Riding in tandem
Five years ago, the labour room of Diwadia Primary Health Centre, Sehor, Madhya Pradesh was the most neglected place in the whole health centre. One small room accommodated two tables, two beds, a few chairs, and a refrigerator. It was no better than a storeroom. There was hardly any space for any movement. The PHC did not have a separate space for an anti-natal check-up (ANC) either. The pregnant women in the village were reluctant to come to this PHC.
However, today the scenario has totally changed and it does not look the same place at all.
What it took to overturn the situation was an initiative by the PHC Medical Officer (MO) Dr Anil Chandak, which was doubled by the combined efforts and dedication of the PHC staff.
“When I joined the PHC in 2016, the state of affairs was quite pathetic,” says Dr Chandak while recalling the situation then. “The Out Patient Department (OPD) did not function properly, no woman came for the delivery because there was no staff nurse, there was no provision of food, water, and other such facilities for patients, washrooms were either non-functional or not useable –the place was being run in a haphazard way.”
His observation is endorsed by the staff nurse Leena Khandare who also joined in 2016 and worked in tandem.
“Now, every month there are 8-10 deliveries taking place because the new setting of the labour room with enough space as well as a separate ANC room,” says Khandare, who is now the in-charge of labour and ANC rooms. “There is regular cleaning before and after the deliveries.”
Dr Chandak says that it seems no one paid attention to cleanliness or gave a thought to developing a system, in the past. What inspired him and changed the state of affairs, was the Kayakalp workshop and its clear guidelines that helped in evolving a system at the facility. Now there is a Kayakalp checklist, which is strictly followed by each member of the facility.
“I have delegated responsibilities, the pharmacist is in charge of OPD and medicine store, whereas the staff nurse is responsible for labour and ANC room, and I personally check the Bio-Medical Waste (BMW) segregation,” says Dr Chandak. He also re-scheduled (roster) the duty hours of cleaning staff to ensure there is someone available round the clock.
Before a system could be developed, it was necessary to orient the workers as they had been working in a particular way for long and needed to understand the importance of following the government guidelines for maintaining cleanliness in the facility, Dr Chandak explains the process.
Assistance came from the WaterAid India (WAI)-funded organisation Samarthan, which provided technical support to the PHC. It included the training of the PHC staff in four major areas – BMW management, self-protection, hand washing, and infection control. Samarthan also liaised with the government for its necessary intervention to improve the conditions of the facility. Consequently, the government has sanctioned to pave the entrance of the PHC which currently has only a trail pathway which gets full of wild weeds and muck, especially during the monsoon season.
With the support of WAI, Samarthan added a few other ancillaries to the PHC, including the rainwater harvesting system, which has made water crisis a thing of the past. The washroom of the wards for both men and women, have been equipped with handrails for support. The PHC now has a ramp and handrails facilitating access to those who need support, especially pregnant women and frail or infirm patients. Each bed of the 6-bedded PHC is protected with a mosquito net.
“These facilities will motivate the people in the area to come here for medical help rather than going to Ichhawar district hospital which is about 30 km away from the village,” says the pharmacist Maharaj Singh Rathore, who methodically maintains the medicine store as well as records of OPD patients’ inflow.
The distribution of 25% of award money among the staff also worked as a booster dose, says Shakun Kandare, one of the three cleaners the PHC has. She has been working at the PHC for a decade and has witnessed its metamorphosis. Shakun is responsible for the disposal of BMW in the ‘Sharp Pit’ and the ‘Deep Burial Pit’ and she never makes any mistakes.
“The rest of the award money will be spent on building a BMW segregation shed, herbal garden, and some elbow taps for labour room and OPD, Dr Chandak enthusiastically elaborates the plan.
Recently, the PHC has been chosen to have a ‘Health and Wellness Centre’, which will ensure additional provisions including the facility of various pathology tests, more staff support, and some further sprucing up of the centre.
Witnessing the transformation, even the local panchayat and Rogi Kalyan Samiti (Patient Welfare Committee) have come forward to pitch in for a community toilet (separate for men and women) for OPD patients.
“This PHC is now no less than a small hospital in terms of facilities and services, primarily because of the efforts of the MO, who took an initiative and other staff members who followed him,” the affirmation comes from the Samiti member Shankar Lal Verma. He adds, “Being a resident of the area, the doctor takes a lot of interest in improving the centre, besides he is available all the time as well as understands the sentiments and emotions of people.”
The annual figures of OPD footfall, which was nearly 5,500 in 2013, has gone up to 7,500 in 2016 and 2017, endorse the observation of Verma.