Reaching Out To The Most Vulnerable With The Healing Balm

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Dr. Ravikant Singh

A discussion between friends who were pursuing a Masters degree at the KEM Hospital, Mumbai in 2007 regarding the need to kick start a blood platelet donation drive to offset the severe shortage of blood platelets due to the outbreak of dengue, set the tone for the genesis of Doctors for You with its vision, ‘Health For All’. At the helm of this pan India humanitarian organisation is ‘Health for All’ is Dr. Ravikant Singh who became even more convinced that he needs to dedicate his entire career to public healthcare when he went through a personal tragedy. There has been no looking back since. Doctors For You (DFY) has been working in various disaster- hit zones for the last nine years. It focuses on providing medical care to the vulnerable communities during crisis and non-crisis situations, emergency medical aid to people affected by natural disaster, conflicts and epidemics. Regarded as the country’s foremost medical relief specialist, Dr. Ravikant Singh, Founder,Doctors For You, spoke with Atula Imchen on what it means to take a call between big money and public healthcare, the various projects undertaken by DFY so far and the road ahead.

Doctor, tell us something about you and what made you give up a lucrative private practice to provide healthcare to Mumbai’spoor?

I did my MBBS & MD from KEM Hospital Mumbai. Ever since my under-graduation days, I was always interested in doing wholesale business and not retail, meaning I was more interested in doing something at the State or national level rather than open my own clinic or hospital. I was also not interested in cut practice business or do anything unethical to run a clinic, so private practice never attracted my attention.

When and how did you start Doctors For You? What are the various healthcare services provided by the organisation at Govandi? Do share some information about this area and why did you choose it to set up your centre?

I started DFY in August 2007. It was not a planned venture. There was a big outbreak of dengue, leptospirosis and malaria in Mumbai in 2007. Most of the blood banks, including KEM Hospital blood bank, were out of platelet (A blood component require to stop bleeding in case of severe dengue or malaria cases). I was a regular platelet donor so I started an awareness drive to promote platelet donation. Many people, including medical students and doctors, were not aware of the fact that you can donate platelets every 15 days, coming up to a total of 24 times a year, while blood donation can only be done at a maximum four times a year (once every three months). Fortunately, this drive went off very well and many donors across Mumbai came forward to donate platelets. We organised many blood and platelet donation drives thereafter and registered the organisation as ‘Doctors For You’ because of the good response and the many lives saved due to this platelet donation.

Doctors For You set up a centre at Govandi, which is in M- East Ward, the Ward with the lowest Human Development Index, despite having the highest density of doctors and social science institutes like TISS, Mumbai. One of the reasons is that all that has been done in the past many years was study, survey and publication with no action on ground. Things changes only by action, not by discussing the problems.

So we decided to intervene head on, and fortunately, MMRDA provided us the space to run health centres in slum resettlement colonies for Project Affected People (PAP’s). We are currently running three health centres focused on providing basic maternal and child healthcare like General OPD, Immunisation, Antenatal checkups, Dental and TB DOTS centres. Since the past two years, we have started specialty services also like Gynaecology, Skin, Ophthalmology, Psychiatry, Physiotherapy, Orthopaedic, Diabetes, Hypertension OPD & Geriatric care services. Apart from the fixed health centre- based activities, we do many community out reach programmes, immunisation drives, household health checkups and awareness drives. Our focus is on providing comprehensive preventive, promotive, curative and rehabilitative services unlike the curative services provided in private hospitals. We want to see the overall improvement in health indicators on the community, NOT just on one person.

“The number of severely malnourished children is very high (>80 Lakh) that it is impossible to admit and treat them in hospital as there are not enough paediatric beds to accommodate them. So under the Community-based Management of Acute Malnutrition (CMAM) programme, we treat cases/patients at their respective homes and only very serious or complicated cases are admitted in hospital”

“Things changes only by action, not by discussing the problems”

Apart from health, we are also involved in many other activities like malnutrition treatment and women empowerment by training local girls as Nursing Health Assistants and other livelihood generating activities.

As you stated, DFY was established in 2007. What are the guiding principles and core values of the organisation?

Doctors for You is a social organisation (Registered as a Society) with a mission to providing sustainable, equitable, effective and efficient healthcare services to the most vulnerable individuals and communities.

Our guiding principles are Rapid Response, Reaching the Unreached, Accountability to our Partners, Donors and Communities, Community Participation in decision making.

Our core values of being a neutral, non-political, non-religious social organisation with transparency and evidenced- based actions have been the driving force for us and we always try to adhere to these values for all projects.

Which are the different areas of operations that you are involved in and the States where these humanitarian services are being implemented?

We are mainly involved in three types of operations: Disaster Relief and Response, Strengthening of the Public Health System and, Community Development Initiatives. We are currently working in seven States across India- Assam, Bihar, Delhi, Kashmir, Madhya Pradesh, Gujarat, Maharashtra and Tamilnadu.

Let me quote you from an interview you gave to a newspaper daily a few years back. “For their own sake, the rich must ensure the poor have access to healthcare facilities. TB, for instance, is no longer a poor man’s disease. A single patient can infect 15 people.” Share with us the work DFY is doing in this field through Project Poshan.

Yes, tuberculosis is a huge problem now especially with a high number of Multi Drug Resistant (MDR) TB cases. TB does not discriminate. Anyone can be infected if their immunity is down or if they are in close contact with a TB patient. Tuberculosis is common even among well-to-do families and well-known personalities. We have to diagnose and treat all TB cases in the community. Only then can it be eliminated. No family is safe if the people they interact on a daily basis are suffering from tuberculosis.

Under Project Poshan, we are providing protein-rich nutritional support (around 16-18 kg dry ration per month) to each MDR patient during the first six months of treatment as most MDR TB patients are bedridden, jobless and not able to afford a protein rich diet (a vital requirement). We are currently running this project in six States (Assam, Bihar, Delhi, Madhya Pradesh, Maharashtra and Gujarat) targeting 1500+ MDR patients. We are also monitoring the weight gain and compliance to the treatment after this nutritional support. If successful, the government can replicate this in other States too.

Malnutrition among under-five children is a major public health problem and underweight children in India are among the highest in the world, nearly doubling that of Sub-Saharan Africa. What are the steps taken by DFY through CMAM in combating malnutrition in India?

Yes, malnutrition is a big problem as you can see from the two images below and the damage it is causing to the country’s workforce.

Brain damage occurs in the first 1000 days (nine months intrauterine and two years after birth) and it is irreversible after this period. So we have to work on a war footing to save this irreversible brain damage otherwise we will produce large numbers of children with low IQs and poor physical build up manpower which will eventually lead to GDP loss as high as 11 percent.

The number of severely malnourished children is very high (>80 Lakh) that it is impossible to admit and treat them in hospitals as there are not enough paediatric beds to accommodate them. So under the Community-based Management of Acute Malnutrition ( CMAM) programme, we treat cases/patients at their respective homes and only very serious or complicated cases are admitted in the hospital.

Our outreach workers and regular follow-up by mothers with malnourished children is the key component of this programme. We are currently running CMAM in Bihar and Maharashtra, covering more than 300 children.

Which State, according to you, is a worst case scenario of child healthcare and malnutrition? What are the measures taken to tackle this situation?

If you ask me, Bihar is at the bottom due to a very weak public health system(80 percent medical care is run by the private sector), poorly skilled manpower and corruption at many levels. After Bihar, Uttar Pradesh, Madhya Pradesh, the Chhatisgarh tribal belt and Jharkhand are the other States with a large number of malnourished children. Urban slums with poor water and sanitation conditions also have a large number of such children.

Malnutrition is not just about lack of nutrition. There are many other reasons for this, ranging from illiterate mothers, lack of toilets, climate change and so on. So we have to focus on many areas, most importantly, on water, sanitation, nutritional support to vulnerable children and ensuring family economic security by creating more jobs. The Government should spend more money on the social sector (Health, Education, Nutrition and Social Welfare). This will ensure good returns in the long run.

WASH is an other major programme which your organisation is involved in. How have the various camps and awareness programmes conducted by DFY impacted the different States where this project is running? Any plans on extending it to other States?

Yes, after being in the medical field for over ten years now, I realised that building toilets and creating awareness about cleanliness and hand washing is much more effective than any multivitamin or antibiotics intake to improve the health of the country. Under WASH, we are doing mainly three types of activities which are also keys for the success of Swachh Bharat Abhiyaan.

1. Construction of Toilets – We are building more than 500 toilets in Bandipora district of Kashmir as well as in 24 schools in Bihar.

2. Maintenance of Toilets – We provide hygiene kits (bucket, mug, water tank with tap, brush and Harpic toilet cleaner) to each beneficiary so that they can maintain the cleanliness of their toilets.

3. Behaviour Change Among Users – This is the most important component. Under this, we are promoting behaviour change among school children, the community and all other stakeholders to bring a positive change in the community towards use of toilets and therefore do away with open defecation. Under the hand washing promotion programme, we have ‘Soap For Hope’ where we collect used soaps from five star hotels, clean and crush them and then recycle them into new soap bars. We give these soaps to school students and vulnerable communities free of cost to promote hand washing. It is a very successful programme and is bringing a lot of change at the grassroots.

“Malnutrition is not just about lack of nutrition. There are many other reasons for this, ranging from illiterate mothers, lack of toilets, climate change and so on. So we have to focus on many areas, most importantly, on water, sanitation, nutritional support to vulnerable children and ensuring family economic security by creating more jobs. The Government should spend more money on the social sector (Health, Education, Nutrition and Social Welfare). This will ensure good returns in the long run”

There are many facets to the after-effects when disaster strikes a place or region. What are your objectives and commitment towards emergency relief and response as well as rehabilitation, and the States you have been engaged in for relief programmes?

Medical relief and response during humanitarian crisis across India is our USP. We have won two international awards for our disaster response work (British Medical Journal Award for Best Medical Team in Crisis Zone, 2011 and SAARC Youth Award 2009 for Outstanding Work in the Aftermath of Natural Disasters).

“Our aim is to identify the most disaster-prone districts in India and keep doing local resilience building and community development programmes so that these communities can eventually sustain and take care of themselves without any external support”

Our aim is to provide quick medical response after disasters to restore emergency medical care and restore public health services ASAP. Our target is maternal and child health as they are the most vulnerable and they suffer maximum preventable morbidity and mortality post crisis. Doctors For You provide medical relief in all kinds of disasters like flood, earthquake, conflicts or man-made disasters.

In the acute phase of disasters which usually last for six to eight weeks, our focus is usually on reaching maximum number of people and providing immediate medical support. We would then gradually take up rehabilitation and work in strengthening the public health system like building toilets/hospitals, training doctors, strengthening immunisation, etc. We continue with these two projects in the affected zone even after the relief work is over to build the resilience of the community. We are lucky to have very good partners who understand the importance of disaster risk reduction and provide all support to build the local capacity along with local government departments and the community.

Our aim is to identify the most disaster prone districts in India and keep doing local resilience building and community development programmes so that these communities can eventually sustain and take care of themselves without any external support. That is our ultimate goal. North Eastern States, Bihar, West Bengal, Uttarakhand and Kashmir, are priority States for us in terms of disaster risk reduction work. We always work with local governments and try to strengthen their system and not replicate or run any parallel system. Therefore, all projects have State government officials are our main partners.

Capacity building is another area where you have been working on. Do share with us the progress in this area.

We started capacity building programmes in 2012 in Assam and we have trained more than 5000 doctors and paramedics from the North East. Apart from that, we have also conducted trainings in Kashmir, Uttarakhand and Bihar. We train doctors, paramedics and the police force on mass casualty management, hospital preparedness, public health in emergencies, WASH in emergency, mass gathering event management, crowd control, trauma care etc. We have developed modules and trained Accredited Social Health Activists (ASHAs), Aaganwadis and Auxiliary Nurse Midwives (ANMs) from villages on disaster management and basic public health activities to be done during emergencies, so that they can provide essential and emergency services till specialised doctors involved in emergency management are able to reach ground zero. We are now expanding these programmes to other States as well.

Are you also looking beyond India to reach out to those facing challenges in healthcare as well as relief operations?

Yes, we would like to expand our services to the entire South Asian countries like Bangladesh, Bhutan, Nepal, Pakistan, Afganistan, Maldives and Sri Lanka if we get sufficient support and resources. We have partners in all the SAARC countries. We have been a member of ADRRN (Asian Disaster Reduction and Response Network) for the past five years. We hold exchange programmes for our staff, for example, we had two last year, with Bangladesh and Afghanistan. The Nepal Earthquake Response was our major medical response outside India. We are still involved in Nepal for research and best practices documentation work, post 2015 earthquake.

Working in challenging situations and areas also has its share of richly encouraging comebacks and testimonials. Share with us some inspirational incidents you have encountered in your journey so far.

There have been innumerable incidents that have impacted and altered the course of my life but I would like to mention a few here.

Death of a Team Member on Field

This was our first relief work post Koshi Floods in Bihar in 2008. Dr. Chandrakant Patil was my junior from KEM Hospital, Mumbai, and one of the first doctors who responded to help me deliver relief work in Bihar. While we were tirelessly working there, an unfortunate thing took place on September 21. Dr. Chandrakant lost his life when he was struck by lightning at the residential camp in Supaul District. It was a devastating time for me as well as the entire team. We returned to Mumbai within two days. As I sat and ponder about my friend and a precious life being lost, I also realised that I should not give up as the people of Bihar desperately needed our help. A week later, I went back to Bihar and decided to finish the work started by Dr. Chandrakant. The Team and I stayed there for almost six months. Our relief work in Bihar received much appreciation internationally. I was honoured with the SAARC Youth Award 2009, becoming the first Indian to do so.

Prior to this, I will not deny admitting that I was quite ambitious. But somewhere along the way, especially after losing my friend, I had to take a call between big money and public healthcare. I chose the latter and there was no looking back after this. I felt at peace knowing I made the right decision.

Medical Equipments Support Post-Earthquake in Nepal

DFY has provided five ventilators along with other medical equipments like X-ray, C-arm, implants and medicines to the Nepal Government after the devastating earthquake of 2015. When our ventilators reached Kathmandu by truck, two ventilators were immediately shifted to TUTH (Tribhuvan University Teaching Hospital) and ICU patients were thus saved from untimely deaths. It was a poignant incident which reminds us the importance of rapid response post disasters.

Importance of Data

I would like to mention here the importance of collection, compilation and analysis of all healthcare-related information into data forms so that it can be utilised appropriately to improve care for patients. Good data from the field improves the quality of intervention to a great extent and has more impact than just sharing some good stories. For example, during the Kokrajhar violence in Assam, we were working in some of the biggest relief camps and treating malnourished children as well. Incidentally, Mr. Rahul Gandhi visited one of the camps and we presented him with a data of severely malnourished children. The detailed data and evidence of the facts on the ground spurred him to act immediately. Within two days, we received a truckload of eggs and bananas. We were ecstatic with the quick response from him. This timely intervention enabled us to feed and take care of the children and pregnant mothers staying at the camp, thus reenergising them for the tough days ahead.