“The only time I feel visible and cared for is when I am at this clinic. At all other times, I feel invisible” said Mallamma (name changed for confidentiality), one of the patients at MSF’s mobile clinic in Pusuguppa, located on the Telangana-Chhattisgarh border.
This one statement encompasses the ongoing reality of access to healthcare in a region that has been affected by the low intensity conflict between the government security forces and the Maoists over the last decade.
“Access to healthcare” is a phrase that one normally hears on joining MSF. In order to understand the true meaning of this phrase, one has to first travel to some of the most inaccessible parts of India, where communities do not have access to even basic healthcare. One of the core principles of Doctors Without Borders/Médecins Sans Frontières (MSF), the international medical humanitarian organization, is to provide healthcare to those who need it the most, when and where it is not available. The Telangana-Chhattisgarh project of MSF India is one such example where I spent three days.
While all I got was perhaps just a sneak peek into the lives of the patients and the MSF staff who work tirelessly, it was still enough to understand the importance of providing medical care in such a difficult context. I began my visit by traveling along with the mobile clinic team to the remote village of Pusuguppa. The MSF mobile clinic is run in different villages each day of the week and often comprises of 2 doctors, a nurse, a nurse aid, a translator, a lab technician and a person who takes care of health and promotion.
Photo Credit : Camille Gillardeau/MSF
After a long two hour drive in the sweltering heat, we reached Pusuggupa. Patients and attendants were waiting anxiously and began to mill around the MSF vehicles as we began to pull in. The setup at Pusuguppa is quite basic as no permanent structure is available. Five short thatched huts built by MSF turn into a mini clinic every Tuesday. The first hut is where patients are registered and checked for their temperature and weight. Children below the age of five are also weighed and checked for any possible signs of malnutrition. Once this is done, patients are sent to the “lab” hut, where patients suspected with malaria are tested for the parasite using Rapid Blood Test. They are then sent to another hut where, once all patients have gathered, the Health and Promotion (HP) staff takes over and spreading awareness on malaria, tuberculosis and hygiene. Often the HP sessions last anywhere between 15-20 minutes and patients are encouraged to adopt preventive measures in their homes. The doctor then begins his consultations.
At the Pusuguppa mobile clinic, almost 50% of cases who turned up on that day (54 patients in all) had some sort of skin disease – often fungal infection or ringworm infection. Many others were diagnosed with malaria. According to Dr. Nagender, who has been with MSF since early 2014, malaria is endemic in the area and the disease morbidity rate is quite high. Diarrhea too, is a big area of concern in this region. “While most of these diseases are preventable, it is to be noted that the morbidity rate is high in this region because of lack of access to healthcare,” he said.
The mobile clinic also provides ante-natal and post-natal care to women. Most often, the women come from villages as far as ten to fifteen kilometers away for consultations.
Patients with complicated medical conditions are referred to a hospital in Bhadrachalam. MSF provides these patients with travel costs to and from Bhadrachalam to encourage them to seek medical aid.
The beauty of a mobile clinic is the proximity of medical care it brings to the patients. Often, this is the only place where they can get any medical aid without having to travel very far – a stark reality of the state of healthcare in rural and conflict-ridden India. The mobile clinic team visits Pusuggupa once every week and in some other places like Dharmanapeta twice a week. However, it is during the monsoon season that the true merit of the mobile clinic is tested. “During monsoons, the access to these villages is completely cut off due to flooding streams. We have to walk most of the distance with all our equipment to reach the people. Also, the number of patients almost doubles during the rainy season,” said Vijaya, the MSF translator at the project.
In 2013, MSF conducted over 52000 consultations and administered over 14500 vaccinations at its primary and secondary healthcare programs in Telangana and Chhattisgarh. For the people living in areas where a low intensity conflict means restricted or no access to essential health services, organisations like MSF plays a crucial role of a health provider. Currently, MSF runs eleven mobile clinics under the Telangana-Chhattisgarh project, apart from 24/7 fixed clinics in Mallempeta and Bijapur.
Written by DVL Padma Priya, Press Officer, MSF India