Objective | Location | Background | Milestones | Programmes | MetarnalHealth | Laboratory
Rural Health Centre (RHC)
Voluntary poverty is one thing but compulsory poverty is quite another.
The villagers were poor and diseased …..
the damage wrought by centuries of privation
could not be wiped away in a few years.
J Krishnamurti
Objective:
To provide affordable quality primary level health care for below poverty line rural families.
Location:
An outreach of the Rishi Valley Education Centre, the Health Centre, provides health care to approximately 50,000 BPL (Below Poverty Line) Families.
About 50% of those from BPL families have incomes less than ₹ 60000 pa.
These patients are mostly landless, do not have their own homes, work as daily wage earners (coolie work, shepherds, vegetable/fruit/flower vendors, small shops). The income of these patients is variable depending upon the season.
These families are resident in villages and hamlets of the Western parts of Annamayya District, as well as from adjoining parts of Anantapur, YSR (Kadapa) districts and Karnataka.
Background:
The Rishi Valley Education Centre has, for several decades, been providing basic health services to the nearest villages. Perceiving a need for a healthcare programme that would provide affordable, quality primary level health care for the rural poor, a programme was started in July 1999 when a doctor (an alumnus of Rishi Valley and Armed Forces Medical College) joined the school with such an intent in mind.
This outreach activity finally took concrete shape in January 2001, with the setting up of an Outpatient Programme, followed by training of an optometrist and setting up of an eye care programme.
Over the years the Rural Health Centre (RHC) has added other programmes and facilities besides collaborating in research in the field of Public Health.
Milestones:
July 1999: Small beginnings. Monthly visits to the Satellite Schools of the Rural Education Centre, with a small backpack of medicines.
November 1999 – Nov 2000: Training of Optometrist at LV Prasad Eye Institute
January 2001: RHC moves to present premises (an old building of the RVEC). This location is on the bus route to Thettu Village, thus providing easy access for patients.
2001 – 02: Start of Eye, TB and Antenatal Programmes, supported by donors. These programmes now dovetail with the Government Programmes.
June 2004: Community Diagnostic Centre starts with basic Haematology, Biochemistry & Clinical Pathology - funded by an RV Alumnus
Feb 2005: X ray facilities: Funded by an RV Alumnus.
July 2005: Microbiology Unit commissioned. Funded by an RV Alumnus.
June 2010: New OPD Block was constructed with funding from a Rishi Valley Alumnus.
December 2015: Electronic Medical Record System. Funded by an RV Alumnus.
Jan 2020: 12.3 kVA off grid Solar Power System commissioned. Funded by Coal India under their CSR scheme
June 2023: Upgradation of the Microbiology Unit and addition Diabetic Foot Lab, Pulmonary Function Test: Funded by Sarda Energy and Minerals under their CSR
February 2024: Histopathology Unit commissioned. Funded by Jindal Power, Simhadri under their CSR scheme
Programmes:
All programmes are patient participatory, with the patients paying for consultation, diagnostics and medicines.
Subsidy is given depending on the need of the individual patient.
The RHC diagnoses and treats, or suggests treatment options, to an entire range of diseases from common colds to cancers.
General Outpatient:
Our annual patient footfall is about 15000. Non-communicable diseases like Diabetes, Hypertension, Chronic Pulmonary Disease and Hypothyroid disorders account for 70 – 80% of the Adult Outpatient load.
Non-Communicable Diseases
The RHC follows a team approach for the management of Non Communicable Diseases. All our nurses are trained to assess patients with NCDs. They do the following:
Assess patients for complications.
Measure BP
Check Feet
Education: Done using a combination of Flip Charts and Videos
On Diabetes - diet, foot care, exercises etc
On Hypertension
Healthy Living
Eye Care: An optometrist with basic ophthalmic equipment provides for the diagnosis and treatment of all common ophthalmic ailments. Spectacles are prescribed as well as eye drops/simple medications as required. Those requiring surgery or other procedures are referred to Ophthalmologists at Madanapalle.
Maternal Health:
Aimed at increasing birth weight, reducing maternal mortality and morbidity by ensuring regular antenatal visits, institutional deliveries and Nutritional supplementation, this programme has seen some notable successes. The RHC works with the local ASHA workers to ensure standard of care. Institutional deliveries are insisted upon.
Care of The Elderly:
The Centre treats about 2000 marginalised elderly and destitute people annually providing free/ subsidised investigations and treatment.
Under 15s Clinic:
This programme provides free treatment to the children of the Rural Education Centre and the children of Thettu Valley. About 500 children benefit annually from this programme.
Type I Diabetes :
Starting in 2010, the RHC has been providing subsidised/fre care for children with Type I diabetes. Some of these children have gone on to graduate, get jobs, marry and have their own children.
This programme is funded by various individual donors.
Presently there are 06 children under our care.
A 4 year old carries his Insulin in the pouch. The mother with type I diabetes, has been with us for 15 years. She married and her
daughter has recently been diagnosed with T1D. Shortly thereafter her husband was also
diagnosed with Type 2 Diabetes. The whole family gets subsidised treatment at the RHC
Mental Health:
Over the last few years there has been a spurt in the number of patients needing counselling and/or treatment. This encompasses the adolescent as well as the adult. We have trained ourselves in recognising mental health issues and offering comprehensive management of illness. Many times all that is needed is counselling. Patients requiring additional care – eg Alcoholism, Severe Depression, Suicidal ideation are referred to NIMHANS. Follow up of all such patients are done here.
There is a need for a programme for primary prevention of mental health issues.
Children With Special Needs
There is a lot that needs to be done here. At present, the RHC is only able to diagnose and refer them to a higher centre for evaluation and counselling. Unfortunately there are no nearby centres that can help these children and their families.
PATIENT CARE:
Emergency / Day Care:
This facility looks after any emergency, mainly Acute Asthmas, Hyperglycemia with or without ketosis, Accelerated Hypertension, Hyperpyrexia.
ASSESSMENTS
DIABETIC FOOT ASSESSMENT
India is home to about 101 million Diabetics (11.4% of its population). Of these patients approximately 25% develop Diabetic Foot Ulcers (DFU), of which 50% become infected, requiring hospitalisation while 20% need amputation.
Education, Awareness and Assessments are the key to prevent DFUs.
DIABETIK MINILAB Non Invasive Vascular Screening Device Distributors, Manufacturers
In June 2023, the RHC acquired a comprehensive system that measures Ankle and Toe Brachial Indices, Doppler Velocity Waveform, Biothesiometry, Monofilament 10g, Podiscan and Foot Temperature. This Minilab has helped us pick up early diabetic complications and thereby minimising or preventing further damage. This Minilab has more than proved its worth since its installation.
PULMONARY FUNCTION TEST
About 10% of our patients have Chronic Pulmonary Disease. A pulmonary function test helps in identifying the severity and progression of Lung Disease.
In June 2023, the RHC acquired a PFT test equipment.
DIABETIC FOOT CARE
A number of Diabetics develop Diabetic Foot Ulcers, Cellulitis, Gangrene etc. These patients are looked after to the extent possible in our Day Care setting. Some of them come back for follow-up after an amputation.
Under Dr Anandhi’s care, wounds are cleaned, debrided and dressed. About 2 years ago, Vacuum Therapy and local hyperoxygenation therapy was started using improvised methods. With these interventions, the RHC is able to salvage a number of limbs which have developed complications.
ELECTRONIC MEDICAL RECORDS
Dec 2015: A simple rudimentary E Med Record was installed with help from an Rishi Valley Alumnus.
This E med record was replaced with a more robust user friendly system in Feb 2024.
February 2024: EasyCare Hospital Management System - developed by SoCIT Home | SocIT Technologies was installed and operationalised.
DIAGNOSTICS
The Laboratory services are used by
Patients of the Rural Health Centre
Students and Staff of Rishi Valley School and Rishi Valley Rural Education Centre
Some clinicians from Madanapalle primarily for Microbiology and Histopathology
Laboratory:
Dr Kamakshi, MD (Path) has been with the RHC since Jan 2001. Under her guidance, the Laboratory has grown from simple beginnings, to doing high end tests and most recently addition of a Histopathology Unit.
Three laboratory technicians (Two for Laboratory and One for Histopathology), the Laboratory does up to 50,000 investigations annually. Fully equipped with a semi automated biochemistry analyser and an automated haematology analyser. The laboratory has the equipment for HbA1C, Thyroid Tests, and blood tests required for monitoring patients with COVID.
A few high end tests are sent to an NABL accredited lab in Hyderabad.
Quality Assurance: The Laboratory is part of the External Quality Assurance Scheme (EQAS) of CMC Vellore , with consistent quality being reported.
Microbiology Unit:
Headed by Kavitha Rajagopalan, a microbiologist,, this unit was set up in June 2005. This unit provides for culturing bacteria and recording their antibiotic sensitivity from samples taken from various body fluids. This helps in a more scientific approach to patient treatment. The unit does about 500 bacteriological cultures annually.
2007: TUBERCULOSIS Cultures: This was a path breaking initiative. A liquid medium (Medium V), prepared in the laboratory allows for rapid culture of Tuberculous Bacteria in 48 to 72 hours as against 6 to 12 weeks for a standard LJ media culture. More than 700 Tuberculosis cultures have been done. This helps in an early diagnosis for Tuberculosis.
Some clinicians from Madanapalle avail of microbiology services.
The high quality laboratory services are integral to the management of patients.
IMAGING
In Feb 2005, thanks to a donation by an RV Alumnus a 100 mA X Ray unit was commissioned. This served us well for more than 15 years.
In June 2021, the X Ray unit was upgraded to an unit (BPL 3.6 mRAD), using ultra high frequency (110KHz) technology which ensures that only a useful dose is produced over the entire duration of the exposure while suppressing the skin dose. This was funded by two RV Alumni.
AGFA CR System: The RHC entered the digital age of Computed Radiography with this system. The image quality is excellent, so also the ability to electronically manipulate the image is of immense help in diagnosis.
In Jan 2011, the RHC acquired a 3-D Ultrasound: This was funded by friends from AFMC. This unit was decommissioned in March 2023.
Pharmacy:
The Pharmacy is well stocked with only generic or branded generic medicines. Medicines are purchased from Low Cost Standard Therapeutics, http://www.locostindia.in/ Vadodara, and other generic pharmaceutical companies. Medicines are issued only on prescription of a doctor from the RHC.
The pharmacy has been outsourced to a Private pharmacist to comply with the existing Drug regulations.
PERSONNEL:
A close knit team consisting of 04 doctors; [Dr Kartik Kalyanram, MD (AvMed), Dr Ramesh Babu, DCH, Dr Kamakshi Kartik, MD (Path), Dr Anandhi (MD Obs & Gynae)], assisted by well-trained paramedical staff (an optometrist, 4 nurses, 3 lab technicians, 1 radiographer, 1 microbiologist) and 03 administrative personnel.
Secondary and Tertiary Care:
Those patients requiring treatment at a higher Centre are referred to either District Hospital, MAdanaplle, Private Nursing Homes in Madanapalle, SVIMS/SVRR Hospitals in Tirupati, (AP Govt Aarogyasri Health Insurance Scheme), CMC Vellore, R Jalappa Hospital Kolar, or to St Johns Medical College, NIMHANS, Bengaluru.
NATIONAL HEALTH MISSION
Those patients requiring treatment at a higher Centre are referred to either District Hospital, MAdanaplle, Private Nursing Homes in Madanapalle, SVIMS/SVRR Hospitals in Tirupati, (AP Govt Aarogyasri Health Insurance Scheme), CMC Vellore, R Jalappa Hospital Kolar, or to St Johns Medical College, NIMHANS, Bengaluru.
In 2016, Dr Kartik Kalyanram was nominated as a member of the Medicine Sub Group to prepare the India specific Standard Treatment Guidelines for the Management of Hypertension. This was in recognition of the work done on Hypertension by the Rural Health Centre
https://nhm.gov.in/images/pdf/guidelines/nrhm-guidelines/stg/Hypertension_full.pdf
RESEARCH
2006 – 07: Pilot Epidemiological Survey of Villages in Thettu Valley. Done in collaboration with the Dept of Stroke and Ageing, Monash University, Australia.
Funded by National Health and Medical Research Council, Australia
2007 – 16: The RHC has been involved in basic epidemiological research, in the field of Non Communicable Diseases, primarily Hypertension and Diabetes, in conjunction with Monash University, Melbourne, Australia, and Christian Medical College, Vellore.
The ICMR approved study:
“The Rishi Valley Vascular Diseases Project an observational and interventional public health project in Vascular Health in a typical Rural South Indian Community”
Nested case Control
Birth Cohort
Controlling Hypertension in Rural India (Global Alliance against Chronic Diseases)
The various studies involved field level assessment of Hypertension and analysis of possible cause factors.
A number of papers have been published in various international journals.
(Being sent as a separate document)
Feb 2018 - 2021: Consortium on Vulnerability to Externalizing Disorders and Addictions (c-VEDA) is jointly funded by the Indian Council for Medical Research (ICMR) and the Newton Grant from the Medical Research Council (MRC), United Kingdom.
Rishi Valley Rural Health Centre is one of the sites for this research project. This is a multicentric study aimed at assessing possible cause factors for various mental health issues amongst adolescents and young adults. Standard psychometric assessments, neuroimaging, genetic assessment and epigenetic factors were studied. The study continued from 2018 to 2020.
A number of papers have been published.
January 2024: Pathways to Resilience and Mental Health (PARAM): has just got underway. This is an ICMR, multi site project, looking at various factors which modulate or affect mental health. The target population is from 12 weeks of pregnancy to age 5 years, since some of the earliest signs of mental health problems manifest as early as at 5 years of age. This project builds on the success of the cVEDA project.
OPPORTUNITIES
CONSIDER US
If you are at heart a person
Who would like to work in Rural India
Who is community oriented
Who loves the cut and thrust of Family Medicine
Who is willing to deal with a whole spectrum of illnesses from Paediatrics to Geriatrics, Acute Illnesses to NCDs and Mental health
Who has an interest in Community Based research work
The RHC is looking for doctors who would be willing to work at the RHC for both the short as well as the long term:
Short Term ( 1- 2 years)
Qualifications: MBBS
Ideally someone preparing for NEET.
Long Term 5 years or more.
Qualifications
MBBS
MD / DNB in Family Medicine or General Medicine
Prepared to grow with the Health Centre.
CONTACT
Dr Kartik Kalyanram MD - Coordinator
email: ruralhealth@rishivalley.org
Phone / WhatsApp (0830 - 1600) : +918374409606 / +917382533913