Another five community health workers have been appointed and trained following the success of phase one of the Kapaade Akka primary healthcare programme in Jogini villages in the southern Indian state of Telangana. A review of the first phase revealed that it has made an impact on the lives of not just Joginis but also others in the community. The need for healthcare provision in these villages was very clear, and the review highlighted the role of the first five community healthcare workers as ‘agents of change’ advocating for health and bringing the key players – community, government and organisations – together to effect lasting change.
The programme has been running since June 2015, when the healthcare workers conducted a two month mapping exercise in their villages to identify the health needs in the community. This exercise revealed that the main causes of sickness in these villages were: lack of access to clean water and sanitation; alcohol and tobacco addiction; inappropriate remedies stemming from traditional beliefs; and the exploitation of women in unsafe sexual practices, particularly among the Jogini community. Joginis are women and girls, mainly Dalits, who have been dedicated to a goddess, only to find that in addition to conducting religious duties they are expected to be used and abused by the men in the village.
Supporting patients through their treatment
Most of the sickness and disease experienced by villagers is preventable and treatable, but there is a distrust of medicine. Access to health and medical services for the poor and marginalised is extremely limited if it is there at all. Now our healthcare workers are making a big difference, helping Joginis and others not only to access healthcare but supporting them through their continuing treatment.
Two of the most unwell Joginis helped by our Indian colleagues were taken taken to hospital by their respective village health workers. Both were advised to take HIV tests, but refused because they were afraid. The health workers spent time with them both addressing their fears, before they agreed to the tests and both were found to be HIV positive. Now they have access to the appropriate treatment through the government, and they are being supported by our staff who have also helped them to access pensions. One of the women had an infected leg wound, and her health worker was able to obtain support from the rice mill where she was injured as well as secure payment for her treatment.
Accessing medical treatment
Kapaade Akka health workers are able to check blood pressure. Without this, the only way for villagers to have this done locally is by paying a village doctor but even then they are never given advice let alone the actual readings. The health workers measure blood pressure without charging, explain what the reading means and offer appropriate advice. One patient who was found to have high blood pressure had already been diagnosed but had stopped her treatment because she could not afford the fees or medicine. The health worker explained that she could access medicine through the government service for free, and now she is being treated and her blood pressure is under control.
The health workers are also working in conjunction with monthly medical camps run by our partners in the district. They have a particular role in visiting patients following diagnosis to support them and to encourage them to visit a doctor for a review. In a recent camp, five people were identified as requiring cataract surgery. It took four or five visits from health workers to reassure these women and persuade them to agree to the surgery.
It’s not just Joginis and their children who are benefiting, others in the community are also being helped. One health worker came across a child who was having night-time fits but it seemed that no-one was helping the family. They had been to a doctor who said the child would need neurosurgery, but that would be well beyond the family’s means. The health worker persuaded them to come to our clinic in the city for the child to have a CT scan. This confirmed that surgery was not required, and now the child is free from fits because she is on medication, which is available free through the government.
One of the health workers commented, “Now I understand the importance of my role. Before, I felt that I could not be very important because I do not give out medicine. I understand the importance of healthcare. No-one is doing this work in my community, only me.” The five newly appointed workers have doubled the size of the programme, and it is set to expand further in the summer.