St John's Medical College and Hospital, Bangalore, has started a senior citizens health service aimed at providing medical care at reduced rates and improving the quality of the health and life of older persons in rural and urban areas around Bangalore
Senior citizens comprise a sizeable section of our population. Yet elders become socially marginalised due to failing health and a diminishing capacity to contribute productively to the economy. This in turn leads to financial constraints, which prevents them from accessing available medical facilities.
“The healthcare needs of the ageing require a different focus compared to that of the general population,” says Dr Arvind Kasthuri, Professor, Department of Community Health, St John’s Medical College, Bangalore. “While elders are prone to diseases such as pneumonia, which affect the general population, the presentation of symptoms and side-effects differ. Elders are also prone to health problems specific to them. When an elder falls, the causes could be a balance problem or a heart syndrome. Doctors need to take a specialised approach to the causes and treatment. The aim would be to preserve and restore bodily functions rather than rigid control of the disease.”
The government does not offer dedicated health services for older persons, and private facilities are scarce and expensive.
To address this need, a senior citizens health service has been started by the community health department of St John’s Medical College and Hospital, Bangalore. This service is aimed at providing medical care at reduced rates and improving the quality of health and life of older persons in rural and urban areas around Bangalore.
The healthcare programme has a multi-pronged approach. The urban programme is located at St John’s Hospital, with its existing wide range of multi-specialty services. The Senior Citizens Health Clinic at St John’s Hospital was launched in 2005. A weekly senior citizens clinic is held at the hospital, at reduced fees, aimed at making the hospital visit of the elderly as comfortable and useful as possible. A home health service registers seniors within a 5 km radius of the hospital, assesses their health status at the clinic, and follows up with monthly home visits by a doctor and nurse. The programme also encompasses assisting institutions for destitute elderly in Bangalore, and is currently serving two such institutions.
The rural thrust of the programme is of special interest as it takes medical care to the doorsteps of elders living in outlying areas. The rural programme commenced in 2003 based at the Mugalur Community Health Training Centre, a village 30 km from St John’s, which is the longstanding rural field practice base of the medical institution. This programme currently covers five villages, and there are plans to increase that number.
Each new rural clinic is opened after a survey of older persons resident in the village to document their number and healthcare needs. Cooperation of village elders, panchayat members and mahila mandals is sought in order to make the clinic a welcome facility rather than an alien imposition upon the community. Once a village is identified, monthly clinics are regularly conducted for senior citizens. Seniors are assessed by doctors, and a notebook with details of their treatment and follow-up is given to each of them. Drugs and investigations are provided at reduced cost with the aid of public donations. A community health worker makes home visits between clinics and motivates the elderly to adhere to treatment, visit the clinic and report problems early. Currently, surgery for cataracts is done at a cost of Rs 200 at the Mugalur health centre. Plans are underway to extend this facility to ear, nose and throat surgeries.
A visit to a typical monthly clinic held at Kugur village on May 7, 2008 showcased the medical team’s methodical and holistic approach. Cooperation and participation from the village community is actively sought. The room for conducting the clinic is provided by a village resident, along with chairs and tables. The system is streamlined to ensure maximum benefits. On the Saturday prior to the clinic, a team from St John’s goes to the village to take fasting blood and other samples. The samples are analysed at St John’s and the medical team arrives for the clinic with ready reports. “Our aim is to devote as much time as possible to listening to and addressing the problems of the elderly,” says Dr Kasthuri. The doctors from St John’s take time to examine each patient, asking questions regarding medication taken, follow-up, and food habits. Cases requiring specialised consultations are referred to the nearby Mugalur health centre.
Educational sessions aimed at creating health awareness are an integral part of this programme. At 10 am, Dr Swaroop held an interactive session on anaemia with the assembled elders, using pictorial materials created by medical students. It was heartening to see the enthusiasm among rural senior citizens as they arrived dressed in their festive best. They answered questions readily and said they encouraged their friends and neighbours to come for check-ups. Thimmarayappa, aged over 100 years, arrived unescorted, embodying the positive spirit of the elderly. Impaired vision due to corneal opacity obviously did not deter this sprightly grandfather from enthusiastically participating in the proceedings. By the end of the session, over 25 elders were medically examined, with blood sugar levels measured where required and medicines dispensed at reduced rates. The doctors took great care to explain the dosage and method of taking the medicines.
The St John’s team acknowledges problems faced by the elderly which require social intervention. Problems such as maladjustment and ill-treatment within the family, abandonment and loneliness are identified by community health workers during field visits. They talk to family members, as well as friends and neighbours, in an attempt to arrive at the root of the problem and offer possible solutions.
During the clinic at Kugur, Chikkaraju, a professionally trained social worker attached to St John’s, visited the family of Thimmakka, aged 75. She had been abandoned at a young age by her husband and had struggled lifelong as a farm labourer. Nearing the end of her harsh and poverty-stricken life, she is now disabled and mentally disturbed. She lies in a thatched animal shed outside the family cottage, alone and neglected. The social worker gently tried to persuade her relatives to take her to the Mugalur health centre for a primary consultation with the orthopaedic doctor, psychiatrist and other specialists. Follow-up care could be given at the time of the medical team’s monthly visits, she told them.
“We arrive at their doorsteps and offer a helping hand to cases such as these,” says Dr Kasthuri. “We try our best to motivate them to avail of medical assistance. We persuade them to meet us halfway and take interest in improving their own lot. That is the best approach for lasting beneficial results.”
-- Monideepa Sahu
(Monideepa Sahu is a Bangalore-based freelance writer of both fiction and non-fiction, with a variety of interests including social issues and literature)
InfoChange News & Features, June 2008