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Vision at Risk: Tackling Diabetic Retinopathy in Rural India

Keywords: Diabetic Retinopathy, CHW, Deep Learning, Rural, Eye Condition


According to National Library of Medicine, the prevalence of Diabetic Retinopathy (DR) is 14.0% (95% confidence interval [CI]) in rural India with a prevalence of 7.9% in males and 7.5% in females by 2321. There is no significant difference between the urban (19%) and rural (14%) population in India. But majorly the rural population have been suffering due to the lack of accessible and affordable healthcare services in India. 

High blood sugar from diabetes results in diabetic retinopathy. Blood sugar levels that are excessively high over time might harm the retina, the area of the eye that detects light and transmits information to the brain via the optic nerve, which is located at the back of the eye. Most often, there are no symptoms in the early stages of diabetic retinopathy. Some people experience vision changes that affect their ability to read or perceive objects in the distance. These adjustments could occur suddenly. Blood vessels in the retina begin to bleed into the vitreous, the gel-like fluid that fills the eye, as the condition progresses. 

Santen (Santen Pharmaceutical is a Japanese pharmaceutical company, specializing in ophthalmology) and iKure had intervened in three crucial locations mainly, in Hoskote, Bengaluru, Kankinara, and Domjur, West Bengal. In those rural locations, DR screening and complete body checkups for patients was adopted as part of the iKure-Santen partnership. Frontline health workers from iKure were actively checking for diabetic retinopathy and offering appropriate medication or medical advice to the patients. Screening of 94.5% of diabetic patients had been done. 100% of patients learned about their eye health condition and sought out an ophthalmologist. 92% of patients expressed a desire to get routine eye checkups. By preventing or considerably reducing vision loss and other health problems, early detection and management of diabetes and its consequences, including DR, significantly improved people’s quality of life. The success of the intervention in raising awareness and encouraging routine eye exams was a result of strong community involvement and teaching about the value of eye care in managing diabetes. 

A couple of the significant advancements that have influenced the DR landscape over the past few decades are the introduction of anti-vascular endothelial growth factor (VEGF) treatments and the accessibility of imaging with optical coherence tomography. Over the next ten years, deep learning (DL) and artificial intelligence (AI) algorithms will become more and more crucial in fields including medical diagnosis, screening, prognostication, and decision support for management or therapy. Utilising AI to conduct a thorough examination of retinal imaging, systemic parameter profile, and other blood biomarkers may yield more insightful, and possibly even more accurate, results than human intelligence alone. 

A sustainable strategy to improve diabetes and DR services at the primary level of care was seen by utilisation of Community Health Entrepreneurs (CHE) who are already part of the health system, especially if it involves community awareness, health education, and the facilitation of health services. iKure has been ensuring that the services are available at the last mile community’s doorstep through their Community Health Entrepreneur (CHE) model. 

References: 

  • Article: Rajiv Raman, MS, Joana C Vasconcelos, MSc, Ramachandran Rajalakshmi, PhD, Prof A Toby Prevost, PhD, Kim Ramasamy, MS, Viswanathan Mohan, PHD. (2022). Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban–rural locations, and socioeconomic indices: results from the SMART India population-based cross-sectional screening study. The Lancet Global Health, Volume 10 (Issue 12). 
  • Article: Praveen Vashist, Suraj S Senjam, Vivek Gupta, Souvik Manna, Noopur Gupta, B R Shamanna,Amit Bhardwaj, Atul Kumar, and Promila Gupta. (2021). Prevalence of diabetic retinopathy in India. Indian J Ophthalmol, Volume 69 (Issue 11). 
  • Article: Srikanta Kumar Padhy, Brijesh Takkar, Rohan Chawla, and Atul Kumar. (2019). Artificial intelligence in diabetic retinopathy: A natural step to the future, Indian J Ophthalmol, Volume 67 (Issue 7). 
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iCHAs in Serving the Last Mile

Keywords: Sundarbans, iCHA, digital healthcare, healthcare,  iKure


My name is Pranati Karan. I am working as an iKure Community Health Activist (iCHA) in Satjalia, Sundarbans.
Six months back my life was confined to household chores and taking care of my family. But now I have a more prominent role to play. Now, I take care of my community as well. Usually, my day starts at 5 am in the morning. I finish cooking mostly fish and rice to feed my family during the day and leave my house by 8 am. My mother in-law takes care of my two children till my husband and I return in the evening. My day at the iKure facility starts by login into the WHIMS application to check the scheduled tasks of the day. I check my Medic Bag, check the BP machine, put on my apron and start with the day’s first door-step visit. Uma Pradhan, 56years of age, has been suffering with high blood pressure. This is my second visit and I find her slightly better than my previous visit. “Uma Amma how are you doing today.” She seems to have recognised me, as she smiled and said, now, I am fine after seeing you.” I told her, Amma, I will monitor you in the next few days, if your blood pressure remains the same, I will connect you to our doctor via teleconsultation. Persistent High BP is not good for you. It can affect your eyes, heart and Kidney, I learnt about this all and more in my training program that I get from the iKure periodically.

iKure selects women like me with minimum educational background. They provide them with a training program that includes clinical training and technology training. At the end of the training, they provided us with Medic Bags that contain Point-of-Care (POC) devices for measuring vitals such as BP, Pulse, temperature, SPO2, height and weight. These are for capturing basic vitals, with advanced training, I will be able to handle other diagnostic tools as well like ECG, blood glucose and identifying anemia. We, iCHAs are medically trained so that we can provide healthcare services even at the last mile where there are no doctors and access to basic healthcare is beyond reach.

Many of the islands of Sundarbans, are not even connected to proper roads. My maternal uncle who was just 38 years old succumbed to death due to a sudden stroke. It took us more than 5 hours to reach a health care facility in Gosaba. There are no healthcare facilities in these islands to handle emergencies. Moreover due to storms and cyclones like Amphan & Fani, there has been increase in the salinity level of the lands, that is why my husband is working as a daily labourer in Bali. I learnt from my iCHA didi, that saline water levels also can cause high blood pressure with other respiratory and skin diseases.

Like me, there are other iCHAs working closely with the local population to raise awareness about sanitation, hygiene, nutrition, maternal and child health, family planning, and disease prevention. We are not here to replace doctors as my neighbours call me during late hours in the night, I answer to them and seek our doctor’s guidance according to their health conditions, rather we are here to reduce the emergencies by treating and managing health conditions on time. Our primary objective is to promote health and well-being through health education, preventive measures, and early detection of health issues. I am taking care of the burden of Hypertension in Sundarbans.

iKure’s iCHA model is enhancing the existing people-centric to process-centric care to improve the quality of care promoting healthy lives and wellness at the grassroots.
I am happy to take the first step with iKure and serve my communities across the remote islands that have never seen a doctor before.

 

Voice of our iCHAs:

“Working with iKure has helped me gain identity as a health worker. Previously, I was just a housewife who helplessly depended on my husband for the sole income of the family. iKure has given me means to earn my own living and alongside helped me train as a healthcare worker. I have learned to check the blood pressure, blood sugar and body temperature of my patients. In the process I have learned to help my neighbors and community in need while being financially independent.”Moumita Chhatui, 24yrs, Bally

Our iCHAs taking the ferry to provide accessible and affordable healthcare at the doorstep of the last-mile community.

 

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Planetary Health

Keywords: Sundarbans, climate change, planetary health, endangered, salinity,
digital healthcare, healthcare, impoverished, disease burden,
vulnerable, conference, iKure, mangrove, delta.



The Unconference for Solutions was held at Tora Eco Resort, Bali II Island, Sundarbans from 23rd-25th February 2023. The panel for Track II: Impact of Climate Change on Health included Mr. Soumitra Ghosh (Chief of Party ABT Associates) was the moderator of the panel, Mr. Sujay Santra (Founder & CEO; iKure Techsoft Pvt.Ltd), Mr. Todd Huber (Founder & Chairperson; Cattellyst Foundation), Ms. Pompy Sridhar
(Director & Country HeadIndia at MSD for Mothers), Dr. Raja Dhar
(Head of Department; Pulmonology C K Birla Hospitals).
Sundarbans is one of the largest deltaic mangrove forests in the world formed by the mighty rivers Ganga, Brahmaputra and Meghna. It is spanning over an area of 4264 sq. km in India alone consisting of 102 islands of which 54 are inhabited by 4.5 million people. This unique and ever changing ecosystem of Sundarbans is facing aggression from climate change that is challenging the lives and livelihood of the inhabitants. According to reports of 2016, imbalance in the ecosystem, the total area of Sundarbans has shrunk by 451 km 2 since 1904. This has led to human-animal conflict in this ever-shrinking space causing tiger and human to be squeezed up.
The rising salinity in this region due to lack of freshwater and rising sea
levels impacts the health of the inhabitants especially the mother-child health. People living there suffer from stomach ailments related to indigestion and acidity, hypertension, dehydration, skin lesions, anemia and hypocalcemia due to lack of freshwater. Children are three times more vulnerable to communicable and pulmonary diseases keeping aside the constant attacks by animals and snake
bites of the localites who step out for their survival.
Sundarbans is a living example of imbalance in interdependence between humans and environment. Human activity has not only over-exploited the available resources but also generated immense pollution leading to immense loss of biodiversity that has led to one of the biggest threats to human survival, i.e., climate change. This
complex relationship between environmental sustainability and its impact on human health is phrased as Planetary Health.
iKure along with its co-partners Centre for Sustainable Health Innovations, Public Health Foundation of India, Cattellyst, Recanteur and several other global organizations had organised a two day event, ‘Unconference for Solutions’ in the heart of Sundarbans to look for apt solutions.
Survival is a major concern in Sundarbans hence, education and health is not given much importance in this region. Health services in the Sundarbans experience regional imbalance varying from less than one in 5 per 100,000 population. Many of the islands of Sundarbans, approximately 11 of them, are not even connected to proper roads or decent healthcare facilities. It takes almost 5 hours on an average to
reach the main town of Gosaba for a doctor check-up. There are zero tertiary care units in these islands in case of healthcare emergencies.
Lack of proper healthcare and inaccessibility of healthcare increases the disease burden of the region that in turn raises the mortality rate of the vulnerable population.
Planetary Health seeks immediate attention to safeguard the health of the planet and people of the future generation. Development of a climate resilient and environmentally sustainable healthcare system is the need of the hour for the impoverished masses of Sundarbans. This will help them to adapt to alleviate health risks related to climate changes thus reducing healthcare burden, loss of life and causalities.
Climate and social science play a synergistic role contributing to higher chances of survival of the Sundarbans. iKure is also looking at different ways by which the local communities should be pulled out of poverty mostly by empowering women from
different islands of Sundarbans towards raging issues in the field of primary health care. This would help in relieving the pressure on natural resources and promote physical and mental well-being of the inhabitants. Kumirmari, one of the endangered islands of the Sundarbans is the present intervention area of iKure.
iKure, a population health management organisation is coming up with its own living lab set-up at Baruipur that will primarily engage in preventive, promotive and curative aspects of healthcare. It will aim to develop a climate resilient digitally-enabled healthcare system for low-income communities.
An old English proverb says,“The journey of a thousand miles begins with a single step”, iKure invites all with open arms to be a part of this transformative change. The voices of the deprived community have been left unheard and ignored for the past few centuries and it is of utmost importance to empower these inhabitants to ensure that the people and nature can strike a balance and thrive together in
Sundarbans.
iKure welcomes involvement of the local community or collaborative
ecosystems in addressing the looming crisis, making transformative
contributions in the healthcare system and developing a continuum of care for millions.

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Digital Health & Equity

Changing the dialogue of healthcare in Sundarbans

Keywords: WHO, rights, healthcare, deprived community, poverty, Sundarbans, digital health, telehealth, conference, Unconference, unserved.

 

 The Unconference for Solutions held at Tora Eco Resort, Bali II Island, Sundarbans from 23rd- 25th February 2023, concluded with distinguished panelists for Track III: Health and Equity, Dr. Sanghita Bhattacharyya (Senior Public Health Specialist at PHFI) was the moderator of the panel, Ms. Priya Kakkar (Senior Public Health Scientist; Director, PHFI-RNE), Mr. Kevin Schmid (Technologist with specialization in public-sector applications), Mr. Sujay Santra (Founder & CEO; iKure Techsoft Pvt.Ltd), Prof. Yoshiro Okazaki (Ph.D Associate At Waseda University) and Prof. Suman (Former Dean R&D and Head, IIT Kharagpur). WHO quotes, “The right to the highest attainable standard of health for every individual” is an internationally agreed human rights standard. Decline in health of the deprived community is a foregone chapter. Poverty significantly impacts health and health outcomes. We should seek accessible and affordable means by which
we can sustain a healthy living. Digital health seems to have a potential to pave a way for affordable healthcare and also make healthcare more accessible for these low-income communities. iKure along with its co-partners Centre for Sustainable Health Innovations, Public Health Foundation of India, Cattellyst, Recanteur and several other global organizations had organised a two day event, ‘Unconference for Solutions’ in the heart of Sundarbans to look for solutions in terms of Digital Health and its accessibility among the unserved.
Sundarbans is marked by frequent climatic shocks and inhospitable terrain both of which lays a heavy impact on the accessibility of healthcare services. There are very few quality healthcare options in Sundarbans; the number varies from less than one in 5 per 100,000 population. Some of the existing publicly funded healthcare is non-functional due to weak infrastructure or shortage of staff. Even if some are functional, the islands of Sundarbans are not even connected to proper roads. As a result this region experiences high morbidity in comparison to the state average. The dual burden of communicable and non-communicable disease is evident among the impoverished. Children in Sundarbans suffer from chronic malnutrition and
exhibit high prevalence of communicable diseases. Sundarbans also exhibits a high prevalence of mental health problems.
Healthcare though traditionally is slow to adopt yet it is a growing and ever-changing field. Digital Health has improved the healthcare delivery and outcomes, it has also altered the healthcare industry as a whole.
Telehealth plays a significant role in delivering proper healthcare in remote areas. Sundarbans is one such area, that is spanning over 4264 sq. km in India alone consisting of 102 islands of which 54 are inhabited by 4.5 million people. People inhabiting the remote islands face much hardship in comparison to the ones who
inhabit the peripheries. People of Sundarbans are exposed to poverty, deprivation and acute struggle against geographical challenges.
“Healthy citizens are the greatest asset any country can have, aptly stated by Winston Churchill. iKure is looking at different ways to take the first initiative in shaping a better tomorrow for the deprived community.
Digital Health would reduce dependency of patients on physical doctor consultation and promote timely prognosis of the disease providing sustainable patient health outcomes. Through the Digital Health and Equity panel, the focus was on building innovations with a top-down, bottom-up approach to empower communities digitally in an equitable way and digital technology contributing to sustainable attainment of
universal health coverage for the ones who need it most.
iKure invites all with open arms to join in the mission of developing health solutions that can bring accessible and sustainable care for the communities.

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Women as agent of change

Keywords: Sundarban, women, conference, gender discrimination, healthcare, quack
doctors, women empowerment, equity. 

Unconference for Solutions was looking at different ways by which women from different Islands of Sundarbans could be
empowered to make strong contributions
towards the Raging Issues in the field of
Primary Healthcare by providing solutions.
This two day event at Tora Eco Resort, Bali II Island, Sundarbans was held
from 23rd-25th February 2023. Track I: Women as agents of change was
moderated by Dr. Tirumala S. Mandal (AVP Research &
Communications; iKure Techsoft Pvt.Ltd) and other eminent panelists
included Ms. Pompy Sridhar (Director & Country HeadIndia at MSD for
Mothers), Dr. Debashis Bhattacharya (Mentor And Advisor iKure
Techsoft Pvt.Ltd), Ms. Paramita Banerjee (Ashoka Fellow Child Rights
Activist Founding Member of Diksha), Ms. Pritha Chakraborty
(Filmmaker & Founder of Recanteur Media).
Environmental challenges in the Sundarbans have impacted
socio-economically and environmentally, making the society in this
vulnerable community highly disorganized. Needless to state that
gender discrimination is common among these vulnerable
communities. A patrilineal and patriarchal culture is shaping the lives of
women living here. Women in Sundarbans face a host of challenges like
hard physical labour, limited or no income and wealth, power. They are
underrepresented in decision and policy making. They experience poor
social status, violence and intimidation. Extreme poverty, poor
sanitation and housing, lack of potable water, limited access to health
care adds on to their misery. Their educational status and literacy rate is
also low.
The healthcare gap worldwide impacts the indigent population, the
women and girls are the ones who bear the brunt of inequalities.
Sundarban region of India is a living example of this looming adversity.
According to a 2016 study, the impoverished in the Sundarbans lack
choices in healthcare. The publicly funded facilities are non-functional or
non-existent and the available functional facilities are mostly physically
inaccessible. This gap is often filled by quack doctors that might
increase the disease burden in this region. It was observed in a study in
2010, among the people living in Sundarbans aged between 15-59,
women disproportionately have a higher burden of disease in
comparison to men. Climate variability thwacks women more than
men in this vulnerable community.
In the looming crisis of climate changes and calamities, women are the
key agents and active responders in early adaptation and mitigation
for healthcare equity, access and climate crisis. Thus, women prove
themselves as entrepreneurs even in hostile environments, with their
dogged determination and resilience. Women as an agent of change
can bring transformative change at a grassroot level. It provides a
platform for them to voice their opinion and showcase their potential
as well. Financial empowerment of women would ensure an
environment of survival with justice and equity.
As aptly quoted by Mahatma Gandhi, “It is health that is real wealth
and not pieces of gold and silver,” let us join hands to shape a better
tomorrow for this vulnerable community. High self-assurance, social
recognition, changed roles are a significant indicator of women
empowerment that would aid in implementation of women as a
transformative change agent in primary healthcare. Women
constitute half of the population, but stories about women, for women,
and by the women are far and scarce.
iKure at the two day event, ‘Unconference for Solutions’ received
ideas and innovations on women as change agents that included
mobilizing microfinancing schemes to women’s rights for sexual
reproductive health and empowering women to demand quality care,
and understand what quality care is, in a way that can shape the
overall health systems.
iKure is open to any assistance via collaborative ecosystems,
integration of local actions to implement potential solutions that can
bring a transformative, inclusive, and disruptive approach involving
women as agents of change in the last-mile communities.

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Health Corner- Myths versus Facts

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Preface: I was given a rather daunting task by one of my acquaintances to put down some tips on good health for general information to my fellow crowd and beyond to humanity at large. Naturally it was difficult to decide where to start from, since the target readers may be from all strata and communities of our society and of all age groups.

But let me begin somewhere….

In the beginning, I would like to put some very general lifestyle habits which should be followed by all people for general good health to one and all. Many of what I am about to unfold are known to public, but some new concepts will also he hereby known-to undo any faulty /wrong habits which the reader may have inculcated, inadvertently.

Let me suggest a listing of never do’s & don’ts:

Never to skip your Breakfast in the morning. This is the most important meal of the day.

              1. You may skip your lunch/take a light lunch.
              2. Never take a heavy dinner moreover with lots of spicy and oily food. Night is the time of metabolic house-cleaning. The less the task assigned to the body in the form of digestion and metabolism at night, the better the body gets self-cleansed and detoxified by the next day.
              3. Drink at least l0 glasses of water in a day. Maybe more in the hotter regions.
              4. Soft drinks are real nuisance consumables with lots of empty calories. They are never to be considered for replenishing the fluid content of the body.( I have found hardly anybody drinking water along with any food-it is invariably a soft drink to go along !!!)
              5. If milk is tolerated, one can go for it, it helps one to go off to sleep. But it should be avoided by people who are trying to get into shape and lose some weight! Dairy products in general are fattening with the exception of some skimmed milk, etc. All the same, rnilk is regarded as one of the compact forms of nutrition…for calcium supplementation .
              6. Eggs are nutritionally recommended for calcium/protein etc. and they do not contribute to high Cholesterol, unless one is predisposed to high lipids in the blood.. (as per recent research). The no. of eggs should be restricted to 1-4 in a week! Not to forget that eggs go into the making of a lot of confectionery products as well, at home. This should also be considered.
              7. Red Meat/Meat of bigger animals should be avoided at all cost. Mutton maybe very delicious to the taste buds and a gratification to cook at home and places of formal eating, but it is a strict no-no as far as good health is concerned. Its fibers arc very much loaded with fats.
              8. Country chicken is always better-they run around a lot and their flesh is tastier as well than poultry bred chicken!!! Chicken should always be taken with the skin removed preferably before cooking. Ideally eggs of such country chicken are good to taste and good for health also. Duck’s Eggs are tastier but rich in Cholesterol!
                Recently the eggs of Quail birds are available locally too.
              9. Green vegetables and at least one serving of fruits should be present in the platters of all meals. Bananas are good in conditions of constipation/diarrhea but they are fattening as well as they contain a lot of calories. ( Bananas are an item with high GI –Glycaemic Index–They can be taken in moderation from time to time. People suffering from ‘Acid Peptic Disorders’ should refrain from Oranges and all sour fruits.
              10. Dry fruits – recommended best ones are Almonds and Walnuts. Cashew nuts although are common and tasty, they are rich in lipids. Peanuts are very good as well.
              11. Chocolates in general should be taken occasionally-but the darker ones with cocoa are said to be now good for heart, as per recent research, although in moderation .Teeth must be brushed at all times after ingesting chocolates to avoid Dental Caries and related conditions by people of all ages, more so children.
              12. Microwave Cooking is to be discouraged-as it robs the food element of their nutritious values! Microwave ovens can best be used as Food Warmers.
              13. The pattern of eating should ideally be when you leave the dining table you feel as if you could have eaten some more………..!!!
              14. Brown Bread is better than White Bread. But Breads again should be taken in moderation, to keep a check on carbs.
              15. Visits to places like McDonald’s and KFC should be avoided in principle, particularly if children are there in the family. Deep fried junk food is just not advisable for good health for persons in any age group-particularly kids and adolescents.
              16. Not to hit the bed immediately after lunch/dinner. It is better to sit upright for about half an hour (watching TV can be done) before one retires tor the day. This prevents conditions of Reflux Oesophagitis/ Heartburn/Waterbrash etc. which are very common. One should not stoop down to do anything just after main meals!
              17. It is better to avoid eating in between principal meals-as this distorts the real appetite and calories cannot be controlled.
              18. Given the option between Tea and Coffee – it is better to go for Tea. Due to its Tannin content, it acts as a good anti-oxidant. (An anti-oxidant is a substance which mops up the potential carcinogenic radicals in the human body.)
              19. Salad dressing/salted preservative added food/fruit Cocktails/ Creamy pastries/ Pudding/ concentrated Kheer products/ Cheese/Butter/ Non-skimmed milk are better avoided.

Few topics relevant to people with certain known disease conditions:

Persons known to have Renal/Ureteric Stores should refrain from eating tomato/related products. A lot of water should be consumed daily.

              1. Persons known to have Diabetes/with father or mother a known diabetic, should maintain a vigilant Diet Chart at home and also, as much as possible outside home. Everything can be taken but in moderation, depending on one’s body weight. What matters is the daily calorie consumption in the guidance of a Dietician or a Doctor.
              2. People with Diabetes should ‘keep their feet as clean as their face’. It is a very well believed saying, respected by Doctors and well educated patients alike. Diabetics are very prone to develop foot ulcers which do not show a tendency to heal can cause big problems to the patient and Doctors and many people have ended up losing their limbs (by amputation) simply arising out of sheer neglect of themselves and their Physician’s advice !!!
                A word of caution here – today children are also diagnosed to suffer from Diabetes simply out of leading an erratic life style!!!
              3. Elderly people with Diabetes for many years are typically prone to have some of the following. So their care takers should be aware of them:
                            1. Silent Heart Attacks – which has a high mortality;
                            2. Sudden Strokes ending up with paralysis of different grades;
                            3. Sudden infective episodes inside their system requiring urgent Surgery;
                            4. Sudden/Early Blindness arising out of a process called Retinopathy…even Cataracts;
                            5. Damage of Kidneys-causing renal failure and heading for dialysis etc. which are very expensive, even by Indian standards and the outcome is always grim;
              4. People with Hypertension (High blood pressure) should try to lead a stress free life, with regular checkup of BP) and medication from Doctors. Long standing improperly treated Hypertension can also lead to damage of Eyes/Kidneys/Heart etc. excess salt on the dining table to be avoided, salt may be used, albeit sparingly in the kitchen.
                ( Less than 5-6 gms a day)
              5. Persons suffering from both ‘Diabetes and ‘Hypertension’ need to be doubly cautious with respect to their day to day life, follow-up with Doctors, dietary habits and medications. All the potential complications of these silent killers get multiplied in such people, but with regular supervision from medical personnel they can lead very compatible normal lives.
              6. Persons known to suffer from a condition called as “Gout” need to have a real look into their diet and consult Doctors when they have episodes of acute pain in joints etc. This is usually due to a genetically inherited metabolic deficiency of an Enzyme, which takes part in Purine metabolism in the body. Simple analgesics after seeing a Doctor may be tried and usually the attacks subside within a few days, in some cases other medication are required and even to go on for life in resistant chronic cases. Beer is to be strictly avoided in such patients and Red Meat and certain leafy vegetables too, should be avoided from their Diet.

I think this has been a synopsis of handy health tips- which all good samaritans of this country need to know-.in order to lead a healthy life here . I have chosen this simplistic approach, as it is easy to be followed by lay persons, avoiding complicated terminology which might intimidate the readers and will defeat the purpose. The List is exhaustive and it goes on and on! It is only a humble effort to pick up a glass full of knowledge from an Ocean of the same . Parents should be rather strict on their children on many such issues. Working men and women must take care of themselves in an adequate manner as hinted above . Elderly people must be closely taken care of by their sons/daughters and taken to visit Doctors if something sinister really comes up with them.
Good Luck and Good Health to all my brethren & friends – young and old.

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CHWs-Newfrontier to drive innovations in rural healthcare delivery

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The need:

Jayashree,is a Community Health Worker(CHWs) in her village called Hubli, in Karnataka. One day,while she visited a woman named Pushpa in her first trimester,she looked quite unwell. On enquiring Pushpa was found to suffer from Epilepsy. Her family also revealed, she has been prescribed with medicines by a local doctor, but she didn’t take them regularly. Epilepsy is a disorder of the nervous system and such patients during pregnancy have major concerns. Jayshree felt the need! She promptly captured her vitals on her smart phone loaded with Wireless Health Incident Monitoring Systems, (WHIMS), and pushed the patient’s vitals on to the cloud for a quick doctor reference. For the next few days, Jayshree monitored and screened her closely and counselled her and family about different preventive measures pertaining to her health conditions. Soon after,Pushpa recovered and gave birth to a healthy child. Like Jayashree, there are over 330 CHWs who are trained and strategically deployed across six states in rural India to become the frontier in iKure’s healthcare delivery system.
 

Context:

India faces large disparity in workforce distribution especially in rural regions where burden of diseases is high. With 44,000 doctors for 833 million people, the shortage of doctors in rural areas is severe where each doctor serves a community close to 19,000 people. The severe lack in rural areas has been attributed to lack of effective training and recruitment, ineffective distribution of workforce and failure to retain labour where needed the most.
With the urgent need of creating new cadres of frontline health workers that meets the demand of rural health, iKure implements strategic training, evaluation and monitoring programe with the judicious use of digital technology to address the gap. iKure has developed a cloud based platform called Wireless Health Incident Monitoring System (WHIMS) designed with an intuitive graphics user interface that health activists, with basic education can use. WHIMS is accompanied with instruments to measure vital statistics of patients, and for it to be a more reliable diagnostic tool, iKure created Medic Bags with low-cost POC instruments to assist CHWs to measure basic statistics. iKure has established ecosystem partnership with Public Health Care (PHC) system, and low-cost private healthcare providers, under which diagnostics collected by the CHWs are shared in real-time with doctors in these hospitals, who suggest treatments and prescribe medication through the WHIMS platform to the health workers, who relay this information to the patients. The evidence based data collected using WHIMS platform offer huge potential to drive policy and advocacy on the health status of the rural community.
 

CHW’s MEDIC BAG:

To address the fragmented approach of primary care delivery in rural community, iKure establishes integrated care enabled by the CHWs at different levels of the delivery system. To ensure quality care at each level, we build the capability (both technology and clinical) of the CHWs as the first step, to build technology enabled health system support, improve health practices at the household level, and bring integrated actions for health at community level. These cadres will be mobilized by iKure for different handholding of their designated roles in performing household visits, community level outreach camps, and facility based concept clinics. CHWs equipped with a Medical Kit that consists of devices such as BP machine, Stethoscope, pulse oxy meter, Thermometer, First Aid Kit, Weight machine, Height measuring scale, gloves etc., they carry medicines for basic common ailments, non-invasive haemoglobinometer, Haemoglobin kit to measure Hb level, mobile phone based sphygmomanometer, urine analyzer, calorimeter, ECG, flipcharts/Hoardings & registers. Through these CHWs, every patient is also provisioned with Digital Health Card (DTH) encrypted with a QR (Quick Response) code and during home visits, DTH gets updated with latest clinical indicators. The health data obtained from the health cards is synced to a cloud for effective utilization in the upward heath chain at both secondary and tertiary levels.

Prior to working as CHW, these village women remained mostly confined as homemakers performing daily household chores. As iKure build their capacity both technologically and clinically to work as frontline health workers, they also gain respect and position from their communities in the long run. Further, their contact and association with the community helps iKure drive effective community mobilization measures and act as a catalyst to drive behavioural change. While they interacts and communicates the necessity on the ground and identifies appropriate health needs, they conduct street plays, demonstrates hoardings and facilitates automatic health nudges through mobile phones of the beneficiaries at different levels. They are also attuned to provide nutritional counselling, and spectacle services based on the community needs.

iKure also build sustainable model for its CHWs. Through robust supply chain model, these CHWs promote various lifestyle products such as sanitation pads, branded spectacles, hair care, skin care products etc, which helps them gain daily incentives apart from monthly income.

 

Conclusion:

The CHW model of empowering the women community and gender mainstreaming represents transformational change in rural healthcare delivery. As they champion tech-savvy cultural values in otherwise austere facilities, and limited supply of doctors, such effort has established inspirational leaders driving catalyst change in public healthcare delivery.

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Diet Plan for good health and keeping a check on weight gain

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Things NOT to consume


1. All Fried Stuff…KFC / McDonald’s / Deep Fried Items etc.

2. All soft drinks…such as Colas / Fruit Juices and fizzy drinks

3. Mutton of bigger animals… Beef/goat/pork/steaks/non b veg burgers/salami etc.

4. Frequent Fried Rice products… Biryani / Fried Rice etc.

5. Cream enriched – Dairy Derived products………. Butter / Cheese / Marmalade etc.

6. Ice Creams / Cakes / Puddings / Pastry / Confectionery Items with cream etc.

 

Things to be taken in moderation

1. Milk, if it is tolerated

2. Honey / Jam… applied on bread toast

3. Eggs. Two / three per week….more of the white than the yolk!

4. Maida derived products… such as parathas / egg-rolls etc. (Indianised version)

5. Excessive Indianised version of Chinese food (With MSG-Mono Sodium Gluconate

6. Spinach and other leafy green vegetables

 

Things recommended for frequent consumption


1. Fibre rich fruits and vegetables (Banana is calorigenic… once in a while )

2. Oat meal / Breakfast cereals / Brown bread (instead of White Bread)

3. A handful of specific Nuts like Almonds (non-roasted and Walnuts only.

4. Occasional diet of dates / apricots etc. as snacks

5. Tea in place of Coffee….. Tea without milk and sugar… green tea etc.

6. Several glasses of plain water a day… more in summer months

 

Lifestyle habits/practices

1. To use the staircase instead of the elevator…. as much as possible

2. At least 20 minutes of walking on every other day if not every day – swimming is the best.

3. To leave the dining table when you feel you could have eaten some more.

4. Never to take second helpings in parties… particularly oily and greasy items.

5. No junk food like fried chicken / pizza / burgers etc.

6. Wash your face with cold water before the night sleep – sometime cucumber slices around eye.

7. Avoid heavy meal at dinner and not to hit the bed directly after dinner/lunch.

8. Get up at the same time everyday.

9. Pursue any hobby on a daily basis – even for a small duration.

10. Do some household work frequently at home, which entails physical exercise.

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Prevention and Management of Non-Communicable Disease in low-income community

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Non-Communicable Diseases (NCD) are leading cause of premature mortality. According to Indian State-Level Disease Burden Initiative report, disease burden of India has shifted from Communicable, maternal, neonatal, and nutritional diseases (CMNNDS) to non- communicable diseases over the period of 1990 to 2016 from 37.9% to 61.8%.

 

Risk segment and socio-economic impact of NCD

Though major NCD diseases are associated with old age people approximately 42% of all NCD deaths globally occurred before the age of 70 years. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs. Poverty is another factor closely linked with NCDs. In resource constraint setting of healthcare, NCDs increases out of pocket expenditure of an individual or sometimes loss of breadwinner of the family forcing many families below the poverty line. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services.

 

Chronic Disease Prevention Programme, an initiative towards NCD management:


iKure together with MIT Sloan School of Management in the District of Paschim Medinipur, iKure initiated a study on NCD with randomly selected 500 people in test group. The initiative is measured following parameters to get greater insight on the contributing factors towards cause of NCD. Low-density lipoprotein cholesterol (LDL-C), Hb1AC, Systolic Blood Pressure, and BMI are collected to derive the analytics. Using power BI tool following trend has been identified where 25% of all respondents suffered from type1 diabetes, 43% type2 diabetes, 11.8% with high cholesterol, 65.6% hypertensive and 5% obese. Though it is surprising to know such trends were known to affect the elite group, but our findings shows the emergence of NCD trends even in low-income community group.

Moreover, the High-cholesterol, High Blood pressure and High pulse rate was a common trend among identified high risk CVD patient found in 8.4% of the population.

Further, we found high risk CVD zone affected mostly within 56-80 years of age group.
Case of Diabetes was found between 41-56 years age group and females are marginally more prone to diabetic in the catchment areas.

The clinical observation was recorded during door-step screening, monitoring, and doctor’s consultations. The high-risk patients were provided tertiary care through telemedicine platform and appropriate medication. Awareness was created by the CHWs on self-management, prevention and control on NCDs.
 

Conclusion:

In the heterogeneous country like India, iKure is putting the right step forward to achieve WHO’s global targets for prevention and control of non-communicable disease by 2013-2020.

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Malaria

 

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Malaria is a dreaded disease since primitive times and time immemorial.

There is no statistics on how many lives has been lost since the dawn of civilization, from this preventable malady…this far.

It is a vector borne disease caused by the parasite Plasmodium species transmitted by the ubiquitous mosquito…Anopheles type…the female variety.

The parasite variants are Plasmodium Vivax/Plasmodium Falciparum/Plasmodium Malariae and Plasmodium Ovale responsible for causing the different clinical types of Malaria, each with different characteristic features and morbidity potentials.

The essential symptoms are Fever with chill and rigor and a subjective combination of headache/nausea/vomiting/abdominal ache/body pain etc.in an apparently non-complicated case of malaria. In complicated cases, the signs and symptoms become more sinister.

The fever often takes a typical periodical rhythm and gets the typical name of Tertian/Quotidian types of fever…associated with other typical/atypical symptom complex. Out of the whole galaxy of Malaria variants, what is dreaded most by the medical fraternity is Falciparum Malaria…which often ends up with fatal complications unless treated promptly and appropriately. The usual complications are affection of the central nervous system (Cerebral Malaria) manifested by convulsions and passing of black urine ( hence the name of Black Water Fever)….due to massive intravascular haemolysis of the parasitised RBC-s and the haemoglobin finding its way out through the kidneys….ending up with Renal failure… ! However with prompt and adequate treatment ,the complications may be avoided completely !

The treatment of Malaria is simple following its correct diagnosis and goes by a certain protocol adapted from country to country depending on the epidemicity of the disease and the resistance/susceptibility pattern of the region to the different drugs meant for the same. The basic tenets of malaria treatment remains the same guided by the parasite species and the nature of treatment required…..prophylactic / therapeutic. Travellers destined for Malaria prone areas are recommended to undertake Malaria prophylaxis prior to travel in those countries.

For some species relapse of Malaria isa big potential problem and some typical medication needs to be taken to prevent this relapse,due to characteristics of its lifecycle in the Red Blood corpuscles in blood/liver…over a certain period of time.
Some typical drugs used in Malaria prophylaxis / treatment /relapse control are..Chloroquine/Mefloquine/Quinine/Artemisin group of Drugs/Primaquine etc. guided by the indication of the type of approach required.

Prevention of Malaria is a daunting and herculean task targeted to different strategies of vector control ,through adult and larvicidal measures and adopting self protective measures like avoiding mosquito bites at all costs and steps to drastically reduce the adult mosquito population through strategic measures.
Emphasis should be placed on diagnostic approach to Malaria by proper facilitation of blood collection through Smear preparation on slides….thin and thick smears ..and identifying the exact variant of the parasite and its density.

Immediate treatment begins as soon as results are available and confirmation is also seeked through Immunological Tests for Malaria. (Malaria Antigen)…on select cases,as per the decision of the clinician.
Trained manpower is also a perquisite in Malaria control at all stages of its management approach.
In spite of adopting all the recommended measures in Malaria control…old and new….the menace of the disease is far from over and the human race needs to take particular precautions to prevent its transmission and spread to the community and keep the mortality as low as possible !

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