Lifestyle, Tech, Travel

What Causes High Prevalence of Anemia in Rural Hinterland- A case study to assess the gap

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Anemia is most prevalent in low-resource settings, where it goes undetected until becomes severe. Despite the implementation of several initiatives by the Government, India has made only 13 percent progress in eradicating anemia (Global Nutrition Report, 2017).1

Periodic screening and early diagnosis are the keys to controlling anemia. The conventional Hb tests involve invasive methods with the requirement of hygienic infrastructure and skilled healthcare providers. But with the huge gap in basic health infrastructure, rural community members have very little provision for diagnostic facilities.

In Kenduapal Village of PaschimMedinipur, West Bengal shows 88 percent of reproductive-age women have undergone Hb tests for the first time in their lives. They were not aware, if they are prone to a high-risk pregnancy or not. It also indicates the behavioral risk factor which contributes to delay in Anemia detection.

According to WHO recommendation, a non-invasive hemoglobin device is proved to be a good addition. Non-invasive point of care devices can eliminate the potential contamination, bio-hazard handling and can even enable frontline health workers with basic education to perform Hb Test.2 Joseph et al. (2016) also affirm that non-invasive methods are safer than invasive methods and improve patient satisfaction.3Bandyopadhyay S., Neogi, and John D. et al. (2019) further contributed to the fact that as most of the anaemia screening happen in outreach settings, where provision for laboratory support seems difficult, the device ought to be tested in field settings with health workers, non-invasive diagnostic provides viable accuracy.4

iKure’s non-invasive anemia screening initiative started with the vision of reaching out to the last mile community. Members are chosen from the community and are technologically and clinically trained to use them for screening patients. The community health workers are further mobilized to collect other health parameters important to understand the risk of the patients. Instead of using a paper-based format, CHWs use WHIMS that is able to collect patients’ vitals on a cloud server. The data available on the cloud are further sent to medical professionals for referral and counseling.

However, while iron deficiency is the main cause, micronutrient deficiency, inflammations and inherited disorders also contribute to anemia. A baseline report of mother and child health camps reveals that 64% of pregnant women were anemic and 30% with milder anemia. Nutritional experts suggested that a large section of the community are found to be anemic because of women’s ‘‘non-compliance/non-adherence” to the consequences of the anemia and fear and anxiety towards invasive blood drawing.5 Also, women’s consumption rate of IFA supplements are low since they complain of suffering from gastrointestinal upset. Altering such behavior requires regular counselling. iKure’s CHWs are deployed to spread awareness and bring positive health-seeking behavior among pregnant women, new mothers, and adolescent girls.

iKure’s non-invasive anemia testing initiative has been rolled out successfully in school health program and mother and child health camps catchment areas. Within few months, it has gained significant traction such as:

 

  • In West Bengal and Karnataka more than 50% population are found to improve IFA tablets consumption rate.
  • Regular awareness and counseling by iKure medical team during health camps have altered care-seeking behaviour with a reduced percentage of anemic patients
  • The introduction of non-invasive screening devices has improved patients’

    footfall with more women willing for Hb tests

While priorities and approaches may differ according to geographic settings, but strategies to curb anemia remain the same. At iKure, we believe in bringing the desired change soon in India’s rural villages.

Reference :

1. “From promise to impact ending malnutrition by 2030”,Global Nutrition Report,2017,
2. Ma’ayan L., Choppe L., Tikva P., Israel, Lausanne, “Non-Invasive Hemoglobin Screening for Diagnosis and Monitoring of Anemia”, Read More
3. Josheph, Bella., Haider, Ansab., Rhee, Peter., “Non-invasive hemoglobin monitoring”, International Journal of Surgery, 33 (2016):254-257
4. Neogi SB, John D, Sharma J et al. Cost-effectiveness of invasive devices versus non-invasive devices for screening of anemia in field settings in India: A study protocol [version 1; peer review: 1 not approved] F1000Research 2019, 8:861 Read More
5. “Nutritional Anaemias: Tools for Effective Prevention and Control”, World Health Organization, 2017, Read More

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Featured

World Alzheimer’s Day

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This Day is observed on the 21st September every year, as a day in the World Alzheimer Month…by organisations and foundations worldwide with this name.

Alzheimer’s disease is a slowly progressing cascade of cognitive decline affecting subjects in the senile age group and is regarded as multifactorial in its origin and with no significant treatment as yet, assuring a reversal or stoppage in the progress of this slow brain cell death…ending up with bodily cessation of functions in course of time.

The hallmark of this disease is dementia and this particular condition is the commonest cause of dementia affecting human kind.

It has an obscure aetiology this far ..speculated to being caused by the abnormal deposition of proteins amidst the brain cells….like Amyloid ..causing plaques and and Tau…which remain entangled with the neurons in the brain.

While the unmodifiable factor(s) could be…age/familial/genetic…modifiable ones could be lifestyle/environmental/smoking/depression-due to any cause/sedentary life in solitude /exposure to cumulative effects of noise /untreated hearing loss etc. Also morbid grief after losing a loved one , financial worries,health anxiety of chronic debilitating illnesses could be a common precipitant of this condition. It is seen to have a gender bias..as to slightly more common in women above 65 years than men of similar age.

Some common pointers towards this affection is the initial presentation of very mild memory loss/cognitive decline…appearing to be normal of this age, but gradually advancing to affect the normal ability of a person, to execute the very basic tasks of day to day lives and failing to recall the names of familiar persons and simple objects of life, accompanied with inappropriate social behavior and lack of mental restraints. With this begins a phase of dependency on others around, to lead a normal daily life and ultimately ending up with immobility and gross paucity of activities towards the terminal phase of this phenomena…of senile dementia.

Since this disease does not kill immediately…a chosen caregiver has an immense role to play in caring for such affected individuals in their twilight years.Empathy and not sympathy is the sheet anchor of an approach to any person affected with Alzheimer’s. In fact..it is always better if a normal personwho is supposed to play the role of a caregiver, to undergo a brief orientation session, as to how to deal with a person affected with Alzheimer’s Disease.

Some important aspects of communicating with persons suffering from this condition may be as below …

  • To speak in simple sentences with them,in a slow pace, stressing more on long term past memories and avoid asking questions which emphasize on short term memory.
  • On seeking for preferences….as to wishing to have egg/fish for lunch..it is better to show them the objects ,for a better clarity in the question and response.
  • The speaker must remain aware of his/her own’s body language or mannerism while talking to the affected one…focusing on direct eye contact and in the absence of any sensory distraction.
  • Demonstrate ample amount of patience while communicating with a dementic person…till the patient is able to comprehend the topic on which spoken to.
  • Never ever comment on the mental /intelligent set back on the faculties of an affected person in front of the communicator.
  • Be aware of the limitations of the affected person….on memory loss/difficulty in handling complex tasks/problems in planning and organizing their personal lives/difficulty in coordination and locomotion etc. etc.Preventive aspects on this condition are many ….which includes leading a simple lifestyle….avoid being affected by extremes of emotions…regular touch with friends and relatives….cutting down on caffeine intake to increase the sleeping hours,following a simple rule to keep the cognition active…by doing simple calculations mentally-trying to recall all those whom the person had met earlier in life-trying to place the names of persons by visuals (pictures/photos)-and spiritual recourse at convenient timings in day to day lives.

Researches are on for a definitive management strategy of this disease but the results are yet to come forth in a big way.

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Lifestyle

Peace Proposal

The challenges facing society—a global pandemic, the climate crisis, social and political upheaval, and inequality—are happening at a time when there is a significant trust deficit, and in large part because of it. The implicit social contract between institutions and individuals has frayed.

And we’ve seen the results first-hand. So, the first step in any healing and rebuilding is the reestablishment of trust.

Trust is a relationship in which we are vulnerable to others’ actions—a relationship in which we are not just relying on the other party to do what we want; we are trusting them to do what we want and not hurt us in the process. This means that the poor and downtrodden must feel safe that you will not be inflicting any further misery. Trust goes much beyond following the letter of the law, it is about setting high standards. It is about replacing every iota of greed with purpose. It is about being the change that we want to see and service before self. It is about enabling the best minds and action and service before self. It is about leadership. It is about listening and then acting. It is not about imposing one`s ideas on others, but about letting the people speak. Though the wounds inflicted are medical in nature, it is not about treating, but about healing, it is about the person and not the patient. It is about empathy and humility that we do not know everything, but we shall work with you and find solutions. It is about being sensitive and feeling the pain and misery of others and about giving.

To win the trust of the population at large, all teams, groups or companies must first establish trust among each other and establish purpose. It is about breaking down barriers and silos and reaching out to one another and filling in any deficiencies that the other may have. It is about helping people introspect, meditate, dig deep and bring solutions themselves. It is about building human connections. It is about enabling bringing the whole selves into society. It is about accepting imperfections and making people believe that it is alright to fail. It is about providing people psychological security and its not just about the winners, its also about the people who put in effort and did not succeed. Its about celebrating the little goodness and throwing away the not so good.

This must start from the top and the leadership must by example. We must define leadership as looking after the person to the left and the right of you and win them over with honest deeds. It is important to look at the bigger picture and the haves need to look after the have nots and one must give till it hurts. Greed and hate will only beget destruction which will come back to engulf us. Leaders need to sheath swords, silence war drums and become the missionaries of peace. We should speak the language of humanity, in a language that people understand.

At iKure, we not just hire, but work with people who are aligned with our core values and believe in being good and doing good. We believe in each other and our drive is purpose and not wealth. We believe in managing and healing the whole human being and therefore we are working with like minded musicians and artists to build purpose and community cohesion.

We believe that vaccination is important for our future survival and are making an effort not just to immunise our own team but people in far flung areas where the supply chain may not reach. We are collaborating with government and non-governmental bodies in not just providing medical help but also improve the social determinants like Income and social protection, Education, Unemployment and job insecurity, Working life conditions, Food insecurity, Housing, basic amenities and the environment, early childhood development, social inclusion and non-discrimination, structural conflict, access to affordable health and services of decent quality.

Going by the plight of the migrant labourers, it has now become imperative to find employment near the place of residence, which will mean working with the people and develop a love for their own land and identity and making the villagers to be self sufficient and develop business models for them to thrive. The enormous indigenous wealth in the villages needs to be tapped, which is sustainable and green.

As much as the pandemic has been a cause for death, despondency and destruction, there has also been increased amount of collaboration, cooperation and resilience. People have gone out of the way to help their neighbours and in this strife, there have emerged stories of compassion that have given hope. With digitalisation and less consumption of fossil fuels, there has been gross improvements in the environment. For the first time we have been able to breath fresh air.

We at iKure are committed to continue breathe this fresh air and are committed to do what it takes. We are people with courage, empathy and humility and healers of the mind, body and soul who look at the holistic approach to healthcare and combine the tradition with the modern. We combine human touch with technology and believe in the user experience of both the healers and the healed.

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Lifestyle

Mucormycosis

 

 

 

 

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Staff Picks, Travel

The untold story of iKure beyond the narrow trails

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We were at the first mile in the last mile. Our car driver whom we lovingly called Nattu was in high spirits praising the new road which has recently found a new shape after the smoothen pitch. Soon his sunlit smile faded when the road started getting narrow after taking first few turns from the NH6  Highway. The journey continued, and my heart sank, more we drove in. The road was getting narrower and almost disappearing now and then. However, the golden wheat fields, field laden with marigold flowers, and the untamed river that followed us assured me of the hope that there is a way beyond. I was led by two team members who drove the motorbike, carefree but determined of the road ahead and the founder of the ‘Unicorn’, acknowledged as the ‘100 most Influential Leader 2020’ continuing his untiring efforts of handling the venture’s responsibilities over the phone, while I waited impatiently for the journey to get over through the narrow trails.

Finally, the stop arrived at a primary school in an unknown little village in Gologram in West Bengal. iKure’s mobile medical team was already in full gear attending the patients that have gathered for the eye and medical check-up. Two Doctors, with a Paramedicine staff, Health Worker, and Program in- Charge were busy registering patient’s vitals using AI enabled health tech devices.

Locational factors have an important bearing on the potential of healthcare supplies. In urban poor and remote locations, it is difficult for healthcare systems to attain the demands of critical services. Most of the journeys made by our beneficiaries are at substantial risk of fatal outcomes during emergency cases. Therefore for iKure, it is important to provide access to primary healthcare facilities through mobile medical teams that are usually set up in schools or in local administrative offices.

The pandemic in India is witnessing its second wave, people are creeping out of their shelters, still hesitant to explore beyond their safe zone, but this medical team has a message for all of us. Inspiring as they accept risk as part of their chosen job roles, hardly exhibiting concerns on their routine door-step schedule, at iKure’s medical camps and in hubs. The immense accreditations and support to fulfill the mission of iKure ‘Creating zero mortality in primary healthcare’ through their hands and the unwavering determination of their hearts is enough to bring smiles to our beneficiaries during the challenging times of the COVID-19.

Primary healthcare is the first line of defense to keep people safe. The primary healthcare system has the capacity to diagnose, track, and contain community outbreaks while providing essential services.

iKure is prioritizing its regular services through technology innovations, mass screening operations, and research interventions that use primary data to help identify and address the gaps and laying a strong foundation for primary healthcare to protect people from the next health threats.

iKure has treated more than a million patients with plans to open 200 clinics in the next three to four years. It is already offering health-tech solutions in Vietnam with plans to serve in other South-east Asian countries like Cambodia, Philippines, and Indonesia.

The journey way back home was different. I found Nattu’s face lit up again while he shared one of his journeys with the iKure’s medical team in Keshiary, in remote West Bengal. He recalled, he had to carry back home the team through a bamboo bridge that was half immersed due to the flood. Fearing the car might not find its way underneath the water, they waited till 2:00 am for the water to subside. And finally, when they returned, it was time again for another journey.

It might come across for many that Ratan Tata’s investment has been easy for iKure. But the immense trade-off, patience, and teamwork go without saying, they haven’t had it all yet. While the team is gearing up to scale-up and expand its operations, this investment is a huge encouragement for iKure as they believe, iKure’s services will make the real difference for the people who need it most, as access to primary healthcare will be the corner stone to confront the pandemic and the situation beyond it.

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Lifestyle

Covid-19 & iKure

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Covid-19 and the adaptation by iKure in the service offerings……with hints in the way ahead….

Preamble :

Covid-19 has churned out the whole human civilization into an abyss of indefinite uncertainty..withapalling incidents and consequences ,including an unacceptable record of deathsand sufferings worldwide, which has thrown mankind out of gear and the uphill struggle for a safe survival continues, with no sight of a vaccine yet and no definite medical guidelines to resort to, in order to tackle this pandemic in a manageable framework of confidence…within the medical fraternity.

Coupled with this disease menace, is the scenario of economic gloom arising out of job layouts,downsizing of companies, lack of new job prospects etc which is bringing in an enormous amount of despondency and negative affections of mind and body ,unheard of this kind earlier.

iKure being a population service provider enabled by Technology and research oriented objectives,has made an attempt to be a forerunner in the sector of healthcare in rendering its services, during such difficult times, to all stake holders…in more than one novel ways…backed by the skills and expertise of our employees from all walks of training and experience.

Ways in which iKure stood out to adapt to the current unprecedented crisis ..

•  Based on the three prongs of prevention…ie..social distancing/usage of barrier tools like masks & hand sanitizers..to say the minimum, iKure has embarked on a path of remote consultation for patients..through the new concept of Telemedicine..which has enabled a large no. of clients/patients to seek medical attention from the safe confines of their homes and the Physicians feeling safe at their point of presence.

•  In the events of some subjects/patients approaching our hubs/clinics, the safety measures have been strictly put in place,(with PPE-s etc) to ensure safety of all concerned and a smooth play of operations to continue as earlier…within the norms of recommended prevention guidelines.

•  Special measures have been put in place to render door step services( albeit with mutual protection of subjects & staff) to deliver medicinal items/ related consumables and any other medical attention/advice that may need at any point of time…through our field workers ( CHW-s).

•  Our Doctors have been attuned to the call of the times , to be sensitive towards our patients, at the same time being on guard to detect suspicious infected cases and do the needful as per the advised protocol of the health authorities.

•  Special projects are being undertaken with big business sectors ( such as realty and housing industry) to screen the blue collar workers for Covid-19 by means of well decided clinical vital parameters at site and follow the recommended protocols of suspicion of the infection in any of the persons screened. Our ground staff are physically attending such events with due precautions ,almost on a daily basis,thisfar,and providing a social service in a proactive approach to healthcare.

•  A good number of projects for population screening for the Covid-19 infection are on the way, across several locales in the nation, to provide such services with impunity.

•  Since a second resurge is feared in this country, as well as elsewhere,theGovt would need more and more private sector operators to enter a PPP in order to tackle the growing menace of this crisis.

•  Modalities could be……..allowing screening in the semi-urban areas on a request basis/enabling testing by the private sector liberally without much regulatory protocol and paperwork/leasing ground workers for day to day support to an organization like us, for more community approach to reach out the needy and non-privileged/helping in a proactive manner to set up small check up kiosks in prominent areas where most of the population are expected to visit…etc.

•  A recent glaring example of a PPP may be cited by mentioning the launch of a Telemedicine collaboration with theGovt of Nagaland, in joint efforts with another prominent Indian association, to serve the community of Nagaland,which is a hilly terrain basically, in seeking medical attention from Doctors at Govt Health Centresthere.,,by means of remote consultations on general and specific health issues.

•  To boost the morale of our staff, iKure had arranged a whole remote session with a ‘clinical psychologist’,to address the common feelings of our employees during this pandemic season, where ‘work from home’ has been the norm, so that alongwith their psyche the productivity does not sag and they can adapt themselves to cope up with any such mental issues in their stride.

The way ahead………

• iKure wishes to plan with foresight ventures involving our service offerings in other states and may be beyond Indian shores based on the success of our initiatives this far.

•  More and more Technological advances in the form of devices and tools are being incorporated in our operations, to assist the ground workers for a quicker and better screening with results approaching to the 100th percentile. A robust Telemedicine platform is fine tuned, to enable Physicians to get universal access to an easy going software for navigation and patient prescribing…with maintenance of EMR.

•  Work in the Non-communicable Disease area ( NCD) which is the need of the hour in this country ,keeping the Covid-19 affection in mind, is being planned, since this particular virus affects the CVS in a major way, along with other co-morbidities, as surfacing from those who contracted the disease and those who recovered from the illness !

•  Some critical research areas are also been looked into, which engages the data acquired in re-guiding us through AI and/or ML mechanisms,
on few members of NCD-s..as the scope may be obtained…such as Diabetes/Hypertension etc.

•  Stake holder partnerships are being explored by our business associates for more and more Govt/Pvt. Collaborations and grant providers ,based on our track record of success and innumerable accolades that theOrganisation has achieved by dint of merit amidst tough competitions.

Since the pandemic is far from over yet…we do not know what is in store for mankind ,once the Virus leaves civilization !

Whether we have really achieved Herd Immunity..whether we have managed to eradicate the virus for good..what are the residual signs/symptoms of those who have been affected by the Virus..are only issues that time will tell..and help us unfold..but till then, iKure shall continue with its offerings in healthcare in all possible ways….both traditional and innovative…in nature…to mitigate the health issues in the post-pandemic era.

Dr. Lalmohan Banerjee
Sr. Medical Adviser & Medical Director, iKure

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Travel

Dedicated to all the women who shaped and defined iKure

Dr. Tirumala Santra Mandal, Sr. Research & Communication Analyst, iKure brings forefront her experience in working with the other women of iKure who with her contributed and defined the venture’s entrepreneurial journey, carved new beginnings supported through women power and sisterhood- a must have for every startup culture. Read on… image iKure’s journey over several years has been shaped by countless hands. And few among them are the fearless, prominent, and prolific women, who championed new initiatives at iKure, took away our doubts, stood by us and ushered hope – with support and smile. On International Women’s Day, I take this opportunity to thank them all with immense gratitude.…. I remember the old adage, “A strong women stand for herself, a stronger woman stands for everybody else.” The narrative tells us that over the years, women have transformed and supported other women to rise up and above the rest. At iKure I have had the privilege to experience the participation of such women who stood and supported our journey both externally and internally paving way for success, flourish and thrive. Satoko Kono, Arun LLC, President-Her association with iKure started as an investor from Japan. Her calm and vibrant nature has always amazed me. She is extremely polite, naïve and takes a keen interest in our activities, success, even failure, and impact. Her eye for detail, down-to-earth attitude, and her infectious energy is something that my team always admires whenever she visits them in the field. Shreyshi Dey & Sharmistha Roy, University Of Michigan-They joined us back as VP in Research iKure. Though for a brief period of time, I recall their contribution particularly for bringing up the new iKure logo. I remember, the entire team debated around it, but they were quick and prompt to understand that what we wanted was something that can resonate with the community and reflect our motto. Kudos to them to get it just right! Mallika Rani. Das, CHW Tabageria- One year back, I met her in our Tabageria Hub. Draped in green saree, the uniform she adorns was sited among other CHWs who were getting ready to start their day’s job with door-step visits. I asked her, can you tell me what exactly you say when you visit our beneficiaries. In the next minute, the way she introduced us with a brief narrative of iKure’s mission left me amazed. While few of her fellow mates have left, but she remained with us, sure of the journey that brought her more value and respect than anywhere else. Today she handles new devices, screens patients and counsels women like a PRO. Way to go! image Gayatri S. Achari, Project Assistant-I am inspired by her continued faith and dedication towards her job. She has been a valuable member of iKure’s initiatives in Karnataka. She would often tell me, how she has become an inspiration for her family. Many pregnant women in her community preferred consulting her rather than a doctor. She told me, how working for iKure has helped her gain such respect for herself. I learned from her, it is important to love what you do, rather how you do. It adds value to work in many ways. Shwethnisha Bose,Parswati Das, Ritika Singha Roy, Riya Das, & Debleena Ganguli, Kanika Das, Technology, Operations, Research developer – The current women brigade of iKure are known for multitasking, promptness, emphatic and carrying never- say-no attitude towards their deliverables. During my daily course of interactions with them, I found them immensely passionate, braving all-odds at personal fronts and making new narratives of women co-working, co-learning and supporting each other which very few workplaces can even boost. They are responsible for bringing customized technology solutions across borders, operational acumen, in-depth impact reports, and excellent designing skills. You guys rock! image Avanti Gomes, Trainee at iKure- The young women from the University of Technology, Sydney proved that you should never undermine the young minds, making us believe once again, good things come in small packages. Her insights and deep understanding of iKure’s operations were well researched and thoroughly studied. She left behind the thought that there is lot more to women self than meets the eye. Jayanti Santra, My Mother- She is a homemaker, but a cheerleader for iKure. She raised both of her children with a wider perspective in life. Both our parents have been always supportive of our decisions and taught us to value others, be courageous and self-reliant. Her immense belief and faith in me helped me overcome my self-doubt whenever I felt low & timid. Sarah Santra, My sister-in-law- This narrative would be incomplete without mentioning her about her support towards iKure. While her husband, the CEO travelled extensively, she managed the home front with Élan, and we all know, it is no less than managing an empire. I admire her playing a pivotal role in beautifying the office ambiance with her intricate designing and styling sense which goes without saying is much valued for. She helped me understand the bigger picture of life and admiring the fact that we stand for each other when needed. More power to sisterhood. image iKure has been led by many other peers, trainees, partners whom I could not mention here due to word limits, but they are truly our cheerleaders, importantly helping us become one of the very few start-ups acquire immense acceptance and global recognition within a short span of time. We value each one of- you and look forward to having onboard more women power to inspire and support us ahead! Dr. Tirumala Santra Mandal, Sr. Research & Communication Analyst
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