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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
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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)

 

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  • Pashchiema Bhatia

    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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A New Virus Typhus Rises In Los Angeles

Officials in Los Angeles say they are working toward housing for the county’s 53,000 homeless residents to relieve conditions that help give rise to typhus and other diseases.

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coal miner,Typhus
Retired coal miner James Marcum, who has black lung disease, takes a pulmonary function test at the Stone Mountain Health Center in St. Charles, Virginia, U.S., May 18, 2018. (VOA)

Typhus, a bacterial infection that is sometimes life threatening, is on the rise in Los Angeles and several other U.S. cities. Public health officials say homelessness is making the problem worse and that the disease, which is associated with poverty and poor sanitation, is making a comeback in the United States.

Los Angeles County has seen 64 cases of typhus this year, compared with 53 at the same point last year and double the typical number, with a six-case cluster among the homeless in L.A. this year. Two cities in the county that have separate counts are also seeing higher numbers: Long Beach with 13 cases, up from five last year, and Pasadena with 20, a more than three-fold increase from 2017.

At a clinic in the L.A. neighborhood called Skid Row, Dr. Lisa Abdishoo of Los Angeles Christian Health Centers is on the lookout for symptoms.

“It’s a nonspecific fever,” she said, “body aches, sometimes a headache, sometimes a rash.”

This kind of typhus is spread by fleas on rats, opossums, or even pets and is known as murine typhus, from the Latin word for “mouse.”

The risk is higher when people live on the streets in proximity to garbage, but the disease seems to be spreading through the Southern United States.

Not the typhus of WWI

“It’s never been considered a very common disease,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, “but we seem to see it more frequently. And it seems to be extending across from Southern California all along the Mexican border into southeastern Texas and then into the Gulf Coast in Florida.”

 

Typhus
A homeless man sits at his street-side tent along Interstate 110 along downtown Los Angeles’ skyline, May 10, 2018. Thousands of homeless people sleep on the streets of Los Angeles County.. VOA

 

Texas had 519 cases last year, said spokeswoman Lara Anton of the Texas Department of State Health Services. That’s more than three times the number in 2010, with clusters in Houston and Galveston. No figures for this year have been released.

This is a separate disease from typhoid fever and is not the epidemic form of typhus that caused hundreds of thousands of deaths in war time. That type, called epidemic typhus, is carried by body lice and often spreads in conflict zones. It led to millions of deaths in World War I alone.

Flea-borne typhus, the kind seen in California and Texas, is serious but often clears up on its own and responds to an antibiotic, Abdishoo said.

Typhus
Dr. Peter Hotez, dean of the Baylor College of Tropical Medicine, shows Associated Press journalists areas of Houston’s 5th Ward that may be at high risk for mosquitoes capable of transmitting the Zika virus in Houston.. VOA

“It seems to get better a little faster if you have the treatment,” she said. “But there are cases where people have had more severe complications — it’s rare, but getting meningitis, and even death,” she cautioned.

Migration, urbanization, climate change

The reason for increased typhus numbers is uncertain, but it may be linked to migration, urbanization and climate change, said Hotez, the disease specialist. In some parts of the world, typhus is still linked to war and instability, “in the conflict zones in the Middle East, in North Africa, Central Asia, East Africa, Venezuela, for instance with the political instability there,” he said.

Murine typhus is one of several diseases on the rise in the southern United States, Hotez said.

Typhus
People line up on Skid Row in Los Angeles to receive food, water, clothing and other basic necessities from Humanitarian Day Muslim volunteers.. VOA

“Others include dengue, now emerging in southern Texas and Florida, the Zika virus infection, Chikungunya. We have a huge problem with West Nile virus,” he added, and Chagas disease, a condition usually seen in Latin America.

A report in May from the U.S. Centers for Disease Control and Prevention found that such “vector-borne” diseases, transmitted by ticks, fleas or mosquitoes, more than doubled in the United States between 2004 and 2016.

Hotez says they are on the rise in many industrial nations with crowded cities and pockets of poverty.

Also Read: A Full Guide To Public Health Disease Hepatitis

Skid Row physician Abdishoo says flea-borne typhus is still uncommon on the streets of Los Angeles, but “it has us all on high alert for this illness that we don’t necessarily think too much about. We want to be vigilant,” she added, “when you see a communicable disease on the rise.”

Officials in Los Angeles say they are working toward housing for the county’s 53,000 homeless residents to relieve conditions that help give rise to typhus and other diseases. Voters approved funding in 2016 and 2017 to finance the efforts. (VOA)