Towards a healthy rural Kumaon: Aarohi-Himalaya Health Initiative

Second six monthly (First Annual) Report (October–April 2014)

Submitted to: The Himalaya Drug Company

04 April 2014

Table of Contents

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No Topic Page1 Introduction 3 1.1 Project Aim 3 1.2 Objectives 32 Key accomplishments 43 Aarohi Aarogya Kendra 4-6 3.1 Outreach Medical Camps 6 3.2 Specialist Medical Camps 64 School Health 6-12 4.1 School Health Sessions 11 4.2 Cleaning Campaigns 125 Case Studies 126 Traditional Healing Practices 137 Co-Branding 148 Annexures 14

1. Introduction

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The project was initiated on 1 April 2013. The area selected for intervention was:

Six schools of Ramgarh Block

Four schools of the Pindari Basin in Kapkot Block

The six months ended on September 2013 and the following was achieved:

Total patients seen in Aarohi Aarogya Kendra (AAK) were 3,242. Seven multi-specialty camps were conducted in which 53 different types of surgeries were performed.

The Block Education Officers granted us permission to begin the intervention in the selected schools in their respective blocks.

Height and weight data for 518 students from the 10 selected schools was collected.

340 students received dental screening and education sessions.

494 students received a complete medical check-up and deworming.

183 students in the three schools of Pindari Basin received a complete eye check-up.

14 extractions were performed under rudimentary conditions in the villages of Khati, Malagaon and Sarni in the Pindari valley.

A primary record of 50 traditional medical practitioners was made.

With these encouraging results the following phase started in October 2013.

1.1 Project Aim

The project aims to improve access to quality clinical services for rural populations and introduce health education to children in rural Kumaon.

1.2 Objectives

1. Improve the reach of clinical services of Aarohi Aarogya Kendra in both Ramgarh and Okhalkanda blocks of Nainital District.

2. Organize regular medical, surgical and Antenatal Care camps at Aarohi Aarogya Kendra and extend its reach to Okhalkanda block by organizing transport services for easier access.

3. Extend health education sessions to some 500 children of 10 local schools (government and the Aarohi Bal Sansar).

4. Conduct six-monthly medical check-ups for these school children, monitor their height and weight and provide routine six-monthly deworming and requisite medical care.

5. Promote Ayurveda as an alternative to existing choices.

6. Document traditional medical practices in the region.

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7. Develop and build on the strengths of Aarohi and Himalaya Healthcare, to co-brand quality and ethical healthcare in rural Kumaon.

2. Key accomplishments during the reporting period (October–April 2014)

Total number of patients seen in AAK was 2,524. Eight multi-specialty camps were conducted in which 48 different types of surgeries were performed.

Height and weight data of 459 students from the selected schools was collected.

429 students received dental screening and education sessions.

459 students received a complete medical check-up and deworming.

A primary record of 50 traditional medical practitioners was made.

Himalaya shampoo and soap was distributed to 415 students.

3. Aarohi Aarogya Kendra

We continued essential routine outpatient, inpatient, diagnostic and emergency services at Aarohi Aarogya Kendra. Multi-specialist camps were conducted on a monthly basis providing surgical, ultrasound, medical, paediatric and eye care. Below is a brief summary of the curative care provided:

Sr PARTICULARS Apr-Sep 2013 Oct-Mar 2014 Total

TOTAL PATIENTS SEEN 3,246 2,524 5,770

1No. of patients treated in hospital

1,264 792 2,056

Female 502 326 828

Male 690 426 1,116

Children< 5 years 72 40 112

Indoor patients seen 54 50 104

Home visits / Emergencies 0 0 0

2 Laboratory Tests 545 454 999

3 X-Rays 39 61 100

4 ECG 9 14 23

5 Total villages covered 33 24 45

7(a) Specialist camps held 7 8 15

No. of screenings 620 569 1,189

Plastic Surgery 15 17 32

Pediatrics 0 0 0

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Eye 145 135 280

Gynecology 22 8 30

Surgery / Surgeon 49 25 74

ENT 20 12 32

Physician 358 359 717

Psychiatric 7 0 7

No. of surgeries 53 48 101

No. of ultrasounds 111 91 202

7(b) No. of Dental camps held 5 4 9

No. of dental Screenings in Dental OPD

228 208 436

Dental screenings for school children

32 429 461

No. of dental extractions 70 46 116

No. of dental fillings 3 7 10

No. of scalings 0 0 0

10 Mobile health camps 12 20 32

No. of patients seen 415 301 716

Health check-ups for school children

183 659 842

3.1 Outreach Medical Camps

In an attempt to increase Aarohi Aarogya Kendra’s the coverage area and encouraged by the success of our six specialist ENT outreach camps from April to October 2013, we organised more ENT camps during the reporting period to increase access to quality ENT care. The camps were held at Lweshal and Nathukhan villages of Ramagarh Block, CHIRAG Hospital (Sargakhet), Khansyu, Karayal, Zhadgaon, Kalagar, Bhadyun, Patlot and Churigarh villages of Okhalkhanda Block and Aarohi Aarogya Kendra. These camps were a big success. Since April 2013, a total of 257 patients benefited from ENT outreach medical camps.

3.2 Specialist Health Camps

Over the last six months we have held monthly specialist health camps at Aarohi Aarogya Kendra. The response for camps has been very good. Patients travelling from various villages even far then 90Kms have undertaken the services provided. Patients are satisfied with the care

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and quality which is evident from their smiling faces on discharge. Surgical cares including rehabilitative surgeries are provided at minimum cost and eventually at a cost even low then the government facilities.

4. School Health

Encouraged by the success seen from April to October 2013, we pursued school health activities during the reporting period. This involved:-

a) Complete medical and dental check-ups Medical and dental check-ups for students of Classes 6-8 in the ten selected schools were done. All of these students were also dewormed. Some children were prescribed Iron and Folic Acid (IFA) tablets.

b) Educational sessions (See Section 4.1 below for more detail)

c) Cleaning campaigns (See Section 4.2 below for more detail)

d) Distribution of Himalaya shampoo and soap This increased the children’s enthusiasm towards personal hygiene and motivated them to put what they had learned into practice.

e) Collecting height and weight data Height and weight is measured for each student and subsequently analysing it on the basis of Z scores.

Analysis of the October 2013 to March 2014 height and weight data showed that:

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Data table showing the status of school children (October 2013-March 2014)

Result Number of students % studentsNormal 511 83%Marginally Wasted 90 14%Moderately Wasted 6 1%Severely Wasted 12 2%Total 619

Pie Chart showing the status of school children (October 2013-March 2014)

83%

15% 1% 2%

Normal Marginally Wasted Moderately Wasted Severley Wasted

Comparative analysis of the oral status for the past year showed a marginal decrease in the oral status of students and shows a need for more inputs in the coming months.

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Multi-Speciality Health Camp 24-29thMarch 2014

Aarohi organized a successful multi-specialist health camp in March 2014. Thanks to a new approach to advertising, we attracted 341 patients in only six days, many of them travelling from as far as Khansyu, Okhalkanda Block, 70 km away. In contrast to previous snowy camps, we were blessed with bright sunny

No. Student ParticularsOct 13-Mar 14

%Apr-Jul 13

%

1 Good oral hygiene 10 18

2 Poor oral hygiene 26 21

3 Dental caries 43 41

4Other abnormalities or having a cluster of dental problems like crowding of teeth, gingivitis, multiple caries etc

21 20

4.1 School Health Educational Sessions

Over the reporting period, a total of 22 educational health sessions were provided in the ten schools by Aarohi staff. The focus was on revising the topics introduced during the first six-month period. The subjects covered were:

1. Introduction to the ‘Aarohi Himalaya Health Initiative’. Various aspects of the program like collection of height and weight, dental and health check-ups etc.

2. Oral hygiene and brushing technique.3. Personal Hygiene.4. How to wash hands.5. Hygienic practices while cooking and eating food.6. Environmental Hygiene and Balanced Diet.7. What is dental hygiene, how a dentist works and the importance of dentistry for

general health and wellbeing

The sessions were designed to be interactive and involved the use of posters and flashcards. Models of teeth, toothbrushes and mouth mirrors were used to make the dentistry teaching sessions hands-on. Furthermore children were trained to teach others so that they can spread awareness of health issues within their families. Students were enthusiastic and the school authorities provided considerable support.

4.2 Cleaning Campaigns

During the first six months of the project (April-September 2013) Aarohi organised cleaning campaigns at the Junior High School Kaphura Kumati and Intermediate College Lweshal with the objective of increasing environmental awareness. Students were invited to the school to clean the school’s premises. Participation was high at the Intermediate College, Lweshal, but comparatively low in Kaphura Kumati. The level of enthusiasm of the student boosted the spirits of Aarohi’s front-line workers who were keen to pursue this activity during the second six-month period. However this was not possible due to annual school exams schools in March

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Multi-Speciality Health Camp 24-29thMarch 2014

Aarohi organized a successful multi-specialist health camp in March 2014. Thanks to a new approach to advertising, we attracted 341 patients in only six days, many of them travelling from as far as Khansyu, Okhalkanda Block, 70 km away. In contrast to previous snowy camps, we were blessed with bright sunny

Story of Nandi……

Nandi Bhatt is a 78 year old lady from Sheetla village in Ramgarh Block. She arrived at Aarohi Aarogya Kendra complaining of swelling and pain in her left hand from which she had been suffering for 6 months. She gave a long history of having visited different hospitals for this complaint in Almora, Pithoragarh and Haldwani. She told Aarohi’s doctor that all previous attempts to alleviate her suffering have been in vain. She had been continuously taking a number of pain killers which provided only momentary relief. On her visit to our facility we started her on a treatment of Himalaya Rumalaya Oil and Tablets. On her follow-up visit 15 days later the swelling had reduced and she reported that the intensity of the pain had reduced. Encouraged by these results we started her on a two-month treatment of the same drugs. Since then Nandi has not experienced any pain and in her own words is happy and now able to complete her daily chores. She is grateful to Aarohi and for the Himalaya drugs.

2014. In an attempt to increase awareness we had a cleaning campaign in Naulikan village.

5. Case Studies

6. Traditional Healing Practices

We started with the primary documentation of various traditional practices from April 2013. This included collecting basic information and the practice used. Till now we have documented the presence of 50 healers with their address, method used and type of disease for what they provide their services. The objective is to prepare a document based on this information so that their knowledge could be acknowledged. In the process of documentation we have classified the traditionally healing practices of the area.

Treatment by using religious faith Treatment by using mantra Treatment by using herbal plants

From September we collected more information by visiting a number of traditional healers. In these visits we tried to collect in-depth knowledge about the various practices. Traditional healing runs in families and the knowledge is transferred from generation to generation. Many traditional healers stated that they got message from God via dream and they started to heal the people as instructed to them by God. Some of them use herbs gathered from the forests to be used as drugs and they stated sometimes they even ask their patients to visit professional doctors to so they can have modern treatment also.

7. Co-branding

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Co-branding is an important aspect of the project. The combined signage has been made and is displayed at Aarohi Aarogya Kendra and Aarohi Bal Sansar

8. AnnexuresI. Utilization

II. List of schoolsIII. Traditional Healer’s listIV. Traditional Healer’s Documentation Draft 1V. School-wise growth monitoring

VI. Photographs

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