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Why there is need for good Home-care Health System in Rural Areas?

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Maharashtra, March 30, 2017: Last month, my mother, who is 92, fell in the bathroom and broke her pelvic bone. I live in the rural town of Phaltan in western Maharashtra and to get a simple X-ray done was a nightmare.

We called the local orthopedics hospital and they sent a ramshackle ambulance. How an old Maruti Omni van got permission to ply as an ambulance is anybody’s guess. Even a healthy passenger would feel sick and his/her bones would be rattled in that ambulance while going over the potholed roads of Phaltan. Some of the worst roads in the country are in Maharashtra, especially in rural Maharashtra.

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The driver of the ambulance also doubled up as the paramedic and his callous and non-empathetic attitude almost broke my mother’s heel. He almost threw my mother on the stretcher! Most of the ambulances in rural areas are like that with hardly any facility to help the patient. I had to use an old saree to tie my mother to the stretcher so that her broken pelvis did not shake very much.

At the hospital, after a good deal of arguing, we got her X-ray done quite quickly. Otherwise it takes forever to get it done. Since the pelvic bone was fractured, the doctor advised complete bed rest and told us to take her home. In such cases, there is no surgery needed but just plain bed rest so that the broken bone heals by itself. That is also the reason why I did not take her to Pune for treatment.

We brought her home and were immediately confronted by the stark reality of who will take care of her nursing needs. We tried to locate nursing care in Phaltan but were unsuccessful. Even the hospitals do not provide that facility. The relatives of patients do that in most rural hospitals.

Finally, after great difficulty and searching, we got a 24-hour help (who had almost no training as a nurse) from Pune. This helped relieve our emotional and physical stress.

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Searching the net and talking to my doctor friends, I have finally been able to convert my mother’s room into a home health-care facility. This includes the adjustable hospital bed with an air mattress and a specially fabricated small wheel-chair, which can navigate the narrow passages of the house and can go into the bathroom. I feel I could get all this done because of our resources and ability to spend time searching for solutions on the net. Most of the rural population does not have this luxury.

Another tragedy in rural areas is that no doctor wants to do a home visit. No matter how ill or old the patient is, they insist that he/she should be brought to the hospital or their clinic. I was able to get a person who was not an MBBS doctor but could administer saline or do basic dressing for bed sores. That was a partial relief.

Secondly, I was greatly helped by my brother, who is an orthopaedic surgeon in Australia. He constantly advised us on the basic care and his telemedicine greatly helped us.

Very frequently I have seen that in rural — and also in urban — areas, the missing ingredient in patient care is good nursing facilities. Putting a patient in hospital (whether he or she is terminally ill or suffering from non-life-threatening ailments) means endless headache for relatives, who have to stay in the hospital, undertake the nursing care of the patient and run continuously to get medicines and medical supplies. Besides, the hospitals charge exorbitant amounts for surgeries and for lots of unnecessary tests performed on the patient.

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The government has mooted quite a number of good schemes which provide hospitalisation for below poverty line (BPL) patients and take care of their bills through insurance cover. Yet I have seen these schemes misused by doctors and hospitals where they admit the patients at the slightest pretext and charge them the full amount even for minor ailments. The money is then paid to the hospital by the insurance company.

Our medical care system in rural areas is, therefore, quite broken with very greedy doctors and hospitals that, in collusion with insurance agents, fleece both the patients and the government.

A hospice or home-care health system might alleviate this problem greatly.

This system will rely on specialised agencies that provide trained nurses (at nominal cost) for homes, simple equipment like small wheelchairs, beds, commodes and the like, and qualified doctors on duty who can respond through the internet or mobile phone to the queries from the nurses – and, in an emergency, make home visits. At present there are no such agencies but they are urgently needed.

For the terminally ill, a home-care system which provides nursing care and basic equipment will be extremely helpful. He/she will be surrounded by family and nursing care given by trained nurses will help relieve the pain.

Financially, this system will be much more viable than having a dedicated hospice facility. The financial arrangements on how the government can help organisations in facilitating such a system need to be worked out. A possible solution could be to provide insurance coverage for such a home-care system.

Also such a facility can provide home-care for patients who are discharged from the hospitals. Too often, relatives and the family have to provide prolonged post-operative care –which they are ill-equipped to do. Such a facility could be a boon for those patients.

In urban areas, better medical facilities, including good ambulances, can provide timely care. In rural areas, in the absence of such facilities it is very necessary to have a home-care facility. (IANS)

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Come April, government will be more comfortable in Rajya Sabha

Of the 100 BJP-allies MPs, 24 are retiring. Which means, the government will be left with 76 MPs

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Parliament of India is a source of interest for many people because of various reasons. Wikimedia Commons
Parliament of India is a source of interest for many people because of various reasons. Wikimedia Commons
  • In April, the opposition may lose its edge over BJP in Rajya Sabha
  • NDA led by Modi has faced many embarrassments in Rajya Sabha in past few years
  • This is expected to change soon

Come April, the opposition in the Rajya Sabha may lose its edge in the numbers game and the power to stall any government bill, as the ruling BJP-led NDA coalition is set to catch up with its rivals, though a clear majority will elude them for a while more.

BJP to soon get more comfortable in  Rajya Sabha. Wikimedia commons
BJP to soon get more comfortable in Rajya Sabha. Wikimedia Commons

As 58 MPs, including three Nominated and one Independent, are set to retire in April, the Rajya Sabha math is going to change. It is set to favour the National Democratic Alliance (NDA), and the trend may continue in the elections to the Upper House later too with the Bharatiya Janata Party (BJP) having solid majorities in a number of state assemblies, especially the ones it won after the 2014 Lok Sabha polls.

With this, while the Congress-led opposition’s numbers will come down to around 115 from the present 123, the numbers of the BJP, its allies and sympathisers together would climb to around 109 from the present 100-odd members.

And the gap, once wide enough to let the opposition invariably have its say, will keep narrowing further in the coming months.

Of the 55 retiring members (excluding those Nominated), 30 belong to the opposition camp while 24 belong to the BJP and allies. Of them, a large number of NDA candidates are set to return while the opposition will lose a chunk of its members.

As things stand now, the Congress-led opposition has 123 MPs (including 54 of the Congress) in a house of 233 elected members (apart from 12 Nominated), while the NDA has 83 members (including 58 of BJP) plus four Independents who support the BJP (these include MPs Rajeev Chandrashekhar, Subhash Chandra, Sanjay Dattatraya Kakade and Amar Singh).

Rajya Sabha or the Upper House can often be a game changer while passing of the bills is in process.
Rajya Sabha or the Upper House can often be a game changer while passing of the bills is in process.

Also, for all practical purposes, the All India Dravida Munnetra Kazhagam (AIADMK), that has 13 members in the Rajya Sabha, is also with the NDA. This means the NDA’s effective strength in the upper house of Parliament is 100.

The gap was wider till just a few months ago. This meant that during any battle between the government and the opposition in the Upper House over bills and major issues, it was the opposition that invariably had its way. The recent example was the triple talaq legislation that the opposition stalled in the upper house, demanding that it be referred to a Select Committee.

For over less than four years, the Narendra Modi government had faced quite a few embarrassments in the Rajya Sabha thanks to the majority of the opposition, forcing it often to take the money bill route to avoid a clash in the house. Under the Constitution, a money bill needs to be passed only in the Lok Sabha and the Rajya Sabha cannot stall it.

Also Read: For Modi, Road To 2019 Will Be Steeper

However, after April, the NDA will be in a far better position.

Of the 100 BJP-allies MPs, 24 are retiring. Which means, the government will be left with 76 MPs (including AIADMK). But at least 30 from the NDA are set to get re-elected. So the number will rise to 106. Add three members that the government would nominate to the upper house and the final NDA tally will roughly be 109 MPs.

Further, there are fence-sitters such as the Telangana Rashtra Samiti (TRS), the Indian National Lok Dal (INLD) and the YSR Congress, which are not virulently against the BJP and would not oppose the government unless for very compelling reasons.

Now, for the Congress and the rest of the opposition, they are set to lose 30 MPs (including one Independent, A.V. Swamy) through retirement and would be left with around 93 members. The Opposition may win roughly 22 seats, which means that its final tally after April is likely to be around 115 members.

Government can now expect some smooth sailing in the Rajya Sabha, coming this April.
Government can now expect some smooth sailing in the Rajya Sabha, coming this April.

The gap has clearly narrowed and the government may not be at the mercy of the opposition during crucial votes and can have its way in the Rajya Sabha if it musters its numbers by deftly wooing “floater” MPs.

The three newly-elected Aam Aadmi Party (AAP) members may remain equidistant from both the BJP and the Congress, though the party is friendly with some of the major opposition parties like the Trinamool Congress.

Also Read: BJP MP Seeks Amendment to the Protection of Children from Sexual Offences Bill

In an interesting development recently, the AAP actively participated in the opposition’s walkout and the day-long boycott of the Rajya Sabha over long intra-day adjournments of the Upper House by Chairman M. Venkaiah Naidu.

The AAP, which was not welcome at any opposition meetings earlier, particularly those held in Parliament House, was invited to speak at a joint opposition media interaction on the day. But nobody can be sure as to how long this bonding would last.

Partywise tally of those retiring in April-May from the opposition’s side include 13 from the Congress, six from the Samajwadi Party, three of the Trinamool Congress, two each of the Nationalist Congress Party and Biju Janata Dal and one each of the CPI-M, the Bahujan Samaj Party and the Jharkhand Mukti Morcha.

NDA has to face many embarrassments in past few years in Rajya Sabha. Wikimedia Commons
NDA has to face many embarrassments in past few years in Rajya Sabha. Wikimedia Commons

From the ruling side, 17 MPs of the BJP, three of the Janata Dal United, one of the Shiv Sena and two of the Telugu Desam Party (TDP) are retiring.

In terms of state-wise vacancies to be created in April, the highest number is from Uttar Prdaesh (9), followed by Maharashtra (6), Madhya Pradesh (5), Bihar (5), Gujarat (4), Karnataka (4), West Bengal (4), Rajasthan (3), Odisha (3), Andhra Pradesh (3), Telangana (2), Uttarakhand (1), Himachal Pradesh (1) and Chhattisgarh (1). IANS