
L«MI*
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-------- [VALUC
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lOSlCX’ATIOM
no r b i t lotrj— ------ —
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COMMVNrTy OeilHrAtlOH I l1e
People Centered Primary health
care before Alma Ata-1978 -IV
Alternative Approaches to Health
care
- an ICMR Study 1976
0
initiatives in community outreach
SERVICES IN THE SECOND DECADE-III
• Integrating Health with
development activities
• Preventive and Promotive services
•
Lw;
AppropriateTechnology
healers1'011 Of loCal resources an<l
• Village based health cadres
• Community participation
• Community organization
• Local finances through
cooperatives
6
• Education for health
• act?onknti7'at'Onand Political
ICMR initiative and Monograph 1976
TEACHING HOSPITAL OUTREACH
Action Group for Community Welfare (AGFCW)
- Network of institutions within five km around
St.John’s Hospital
> Social obstetrics outreach clinics in Uttarahalli
■
P Social Pediatrics outreach from St.John’s
Hospital in AGFCW area
Specialist camps in all Community Health
Centres facilitated by interns initiative
Medical social work unit in Hospital
Source: Narayan, 1985
■
3
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initiatives in community outreach
SERVICES IN THE SECOND DECADE -IV
Report of Workshop for Pioneers of the
Rural Placement Scheme of SJMC-May
1984
OTHER HEALTH INITIATIVES
> Ross Institute Unit of Occupational Health focusing
□Recommendations on Medical Education
□Recommendation of Rural Placement Scheme
on non.industrial occupations including plantations
( Collaborative partnership with LSHTM and UPASI)
Ross Society of Occupational Health ( Multi
□Some Mission Hospital Policy Issues
institutional network to support above)
Q History of Medicine museum (Late S.L.Bhatia)
Rural Bond Scheme Liaison Office and Officers
Support to Community Health Department of
Catholic Health Association of India from 1981
( included CD Ravindran, George D’Souza, Domnic
Misquith, A Mohan, K.R Antony + 14 other RBS
doctors & also Prem Pais, Ravi Narayan,Thelma
Narayan, MJ Thomas, Mario D’Souza,
Sr. Agnesita, Sr. Adelcia and others )
Community Medicine Departmental
Development :(1979 onwards)
WiCf'S
ur” Refo™ through graduate .
feedback-ACHCStudy (1993)
I
TWO COMPLEMENTARY WINGS
Key Findings from feedback of SO graduates
University Department of
Community Medicine/
Health
<• University linked
department
•> UG/PG teaching
•> Internship
<• Research (Interns, PC’s
& Stall)
•••
Rural Urban Field Practice
Areas
<• Mobile clinic services
••• Hospital Collaboration
working in PHCZ PHI
Directorate of Rural Health
Services and Training
Programes
Extension and Outreach
initiatives
— Cor.ii.'.uiiiiy rieaith
Orientation courses
(Doctors, Nurses, and
CHW’s)
Plantation Medical Officer
Courses
Ross Institute Unit of
Occupational Health
Networking with CHAI.
VHAI,CMAl,etc
Skill developinenlorientalion and capacity for
independent decision making
1-
6',OL''^5w.‘'e’'£AL
£»ct<^ reepa^K
Involvement in community health programme.,
2-
penpherals health institution., primary health
renters.
17
(,5r
,
3.
kxaiiiination reform
4.
Career guid.iiH
. ........................ Internship int i........
thstritt Ixmpilalti/NGO tenter.
KSthg6'
- k
Introduction to alternative ayitem. ofinetliciiies,
ethics,management etc
(Many Johnites who had completed rural
-CO Ir^r
placement scheme were part of this study
anti many are now senior leaders including
participants of this workshop.)
—H°S,U11Y
1
St. John’s Medical College identified as among
------- o......... ........... as among
six pace setter institutions
^TlATKIM
1.
RO*. 3«4*L KIUWMcr
THE CHC/SOCHARA
PHASE 1984 - 2018
*NJ
I •>*H*W; *
Define institutional objectives with social
component
OMMTMK*
fwi*w U*wifa<a
2.
Selection procedure based on group
observations on social skills, values, and
motivation
1
3.
Well organized community health
department with six field practice areas
_ J kK/Oiirx
i______ j
4.
;
w*- 1
Rural orientation program for I” years &
community posting in clinical years
5.
Community inivnuhip including plantation.
6.
Community based ipccialist camp.
7. Rumi bond scheme
J
- a C»?•<■» I .<>,»<
#.
MciHchI Ethics tcuching
9.
Community health worker, training
10. Student nurture program, including tutonhlp
4
I
1
4/11/2019
Recommendations of RPS workshop May 1984
Studentship
•^’Community orientation camps
❖ Graded clinical responsibility during Hospital posting
Internship
•’•Promote capacity for independent decision making
❖ Promote procedures/competence based program
❖ Skills outlined for Medicine, Surgery , OBG, Community
Medicine
❖ Postings in Pediatrics, Orthopedics, Ophthalmology, ENT,
Dermatology and Psychiatry
❖ Casualty Service posting
THANKYOU
Post Internship
❖6 months - 1 year housemanship.
Inspiration: A new orientation to health
development
-c
SB
......
i WHICH WA’y%%0 -
A nationwide platform of
secular, pluralist, and
pro-people, pro-poor
health practitioners,
scientistsand social
activists - critically
analysing, and
developing a system of
system health care which
is humane and meets the
needs of the vast
majority
For further information visit
www.sochara.org
www.com m u n i ty h ea 11 h. i n
http://mohfw.nic.in/NRHM.htm
www. m fc i n di a. o rg
www.copasah.in
5v w w. p h m ove ment.org
www.ghwatch.org
www.phmovement.org/iph U
5
The rural service obligation/rural bond - St Johns
On the 17th of November 2018, a meeting was held to discuss the Rural Service Obligation of 2 years
that St Johns Medical College has as a part of the MBBS course for undergraduates. This Obligation
or bond can be completed either by working in a peripheral centre designated in a list by St Johns or
by paying a certain specified amount to the institution.
The St Johns Facuity and alumni who were part of the meeting:
Dr G.D.Ravindran
Dr George D'Souza
Dr Bobby George
Dr Suneetha Nithyanandan
Dr Dennis Xavier
Dr Pauline
Dr Clement
Dr Johnson
Dr Randall Sequeira
Dr Carl Britto
There were a number of limitations to this meeting the foremost of which was a time constraint due
to which issues surrounding the rural service obligation couldn't be discussed in complete detail. But
a number of issues were broached and the most important reason why the bond should be taken up
as a service by the SJMC management to improve so that it becomes an enriching experience to
both student and the institution they serve at was also touched upon. With the increase in students
and a change in their demographic and geographic backgrounds, new regulation-way of entry like all
other medical colleges with the matrix, change in fee structure (increase) and change in the bond
amount (increase) it might seem like SJMC might be veering toward being any of the other private
medical colleges in the country.
In such times, the 2 things that would set us apart as a unique autonomously medical college are:
1) The large number of sister doctors who pass out from our college and go on to work in the vast
network of peripheral hospitals all over India serving in underserved areas.
2) The fact that we are one among the very few non-government medical colleges that expects its
students to do a 2 year rural service obligation.
Both of these services provided by St Johns Medical college are along the lines of the mission
^tement of St Johns- He shall Live because of me and that should be our guiding principle in all that
The various suggestions and improvements discussed along with the reasons for the change, during
the meeting were as follows:
1) Rural Bond or Rural Service Obligation - The Name : A number of the places where doctors serve
this posting of 2 years aren't rural in the right sense of the word. It was unanimously agreed that this
epithet could be replaced by either Community/ Underserved areas. A bond has a slightly
derogatory ring to it and a service obligation is language that young doctors do not relate to in the
present generation. Although a number of suggestions were discussed like Experience/
Opportunity/Liaison/ Interchange/ Convergence. A change in the name although not essentially
necessary does initiate a favourable thought process towards the way younger doctors graduating
from medical college look at the "Bond" and a name change was therefore suggested without any
change in the actual specifics.
2) Criteria for Bond centres: There already exist a criteria for Bond centres as A and B centres based
on the proximity to cities and ease of doing medical work -. This criteria though is slightly inadequate
and there needs to be a basic framework of infrastructural and personnel based requirements of all
the bond centres (that number upto 300).AII centres should have decent living facilities for doctors
residing there with the possibility of internet connection both to make contact for medical and
medico-legal issues as well as for entrance preparation. Once there exists a criteria like this all the
facilities and support available at each of the bond centres can be enlisted and tabulated and
regularly updated so that they exist as an opportunity for the doctor posted there to learn
something new or practice something already learnt. For e.g. OT facilities and the presence of a
surgeon/ anesthetist/ nurse anesthetist to learn basic surgical or anesthetic procedures like l&D,
debridements and laparotomies, Ob/Gyn and radiologist with USG facilities to learn obstetric or
emergency ultrasound and conduct normal and high risk deliveries and provide antenatal services,
Lab technicians/ Internists /Paediatricians with a well-equipped lab for developing a sense of rational
use of investigations for diagnosis and medications for treatment.
This criteria as it is developed finalised and then applied to all the bond centres over a period of 2-3
years can then be ratified by the CBCI as an official document to be used to include or exclude newer
centres
It also exists as a list - an opportunity for students to be able to learn new things and the
shortcomings of the centre so that as a medical college we could provide infrastructural or personnel
support in case of dire need
Centres that do not match up to the criteria already developed but are truly underserved due to
inaccessibility or acute lack of personnel can then be visited and confirmed as Underserved areas
needing a doctor and the student can be given additional support if he /she decides to do the bond
at such a place.
3) Periodic Inspection: Once the above criteria is established there will have to be work done at
periodic intervals with the development of a monitoring checklist sheet for a yearly appraisal of
basic living, safety, personnel and infrastructure based facilities which can be filled by the centres
administration and an evaluation checklist sheet that can be used on surprise checks if possible by
faculty at St Johns to make sure that the same standard of care is being maintained.
4) SJMC's responsibility to its students and the centres they are posted in: The underserved areas
service obligation is an excellent opportunity for St Johns to train doctors to make them reach out to
more peripheral areas where health care is an acute need, particularly places that have poor health
care indicators like the aspirational states in North, central and Eastern and North Eastern India as
well as in pockets of the South. There needs to be extensive 2-3 days trainings before leaving for the
service obligation on protocols to be followed in case of emergencies of all kinds, basic protocols to
be followed in case of common obstetric, gynecologic, medical, surgical and paediatric problems
which can then be extended to other specialities like ophthalmology, ENT, Dermatology and
obstetrics, a primer on how to do a health needs assessment in the community or in vulnerable
groups in the community and on how to develop a comprehensive community health program
replete with health education and awareness on government schemes, increasing activities in rural,
tribal or vulnerable communities, a protocol to be followed in case of medico-legal issues as well as
inter-personal issues with the hospital management or staff and a language primer in case the
student is going to a place where he has to learn a new language to communicate.
All of this can then be developed as a document which can be given to the student and the medical
protocols can then be used by the student at the rural outpost to improve the standard of curative
health care at the hospital level and the community needs survey and primer can be used to connect
with the community at a more preventive level.
A further follow-up with each student with the submission of a report and a strategic plan to
improve the health centre and the health status of the surrounding community can then be done
after 4 months which can be looked into by a combination of faculty both senior and junior in the
community medicine dept, alumni association, medical education wing and faculty of other depts,
who are interested.
5) Lack of company: A number of students who do the bond are sometimes the only doctors at the
centre or there are more senior doctors with whom the younger person cannot relate to. Posting of
2 doctors at more inaccessible centres, difficult centres for various reasons, high load centres can
help the problem of loneliness and lack of support that a number of serving doctors feel is a major
problem. In addition at these centres it also helps a pair of students to keep in touch with the
preparation as required for entrance exams
6) Orientation during UG: St Johns hostel with the hospital is a very closed community with the
hospital across the road and that's why the only role models and successful people that medical
students see during their MBBS are mainly doctors from the hospital. It is essential to have exposure
visits to colleges teaching the other humanities like sociology, philosophy, psychology, fine arts and
theatre as well as social work and a look into the curriculum and field involvement of these students.
Another intervention that the administration carries out are the CHAP and ROP program during the
first and third years of MBBS. This program is usually a very tailored experience in Mugalur with
repetitive work in the same centre. In contrast there are a lot of very popular hospitals where
students choose to do their bonds with a lot of both medical work as well as social and rural
immersion experiences. A small training program held for the members of these centres in St Johns
for a day or two followed by sending these students in groups of 10-12 students to each of the
centres can broaden the exposure of each group and there can be a debriefing and experience
sharing at the end of the CHAP or ROP
Toward the end of the final year or during vacations an informal visit to some of these centres can
also be arranged for the benefit of medical students
6) Distress protocol: It is important that starting of the rural service on a good note with the drawing
up of a contract and fixed duty days with extreme contingency plans in case of non-availability of
doctors should be insisted on by the student as well as by the medical college at each of the centres
a ong with facility for a leave policy. In extreme cases where a student is unable to cope with the
load of work, lack of support or severe interpersonal issues there should be a system in place for
counselling and support of the student as well as an opportunity for the student to pull out of the
ond centre. A number of cases of blackmail on the condition of not giving the bond completion
certificate are reasons why a lot of doctors and sister doctors continue at dysfunctional centres
despite being mistreated.
7) Documentation of stories and experiences: A number of faculty at St Johns have had marvellous
experiences while doing their bond. Some have had weird ones and some have had downright horrid
experiences. A documentation of these stories so that the popular ones can be made into a series of
interviews, short stories, comics, blurbs, essays or prose of any kind with photographs so that a
magazine can be brought out with possibly the help of the alumni association would help to
popularise the bond as well as look at where the problems are in the whole process
A documentation of stories of the 2 batches that are currently doing the bond can help to
understand how a lot of the centres function and help students form an opinion about the kind of
place they would like to work at
8) Quality of care in Catholic Mission Hospitals: There are a large number of Catholic mission
hospitals in India and a number of them are bond centres where Sister doctors who pass out from St
Johns go to work. The quality of health care provided at some of these hospitals is outdated and
they are run by congregational postings with a lot of internal politics. This affects the perception of
the hospital by the surrounding community. At a more existential level each of the centres where St
Johns sends its students to work should be considered an outpost of the Medical college and
hospital. The politics are not issues we should be getting into but by providing adequate support
both emotional and technical especially to Sister doctors with the involvement of the Sister doctors
forum of India as well as with the involvement of the management at SJMC as a moral authority the
standard of care provided and the community involvement of the mission hospitals will improve and
that will stand as a testament to the commitment of St Johns to its ultimate mission and vision.
9) Exit Interviews and Debriefing: There are already CME's being held twice a year for students doing
the bond and a Whatsapp group where they can post clinical problems. All of these students
eventually come to the campus to get their documents. A debriefing and possibly an exit interview
would help St Johns develop a database of the pros and cons of each of the centres that the students
have worked at as well as understand what problems the students face while working in the
periphery.
10)Retrospective Study: The bond was introduced in St Johns from a service perspective considering
the demographic of a country where 70 percent of its people live in far-flung rural or inaccessible
areas where health care isn't available. As an intervention its success can be measured by finding out
how many of the the alumni who passed out from the institute and who did the bond are presently
working in Rural, tribal, difficult or underserved areas as opposed to urban centres. A study thus
done would help the administration, management, staff, alumni and students to introspect on the
direction we are heading as an institute with regards to our mission
11) Full time In-charge and office: After discussions with Dr.Suneetha who is the present in-charge of
students who are doing their rural service , it is essential that the management recruit a full time
staff for the purpose of monitoring all the myriad bond centres and work related to the same along
with office space for the same. This could be in collaboration with the alumni association or done
with its help.
I do understand that in essence what I have suggested includes a lot of concerted effort and
collaboration right down from the management and administration to the different medical
departments with speial focus on the medical education dept and the community medicine dept as
we as various organisations like te sister doctors forum of india and the alumni association I also
know that some of what I have suggested might be rally impractical and this isn't a complete
document. Ido need all the help that everyone can give to make it so and improve on it
/■
7
y
1
fiK-
RBS/1/28/79
4th October# 79
Dear Dr.
As you may know the students of our College are liable
for two year period of Rural Medical Service on completion
of their internship. One of the first such Doctors,
Dr. K.R* Antony has been working in St. Thomas Hospital,
Poroor# in North Wynatf. district of Kerala*
He has recently written to us a very detailed letter
of Ms
in that Hospital, The letter has been
published in the College MagaaiW which will be out soon,
and makes very interesting reading. He has written again
recently with some suggestions regarding the Internship
programme. I am re-producing the relevant >
rts of his
■ ' i ideas will be of help in the
hope' that bis
planning of our Internship programme.
Y’ours sincereijfe
CCs
(Dr. Preffl Pias)
Liaison Officer
a) Dean
b) Prof, of Medicine
Pediatrics
c) M
Obst & Gynaecology
d)
It
Surgery
e)
f) President of Junior Doctors Association
■
.. ‘•’>-x97“
.' / 11
t.L!
2
1 ' 'f'
few thihgp which I feel th®t ,our House Surgeons going
village should master during their internship training (
they should sake tn effort, th erests chances and
<
job to
are, •
ly
' .ffe
'■
< "'
the
(1) ex'^rlance in gafctlng a vein Ip children including scalprelh, ''
and starting an. XV drip at the fastest pace. W®.nagleet
We neglect
leave th«t job to the nurses in Feed. ward.
(2)
'%■
'
experience In. doing < ftet'renous cut down.
(3) Reduction of dislocated shouldeV aM' first aid ■management df;*.compound fitaetutee
(4) Ollutatlon and curettage' - mnegnment of.
Breach -d^Jiwry./ Xnterwl
, 7
'
‘
\
'
'
.W
:■■
■
’
• ..
U < • pi—.xw.atiX0n of. outlet aftd midcavity forceps^ suctloR
«) Bxcision of largu sebaceous,
saoaeeous cynts.
cysts,' roanagamnt of s«mU cio*K
injuries, rsrovul of deep penetrating foreign bodies. Foreign
Body removal fra». tlie eye, . .
(7) Cost analysis of different drug - regimes and an
'gddd'' idd*
of the coat.of.'major '(commonly used' )■’ drugs. fttieWlll help to
select the cheapest way of managing each dlsean^
'BRW*®
linos of management are absolutely Inappropriate for rural community.
for eg: for ordinary respiratory tract Infections we use Septron,
Ampicillin, Cexycyeiino etc., in st. mrtha*'s, where an here
Strepto pencillin Injections or Tetracycline capsule is more than
sufficient. Drug resistent organisms are wry few.
(8) Familiarity with different av^llabla commercial prepare,tions of
antibiotics. Vitamins, Iron preparetlona, antipyaretlcs, anti*
inflammatory drugs, anti. asthamatlc and antihelminthics ■<* th^lv
cost, 'efficacy and reliability
The wst important tiling required of a rural doctor is his
adaptability to the widest range of people, situations and incidents.
He should Ihj prepared to learn new things and go along with the people
Kven dosages of modlctnas I haw Changed according to the people.
There are situations when wo cannot stick to what we have learnt and
manage things in the strictest scientific manner.
I'*
The Way Forward - The Community Outreach - Vision and Mission.
The St. John s National Academy of Health Sciences has evolved over five decades into a premier health
human power development campus producing doctors- undergraduates, and post graduates; allied health
professionals like laboratory technicians, hospital aids, community health workers, and offering shorter
courses in a wide range of areas from ethics to health management. The St. John’s Research Institute on
the campus has promoted the research ethos at all levels with initiatives moving beyond hospitalsand
patients to public health challenges and the community. Over the last five decades and particularly in the
first three decades a very strong thrust towards community health, primary health care and outreach and
extension services was also promoted which got somewhat marginalized during the last two decades,
when the hospital evolved towards secondary and tertiary case; specialization and super specialization
and also was caught up in a sustainability challenge as the health sector boomed in Bengaluru and the
corporatization and commodification and commercialization grew at a rapid phase.
As the SOCHARA Jubilee year has been a time of reflection , renewal, retreat and revitalization and
based on all that has been experimented with in the past decades, much of which has been described or
at least touched upon in this review.
The following 12 point outreach agenda could be endorsed by the college authorities and faculty
and included in the post jubilee vision and mission.
1. Outreach Commitment:
In keeping with the original vision of Dr. Sr. Mary Glowery and the Bishop’s of India (CBCI) and
endorsed further by the Cor Unum document (1976) and the CBCI Health Policy document of 1992 and
1995. St. Johns will recommit itself to ‘reaching the unreached’ in the country with health awareness health
care and health empowerment as one of its primary and focused post jubilee agenda.
2. Community orientation and skill development:
The college will continue to strengthen community medicine, community health and primary health care
in lural and in ban areas and the development of knowledge skills and capacities for these among all its
doctois and nursing students by strengthening the Department of Community Medicine and expanding
the opportunities and sites for rural and urban field practice.
3. Strengthening Religious Sister and student orientation and capacity
Religious sisters who form a significant component of its annual intake of students both in medicine,
nursing, and allied health professionals will be provided additional support in orientation, skill buiIdins
and vision/mission reflection to enhance their scope of work, leadership, potential and community
orientation in their future work.
4. Re-energizing Rural Placement Scheme and Opportunities:
Young graduates will be encouraged and inspired to participate in the Rural Bond Scheme which will be
further strengthened through a liaison office which will improve the selection of those hospitals; support
their development; improve peer contact and continuing education for the RBS and renew and strengthen
the links between RBS obligation and selection for postgraduate
5. A Job nite referral system network for hospitals with a mission:
As a new post jubilee initiative a more proactive networking between the college campus and hospital
with all the mission hospitals especially those which have Johnite Sister doctors and rural bond scheme
candidates or both. This referral system and CME linkage will be done in close collaboration with the
SJMC Alumni Association and the Sister Doctor Forum for India.
6. Internship innovation:
To strengthen the options, opportunities and skill development during the rural camps, community
extension learning, and the compulsory internship phases the field practice areas will be enhanced in
diversity to offer choice, closer community contacts, and more proactive skill and capacity development
and orientation.
1. Humanizing the professional development on the campus.
The professionals trained on the campus will be exposed to values, humanities, social context and
challenges, through a creative and focused humanities learning facilitation programme in which the new
department of Humanities and the History of Medicine and History of St. John’s Museum will be
involved. The learning strategy will be creative, interactive, participatory, contextual and experiential.
8. Broadening the Horizons
The campus will provide opportunities for students and faculty to broaden their horizons by offering
short courses and learning experiences in Ethics; Humanities; Language skills; Community electives;
Oiientation to traditional and complementary alternative medicine; Health informatics and Career
counseling,
9. The Alumni outreach learning program
For the first decades the alumni association of SJMC has done a good job of establishing contacts and
involving alumni in eventsand fund raising and from time to time in continuing education as well. The
post jubilee challenge is to recognize alumni contribution to health and medicine globally and nationally
and locally and to enhance the linkages between what alumni do in their field with particular focus on
India lelevance, social context and orientation to Health for All goals. The Association should be
encouraged to play a more proactive networks and linkage building, role that will make alumni part of a
referral system complex, continuing
education network and a network for elective and service
opportunities.
10. Health Research for Reaching the Unreached.
If outreach becomes a new focus then Health for All with a focus particularly on themes such as equity,
gender, health systems, health policy, and social research, appropriate technology, TCAM, Health
C ommunication, and informatics, health promotion and healthy life styles etc should be enhanced on the
research agenda on the campus with greater links to the Johnite network.
In the second decade, SJMC evolved the idea of ACHARA to form Agency for Community Health
Assistance Rural Areas, which will run parallel to the college. This idea got lost in the development that
followed.
As a post jubilee commitment the college can recommit itself to a new vision of Community Outreach;
Community Action; Community Research; and Community advocacy; not as an informal or adhoc
departmental initiatives, but as an experimental, experiential, proactive networking of a dozen or more
departments, and ongoing initiatives on and beyond the campus - coming together with one common
collective vision - COMMUNITY OUTREACH.
These would be the Department of Humanities; Department of Community Medicine; Department of
Ethics; St. John’s Research Institute and especially its epidemiology unit; the Rural Bond Scheme office;
Project Hope ; Medico Socio Unit of the Hospital; Sister Doctors Forum of India; Alumni Association; and
the Society for Community Health Awareness Research and Action ; History' of Medicine Museum; CBCI
health commission ; Catholic Health Association of India and any other extension units or services of the
campus.
IN CONCLUSION
As the vision mission committee reflects on the ideas and suggestions arising from this over view
of the community orientation decade of St. John’s I would like to end this report by bringing to
everyone’s notice three important suggestions from the perspective report of CBCI in 1977 which
observed as follows.
1. St. John ’n will befailing in its duty if it is just another medical college out of the larger
number oj medical colleges in India. It will not have served its purpose if it is simply a
highly competent medical college in the professional sense. What is required is that the
college should produce doctors and other trained personnel imbued with
dedication
as agents of change.
^l f°r
to train out students such that each one of them becomes an agent for
development, training others and helping those around to develop themselves.
3. While continuous assessment and feedback is necessary for corrections, we must be
careful not to stifle and stunt the growth of the institution
A timid hesitant
approach is likely to produce disastrous results: a bold approach is required.
CAN WE MOVE BOLDLY TO ESTABLISH OURSELVES AS THE APEX OF A
COMMUNITY OUTREACH GOAL TOWARDS HEALTH FOR ALL?
Source: The Community Health Decade (Reaching the Unreached), Narayan, Ravi, SOCHARA, July 2014
(An overview of the decade, 1973 - 83 with reflection on implications for future policy. Submitted to Vision
Mission Committee)
t0 br°aden the'r h°riZOnS by offering
short courses andTeaSng^experiences^n ShicTH3^
Orientation to traditional and complementart altemT"
ngUa8e Skil‘S; Community electives;
counseling,
ompiementaty alternative medicme; Health informatics and Career
9. The Alumni outreach learning program
&
in^lX^lnm-SZtg ZtZ
postjubilee challenge is to recognize a m J , L
me >n continuing education as well The
and locally and to enhance the JZes beZenZat' l" * Z
globally and -tionaUy
India relevance, social context and orientation to Heahh’f A11' Z"
With Particular focus on
encouraged to play a more proactive networks and linkaJ bZ g°als, Tlle Association should be
referral system complex, continuing
education netw k' ‘?g’r° e that wdl make alumn> part of a
opportunities.
8
f
network and a network for elective and service
10. Health Research for Reaching the Unreached
xs.r sa fr p“'cuta,y ”■
Communication, and informaticsPhealdt promotion and heahh fPpr°P™te technology, TCAM, Health
™sfZ
Rural Aras'•«
Community Action;
‘
°f Con,m"ni,>
departmental initiatives, but as an experimental J
T advocacyI not as an informal or adhoc
departments, and ongoing initiatives on and beyon JtZZuZ^6 netW°rking ofa dozen or more
collective vision - COMMUNITY OUTREACH
P
~ COming tOgetber with one common
C—mty Mcdtomo; Dep.„raenl of
Project Hope ; Medico Socio Unit of the Hospital- Sister Dnet
un,t, the Rural Bond Scheme office;
the Society for Community Health Awareness Research d a^8 °rUm
nd,a; Alumni Association; and
health commission • Catholi^
•
an<^ Action ; History of Medicine Miisenirr cnrr
campus.
^somauon ot India and any other extension units or services o7the
IN CONCLUSION
,xs,io"s arisi"8 &°™
s:
everyone’s notice three important suggestions from the°Ut0
repOrt by bringing to
observed as follows.
suggestions from the perspective report of CBCI in 1977 which
L
highly competent medical college in the nrof° '
college should produce toct^
dedication
as'agenfofch^
development, trainhig'o^
3.
While continuous assessment and feedha k
J SerVed ltS PurPose if H is simply a
is required is that the
perSonnel ^ued with
one
one of
of them
them becomes
becomes an agent for
ar°Und t0 develoP themselves.
B
I
i
i
«a
ANNEXURE - 3
Recommendations of Review Committee - 1972
General Recommendations:
1.
imafce could be increased t0
subject tQ
of
.
2. 30/0 ot the seats may be reserved for the Catholics
3. Strong effort should be made to admit as many religious sisters as possible
4. 1 here should be competent professor of medical ethics
5. I he permanent Chaplain should be continued
6. Jrofitabfosh011 Id
m
StUd6ntS Can
tOgether and pass their leisure
profitably should be considered
7. briZh C“StmaS and 311 Other Indian festivals should be celebrated officially, so as to
I nng the students together and promote a spirit of camaraderie.
8. The college should try to have small group of students (say about 10-15) under the
guard.anship of the professor who will be a sort of friend, philosopher and guide
10 I"rabsoZtel "
°f °ther medical colle^
10. It is absolutely necessary to nominate a professor as warden, changed if necessary every
11 A 1 aZS
'r'T St3ff member (AsSt Professor or
as Assistant Warden.
1 • All appomtment for the posts of Readers and above should be advertised on All- India basis
b’ XVhoX
n° Pr°ViSiOn f°r PriV3te PraCtiCe Under any cir™tances
13.1 here should be no part time teachers
14. Satisfactory scales of pay and non practicing allowance may be given
15. Normal employment should be only till 60 and specialist over 60 may be engaged for
contract periods till they reach 65
ugaged tor
16. Provident fund, Leave and Study leave should be given to all staff
■ arly step should be taken to obtain the services of a few Visiting Professors
. The hospital must be given enough teaching staff at the cost of St. John’s
' the ~ ’"er“h,p 'S “"’P“k»ry pre degree training program, all interns should be paid
he same strpend, urespecnve of the hospital in which they are placed, and irrespective of
the merit, or number of failures.
irrespective ot
20' hteiX
”f ‘he
l'nivmi,y’
“'»■ of the
inrernsnip period for training in rural areas.
21. Amenities should be provided for members of staff to meet informally and even on a social
level, both on the college campus and at the hospitals
22. In the selection of students some way should be found to ascertain the commitment
the
23-
Zr"’1
i'ntl a bOn<l Sh"“W be
in
’■“I-"'«.
r
i
wi"be
24'
s"f
,or
25. St. J«h„-S can explore the possibility of setting up an extension service for orientation
course for the medical students on a somewhat continues basis.
(The items in bold are all geared to strengthen the colieges community
reach vision)
Student related Recommendations:
oualifvm,m“de °n the basis of
“« *ro«Sh an elaborate process which involves the
• One ft rdf ofThrrr
""
interviews
h students belong to Karnataka, 30% are women and 18% are reserved for
students from schedule castes and schedule tribe backgrounds.
Spec.al consideration is given to priests, brothers, and sisters; layman and laywomen who
communitie^whTare Ek
COmmUnity Services; laymen
from backward
commumttes who are likely to serve as doctors in the local areas where they are domiciled-
•
Initially students belonging to higher socio-economic strata were being selected due to their
faring better in competitive selection. h.,t
,g
ed dUe t0 tlleir
lower economic group ace gening admiin'fs'we'ft
“
Great emphasis has been placed in the objectives on formation of students Chanlaincv
piZX
ln ,he Ia“ sch'“- m
-
“=—=“====
y beginning of the college and
—i subject varied on an average
°C ,he “"e8e Wi” m°re
~
0«e
•..... ■gymnasium. Students have represented the university in various game s and Sports and the
Thc s,uden,s "d steffhM b“"
Faculty related Recommendations
Academically well qualified, competent staff have been recruited Th^rA d
'
=====
»XXX«re“ca,e80nes of p'“““hM ,ed “ f™“" “d ~ <■
The teaching post are advertised
on a all-India basis and selection made. The teaching staff
also represent a national ethos and i
KotI, Matarastra. tXT:* Uttar Pradesh"11''”
•
State Board of Medical Research, Karnataka and MRC Bombay
'
’
.......
:-=“-Surgery The policy of the can 8 h’
• 'iTCS’ °bstetncs & Gynecology, and Thoracic
‘
Hospital is osed
~M^i^ T°
evofv™
-
W “e^olX^Xb
epm' “d ac“°” W area
0* ‘WHS hospital are being
A perspective report to CBCI, SJMC, Bangalore, 11- January 1977
(An overt'^fthe”^
Mission committee)
Unreached), Narayan, Kav|, SOCHARA, July 2014
1973 - 83 with reflection
eCt,°" “ mpte,i“sP°"W ^rttted to Vision
*4
I
6A journey towards health for all- a travel fellowship in primary health care’
Callfor applications
The Rural health care collective* is offering a one year travel fellowship in primary care for
young doctors after their MBBS or post-graduation who are interested in rural health care.
The fellowship is planned as a journey to explore alternate approaches to rural and primary
health care- and for the participants to clarify what they can do to address the health needs in
the country.
If you confused and concerned about the practice of modem medicine as you have leamt it
and are looking for alternative approaches towards addressing the health needs of society, this
programme may be for you.
The programme consists of three stints in rural hospitals, primary health care programs and
social development initiatives and includes interactions with mentors and practitioners in the
field, networking and cross-learning with fellow-travellers. We will be taking 5 fellows for
this programme beginning in early 2020.
If you are interested to apply for this programme write to rhccfellowship@gmail.com
introducing yourself, explaining your background and why you want to apply for the travel
fellowship. We would also request that you participate in the 3 day Rural sensitisation
programme (RSP) at Tribal Health Initiative, Sittilingi in the latter half of September for us to
spend more time and interact with you.
*The rural health collective is a group of organisations involved in rural health work:
1.
2.
3.
4.
5.
6.
Ashwini, Gudalur, Tamil Nadu http://ashwini.org/new/
Basic Health Services, Rajasthan https://bhs.org.in/
Tribal Health Initiative, Sittilingi, Tamil Nadu http://www.tribalhealth.org/
Primary Health Care Program, KCPatti, Tamil Nadu http://kcpphc.org/home/about/
Swasthya Swaraj, Kalahandi, Odisha http://www.swasthyaswaraj.org/
Christian Hospital and Mitra, Bissam Cuttack, Odisha http://chbmck.org/
1
A journey towards health for alla travel fellowship in primary health care
Call for applications
Background
There are lacunae in access to basic health care in rural India. The current mode of medical
education is urban focussed and oriented to speciality medicine. Students are not adequately
exposed to the reality of health problems in our country and the practice of medicine at primary and
secondary care level.
There are an increasing number of young doctors who are dissatisfied with the trends in mainstream
health-care and searching for alternatives. They are looking for opportunities to experiment,
innovate, become entrepreneurs and make a change in the present health scenario.
We have also appreciated the impact of the programme NIRMAN started in Maharashtra by Dr.
Abhay and Dr. Rani Bang to identify, nurture and organize young change makers to solve various
societal problems. We wanted to develop a programme along these lines appropriate to the rest of
India.
To address this gap, we have started the 3 day rural sensitisation programme (RSP) for medical
students and junior doctors at Tribal health initiative. RSP camps were organised to give MBBS
students and young doctors an opportunity to see alternative approaches and interact with persons
and issues that their medical colleges in South India do not seem to provide. The response was
overwhelming with about 150 students requesting to participate in 2019. The feedback from the
participants suggests a delicious discomfort with the unethical, commercial, specialty-drive trends
and a search for a more humane, ethical, generalist / primary health care approach.
This has led to the idea of creating a mechanism or program where interested young doctors can
embark on a 12-month journey of exploration, both of yourselves and your ideas, and of alternate
approaches to rural and primary health care - the models, the concepts and the persons behind
them. The approach in this semi-structured programme is to provide what conventional medical
education does not provide today because of its regimented boundaries. We are trying to offer an
'uncollege approach'1, an educational journey for interested students to explore alternatives to
health care.
Purpose
Offering young doctors of India a seat on a 12-month journey of searching and learning
1 The word 'uncollege' is being used in a deliberate sense of going beyond limits and boundaries of traditional
education to an alternative approach to education to develop ones perspective to medicine and health
through journey, experiences, meeting different people, involvement in the field, working in the community,
observing real need, readings and reflections.
2
Exploring alternative pathways in pursuit of "Health For All2" with special focus on the
marginalised and the poor.
Exploring themselves and what they want to do as doctors in India
The primary intention is for you to find a semi-structured safe space to explore directions in health
care, through opportunities to visit, work at and interact with multiple models and people in the
field of primary and secondary care. This programme does not aim to develop a set of clinical skills
or a specified academic content. However exposure will help you recognise the skills that you may
need and initiate the development of competence in these areas. Your skills and competence can be
further honed and built at a later stage maybe through post-graduate training or further immersion.
Is this programme for you
If you troubled, confused and dissatisfied with the practice of modern medicine as you have learnt it
and are looking for alternative options towards addressing health needs of society.
The programme is designed for the period between internship and PG training. It will require you to
take off one year to participate in this programme.
Although we have in mind young doctors after MBBS, we realise that there are doctors who are
searching at different stages of their lives. Therefore this programme is also open to those who have
completed post-graduation or who are in the middle of their careers and are looking for new
directions.
Educational approach
The program offers semi-structured engagements in multiple real-life contexts. The focus is on the
individual and facilitating their search and journey through experiential learning and immersion
experience. You will therefore be required to work and contribute to the organisations you are
placed with, not just as observers but also learning through work.
The programme will involve:
2- 6 months stints in Rural Hospitals, Primary Health Care programs and Social Development
Initiatives
Interactions with Mentors and Practitioners in the field
Networking and Cross-Learning with fellow-travellers
Sessions for Stimulation, Reflection, Reading, Discussion
Structure of programme:
Three postings (10 months [6 + 2+ 2]):
One posting of 6 months will be in an organisation which has significant clinical components of
primary and secondary care. Two shorter postings of 2 months each, one of these should be in an
organisation which has significant exposure to social development initiatives.
2 We are using 'Health for all* as a concept as it was stated in the Alma Atta Declaration in 1978 of health as a
multi-dimensional concept that we need to work towards
3
Bridge period (2 months): Introduction, inter-session meetings with fellow travellers, interactions
with mentors, networking
The duration of postings can be chosen flexibly based on your needs and what is best for you and
also what is feasible and optimal for the host organisations. However the minimum duration of the
Fellowship will be 12 months.
Selection:
The selection will be based on application form which includes a short autobiography which explains
the reason why you want to participate in the Fellowship programme followed by a face to face
meeting. We would request those who are interested in the Fellowship, to write to
rhccfellowship@gmail.com introducing yourself and explaining why you are interested to participate
in the programme. We would also request you to register for the Rural sensitisation programme in
the latter half of September 2019 at THI Sittilingi for us to spend more time and interact with you.
Clinical exposures in primary/secondary care settings: the postings will be based on your choice.
During these postings you will:
•
•
•
Work as a junior doctor in the hospital/clinic
Learn how the hospital/clinic functions: management, training, finance
Be involved in the community health- health care delivery, village clinics, health
worker/community nurse training, and health education. A significant part of their
involvement should be in the community, to understand their problems and develop
•
relationships.
Interaction with different levels of staff to understand their perspective. To learn how the
organisation started, how choices are made and how its functions.
Bridge periods
Introductory session (~ 1 week): Introduce you to the programme. Explore issues of health and
health care. Introduction to principles of primary care. Facilitate critical observation, reflection and
learning. Form relationships with your classmates and fellow travellers. Discussions with your
mentors.
Inter-session meeting ((~ 1 week): This period would be for review and rejuvenation. You will meet
with your mentors and fellow class-mates
Final session ((~ 1 week): to review experiences, learnings and explorations and think about future
directions for yourselves.
Exposure to non-health fields/social development initiatives:_Each of you will have one short
exposure to broader inter-sectoral fields of your choice such as culture, environment, agriculture,
governance, livelihood, water, education, governance and law.
Mentoring
4
Each of you will have a mentor during the course and a local supervisor at each of the sites where
you are posted. The mentor will have periodic discussions with you by phone or e-mail to explore
larger issues, problems that you may face and provide informal support. The local supervisor will be
responsible for arranging your programme at each site, reviewing your progress and facilitating
discussionsand reflections.
Flexibility : Keep the posting plans and exit options flexible, so that you can discover what interests you and
gives you passion and that which best suits you and the host organisations. However you would be expected to
complete the one year duration of the Fellowship.
Readings and resources: The programme will have a required set of readings and resources
including movies.
Themes of the programme:
The idea of comprehensive and people-centred Primary health Care
Discovering the range of medical skills and competencies needed for this approach
Understanding a Community including socio-political analysis
Raw need and poverty-the challenges people face
The tools for social entrepreneurship and pathways for change, to be able to start up a new
initiative including the managerial skills required and the discipline of the long haul.
Models that have made a difference and role models that have walked the path before
Demonstration that ethical health care and primary health care are viable and do-able
To be challenged out of the security of status quo
Number of students per batch: 5-10 (starting with 5 students in first year).
Centres for clinical exposure
•
Tribal health Initiative, Sittilingi
•
Gudalur Adivasi Hospital, Gudalur
•
Basic Healthcare services Trust, Rajasthan
•
Christian Hospital, Bissam Cuttack
•
KCPatty Primary Health Center, Kodaikanal Taluk, Tamil Nadu
•
Swaraj Comprehensive Community Health Program, Kalahandi district, Odisha
Description of the Primary and secondary health care programmes and opportunities for the
traveller
1.
Ashwini, Accord and AMS, Gudalur, Tamil Nadu :
Description :
Base Hospital, Community Health Program, Education and Development
Initiatives, located in an Adivasi movement and organisation.
Opportunities for the Traveller:
Hospital work - in partnership with members of the tribal
community
Exposure to community based programs : Mental Health, Sickle Cell Anemia etc
5
Optimum Duration : 3 — 4 months
Mentors: Drs. Nandakumar Menon and Shailaja Menon
Link: http://ashwini.org/new/
2.
Basic Health Services, Rajasthan :
Description :
A network of Primary Health Care Clinics in remote parts of south Rajasthan,
that are Nurse-Run and Doctor-Supported with linkages to community based
programs on health, migration, livelihood
Opportunities for the Traveller: To learn and deliver primary healthcare in resource limited
settings, to learn about intersection of health, migration and livelihoods; to learn about key
policy issues affecting healthcare of the undeserved, to undertake a study on a pertinent
local issue and design a solution including initiating implementation
Optimum Duration: 6 months
Mentors: Dr. Pavithra Mohan and Dr. Sanjana B Mohan
Link: https://bhs.org.in/
3.
Tribal Health Initiative, Sittilingi, Tamil Nadu :
Description : A Base Hospital with a community Health program and other initiatives in
Education, Organic Agriculture, Community Organisation, Handicrafts etc.
Opportunities for the Traveller: Combination of clinical work and development of skills at
the Hospital, seeing how to handle complicated cases in a resource constrained set up ,
Community and Home visits ; involvement with Organic Farmers, Porgai handicrafts,
Education and community organisation. Observe how communities organise themselves,
plan and implement innovative community development schemes.
Optimum Duration : 2-6 months
Mentors: Dr. Regi George, Dr. Lalitha Regi, Dr. Ravikumar Manoharan
Link: http://www.tribalhealth.org/
4.
Primary Health Care Program, KCPatti, Tamil Nadu :
6
Description : A Primary Health Care program with a Health Centre and comprehensive care
for 6,000 population, and care accessed by 15,000 population.
Opportunities for the Traveller: To learn about patient-centred care, family medicine and
primary health care approach, 3 stage assessments, working as a team with health workers
from the target community- both at the clinic and on home visits. Please note that we can
only take persons who can communicate in Tamil because none of the health workers
communicate in English
Optimum Duration : 4-8 weeks
Mentors: Dr. Rajkumar Ramasamy and Dr. Mary Ramaswamy
Link: http://kcpphc.org/home/about/
5.
Swasthya Swaraj, Kalahandi, Odisha :
Description : A comprehensive primary health care program with two 24x7, nurse-run,
doctor-backed health centres in remote locations, and community based initiatives in health
and education in 76 villages.
Opportunities for the Traveller: Involvement in all activities ; community based research ;
Optimum Duration : 3-4 months
Mentor: Dr. Aquinas Edassery
Link: http://www.swasthyaswarai.org/
6.
Christian Hospital, Bissam Cuttack and Mitra :
Description : A busy 200-bedded secondary hospital 250 km from a referral centre, with a
community program focusing on health and education in 53 tribal villages.
Opportunities for the Traveller:
In the hospital: To develop skills and confidence through actual work as a junior
doctor on duty
In the Community : As an observer and participant in Mobile Clinics, Experience of
multiple initiatives including the schools
Optimum Duration :
Hospital : 6 months
Community : 5 days to 2 months
7
Mentor: Dr. John C Oommen
Link: http://chbmck.org/
Supporting faculty
Dr. Rakhal Ghaitonde, Professor, Achutha Menon Centre, Sree Chitra Tirunal Institute for Medical
Sciences & Technology, Trivandrum
Dr. Shubhasri Balakrishnan, Senior Technical Advisor, Centre of Maternal and Newborn Health in
India, Liverpool School of Tropical Medicine
Dr. Sukanya Rangamani, Scientist, ICMR National Centre for Disease Informatics and Research,
Bengaluru
Dr. Narayan Devadasan, Director, Institute of Public health, Bengaluru
Dr. Roopa Devadasan, Public health doctor and teacher
Dr. Sara Bhattacharji, Retired Professor of Community Medicine, Christian Medical College, Vellore
Dr. Anand Zachariah, Professor of Medicine, Christian Medical College, Vellore
The base of 'A journey towards health for all- a travel fellowship in primary health care' will be at
the Tribal Health Initiative, Sittilingi.
Starting date of programme: April 1, 2020.
^cr-'. H
Listen and Learn Sessions :
M riiTJy nre and Outreach Experiences
Health for All Learning Centre - SOCHARA
Venue ■ SOCHARA‘ J'04'2019 Time : 10-00 am to 4.30 pm
Introduction
'
““&WAHS
g
In recent years many primary health care
«»™ns)
oriented clinicians have been in touch with the SOCHARA
pastdiXr2aV With UHC1! 'b6" eXpenences and reflcctc^
on some of our own initiatives in the
together XXT'
C becom,ng the new version
Of
the
HFA goal- it is important to bring
ogethei greater convergence between primary health
health/community health approaches.
P
H care, mission health care and public
The event between 10 am anH a qd
afternoon sessions nt St. John’s Nation ” Ac” demyrfi/e’lth .?
“ S0™ARA and with
live sessions - three a, SOCHARA and t„o“ STOAHS
““ (SJNAHS) and will consist of
Programme
Sessions |
Time
Details
Venue : SOCHARA
Session 1
10'0®a^o rafter a round of self introductions- there wil'
11.30 am with be an interactive sessions of key learnings
tea break
from several experiences over the years of the
participants from certain popular clusters/
HJ’^CC0RD’ Swasthya Swaraj,
-^S^StJWaiysJjospital- Malur and others
Session 2
11.30 am to
V^^TsOCHARA^d
12.30 pm
J° 1
A ,r.elated motives in this area
Session 3
including’
Mallur Health Cooperative,
Siluvepura, - SBI projects; RBS pioneers
workshop-J985; Building
Graduate Doctor feedback from peripheral
hospitals-an interactive
-—
------- ‘ research project,
1992, CHLP and hospital with
a mission and
few others.
The next steps
12.30 pm to
Resource Person;s
Randall, Pravin,
Aditi, Sangeetha,
Carl, Rodney,
Samantha.
There may be
others
Ravi,
Thelma,
Mani,
Mohammed
Session 5
■-EM U : i Hnnr JiftiNCi ' ----------- ±
Time to move to SJNAHS venUT
H.Cardinal Gracias Hall, Ground Floor, SJNAHS)
expSSs. °" primilry Mre ”1
1
Thelma
.
2.00 pm to
—_____________ 3.00 pm
Venue : SJNAHS
Session 4
3.00 pm to
3.45 pm
t-:
----- -other
Facilitators
°"ft^
1
----- 1 (Randall and Ravi)
■I
ri
3.45 pm to
4.30 pm
learn about and work in small hospital with a Facilitators
(Denis and Thelma)
1 community mission._____ ___
TThe SOCHARA library- CLTC
II i
_ ____ _ _
training nnd ie.nl,i»g m.nuul, and^urc”
SOCHARA
diSP'*y 'Pr‘™,y
°r'“,Kl
S-Ks
1
some baclgro.md m
and rcfkam
r
II
A
are emerging in THI; Kaapi in
"XT” convergence as they evolve
***
■
[o
■I !■!■
IIIliMMlIBMlllllB
iHlIIIII I
J
A RURAL PRACTITIONER’S
HAPPINESS
OTMTMEEDNTY LALIT NARAYAN 0N MAY 3, 2014 IN OFF THE BEAT | 1
Dr. Lallt Narayan wrote this poem while doing his stint as
a young Medical graduate at the Tribal
Health Initiative, Sittilingi, Tamil Nadu.
:...
Z ZTb '°T£ ” ssk^^^^<^‘y^y!ile.Hm-s
The cutest damn expression in the world.
Thats my reward. That’s happiness.
Then I walk out of the labour ward.
I can see hills all around. Green
Thats my reward. That’s happiness.
My cottage sits on the edge of the forest.
Full of books, art films and insects.
That’s my reward. That’s happiness.
The local women who work at our hospital
Call me 'Anna1.
Thats my reward. That’s happiness.
An old therakoote vadiyar
Is grateful I was with him during his second Ml.
Thats my reward. That’s happiness.
When death comes. Despair.
Loneliness and gastritis.
I think of my rewards. I try happiness.
I
■
- Media
RF_COM_H_102_SUDHA.pdf
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