Millennium Post

Don’t ignore that nagging cough!

Zakir Ahmed’s face lights up every time he meets Anil Paswan, the informal ‘doctor’ of Taiyyabpur, a small village in Vaishali district of Bihar. Zakir cannot forget that it was Anil who rescued Rizwan, his 20-year old son from the jaws of death.

The story began over two years ago when Rizwan started to cough. No one took it seriously at first because cough and fever are common in India’s polluted villages. Soon, the boy began coughing up blood. Alarmed, Zakir took Rizwan to the nearest town, Hajipur for treatment. He first visited a cheap hakim who couldn’t help. Two weeks later, they saw a private ‘big doctor’ – an MBBS, notorious for prescribing expensive medicines and tests. Rizwan underwent a sero-diagnostic test for TB, which is strongly disapproved of by the World Health Organisation (WHO) and the government’s Revised National Tuberculosis Control Programme (RNTCP).He was given a number of medicines, including broad spectrum antibiotics and steroids to treat his cough. The expenses totalled Rs 4,500. Rizwan’s state worsened. He was reaching the end of his tethers but his father was helpless. There was no system in place to help him identify the disease and possible recourse from it. Had there been a trained person who could connect them to the doctors at city hospitals using the Internet and other technologies Rizwan and his father would have gained knowledge about the condition. The same skilled expert could have arranged for appropriate diagnosis and cure. When it seemed that no hope remained and such a person arrived. It was Anil.From loud speakers on a rickshaw, they heard announcements for a new centre located in the village where patients could consult the best city doctors. A place, where, persistent cough would be treated for free. At the newly built and attractively clean, SkyHealth Centre, Zakir and Rizwan met the owner, Anil, who had been newly trained and professionally outfitted with equipment by World Health Partners (WHP), a non-profit organisation mandated to provide basic healthcare to rural communities.

Anil brought Rizwan in front of a computer. A woman appeared on the screen and asked him to describe the problems and took his blood pressure reading via the machine. Then the promised city doctor appeared to review Rizwan’s history carefully.He examined Rizwan’s breath sounds through a stethoscope Anil placed on his chest. The doctor suspected tuberculosis and showed him how to give a sputum samplefor relevant diagnosis. The doctor displayed great sensitivity to the fact that TB is a misunderstood disease among rural communities and spent time assuring Zakir and Rizwan that it is fully curable.

Finally, a prescription was printed out. Anil advised Rizwan to have his sputum collected and delivered via WHP’s supply chain to the nearest block-level DMC (government designated microscopy centre). On the evening of the same day that the sputum was submitted, a message arrived via mobile phone confirming that Rizwan did have TB.

Anil, upon receiving the same message via mobile and email, immediately called Rizwan to the centre for another consultation and TB case registration. The doctor, viewing the test report in the electronic medical record, assigned Rizwan to the appropriate treatment category. Through a tie-up with the public sector, WHP arranged for the drug kit to be delivered rapidly to the village. Most importantly, everything was free.

Anil also got Rizwan registered on MOTECH, WHP’s Information Communication Technology (ICT) platform for TB which tracks adherence with alerts and reminders. Rizwan and his Directly Observed Treatment Short course (DOTS) provider, Anil, both received voice-based alerts via mobile phone as well as reminders to take the medicines regularly. After six months of continuous treatment and close follow-up, Rizwan’s sputum showed negative in a repeattest. By that time, Rizwan had also regained his health and was back to leading the life of a normal teenager.

For every Rizwan saved, there are several others in Indian villages who die from TB. The development of such ICT based system can tremendously improve the healthcare landscape in three ways.

Primarily, to enable health workers trained in knowledge developments. Secondly, to improve healthcare delivery in remote areas and lastly; to increase transparency and efficacy of governance, which in turn, improves availability and delivery of healthcare services.

In particular, someone like Anil was able to help Rizwan because he was empowered enough to do so. We must therefore, strive to overcome challenges encountered in using ICT. These include poor technical skills, lack of adequate infrastructure and limited access to hardware in the underprivileged parts of India.

If health professionals and their supporters across the country are endowed through ICT training, countless Rizwans would suffer less at the hands of the killer disease TB.
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