Care Programmes for the Community
In India, the estimated number of deaths due to Non Communicable Diseases (NCDs) in 2008 was 5.3 million (World Health Organization – NCD Country Profiles, 2011). The overall prevalence of diabetes, hypertension, ischemic heart diseases (IHD), and stroke in India is 62.47, 159.46, 37.00, and 1.54, respectively, per 1000 population (Indian Council for Medical Research, 2006).
With the outreach that TCT has into a defined community, our organization can make a meaningful change in the prevalence of this problem and its consequent complications. The vision of the project, therefore, is twofold:
1. Prevention of obesity by creating awareness of the medical problems related to an unhealthy lifestyle in the community with particular focus on children and young adults and educating them about proper nutrition and physical activity;
2. those already afflicted with the abovementioned problems should have easy access to good quality ethical healthcare at an affordable cost to prevent complications.
Community Health Services
The TCT has the unique distinction of being in Community Health and Development Services for nearly 40 years and has greatly impacted the community through its programmes in community health, women empowerment, disability and deaddiction and many more activities. As the TMH sprang up, TCT had a willing partner in the community to cater to the emerging needs of the community with its new health initiatives. All of TCT’s services in the villages are completely free and charitable in nature. We carry out regular screening and offer education, counselling, referral and treatment to different groups of people through a full-fledged programme.
The programme covers 315 villages, 50 panchayats in Vellore district touching the lives of 160,000 people in 35,000 families. We offer comprehensive care through a network of primary healthcare providers established in the community in all our programmes. For easy administration, this is divided into 7 areas and each of the areas is managed by an area coordinator who has 3-4 multi-purpose assistants. Each of the programme areas we address viz., Non-communicable Diseases, Women and Children, Alcohol and Substance Abuse, Mental Wellness and disability, Geriatric wellness, has a project level coordinator who enables delivery through area coordinators and multi-purpose assistants. The Community Health Services is managed effectively by a General Manager who is an experienced social worker.
At the village level there are Family Care Volunteers for every 50-75 families and Community Based organizations called Annam whose membership is essentially drawn from our beneficiaries who have a great sense of ownership and bonding with the TCT. Both these categories of people are volunteers and play a very useful role in streamlining our services in the villages. They undergo periodic training programmes. They ensure the deserving people from their villages get our care through direct referrals to the hospital, our camps and care programmes.
TCT embeds the hospital within the community and incrementally reaches out to all the villages in the project area to identify and treat NCDs, such as diabetes, hypertension and osteoporosis. It has covered a sizable eligible population in screening for cervical, breast and oral cancer. It continues to work with women and children, alcohol and tobacco abusers, people with mental illness and disability and the geriatric population. TCT has also committed to addressing other emerging health issues in the community, as it recently did during the pandemic in a project to protect the vulnerable and senior citizens.
TCT collaborates with the Government and other private organizations to fill in the gaps in its expertise and ensure cost-effectiveness and maximum benefit to the community.
Camps for the Community and Beyond
The camps for the community are mostly held at the hospital and our health centres for the community by individual departments. Gynaecology, General Surgery, Orthopaedics, E.N.T., Paediatrics, Dental, Cardiology and Pulmonology camps are regularly held on a fortnightly basis. Some surgical and dental specialty camps and multi-specialty camps are conducted in areas beyond our project community based on request and need. Eye camps are conducted on a monthly basis in collaboration with Aravind Eye Hospital, Chennai and patients requiring cataracts and other surgeries are taken there after the camps and free surgeries are organized there for them.
Free in-patient services
For our community patients coming through camps and programmes and for patients from very poor economic backgrounds, free in-patient and surgery services are provided on meeting certain pre-established criteria. These patients are offered the same level of care as other patients and extra steps are taken to ensure that they adhere to our instructions for full recovery after discharge during follow-up.
Obesity
In the minds of the general public, obesity per-se is not considered a health issue although medically it is known to be strongly associated with many diseases including diabetes, hypertension, cardiovascular problems, menstrual problems, infertility, arthritis, stroke, sleeplessness, eye disorders and impotence.
Changing lifestyle and fast-food-type eating habits contribute to the increased number of obese people in our community.
We at TMH believe strongly that this is a health concern that needs to be addressed, and is one of the focus areas of our hospital towards improving the overall health status of our community.
We integrate this as an important aspect of treatment for all the patients we care for. For weight reduction, we offer diet and nutrition education, advice on regular exercise and counselling on lifestyle modifications. Life-long and sustained attention gives excellent results and improves health. This is a regular on-going programme covering different age groups and our field staff offer the interventions and monitor their conditions.
Diabetes and Hypertension
Diabetes and hypertension are very common and are becoming more and more common in India both in urban and rural areas. Both need treatment and monitoring are life-long. The problems can be kept under good control with appropriate diet, exercise and medication but cannot be cured. These diseases lead to a lot of complications over the years. They cause a lot of health problems and decrease the life span. They can impact the heart, kidney, brain and eye. Diabetes can affect the peripheral nerves and also affect blood flow to the feet leading to gangrene that results in amputation. The cost of treatment and follow-up are high and cause severe hardship to low and middle-income groups.
At TMH, we have proven medical expertise to prevent, manage and control diabetes and hypertension. We have physicians, dentists, foot surgeons, physiotherapists, nurse educators, nutritionists and nurses working as a team to deliver comprehensive care. While our medical experts have developed standardised procedures for diabetic and hypertensive care, they are also capable of providing customised care to suit the needs of the individual patient. The hospital laboratory provides reliable results. The hospital pharmacy is well stocked with the medicines suited for our patients.
The hospital has a well-established referral system for complications of eye, cardiac and kidney problems.
The hospital offers heavily subsidised annual packages for diabetes and hypertension patients from the community it serves. Those enrolled in the care package visit the doctor every six months when their status of the condition is ascertained in physical examination, lab tests and screening tests for nephropathy and retinopathy. During the visits, they are also educated on their diseases, appropriate diet, physical activity, need for regular medicines and monitoring of their conditions. The most significant element of the system is that the patients are visited in their homes on a monthly basis by our Multipurpose Assistant who checks their AC and PC sugar levels and BP. If patients have abnormal values, they are shared with the physician at the hospital who provide medicine dosage adjustments and communicate to the patients through the Multipurpose Assistant. This system thus prevents multiple visits to the hospital while care is ensured in a care continuum. Those who continuously show poor control are started on insulin treatment as well. Prior to that thorough understanding of the patient’s condition is assessed. Both the patient and his/her caregiver are taught to administer insulin. To keep the cost of care low for the patients, they are encouraged to get their medicines from the Government Primary Health Centres.
This care system is proving to be beneficial and nearly 2000 patients are under this system now and more people are lined up now for enrolment. This system has been in practice since 2017.
Osteoporosis
The word means “softening” of bone (literally, bone becoming “porous” and hence fragile) and is a common problem among senior citizens. Even an accidental fall or a sudden jerk can damage bones if there is osteoporosis. It is therefore necessary to assess bone density in women who are 5 years post-menopause and men over 60 years. Necessary preventive measures can be instituted if there is a problem.
The DEXA Scan is a specialised x-ray type equipment available at our hospital to assess this condition.
The eligible population from our community are offered a free DEXA scan and are offered heavily subsidised treatment with calcium and vitamin d supplements which are delivered to them in their homes by our field staff. A simple, easy-to-follow, standardized treatment procedure to prevent bone fracture and resultant disability is now in practice. We have studied this programme in over 10000 patients since 2012. Our work in this area has received commendation after the study was published in the Journal of Endocrinology. We have pioneered this at the community level.
Cancer Screening in Women
In a systematic approach, rural women from 30 years to 50 years who have gone through at least one pregnancy were screened for cervical cancer using a visual inspection of the cervix after applying acetic acid, a WHO standardised method. TMH’s nurses were trained in this procedure.
Those who were suspected to be having early symptoms of cancer went through colposcopy and if necessary were given a simple intervention. During the screening, their breasts were also examined physically and assessed for any possible lumps.
Over 9000 women have gone through this screening since 2012. There have been 9 cases of confirmed cervical cancer, 2 cases of breast cancer. There are 54 women who are under follow-up for their CNI infection. The results of the programme have been published as a research paper.
Oral Cancer Screening
We partnered with Raga’s Dental College, Chennai in this programme. Both tobacco and non-tobacco users were assessed for oral cancer lesions in the community. More than 4000 persons were assessed with a visual oral screening procedure by a dentist. Those with potential malignant and malignant oral lesions were biopsied and provided appropriate treatment. This was also developed as a research project and the results were published as an article in Cancer Research, Statistics and Treatment. Incidentally, tobacco users were offered an intervention and a few of them opted for it and benefited from it.
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