The service is innovatively done by basing the Mobile Hospital in
the
village school (the school remains closed on the date every month and instead works on second
Saturday,
which is otherwise a holiday) and creating literally a hospital, and at the end of the day
winding
it up
and moving to the next nodal point.
The Mobile Hospital is sketched into five sections namely;
reception,
waiting, doctors work section, diagnostics and pharmacy. The doctors working area is based in
the
school
rooms and five departments are created viz.
Department of Medicine
Specialist Physicians and General Physicians
Department of Surgery
General
Surgeon,
Ortho and ENT Surgeon
Department of Obstetrics & Gynecology
Obstetricians, Gynecologists and Lady General Physicians
Department of Pediatrics
Pediatrician
and
General Physician
Department of Dentistry / Ophthalmology
Dental Surgeons / Ophthalmologists
For Dentistry there is a fully equipped mobile unit (bus) with
two
dental
chairs. Each of these departments has the full complement of all equipments required for
effective
function and get uninterrupted power supply drawn from the diagnostic bus which has a 15 KW
inbuilt
generator.
Effective curative care emerges owing to the presence of
specialists
belonging to 9 specialties, taking care of 400 - 500 patients at each of the nodal points. The
approach
in each of the department is absolutely proactive. The Department of Medicine and Surgery treat,
all
the
5 types of community ailments viz common, chronic, intricate, asymptomatic and preventive
ailments.
The
Department of Dentistry does procedures like fillings, extractions, root canal treatment (RCT),
scaling,
removable partial dentures (RPD), full set dentures in the dental bus. The Department of
Obstetrics
& Gynecology does procedures like pap smears, cervical biopsies, cancer cervix screening
followed by
cryo surgery or loop electrical excision procedures (LEEP). Antenatal checkup of pregnant women
is
done
and their deliveries are arranged in Sri Sathya Sai General Hospital.
The Department of Pathology does procedures like Fine Needle
Aspiration
Cytology (FNAC) and Core Needle Biopsy. An excellent follow-up mechanism contributes to the
quality
care
that is rendered in each of the departments.
Patients requiring diagnostic tests like USG, X-ray, hematological
and
biochemical investigations are sent to the diagnostic bus, which is parked a little away from
the
Doctors working area. An innovation is done for tests, which cannot be done in the bus by
collecting
the
blood samples, processing it, delivering it in vacutainers to the labs in Sri Sathya Sai Super
Specialty
Hospital for testing and reporting, thus ensuring that the objective of providing a loving
door-step
service is achieved.
The curative work is further strengthened by a strong pharmacy
which
ensures that patients with chronic ailments like epilepsy, diabetes, hypertension, heart
disease,
asthma
etc. are all provided with continuous and uninterrupted supply of medicines (1 month till the
next
month's visit). This has very useful implication since effective treatment prevents serious
complications like diabetic retinopathy, nephropathy etc. which would have meant greater
suffering
for
the patient and huge expenditure for the Government.
About 10% of patients coming to the Mobile Hospital
require
further care in the form of sophisticated diagnostic procedures, medical in patient
management,
surgical interventions etc. The surgical profile for patients requiring surgery is done
on
the
field and these patients are operated by the Mobile Hospital surgeons in Sri Sathya Sai
General
Hospital which gives the operation theatre and nursing support form 1st to
5th of every month. For surgeries, which cannot be done in the General
Hospital,
the
patients are sent to designated referral centers after the diagnostic procedures are
completed.
The patients come back to Mobile Hospital for post-surgical care. For C.T scan and MRI
scan,
the
patients are sent to Sri Sathya Sai Super Specialty Hospital with a referral letter. For
ailments covered under "Arogyasri" scheme, patients are sent to the recognized
Government
centers with relevant reports.
As regards Tuberculosis, Leprosy and HIV there is
excellent
cooperative work with Governmental agencies. The clinically suspected patients undergo
blood
tests, X-rays or procedures like FNAC, Biopsy etc. and are sent with reports to the
Govt.
agencies like DOTS centers for Tuberculosis & Leprosy and State Government
designated
hospitals for anti-retrovirus drugs. Follow-up work like drug compliance, review
investigations
are again done by Mobile Hospital.
The preventive work consists of health education, which is
done
both intensively and extensively. Six major subjects viz; cleanliness (environmental,
home
&
individual), nutrition, healthy air and water, harmful effects of habits like smoking
and
alcoholism, proper physical exercise and mind relaxation, lifestyle changes, have been
selected.
Education on these subjects is done at the individual, family and community levels using
a
variety of tools like audiovisual presentations, demonstrative sessions, interactive
meets,
photo exhibition etc.
The education is done at three different times. Firstly,
before
the start of curative services at every nodal point. The presence of villagers from 30
to 40
villages helps in conveying the message, in effect to a large population. Secondly,
during
the
curative service, the different specialists go to the waiting areas of the patients now
and
then
and educate them on issues relating to their specialty. The third time is during
evenings
when
villagers are back from their work. A community level program is arranged at the
center-point of
the village. Audio-visual programs along with formal & informal talks by doctors, is
arranged. Health Education is done not only by doctors but also by volunteers who have
been
trained and designated as Health educators.
As regards, Nutrition in addition to education, the subset
of
patients like malnourished children, pregnant women are provided with nutritional
supplements
like Sai protein which is an easily digestible, protein rich recipe. It can be made with
ingredients available at home.
Another related preventive work is, conducting of
screening
services aimed at detecting asymptomatic ailments or premalignant conditions. Cancer
cervix
(uterus) screening by the World Health Organization approved latest technique namely VIA
method,
is done daily by the Department of Obstetrics & Gynecology. The method involves both
diagnosis and treatment. Collaboration with an international NGO called PINCC
(Prevention
International No Cancer Cervix) based in USA has resulted in this useful exercise.
The School Health Service is another useful and
interesting
component of work of the Mobile Hospital. In this service, school children undergo a
check-up
every year and this involves outlining what is called the three H's - Health, Habits,
and
Home
environment of every child. Necessary corrections and interventions are attempted for
children
deficient in each of the fronts and they are also monitored periodically till they come
up
to
expected levels.
The Mobile Hospital also has an academic wing. Medical
students
from medical colleges come for clinical training.
With this holistic approach 90% of health problems in the
community are solved because the approach is professional, proactive and integrated and
takes
care of all types of ailments.
Community ailments have been identified and classified
into
five
categories and the operative strategy for each of the category has been outlined as
follows.
Type of Ailments
Operative Strategy
Common Ailments
Simple treatment, education and arrangement of
first
aid
kits in every village.
Chronic Ailments (25% population suffers from
either
diabetes, or hypertension, or heart diseases or others)
Monthly specialist
doctor
examination and dispensing of medicines.
Intricate Ailments
Field identification and evaluation. Base
hospital
support for higher medical management, diagnostic procedures, surgical
interventions
Asymptomatic Ailments
Screening Programs
Preventable Ailments
Relentless Health Education
Sri Sathya Sai Mobile Hospital is indeed not only a state
of
the
art rural outreach service but a state of the heart caring and loving service.
