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

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Rural India (representational image), Wikimedia
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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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Maharashtra’s climate action plan yielded disappointments

Broadly speaking, the plan discusses the impact of climate change on six sectors -- agriculture, water resources, health, forests and biodiversity, livelihoods, and energy and infrastructure.

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Climate action plans were not up to the mark. Pixabay
Climate action plans were not up to the mark. Pixabay
  • The Maharashtra climate action plan yields huge disappointments as it failed to recognize crucial issues in its implementation.
  • The issues like air pollution and damage through thunderstorms and lightening were ignored.
  • The plan only focused on six major factors.

Mumbai, Jan 1: Eight years after the Centre’s direction to formulate a state action plan on climate change, and seven years after awarding the contract for a comprehensive vulnerability assessment study, the Maharashtra cabinet has finally adopted a plan on climate change.

Titled ‘Assessing Climate Change Vulnerability and Adaptation Strategies for Maharashtra: Maharashtra State Action Plan on Climate Change, and prepared by The Energy and Resources Institute (TERI), the action plan assesses vulnerability of the state to changing climate and outlines broad and ambitious strategies for building a climate-resilient future.

Rice Farm, Farming, Agriculture, Farm
Action plan focuses on 6 major factors, including agriculture. Pixabay

The action plan, built on high resolution modelling for which TERI entered into a partnership with the UK Met Office, projects changes in temperature and rainfall across the state at a resolution of about 25 km by 25 km for time periods 2030s, 2050s and 2070s — with the average climate during 1970-2000 as the model’s baseline.

An important component of the action plan is the Macro Level Vulnerability Index based on 19 indicators, which has identified the most vulnerable districts in Maharashtra: Nandurbar is the most climate change-vulnerable district, followed by Dhule and Buldhana. Satara is regarded as the least vulnerable district. Ratnagiri and Sindhudurg are also considered less vulnerable to changes in the climate. The state government has announced setting up a panel of experts to oversee the implementation of the report.

India, Mumbai, Bombay, Tourism
Issues related to thunderstorm and lightening were not taken into consideration. Pixabay

But, meteorologists and environment experts aren’t satisfied with the action plan. “The state has taken considerable time to come up with its adaptation plan on climate change. But the plan misses out on some crucial weather events, such as thunderstorm and lightning, that are linked to climatic changes. Air pollution, an important environment factor, is also missing from the plan,” said Akshay Deoras, Nagpur-based meteorologist.

Ashok Jaswal, former scientist with the India Meteorological Department (IMD), Pune, stresses that an effective state action plan should include all direct and indirect climatic parameters.

“Air pollutants are aerosols and have their own different properties. Some are salt-based, whereas others are carbon-based, or dust, or smoke. Some reflect solar radiation, whereas others trap heat,” he said. “These aerosols influence cloud formation, rainfall and the overall climate, and must be a part of the state action plan on climate change.”

Broadly speaking, the plan discusses the impact of climate change on six sectors — agriculture, water resources, health, forests and biodiversity, livelihoods, and energy and infrastructure. It also makes projections for rainfall and temperature in the state; and assesses the future sea level rise. A section in the plan is dedicated to extreme rainfall, flooding and adaptation in the Mumbai Metropolitan Region.

The document shows that temperature and rainfall are projected to increase all over the state with some regional variations. Amravati division (Vidarbha region) and Aurangabad division (Marathwada region) are going to experience greater rise in annual mean temperatures than other parts of the state.

The projected increase in annual mean temperature for Amravati is expected to be 1.44-1.64 degree C, 2.2-2.35 degree C, and 3.06-3.46 degree C in 2030s, 2050s and 2070s, respectively. For the same time periods, the projected annual mean temperature increase for Aurangabad division is 1.44-1.56 degree C, 2.15-2.3 degree C, and 3.14-3.38 degree C, respectively. An increase in temperature is likely to lead to a decrease in yields for some crops, such as rice, sorghum and cotton.

Minimum temperature is also projected to increase, particularly in the divisions of Konkan, Pune and Nashik, which could have an adverse impact on crops sensitive to high night temperatures in the reproductive phase, such as grain growth in rice or tuberisation in potatoes, warns the state action plan.

The government's efforts came up short. Pixabay
The government’s efforts came up short. Pixabay

The action plan notes that an increase in temperature will be conducive to malaria-transmitting mosquitoes in eastern and coastal (Thane and Raigad regions) Maharashtra in 2030s. By the 2050s, a faster rate of parasite development will take place in Aurangabad, Jalna and Nashik districts.

Since a warmer atmosphere has a higher capacity to hold water vapour, it will lead to intense rainfall events with longer dry or low rainfall spells in between. Extreme rainfall is projected to increase in all regions of the state with greater increases in the northern parts of the state.

Meanwhile, parts of south-central Maharashtra are projected to experience more dry days in the 2030s as compared to the baseline. These districts of Marathwada are already prone to recurring droughts and infamous for farmers’ suicides.

“The findings… clearly describe the adverse impacts of climate change on all regions of the state. The report shows the worrying trend of an increase in extreme weather events and heavy precipitation days,” said Parineeta Dandekar, associate co-ordinator of the South Asian Network on Dams, Rivers and People.

“Increased rainfall will lead to heavy flooding, which will have a direct bearing on the state’s water infrastructure. But, the action plan fails to elaborate upon ways to manage the water infrastructure in times of climate change.”

Lightning is listed as a state-specific disaster in Maharashtra, but the state action plan makes no mention of lightning, which is linked to climatic changes. “Rising temperature means more evaporation and high moisture content in the atmosphere, which leads to more thunderstorm activity and an increased incidence of lightning,” explained Jaswal.

A recent study, ‘Distribution of Lightning Casualities over Maharashtra’, has examined lightning deaths in the state between 1979 and 2011 and found 2,363 casualties from 455 lighting events. On an average 72 casualties per year have been reported with significant increasing trend.

“It is shocking that in spite of so many lives being lost each year due to lightning, the state action plan does not even mention the terms thunderstorm and lightning. Unless the plan acknowledges these weather events, how will the state government manage such disasters?” questioned Deoras.

The action plan does take note of the adverse impacts of hailstorm on horticulture crops in the state. For instance, it notes that hailstorms destroyed the grape crop in 2008-09. In 2010, almost 15 percent of the orange crop was destroyed due to rising heat and untimely hailstorm. But it fails to provide pointed information on ways to minimise impact on crops.

The action plan also makes no mention of air pollution. “Not including air pollution in the state climate action plan is a major drawback and the same must be rectified at the earliest,” said Jaswal.

Dandekar stresses on the need for translating action points into swift action. “The recommendations should not remain on paper, but must be included in the various state policies for immediate implementation,” she said. Deoras recommends setting up of a committee to reframe the action plan, by including the above-mentioned points, and then working towards the plan’s implementation by providing specific directions. IANS