Rural Excursion: Levels of Health Care in Aligarh

This past week we went on a four day excursion to Aligarh, Uttar Pradesh. Along with our cultural adventures (interacting with the women of Aligarh Muslim University, a wedding reception (which I was too sick to attend) and a cultural-music performance), we visited the entire range of health delivery services that exist in India.

Before I continue, let me preface by saying that this is a super detailed and intricate system with many details. I don't plan on going into too much detail here; but as always, if you have a question about something specific, please leave a comment and I'll do my best to respond.

To see the first level of care, we visited a small village.

The very first and basic level of health delivery is provided by the Ashas, a volunteer government position. This level of health care delivery is relatively new (2005) and has been extended to 2017. At that time the system will be reviewed.

An Asha is a woman (who is married and has at least one child) who lives in the community and has leadership ability. Being an Asha is voluntary, but there are certain government perks to meeting goals. The women are elected by the community and they must pass the screening tests. They also receive increased respect from the community and there are reports that say that being an Asha is a source of pride for a woman.

To the right is a picture of a woman with her newborn (40 days old) getting a wellness visit from the Asha. The Asha asks a series of questions like what you would associate with a typical pediatric check up (heart rate, breathing, temperature, rashes, latching for breastfeeding, ect.) but she uses no tools besides a wrist watch. Additionally she educates the mother about proper feeding schedules, hand washing hygiene, and keeping the baby warm.

The Ashas also hold meetings at the village Anganwadi about health skills and practices. Below is a picture of us at the meeting (the local women are sitting with the children). There was also a camera crew there because the sociology department of the local university (Aligarh Muslim University) was making a film about the Ashas work and also about our visit to Aligarh.

The village was one long main road with brick and concrete/cow dung huts on the sides (see the blue and green structures on the left). There were also open spaces such as this, where various activities took place.

In this village (and apparently I am told all over rural areas in India) there are patches of MJ growing freely.

The next level of care takes place at the health Sub-Center (the pink building).

Here, the Auxiliary Nurse Midwife (ANM) provides care to pregnant woman and also gives basic care to villagers.

Birthing table in the Sub-Center.

The Sub-Center here consists of two main rooms and a "bathroom." The first room is the birthing room. One of the main roles of the ANM is to deliver the all of the babies in the areas. Each sub-center is supposed to cover a 1.5km area, but this one covers 3km.

The ANM monitors all the pregnancies to make sure that the women are going to have safe births (otherwise they will be advised to go to a higher level of care for the birth) because there is little to no medical equipment at the subcenter.

The next level is the Primary Health Center (PHC) (picture on the right). This place was quite frustrating to me. It was practically abandoned. This is supposed to be the first level that has a doctor present, but the doctor that is technically working there is actually working and living in Delhi (a two hour train ride away).

Because there is no doctor there, no one comes to the center. All of the beds are empty. There is a guy there whose job is to clean. But because there is no one else there, he also (without any official training) has become the resident pharmacist. There are an amazing amount of issues that arise with this, but this post is already getting too long ...

The pharmacy box at the PHC. The box gets resupplied every six months.

The fourth level is the Community Health Center (CHC).

They have at least 6 doctors and there are a variety of services available including the DOTS program (Directly Observed Therapy - Short Course) for TB treatment.

The outside of the CHC.

The next level is the District Hospital, but I missed that visit because I was too sick to leave the hostel room. But it provides more and broader scale services than the CHC.

One of the waiting rooms at the hospital.

Finally there is the tertiary level health care: the Government Hospitals which also typically include med-schools.

We visited this hospital/school on the last day. Here we visited different outpatient departments (OPDs) and we also talked to the president and dean of the school.

I went to the psychiatry OPD. Which was pretty crazy. Each patient gets seen for about 5 minutes and we saw everything from dandruff to a man who was diagnosed with schizophrenia and was committed into the mental ward.

There was so much to see during this visit. The systems are of course flawed (they are flawed everywhere around the world), but there were many aspects which I found to be ... functional and appropriate.

The problem is that there are simply too many people here in India and not enough money or infrastructure to support good national health.

Despite being overwhelmed by the problems that the country is facing, I felt very encouraged that there are so many programs and people working towards improving the health of the nation. I am finding the intricacies of the systems to be absolutely fascinating.

Oh! This is so long. "So sorry" as the Indians would say.