Poor people’s resources are already under ever-present threat from poor rains, drought and caste-based upheavals. But being poor and ill, stretches the ability to cope to the extreme, destroys the delicate balance of their existence and leads to crushing poverty.
Rural and Mobile Clinics
Referral and follow-up care
In the early 1970’s, healthcare facilities in the Ananthapuram region were almost inadequate, unaffordable and most of all inaccessible. There were very few health centres in the range of approximately one for one lakh people. The rural poor had to travel 60 to 100 kms to access proper medical facilities, that too at government hospitals which weren’t necessarily well-equipped to provide proper services.
Rural poor communities should improve their health consciousness, knowledge and practices concerning various social, gender and health aspects with a special focus on Gynaecological Problems, Sexually Transmitted Diseases (STD), HIV/AIDS, Cancer, Anaemia, Nutrition, Immunization, Sanitation, Personal Hygiene, Safe drinking water, Epidemics, implications of consanguineous and early marriages, etc.
Target Communities/CBOs should be aware of existing government health resources, schemes and services and access them to improve their health status
Target communities/CBOs should build individual toilets and bathrooms with the financial assistance from the Government/RDT and should use them properly.
Community Health Workers (CHWs) should be well trained about reproductive health care, including importance of institutional delivery, immunization, nutrition/dietary practices and treatment of minor ailments and should promote their services among target communities.
100% of eligible children should access the required doses of immunization either in RDT Hospitals or Government Health Centres.
Children in the age group of 1-5 years old should improve their nutrition with under-nutrition and malnutrition being drastically reduced.
Adolescent girls and women should improve their diet and show less incidence of gross anaemia.
Patients should receive better follow up care through a system involving hospitals, rural clinics, field health staff and patients/attendants.
Availability of qualified midwifes was rare, so no controlled pregnancies existed. Pregnant women did not have regular check-ups or access to safe delivery options, and depended on local women (Dais) using traditional methods, who couldn’t professionally and safely handle complicated delivery cases. Illiteracy and local custom further added to the problem especially on the reproductive health and hygiene front.
Homes did not have indoor bathrooms or toilet facilities, water was scarce so bathing regularly was problematic, and to worsen things, villagers were resistant to these ideas. Even when RDT built bathrooms in the 80s, villagers removed the slabs and used them for cattle sheds or other structures, and mosquito nets given to them would stay unused.
Making villagers aware of education’s benefits was a necessary prerequisite to the betterment of their lives. Education would help their children break out of the cycle of generations of subservience and take charge of their fates. As a foundation stone for the first generation of learners, RDT began by promoting basic primary school attendance in the project areas.
RDT carried out limited immunisation exercises around 1978 against polio, DPT and measles; but practically speaking, till 1987, there was no universal immunization for children in the area. The well-being of vulnerable families of low socio-economic status was fragile, and aside from their poverty, even access to the components of a nutritious, balanced meal was an issue. Meagre incomes definitely would not to stretch to provide any special food for small children, antenatal/lactating mothers, the elderly or sick persons. Everybody had to eat the same food which invariably was of low protein content. It was only during any festive occasions that they ate chicken, mutton or fish.
Only a few villagers consumed milk or milk products on a regular basis, and eating eggs regularly was expensive, and they did perhaps once or twice a month. Also, it had to be shared among all the family members. Likewise, the cost of vegetables was beyond the reach of a common man. Nutritional awareness was also very low which gave rise to many cases of Marasmus (severe undernourishment) and Kwashiorkor (malnourishment) amongst children. Nearly every village had cases of severe malnutrition and/or undernourishment.
When the government’s Universal Immunisation Programme (UIP) did begin, RDT helped the effort with human resources, transportation, cold-storage, awareness buildings and house visits.
exually transmitted diseases if contracted, were left untreated and easily transmitted. Women faced comparatively more problems than men, and illiteracy only added the problem. They knew little about reproductive health, could not seek out information from outside sources, and were shy to disclose their problems. Girls particularly were unaware of the hormonal changes that happen during puberty and how to maintain proper reproductive hygiene. Being oppressed for many years, they were the ones to eat last in the family with what was left after the male members were done with it, therefore, not getting proper nourishment. And when they did, the food was quite unsuitable to derive balanced nutrition from.
Andhra Pradesh is one of the eight states in India that contributes to 75% of its Infant Mortality Rate (IMR). Malnutrition is one of the important factors causing infant mortality. Findings of National Institute of Nutrition (NIN) reveal that 38.8% of children in Andhra Pradesh in the age group of 1 to 5 are undernourished. It was found that 45.6% of the children in rural areas are underweight and undernourished, with 49.6% of them showing stunted growth. As per the reports of the Principal Secretary, Health Department, Government of Andhra Pradesh (May, 2011) ‘The IMR in Andhra Pradesh was 40.3%, while it is 11% in Kerala and 28.5% in Tamil Nadu. The IMR is very high among tribes (102%)and Scheduled Castes (73%) in the State.’
Pregnant women and new mothers were the worst-affected as they did not get proper nutrition before or after the delivery, which directly impacted their health and babies’ health. A prevalent pre-delivery belief in those days was that an expectant mother eating a lot was detrimental to a smooth delivery, and post-delivery that a woman should eat only rice and chilli for 40 days. In adolescence also, girls were worse off. As the marriageable age for girls in some villages was as low as 11-12 years in early 70s, when they were neither physically nor mentally ready for it. Early marriage, and subsequently early pregnancy also posed a massive risk to the life of both the mother and the baby. In all, the Mother Mortality Rates (MMR) for the time were as high as 800 deaths per 1 lakh women. They were also the victims of baseless superstitions that further compromised their health in many more ways - the local practice of Dhrishti, unsafe abortion practices leading to septicaemia and death.
Affordable healthcare to everyone
Even with the great strides made in rural healthcare over the last 46 years, RDT’s goal still remains ‘The rural poor will have access to quality health care at affordable costs.’ The organisation is committed to extending its reach and giving people increased access to government healthcare and its own network of services.