Vrinda Bhola, Sukriti Gupta and Lavanya Rathi outside the mobile medical unit

We termed our community development campaign TeleMedicine - Youth Troops. The three of us collectively took on the responsibility of assisting telemedicine units, established in Mathura as a collaborative effort of Tata Trust and Ramakrishna Mission Sevashrama Hospital, Vrindavan. Our primary focus was to create awareness about the establishment of the telemedicine units in rural settlements, explain their advantages and encourage people to acquire medical help. Driven by a genuine desire for their welfare, we also strained ourselves to help people in rural settlements overcome their ignorance towards non-communicable diseases. As the first step, we planned regular visits to the telemedicine units at Mathura engaging in their orientation programs.

After gaining an in-depth understanding of the services offered, we appreciated the concept even more. there were, however some suggestions, that we had which may improve the overall functioning of the unit and we went to the head of the management with the same.

Some of our suggestions were:

1. EQUIPMENT UPGRADE

Stature measurement was conducted using markers on the wall. Using conventional means of analysis with a high scope for human error will give inconsistent and inaccurate readings.

Suggestion Making a note of the patients height is essential for calculating the BMI (Body Mass Index). Without this reading, assessment of general well-being will remain flawed. Using a standardized stadiometer will give accurate readings and ensure better evaluation and treatment.

Response

With Swami Ji's instant approval stadiometers are being installed in all nine units.

2. SURPLUS MEDICATION HANDLING

Once the prescribed dosage is complete, and the patient is healthy, the remaining medication is thrown away. Due to their lack of awareness and knowledge about storing conditions, medical recourses are wasted. This can potentially result in a massive biohazard if it is not addressed.

Suggestion

Giving patients the exact number/amount of consumables is most effective in curtailing this. However, it may not always be feasible based on pharmaceutical packaging. Posters with “Things to Do” if put up on the walls and notice board, as well as given out along with the medicine and prescription will help make people aware of proper storage practices. This poster can also be customised to carry instructions during recovery from common diseases and precautions for the same. Nurses and physicians should include these instructions even in verbal along with the pamphlet they hand out. An option for returning the remaining medicines at the final review consultation can further improve the units efficiency and cut down supply costs considerably.

Response

Swami Ji requested for minor edits on the sample poster we presented and gave his approval. All 9 units will carry the poster with instructions for leftover medication along with some tips on basic healthcare. Gentle reminders of the importance of hygiene and its connection to healthcare will be viewed by patients visiting any of the 9 units. With regular reminders, the chances of their implementation increase significantly.

1. We trained under block coordinators who impressed upon us the importance of educating the population about non- communicable diseases. Informing them about diseases that the unit was equipped to treat or manage would enable people to avail those benefits. As youth volunteers, we visited schools and interacted with students of our age, to be aware of specific diseases or symptoms.

2. We took the initiative of organising a quiz for female students at the schools to create a friendly and welcoming environment. After establishing trust and comfort, we spoke to them about menstrual health. As adolescents who did not face social ill-treatment based on menstruation, we felt very strongly about enabling them to break through social taboos and not be victimised by them.

3. We also familiarised students with the units in their locality. We worked towards establishing their confidence in seeking help from the telemedicine units in case of questions or concerns.

4. Based on our experiences in Mathura, we also had the opportunity to visit the telemonitoring system set up in semi-urban and rural settlements around Fatehpur Sikri. Ekal, a philanthropic organisation, had set up this unit that was in its infancy stage. As the first set of welfare services, they had begun operations for dental treatments being given to children only. On learning of our time in Mathura, and hearing about its successful take-off, they sought our suggestions for their unit. We shared with them, the response units in Mathura had received for primary healthcare services. We stressed on how that would expand their field of outreach and assisted them to conceptualise their plans and proposals towards the same.

Copy of Population Health and Value-based Care.jpg

HOW DID YOU BECOME INVOLVED IN THIS ACTIVITY?

WHO OR WHAT INSPIRED YOU TO GET INVOLVED?

WHY DID YOU FEEL IT WAS IMPORTANT?

After one of our teammates fell prey to the dengue epidemic in our country, we all took to our own research, collecting information about the healthcare facilities and it's delivery systems in our country. Each one of us, individually shocked by the research we compiled, shared our thoughts with one another. The one aspect we all had felt hopeful about was telemedicine units that are set up in rural areas across the country. We had all looked into the advantages it brought along wherein patients had access to medical advice regardless of the physical distance. While technology has steadily been on an upward climb, the healthcare sector was yet to see this form of revolution. We discovered that:

A centralised medical record system, as well as government, authorised and subsidised healthcare facilities are standard practice in various countries across the globe. Due to limitations arising from poverty, illiteracy, and slow economic growth, India continues to distance itself from such developments. With increase accessibility in internet service across the country telemedicine is opening avenues for improvisation in the medical delivery systems at a rapid pace.

However, only 175 telemedicine units in suburban and rural India and 15 in tertiary care hospitals have been established since it was introduced in India in 2000. Moreover, a recent study revealed that 86% of all medical visits in India were patients coming from rural areas, after travelling an average of 100kms.

This made us realize that telemedicine has the potential to bridge the gap between the patients in the rural areas and their access to medical services.

Thus, we decided to gauge how aware people were about his concept through a survey, the results of which told us how few a people knew about it. It was then that we decided to raise awareness on this topic and do what we could to further this initiative.

DESCRIBE THE OBSTACLES FACED BY YOU FOR THE ACTIVITY

AND THE STEPS TAKEN BY YOU TO OVERCOME THEM

The Quote Above, Along With Perseverance And Determination Gave Us The Strength To Face One Challenge After Another.

Our first obstacle was reaching the Mathura telemedicine unit itself. It was a 185 km travel covered over 3 hours. This restricted our visits to days when we had a holiday from school. But the 185 km would mostly extend since the units were located in remote settlements, deep within the area. Needless to say that lags between our visits, did occasionally seem to undo the progress we had made until then. With a few moments of disappointment, we soon learnt that what we lost in quantity, we could make up in quality instead. We began using the time after school on weekdays to research beforehand and go well prepared.

We approached the head of Ramakrishna Mission Sevashrama Hospital, fondly called Swamiji, without any referrals or references to back us up. As students, too young to be accomplished, we began that meeting with immense apprehension. However, as he listened to us intently, he could see clearly how passionate we all were. Gaining his appreciation and support from was far from intimidating.

Engaging with students residing in remote villages obviously brought out the cultural differences we had between us. One distinct difference was language since we all had English as our primary language while they had Hindi. At each step, we needed to ensure that not only are we being understood but that we are enabling a value-creating experience for them. Another challenge was getting a feature in publications that philanthropic organisations followed. Even before we had the opportunity to publish, we had to ensure that the content and quality of the writing is impactful enough for those organisations to take notice and take action in our favour. It was only after hours of research, writing and rewriting did we have a draft with which we began approaching publishers to move forward.

HOW LONG HAVE YOU BEEN ASSOCIATED WITH THIS ACTIVITY?

WILL YOU CONTINUE TO BE A PART OF IT? KINDLY ELABORATE

ON YOUR FUTURE PLANS FOR YOUR ACTIVITY.

We Began Working On Telemedicine - Youth Troops In March 2019 And Are Eager To Continue Its Progress.

Keeping in mind that we all are at the brink of graduating school, relocations are a possibility for each one of us. However, with the 1 year that we have in hand, we intend to create a set of publications that would continue reaching philanthropic organisations. Gathering more support and involving more volunteers, we are creating modules for our visits where we train the next generation of youth troops. As we gain more credibility through our articles, and through networks of Tata Trust and Ramakrishna Mission Sevashrama Hospital, Vrindavan, we target establishing a firm foundation.

This foundation will serve as a platform for more telemedicine units to be set up in various places across the country and be incubators for learners like ourselves to seek training and in turn, feed the system. With this increased output, we aspire to expand our outreach and readability hence extracting more community development resources. We have created drafts for community meeting schedules for the next quarter and will be initiating a ‘bring a friend’ incentive program for students in the schools we visit to encourage greater participation. Our plans also include topics about healthcare and disease prevention that we will cover, along with periodic visits to the village and the respective unit, for feedback and review.

Adding to this system, we will have a feedback and review format for patients as well, who had scheduled appointments during our previous visits. Ensuring they avail health care services, without delay as well as take suggests on improvements, will automatically create implement strategies for the units. Based on all assessment over the next quarter, loopholes and gaps within healthcare delivery services will be closed, and the overall standard of living and quality of life will only improve.

We plan to, in our next visits to Fatehpur Sikri, see how the units with the newly established provision of primary healthcare facilities are working and gauge its impact on the people.We are in the process of getting our article published in online health magazines such as InnovaCuris healthcare executive and Swarajya. We plan to attend a training session by the Indian Cancer Society on how to make people aware about Cancer screening and treatment and its importance. Mr. Nagesh, head of management of telemedicine units, recommended us for this seminar.

WHAT DID YOUR COMMUNITY SERVICE ACCOMPLISH?

WAS THERE A LASTING IMPACT OF YOUR ACTIVITY?

WHAT CAME AS A SURPRISE WAS THE NUMBER OF PEOPLE IN URBAN SETTLEMENTS, WHO HAD NO KNOWLEDGE OF TELEMEDICINE UNITS BEING ESTABLISHED IN OUTLYING AREAS.

Our impact was primarily amongst people in rural settlements around the city of Mathura. The awareness drives in schools, especially, created a wave of curiosity across the country and be incubators for learners like ourselves to seek training and in turn, feed the system. With this increased output, we aspire to expand our outreach and readability hence extracting more community development resources.

We have created drafts for community meeting schedules for the next quarter and will be initiating a ‘bring a friend’ incentiveprogram for students in the schools we visit to encourage greater participation. Our plans also include topics about healthcare and disease prevention that we will cover, along with periodic visits to the village and the respective unit, for feedback and review. The excitement with which children took the news to their parents,brought in footfall only because they wanted to validate what the children had to share. On seeing the setup, the authenticity of the unit was established, and the news spread like wildfire from there.

We impacted their lives as they encouraged their domestic staff and others they knew within those localities to visit centres and seek medical help for issues that were otherwise lying neglected.

We conducted a comprehensive survey in urban areas to educate people about telemedicine and for us to become aware of the awareness void we needed to fill. We are waiting for development reports to come in from Ekal in Fatehpur Sikri, in which we hope to see an impact that we made with our feedback and learnings. Targeting the Indian Cancer Society and encouraging them to create community meeting support groups, we have submitted a proposal for us to conduct a meeting and are optimistic based on the progress until now.

WHAT HAVE YOU LEARNT FROM YOUR EXPERIENCE?

ANY SPECIAL MEMORIES? ANY MESSAGE FOR YOUNGSTERS LIKE YOURSELF?

Our First Lesson Was Learning About The Daily Workings Of Telemedicine Units. Overcoming The Challenge Of Distance Offering Patients Standardised. Health Care Has A Unique And Comprehensive Way Of Functioning.

Unless personally involved and invested, it would be impossible for one to claim to be aware of such an operation. In the long run, this learning will be in our arsenal as we associate with other activities where such unit based outsourcing activity needs to be set up. With the rapid growth in digitisation, this experience will allow us to lead operations and setups without hesitation.

More humble learning has been in terms of our lifestyle. Our visits to underdeveloped areas and interactions with people who lead fulfilling lives make us more aware of the privileges we are offered today. Things we always termed as essentials now have exponentially more value. On our return journey, we speak about eliminating yet another commodity or facility that we otherwise always relied upon. It also jogged our creativity when we saw how those with lesser means, used innovative alternatives to achieve the achieve the same results. These include even necessary facilities which city dwellers like ourselves take for granted.

Serving as a Telemedicine Youth Trooper, we uncovered a whole new dimension of India, where culture and ethnicity were defined in ways we did not consider. We connected with traditions and beliefs that otherwise had been foreign to us. It was only when we based ourselves on our shared humanity while sharing our cultures, did we establish a deep enough to convey our sincere wish for their welfare.

To our peers and others seeking opportunities to grow, we want to comfort them while they battle their circumstances and let them know that their hard work will pay off. In the face of all our challenges as Telemedicine Youth Troops, we did not estimate the overwhelming joy and pride we would feel at the Telemedicine Conference we attended. We learnt about the reward that comes with persistence and the way our lives expand when we care and work for not only our benefit but for other people’s welfare.

Telemedicine Youth Troops

Three 16-year old students from Modern School Vasant Vihar, Delhi School volunteered for a cause. The cause was to reform the telemedicine scene in Mathura. Healthcare Executive got in touch with the young girls who have massively contributed to the success of the telemedicine project.

WHAT WAS YOUR VOLUNTEER COMMUNITY SERVICE ACTIVITY?

WHAT DID YOU DO FOR THE BENEFIT OF YOUR COMMUNITY?