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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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Atal Bihari Vajpayee: A Peace Visionary and a Man Who Believed in India’s Destiny and was Ready To Fight For It

It was precisely this persona of Vajpayee -- one merged in Hindutva ideology yet seemingly not wholly willing to bow to it -- that won him admirers cutting across the political spectrum.

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Atal Bihari Vajpayee,
Atal Bihari Vajpayee, India's peace visionary. Image: Flickr

Atal Bihari Vajpayee was a man of moderation in a fraternity of jingoistic nationalists; a peace visionary in a region riven by religious animosity; and a man who believed in India’s destiny and was ready to fight for it.

Former Prime Minister Atal Bihari Vajpayee (93), who died on Thursday, will go down in history as a person who tried to end years of hostility with Pakistan and put development on the front burner of the country’s political agenda. He was also the first non-Congress Prime Minister to complete a full five-year term.

Even though he lived the last 13 years of his life in virtual isolation, dogged by debilitating illnesses and bedridden, he has left an enduring legacy for the nation and the region where he was much loved and respected across the political spectrum and national boundaries, including in Pakistan.

Vajpayee, former Indian Prime Minister
Vajpayee stunned the world by making India a declared nuclear state. Image: Wikimedia Commons

In the tumultuous period he presided over the destiny of the world’s largest democracy, Vajpayee stunned the world by making India a declared nuclear state and then almost went to war with Pakistan before making peace with it in the most dramatic fashion.
In the process, his popularity came to match that of Indira Gandhi, a woman he admired for her guts even as he hated her politics.

He also became the best-known national leader after Indira Gandhi and her father Jawaharlal Nehru.

After despairing for years that he would never become Prime Minister and was destined to remain an opposition leader all his life, he achieved his goal, but only for 13 days, from May 16-28, 1996, after his deputy, L.K. Advani, chose not to contest elections that year.
His second term came on March 19, 1998, and lasted 13 months, a period during which India stunned the world by undertaking a series of nuclear tests that invited global reproach.

Although his tenure again proved short-lived, his and his government’s enhanced stature following the world-defying blasts enabled him to return as Prime Minister for the third time on October 13, 1999, a tenure that lasted a full five-year term.

When finally he stepped down in May 2004, after an election that he was given to believe he would win, it marked the end of a long and eventful political career spanning six decades.

Vajpayee had gone into these elections riding a personality cult that projected him as a man who had brought glory to the nation in unprecedented ways. The BJP’s election strategy rested on seeking a renewed mandate over three broad pillars of achievement that the government claimed — political stability in spite of the pulls and pressures of running a multi-party coalition; a “shining” economy that saw a dizzying 10.4 percent growth in the last quarter of the previous year; and peace with Pakistan that changed the way the two countries looked at each other for over 50 years.

The results of the elections could not have come as a greater shock to a man who was hailed for his achievements and who was named by Time magazine as one of the 100 influential men of the decade.

Success didn’t come easily to the charismatic politician, who was born on Christmas Day in 1924 in Gwalior, Madhya Pradesh, into a family of moderate means. His father was a school teacher and Vajpayee would later recall his early brush with poverty.

He did his Masters in Political Science, studying at the Victoria College in Gwalior and at the DAV College in Kanpur, Uttar Pradesh, where he first contested, and lost, elections. He began his professional career as a journalist, working with Rashtradharma, a Hindi monthly, Panchjanya, a Hindi weekly, and two Hindi dailies, Swadesh and Veer Arjun. By then he had firmly embraced the ideals of the Hindu nationalist Rashtriya Swayamsewak Sangh (RSS).
But even as he struggled to win electoral battles, his command over Hindi, the lingua franca of the North Indian masses, his conciliatory politics and his riveting oratory brought him into public limelight.

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

His first entry into Parliament was in 1962 through the Rajya Sabha, the upper house. It was only in 1971 that he won a Lok Sabha election. He was elected to the lower house seven times and to the Rajya Sabha twice.

Vajpayee
Vajpayee spent months in prison when Indira Gandhi imposed Emergency rule in June 1975. Image: Wikimedia Commons

Vajpayee spent months in prison when Indira Gandhi imposed Emergency rule in June 1975 and put her political opponents in jail. When the Janata Party took office in 1977, dethroning the Congress for the first time, he became the foreign minister.

The lowest point in his career came when he lost the 1984 Lok Sabha polls, that too from his birthplace Gwalior, after Rajiv Gandhi won an overwhelming majority following his mother Indira Gandhi’s assassination. And the BJP he led ended up with just two seats in
the 545-member Lok Sabha, in what looked like the end of the road for the right-wing party.

In no time, Vajpayee was replaced and “eclipsed” by his long-time friend L.K. Advani.
Although they were the best of friends publicly, Vajpayee never fully agreed with Advani’s and the assorted Hindu nationalist groups’ strident advocacy of Hindutva, an ideology ranged against the idea of secular India.

Often described as the right man in the wrong party, there were also those who belittled him as a moderate “mask” to a hardline Hindu nationalist ideology. Often he found his convictions and value systems at odds with the party, but the bachelor-politician never went against it.

It was precisely this persona of Vajpayee — one merged in Hindutva ideology yet seemingly not wholly willing to bow to it — that won him admirers cutting across the political spectrum. It was this trait that made him the Prime Minister when the BJP’s allies concluded they needed a moderate to steer a hardliner, pro-Hindu party.

He brought into governance measures that created for India a distinct international status on the diplomatic and economic fronts. In his third prime ministerial stint, Vajpayee launched a widely acclaimed diplomatic initiative by starting a bus service between New Delhi and Pakistan’s Lahore city.

Its inaugural run in February 1999 carried Vajpayee and was welcomed on the border by his Pakistan counterpart Nawaz Sharif. It was suspended only after the 2001 terror attack on the Indian Parliament that nearly led to a war between the two nuclear-armed neighbours.

The freeze between the two countries, including an eyeball-to-eyeball confrontation on the border for nearly a year, was finally cracked in the spring of 2003 when Vajpayee, while in Kashmir, extended a “hand of friendship” to Pakistan. That led to the historic summit in January 2004 with then President Pervez Musharraf in Islamabad — a remarkable U-turn after the failed summit in Agra of 2001. Despite the two men being so far apart in every way, Musharraf developed a strong liking for the Indian leader.

His unfinished task, one that he would probably rue, would be the peace process with Pakistan that he had vowed to pursue to its logical conclusion and a resolution of the Kashmir dispute.

He was not known as “Atal-Ji”, a name that translates into firmness, for nothing. He could go against the grain of his party if he saw it deviate from its path. When Hindu hardliners celebrated the destruction of the 16th century Babri Mosque at Ayodhya, he was full of personal remorse for the apocalyptic action and called it — in a landmark interview to IANS — the “worst miscalculation” and a “misadventure”. He even despaired that “moderates have no place — who is going to listen to the voice of sanity?”

In his full five-year term, he successively carried forward India’s economic reforms programme with initiatives to improve infrastructure, including flagging off a massive national highway project that has become associated with his vision, went for massive privatisation of unviable state undertakings despite opposition from even within his own party.

While his personal image remained unsullied despite his long innings in the murky politics of this country, his judgment was found wanting when his government was rocked by an arms bribery scandal that sought to expose alleged payoffs to some senior members of his cabinet. His failure to speak up when members of his party and its sister organisations, who are accused of killing more than 1,000 Muslims in Gujarat, was questioned by the liberal fraternity who wondered aloud about his secular proclamations. He wanted then Chief Minister — now Prime Minister, Narendra Modi — to take responsibility for the riots and quit but was prevailed upon by others not to press his decision.

A day before his party lost power, Vajpayee was quoted as saying in a television interview that if and when he stepped down he would like to devote his time to writing and poetry. But fate ruled otherwise. The man who once rued that “I have waited too long to be Prime Minister” found his last days in a world far removed from the adulation and attention — though across the nation people prayed for his well-being — surrounded only by care-givers and close family whom he even failed to recognize. (IANS)