VILLAGE SCHOOLS AS PRIMARY HEALTH CENTRES.
Posted by bmhegde on 1
India lives in its villages, of which there are nearly six hundred thousand in all. Clusters of a few villages have the present Primary Health Centres (PHCs). “Time has come” the Walrus said, “to talk of many things- cabbages and kings- and primary health centres”. Let us audit the PHCs to begin with. One can not do most of the minor surgeries in the PHC. Even forceps delivery is not possible there. For these minor problems also the hapless poor patient has to be transported to the nearest Taluka hospital anyway. Come to think of medical treatment let us imagine a patient who lives say, ten miles away from the PHC and suffers from a viral fever. The man has to go to the PHC for treatment. He starts in the morning and can not work that day. By the time he reaches the centre on foot or by bus it would be mid morning and the doctor might be very busy. He gets his turn by noon to be told that it might be viral fever and he is given a couple of tablets of paracetamol to take at home and take rest for a couple of days. His little son wanted to accompany his father on this trip to the PHC. Together the son and the father will have to have their lunch that would cost them forty rupees. One day’s wage of one hundred fifty rupees also has been lost. At the end of the day each tablet of paracetamol would cost that poor man one hundred rupees! This is the simple economics of the present PHCs.
On the contrary, we could have village health workers, who are basically able bodied village boys or girls that have had high school education and have to per force live in the village only. They are given basic training to recognize serious illnesses by their symptoms. This training would take about three month’s time in a good set up specially designed for that task. The health workers are give a walkie-talkie and are thus connected to the Taluka hospital through wireless connection in these days of communication revolution. The worker has to make a morning round of his side of the village and report any serious illness to the hospital to be attended to and picked up in their ambulance. Others who have minor illness syndromes like the farmer with fever mentioned above could be given advice to look after themselves using innocuous folk medicines. One could also put together a First Aid kit with useful home remedies that are harmless and given to the health worker for use in case of need. They are mostly herbs and spices like ginger, garlic, pepper, salt water, honey, tulasi leaves etc that look after most self curing minor illness syndromes in the villages. We could save hundreds of crores of wasteful expenditure on the impotent present PHCs and divert that money to supply clean drinking water to every citizen.
The above plan would benefit for medical care delivery. What about health care delivery? Here comes the vital role the village school and the teachers could play through the students that go to school to educate their parents also about healthy life style that is possible in any village with its clean environment and plentiful fresh vegetables and fruits: even the wild berries are very good for health. Every child in school should have special lessons on health as a special subject. The most important basic requirements of health are dinned into their heads and they in turn will have to educate their parents. Prizes are given to those students that get the best compliance from their parents. The UNIDO report gives five important pre-requisites to maintaining good health in the villages in India. They are:
* Clean drinking water
* Toilet for every house to avoid the deadly hookworms.
* Prevent carbon monoxide containing cooking smoke from coming into the house using smokeless choolas.
* To have three meals a day uncontaminated by human and/or animal excreta.
* Economic empowerment of the women to have their own income to lessen their distress levels.
* Healthy habits to be taught to villagers through their wards in school.
Teachers in the schools should be given additional allowances to be guardians of human health in their respective villages. Children should also be trained in first aid in emergencies including cardiopulmonary resuscitation. Teachers’ increments and promotions must also have the weightage of their excellence in health work in the village.
The government could then use all the money being now wasted for the PHCs to be diverted to create the infrastructural facilities to enable the schools to carry out their additional responsibilities. They will not have the headache of forcing doctors to stay in the villages. Every village in India will have some sort of a doctor who is being licensed by the government anyway, the RMP. If he/she is a good human being he/she would be a good placebo doctor and the final result would be good in spite of the fact that the management of illness by such doctors might not be “scientific”.
The village barber is the best motivator for family planning operations in villages. Village barbers are incessant talkers and they are very influential with men who go to them. It is this kind of peer pressure that works wonders. When the health workers or doctors go and advice villagers, the latter suspect some ulterior motives, but the barber being as friend his advice is always taken seriously. Barber could be given a monthly stipend to do the job and has to be supervised once in a way. Village barber must have short training to do the job scientifically in his own language.