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ASHA: Delivering healthcare services to ethnic tribes in Arunachal Pradesh

An organisation saving large number of lives in Anpum forested area of Arunachal

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'ASHA' workers Source: Wikimedia Commons

Anpum (Arunachal Pradesh): Washed out bridges, absence of roads and uncertainty of reaching destinations deep in the forest, do not come in the way of ASHA workers in their effort to provide precious healthcare services to ethnic tribes in Arunachal Pradesh.

Till a decade ago, un-staffed Public Health Centers (PHCs) in this corner of India often led to the deaths of two-three tribesmen of the Adi clan every week.
Poor roads and remains of washed out bridges is what the ASHA workers have to face every time here in Arunachal Pradesh while delivering the medical services. Poor roads and remains of washed out bridges is what the ASHA workers have to face every time here in Arunachal Pradesh while delivering the medical services.

But the situation started improving after the state government handed over 11 of its PHCs to the Karuna Trust, an NGO, under the public-private partnership model to ensure better health services around six years ago.

Now, the entire task of providing healthcare at the PHCs has been entrusted to the efficient hands of trained ASHA (Accredited Social Health Activist) workers. And the results are visible.
Such has the dependence on ASHA workers grown over the years, that their absence could possibly push the tribes inhabiting the Anpum forested area of Arunachal Pradesh back to what existed earlier.

Everytime ASHA worker Kenjir Perme (name changed) is tasked with immunising children in a far off village, she prepares herself to tackle the tough hurdles she has to overcome to reach her destination.

Covering miles on foot through muddy roads that pass through deep forests full of wild animals, waiting for hours to cross a river on boat, and then uncertainty of being able to return home, is what she has to confront every time.

The presence of an ambulance at the PHC meant for taking ASHA workers to their destinations hardly matters, as often unexpected downpours play foul. Once stuck in the deep muddy roads, the ASHA workers have to wait for hours before being rescued by a tractor, a rarely available transport here.

“This is a regular phenomenon here and we are quite used to it. Just because there is virtually no mode of transportation we cannot afford to ignore the health of the vulnerable tribespersons living in this forest area, and providing them medical services on time,” Perme, who is among a few ASHA workers at the Anpum PHC operated by Karuna Trust, told the visiting IANS correspondent.
Though the PHC also has two other sub-health centers, at a distance of at least 15-20 km, the task of ASHA workers remains the same — delivering health services, including immunisation and drug delivery and reproductive and child health programmes, to all the villages in the area.
Locals say the healthcare has got a new lease of life after the PHC was handed over to the Karuna Trust.
“Earlier, our people would die of minor health problems, due to lack of medical care at the PHCs. But now, we are happy at the healthcare being provided,” Robin Tayeng, a local Adi tribesperson, told IANS.
With an area of 83,743 sq km and a population of 14 lakh, Arunachal Pradesh has one of the toughest geographical terrains in India. Even today about 70 percent of its area is inaccessible and it takes days to reach from state capital Itanagar.

In the initial years Karuna Trust also received funds from the Population Foundation of India to strengthen its medical care facilities in the PHCs.

“To reach some of our PHCs one has to trek, walk on foot for miles as no roads are available. But we have trained our ASHA workers to overcome all such hurdles,” Annop Sarmah, co-ordinator for Karuna Trust NE, said.

The state’s tribal population has benefited immensely from the handing over of the PHCs to the NGO, and they are now provided with services like family planning and immunisation. Today ASHA workers under Katuna Trust ensure that all the newborns are immunised against all major diseases.
Efforts of the ASHA workers has helped bring down the Total Fertility Rate to 2.1, from a previous high of over 3.

PN Thungon, Mission Director, National Health Mission, told IANS: “The ASHA workers are our lifeline. They have made the impossible, possible. Looking at the way Karuna Trust is training its ASHA workers to disseminate health services against all odds makes us feel that we can hand over some more government PHCs to it.” (IANS)

 

1 COMMENT

  1. This is a really good initiative. The Government should also take initiatives for the upliftment of tribal people. Social Activists like Soni Sori are fighting for a good cause.

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Integrate National Plans to Eliminate TB by 2030: WHO

The WHO South East Asia Region includes India, Bangladesh, Bhutan, North Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste

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India TB Outreach Work
A TB patient hopeful of being cured in India. Wikimedia

New Delhi, Sep 11, 2017: The World Health Organisation (WHO) has told the South East Asian countries to integrate their national plans and mobilise and utilise resources efficiently to reach the Tuberculosis elimination target of 2030, a statement said on Sunday.

The WHO South East Asia Region includes India, Bangladesh, Bhutan, North Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.

Also Read: Malnutrition makes children susceptible to Tuberculosis: Experts 

The global health body said that there is a need for countries to identify the package of interventions best suited to their challenges — whether that means focusing on strengthening TB services, accelerating case detection or investing in research and development.

“All countries face unique challenges, meaning they should each adapt the regional and global strategies to their context,” said a statement issued by the WHO’s South East Asia Region Office.

“We must avoid taking one-size-fits-all approach, and must instead seek out and embrace tailored solutions that meet specific needs and challenges.”

The five-day 70th Regional Committee Session of WHO South East Asia Region concluded in Male on Sunday.

According to the global health body, by planning effectively and making smart, high-impact interventions, countries across the Southeast Asia Region can lift TB’s significant burden and end the disease as a public health threat once and for all.

Although the region accounts for approximately one quarter of the world’s population, it has nearly half the number of new TB cases and close to 40 per cent of TB deaths globally.

In recognition of TB’s outsized burden, accelerating progress towards the 2030 target — which requires a 90 per cent reduction in TB deaths and 80 per cent decrease in TB incidence — is now one of WHO South-East Asia Region’s flagship priority areas of work. (IANS)

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Banning E-Cigarettes Deprives Indian Smokers of a Less Harmful Alternative: Experts

The government is allowing the sales of lethal nicotine-containing products while banning a substantially less harmful alternative

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Ban on e-cigarettes, Pixabay

Sep 02, 2017: Banning e-cigarettes may deprive Indian smokers of a substantially less harmful alternative, which can be against public health and can result in adverse consequences, experts have warned.

Some states in India, including Jammu and Kashmir, Karnataka, Punjab, Maharashtra and Kerala, have prohibited sales of e-cigarettes, while tobacco cigarettes remain legal.

According to media reports, the Union Health Ministry has recently ruled out acceptability of e-cigarettes in the light of research findings by experts who concluded that they have cancer-causing properties, are highly addictive, and do not offer a safer alternative to tobacco-based smoking products.

However, health experts argued that such decision creates a paradox. The government is allowing the sales of lethal nicotine-containing products — tobacco cigarettes — while banning a substantially less harmful alternative.

“In my opinion, banning e-cigarettes is against public health. I think it’s going to have an impending adverse consequence, because the ban will deprive Indian smokers of a substantially less harmful alternative,” Konstantinos E. Farsalinos a research fellow at the Onassis Cardiac Surgery Centre in Athens, Greece, told IANS in an interview.

Also Read: E-Cigarettes loaded with nicotine-based liquid may be as Harmful as Smoking, Says Research

“Banning is a hasty decision and can be counter-productive, because we are not aware of the extent of e-cigarette use or its harm in India,” added R.N. Sharan, Professor at North-Eastern Hill University in Shillong, Meghalaya.

An e-cigarette is a battery-operated device that uses a liquid “e-liquid” that may contain nicotine, as well as varying compositions of flavourings, propylene glycol, vegetable glycerin, and other ingredients.

In tobacco cigarette, there is combustion, a burning of an organic material, which generates temperature up to 900 degree Celsius, and thus produces all the harmful material.

Whereas, in e-cigarettes there is neither combustion nor tobacco. There is only the burning of the liquid, made up of ingredients approved for food and contains minimal burning, which is 100-1000 times lower compared to tobacco cigarette.

A study published in the journal The Lancet showed that India has 11·2 per cent of the world’s total smokers. Over 11 per cent of 6.4 million deaths worldwide was caused by smoking in 2015 and 52.2 per cent of them took place in China, India, Russia, and the US, the report said.

Further, the experts contented that banning e-cigarettes is contrary to worldwide trends.

Various studies conducted in the US, UK and other countries in the European Union, have shown that e-cigarettes have resulted in a significant decline in smoking rates.

Several countries like Switzerland, Belgium, New Zealand, Canada and the US, which were formerly advocating for bans, are now moving towards lifting the bans on e-cigarettes, Farsalinos said.

“Earlier in July, the US FDA cancelled the intended regulation saying that e-cigarettes may probably help a substantial proportion of smokers to quit smoking and switch to less harmful alternative,” Farsalinos said.

“The UK’s Royal College of Physicians recently advised the UK Government to promote the use of e-cigarettes (along with conventional nicotine replacement methods) as widely as possible as a substitute for smoking,” Farsalinos stated.

A survey of over 27,000 participants all over Europe, published in Eurobarometer in 2016, showed that more than one-third of e-cigarette users polled reported smoking cessation and reduction.

“With India being devoid of good monitoring systems and rich data of research, it should take cue from these countries. Ignoring the evidence from other countries, while the country doesn’t have much of its own, and deciding on bans, can be a bad idea,” Farsalinos said.

Importantly, e-cigarettes appear to be effective when used by smokers as an aid to quitting smoking.

The hazard to health arising from long-term vapour inhalation from the e-cigarettes is unlikely to exceed five per cent of the harm from smoking tobacco, the experts said.

“While, its not absolutely safe, it is 95 per cent less harmful than tobacco cigarette,” Farsalinos said, adding: “We don’t recommend it to a non-smoker. We always say it’s a product for smokers, and should be used as a smoking substitute.”

However, it is best to quit smoking without use of any alternative.

Farsalinos said that although marketing for e-cigarettes is essential, it needs to be done with strict regulation.

There is also an urgent need to create a competitive environment between a less harmful product and tobacco cigarette, which includes accessibility and price, the experts said. (IANS)

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Can Pain Make You Feel Better ? Understanding Deliberate Self Harm Practices Among Adolescents

What do children and young adults do when the level of emotional pressure becomes increasingly high? According to studies, an increasing number of adolescents indulge in self harm to relieve stress.

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Societal pressure and lack of support often forces young adults to indulge in impulsive self-harm mechanisms like drug overdose and self cutting. Pixabay

– by Dr. Rajeev Nagpal, Australia

  • Deliberate self harm (DSH), also known as self injury is the act of intentionally inflicting damage to the body
  • It has become a common practice among children and teenagers across the globe
  • DSH among teenagers can be attributed to lifestyle and technology changes, peer pressure and lack of support

Australia, September 1, 2017: Dr. Rajeev Nagpal expresses his opinion on the dangerous practice of self-harm increasingly affecting children and young adults across the world.

What is Deliberate Self-Harm (DSH)?

Self-harm is described as an expression of situational crisis or personal distress which leads to harming oneself. NICE clinical guidelines from the UK have defined it as self-poisoning or injury, irrespective of the apparent purpose of the act.

Deliberate Self Harm (DSH) is not a clinical condition but a response to a stressful situation in the life of a young child or adolescent. It can occur after long term stress like abuse or domestic violence or after an acute single event like the loss of a near one or failure in examinations. It is primarily a coping mechanism in which they try to release tension by trying to self-harm.

Self harm
Dr. Nagpal views self-harm not as a clinical condition, but as a coping mechanism adopted by children and young adults to vent their tension.

Already there are reports of Indian children losing their life after playing games like the blue whale challenge on the internet. It is time for the general population, including the parents of young children to understand the issues of this very complex condition called deliberate self-harm.

Public Health Issue

In recent years DSH has become a major public health issue in most developed countries. However, although less reported, this problem is a major under-recognized epidemic in low and middle –income countries like India, Nepal.

According to a retrospective study conducted at the Emergency department of CMC, Vellore, India from Jan 2011 to Dec 2013, among the total 1228 patients who were admitted, consumption of pesticides was the most common cause of DSH in men. Consumption of plant poisoning and drug overdose was more common in women.The study involved all population, therefore, the actual number of pediatric population was difficult to ascertain.

Other international studies have also revealed that adolescents, who experienced anxiety or low mood, were six times more at risk of self-harm in young adulthood compared to those without depression or anxiety disorders.

Approximately a million lives are lost to suicide annually, worldwide.

Deliberate self-harm (DSH) is the single most important risk factor for suicide and is associated with huge health service resource utilization. Deliberate self-poisoning in children continues to remain a significant part of the workload of emergency departments, especially in adolescents, even though fewer children need admission now as compared with earlier decades.

Presentation of DSH

Many young adults find it difficult to express their feelings. Some examples of self-harm behavior are:

  • Self-cutting or scratching
  • Burning or scalding
  • Poisoning with drugs like paracetamol, anti-depressants
  • Swallowing objects

Relatively little information is available about the characteristics and long-term outcome of children and adolescents aged under 15 years who present to general hospitals because of deliberate self-harm (DSH).

Depressive disorders in pediatrics fall in ranges from mood changes in response to persistent mood change accompanied by suicidal ideation or intent.

The difficulties faced by adolescents are getting more complex with lifestyle and technology changes globally. Peer pressure along with family expectations can aggravate this sense of worthlessness.

Deliberate self harm
Feelings of helplessness, stemming from a variety of social and cultural factors can force an adolescent to indulge in self-harm. Pixabay

Lack of support networks can lead them to opt for impulsive self-harm mechanisms like poisoning. Intentional overdose to commonly implicated drugs like Paracetamol in the UK, or organo- phosphorous compounds in Nepal and is a cause of grave concern.

How to Deal with this Issue

As young children are unable to deal very well with emotional stresses, they will need a supportive team to help them in understanding their feelings and the possible outcomes from them.

This requires a multidisciplinary team approach.

  • Understanding the issues by holding awareness sessions of this condition in schools and other organizations
  • Creating referral pathways that all school staff are aware of
  • Confidential telephone lines /NGOs dealing with mental health of adolescent’s
  • Government policies and procedures for treatment of acute cases in Accident and Emergency departments
  • Provision of developing CAMHS(Child and adolescent mental health services ) like services at state level in Indian government hospitals.
  • Increased research particularly in pediatrics and adolescent’s needs to be conducted at state and national level.

ALSO READ Suicide is Preventable: Alarming Effects of Self-harm on Families, Communities, Societies

Conclusion

DSH is an under-recognized, major public health problem in low and middle-income countries. National level medical protocols and increasing the awareness amongst the public and agencies dealing with such conditions can be the first step in saving millions of lives from the untimely death of the most vulnerable yet productive younger sections of the society.

Dr. Rajeev Nagpal  is a Pediatrician and MHID (Masters OF Health and International Development-Flinders University, Adelaide, Australia) 

 


 

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