community needs, and engage with the
community actively.
Our Rural Primary Care & Community
Oriented Primary Care (COPC) Practice
Context:
BHS is a not-for-profit organisation where
community clinics are led by qualified nurses
supported by a Family Physician. Community
health workers and volunteers (Swasthya Kirans)
further extend the community reach of services
and promote healthy behaviours.
Each AMRIT Clinic, managed by Basic
HealthCare Services (BHS), provides primary
health care that is responsive, empathetic
primary health ‘circle of care’, that is rooted in
the community including providing preventive,
promotive and primary curative services to a
cluster of about 3000 tribal families. Most of
these families own small unirrigated farms and
have limited employment opportunities. Such a
situation forces many young men to migrate to
cities for labour. Food is scarce, and
malnutrition levels among children and adults
are high. Terrain is hilly, and habitations are
scattered. Nearest functional government health
facilities are 20-30 kilometres away.
AMRIT Clinics also utilise a range of
innovations including HR Innovation, Partnership
innovation, and Technology innovations to address
a range of day to day situations that are highly
challenging such as: What does a mother do
when the child is sick, father is away to a city for
manual labour, and there is no health facility for
20 kilometres, and no transport? How does a
health provider manage an elderly woman with
severe pneumonia when there is no X-Ray
machine, no blood gas analysis and there is no
referral possible? What nutrition advice do you
give to the family of a severely malnourished
young man with silicosis and tuberculosis, who
cannot afford any milk or oil or egg? How do
you maintain your sanity when you see a
woman in labour walk 5 kilometres to reach the
Clinic at night across the hill?
Intent of the Quarterly Rural Health Feature
Series:
This quarterly feature series on rural health
intends to inspire students and practitioners to
engage in rural community practice, dive into a
unique opportunity to observe from close,
healthcare of adults, children, and whole
families from remote communities, gain
insights on delivering healthcare in places with
limited resources to learn and impart lessons on
what changes in clinical approach, programs
and policies might be required to improve the
care for these neglected and o en forgotten,
populations.
In each article, we will provide a case study, try
to locate it in a wider context, discuss learnings
from clinical, epidemiological, health systems,
and policy lenses, and propose a call for action.
Each case study will illustrate the principles of
family practice such as "deep generalism";
"person and family orientation"; "continuity of
care"; "community based care"; "building a
trusting relationship"; "counseling"; and "an
effective steward of resources" are highlighted.
Additionally, these articles will: (1) reflect on the
clinical insights, joy, challenges, and dilemmas
of physicians in addressing health needs of the
rural communities; (2) contrast between a
disease-oriented (specialist approach) and a
person-oriented approach combined with
COPC; and (3) suggest a course correction to the
existing paradigms in medical and health
sciences education of both generalists and
specialists.
Ultimately, our hope is to enable students and
practitioners of medicine to be more effective in
delivering primary care and appreciate the
privilege they have of serving as physicians in
the community.
So please stay tuned!
Dr. Ramakrishna Prasad & Dr. Pavitra Mohan
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