Report of the Primary Health Care Cell Meeting of MFC at Sevagram on 15th September, 1992
Item
- Title
- Report of the Primary Health Care Cell Meeting of MFC at Sevagram on 15th September, 1992
- Date
- 1992
- extracted text
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/ 31
, 1^53
U<t]
To: Abhay, Anil Pilgaokar , Ani1/Daxa/Rashmi ,Anant, Ashvin,
Ashok, Avinash Savji, Binayak, Dileep Mavlankar, Dhruv, Madhukar
Gumble, Madhukar Pai, Manisha, Millie, Mira Sadgopal, Narendra,
Probir, Ramani/Ravi, Ravi Narayan, Sham, Shridhar &
Nimitta,
friends, Ulhas.
''
The events occurring around us at t^e moment are of an epochal
nature,
leaving most of us disoriented.
disoriented, It would be indeed surprising if they had not affected mfc, like everyone else. The
Annual Meet this time was, if anything, a forewarning of the
circumstances that democratic movements might have to cope with.
BROADENING OF THE CELL
I am enclosing the minutes of the last meeting of the PHC Cell.
It was suggested that we reach out t.o those friends who we know
are; seriously interested in PHC but have not interacted with mfc
should be contacted. I have sentout a letter to the following
people whose names were suggested, along with the minutes and a
resume of all the papers presented at the past meetings.
EPIDEMIOLOGY COURSE
The proposed epidemiology training for mfc members seems to have
run aground. Clashing dates seems to be the prime cause. An
earlier suggestion that we attend the courses on Biostatistics
announced by CMC, Vellore and AIIMS, New Delhi could not really
take off as details about neither were available, despite re
quests having been made. Though I suspect, our vacilliations did
make a substantial contribution to this waning of interest on the
other side.
Anant has recently suggested that fresh efforts be made to revive
ths idea of a separate course with CMC Vellore. I shall followup
on thia suggestion and try to recover lost ground. Ravi Narayan
has asked me if I could spare a day to visit Vellore when I make
my next trip to Bangalore. This seems rather difficult as my
Bangalore trips are usually unplanned. I would be able to do what
I can only through correspondence.
NEXT MEETING OF THE PHC CELL
The next mooting of the mfc - the mid-annual meet- has been
plarmed for mid June. Ulhas has suggested we meet
mee t after this
meet i ng for 2 days at Gadchiroli. I think it may be a good idea
except
that this would mean for the members attending both the
meetings, a week's absence from their respective HQs,
if no t
mo r e. Otherwise I would like to invito all of you in July f i rs t
week to Nasik or Vaitarana where we have been training heal th
workers.
Let me know your preference by the 15th so that we can
p.l an this meeting properly. Also please let me know the themes
you would want to discuss.
With beet wishes,
I
January 16, 1993
REPORT OF THE PRIMARY HEALTH CARE CELL MEETING OF MFC
(At. Sevagram on 15th September, 1992)
Participants : Madhukar Pai, Ulhas, Dhruv, Anant, Binayak,
Madhukar Gumble, Anil Pilgaokar, Manisha, Mira Sadgopal, Avinash
Savji, Probir, Sham, Narendra, Millie.
Health Education : The discussion on this topic started wi th
’ In
/comments on this issue in the context of Ulhas’s article
level . ’
search of appropriate leadership at village level.
Following
points were made by different participants :
A doctor is not needed to do health education, A well trained VHW
can vary well do this work provided s/he has acquired credibility
i n the community. In case of the Sevagram project, the hospital
is near to the project area and it has a good reputation about
quality and accessibility. A village health worker,
therefore,
does not have much scope in such a' situation. But situations are
quite different in many other areas and VHW has an important role
to play in health education in such circumstances.
It was pointed out that the credibility of the health
heal th educator
may be derived from his/her clinical ability or the .credibility
of the organization of which s/he is a part.
All of us agreed that though audio-visual aids are a good help in
health education,
education, they can never replace the live commentary by
the health educator. This does not mean that we do not recognize
the value of different types of presentations for different
purposes - poster exhibition could be a good medium to establish
dialogue;
slide-shows
can be a more
attractive medium;
street plays are the most popular ones. Each medium has its
speciality - preparing poster exhibition requires a good artist
with
some"' understanding of the subject; slides are
more
expensive; street plays or other dramatic forms require a team of
skilled dramatists. Display of human organs from autopsy-rooms,
for example: a smoker’s lung can have a very dramatic effect; but
getti ng such specimen is not so easy. Binayak reported that
heal th education in the Chhattisgarh movement was always a part
of the general socio-political education of the masses and was
effective through this approach.
There was no agreement on whether children can do good
health
education. Doubts were raised whether adults listen to children
and whether children should be ’used’ for doing the job of pro
fessionals. However, there were positive experiences of children
as health educators as regards the issue of night-blindness,
sanitation.
It was reported that ’street play’ by children are
watched with great interest by their parents and hence they tend
to absorb the message in the street play.
We however all agreed
that there is a difference
between
education and propaganda! and the health educator needs a much
broader
information base and skills to enhance the ability of
tho community to understand health issues, It was also emphasized
that there has to bedemystification
demystification of medical
science,
Health education is an art and science and must be learnt, and
practised properly.
Immunisation strategy : Ulhas’s paper*:
"Community
based annual pulse immunization strategy"
(now
published in MFC Bulletin No.186-87) was taken up for discussion.
In general, it was appreciated that the logistics of immunization
schedule in the villages as worked out by Ulhas and his col
leagues is far more efficient and practicable. It was suggested
that we as MFC should try to see that the official immunization
programme also adopts the time-table worked out by the Sevagram
project.
It was pointed out that this time-table moans that tha
working hours of the paramedical staff would have to be changed
to implement the "Sevagram Strategy." It was felt that this can
be done if the paramedics and their union is properly approached
and taken into confidence. The satisfaction
of successfully
completing
immunization can be a good incentive for paramedics
especially if the total amount of,work is not increased.
It was argued that if all the immunization work is over in three
months,
the ANM would stop visiting the village,
village. But it was
pointed out
ou t that ANM has other important functions to do and
hence her village visits woul.d net
not stop,
stop. In any case, some way
the
has to be found out to reschedule the time schedule of
paramedic staff. Otherwise no improvement can be made.
(
The
issue
of
changing
needles
and
syringes
during
mass immunization came up during the course of the discussion. It
was pointed out that both needles and syringes need to be changed
wi th every prick to avoid spread of hepatitis-B and AIDS. More
change of needles is not enough since when we draw the piston of
the syringes before injecting the vaccine to ensure that the
needle is not in a vein, a small amount of body fluid is sucked
into the tip of the syringe. This is enough to spread especially
hepatitis-B since it is a highly infectious disease. The syringe
need not be changed in case of BCG vaccination since in this case
the piston is not withdrawn. It was pointed out that in a
small village, about 30 to 50 syringes, needles would be required
per visit.
It is not difficult to get these many syringes and
neqdles and sterilize them in a pressure cooker.
Though this report is too brief, the discussion was quite de
tai led accompanied by sharing of many experiences. Participants
felt that the discussion was productive and all of us gained
something positive.
Arogya-Mitra curriculum : Sham Ashtekar informed the group that
the Pune University has decided to recognize the training of
"Arogya-Mitras" and to give a certificate of the University for
those who got properly trained. The Department of Continuing and
Adult Education of the Pune University has been
actively
associated in forming the curriculum for this course. This course
has been initially designed by Sham Ashtekar and is based on his
book : ’Bharat Vaidyak’.
Sham Ashtekar briefly outlined the features of this course. All
of us appreciated the systematic work being done on this issue by
Sham. Dhruv reported that the experience of the VACHAN’s staff of
this training was good. At. least some of the trainees were able
to use the diagnostic tables properly.
I
A few suggestions were given about the training. It was felt that
the training programme appears too packed. Secondly, more empha
sis should be placed on acquisition of practical skills and more
time be given for the same. Anatomy, physiology be taught in a
more integrated manner. After a general introduction at the
beginning of the course, anatomy, pathology can be taught when
diseases of various systems are taught.
Sham’s book has been published recently and was brought at
Sevagram.
It looked quite impressive, a work of more than three
years.
Future of PHC Cell : Some old members of MFC who are interested
in the issue of Primary Health Care, are working in this field as
a priority area, have not shown much interest in the PHC Cell.
Amongst those who have given their names to join the PHC Cell,
some do not make it a point to attend. This is despite the fact
that PHC Cell meetings are held after some homework and there has
been
half a dozen
papers written so
far
specially
for
discussion in the PHC Cell. The discussions have also been down
to earth, communicative and productive. With this background,
it
was felt that those who have taken the lead in organizi ng
PHC Cell meetings expect some commitment from PHC Cell members,
PHC Cell can grow as a forum for in-depth discussion on rural,
primary health care only if there is sustained and not casual
interest about it amongst members. To sustain any collective
activity, members must have some commitment to the collective.
Otherwise those who take initiative feel ditched.
It was decided that some of the PHC Cell papers and the report of
the discussion on these papers be sent to all those who we know
are working in the field of PHC. All such people be invited for
the PHC Cell meeting. Since many of them have been working
seriously for many years, their participation would not lower the
level of discussion, but on the contrary, would raise and enrich
it. However,
it should be clear to all that it is a forum for
in-depth discussion on PHC-rural health care for like minded
people.
The next meeting would be after June, 1993. Agenda
worked out on the basis of suggestions from invitees.
is
to
be
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