Mobile Hospital And Research Centre In Uttaranchal

We have several hypes such as 'health care for all', 'disease free India', 'accessible health services' etc in addition single disease oriented massive international campaigns. But most of the people of India depend upon nearby private practitioners. A few may access govt. hospital High quality specialty, private sector hospitals or nursing homes are high budget system often available (almost exclusively ?!) to big corporate employees or high level govt. employees or otherwise rich persons. Noting that about 94% of those employed in India are not in organised, only 6% of India are in organised sector, some form regular medicare is available only to a very few Indians.

The old cliched statements of strengthening Primary Health Care (PHC) units do not work. Firstly modern diagnostic equipment crucial for a physician to assess the course of action for a patient are costly and cannot be afforded by a single physician or a nursing home. If we keep them in a village of 5000 persons, they will grossly underutilized.

Also to expect physicians and nurses to be sanyasis and sanyasinis is not a workable proposition. All of them worry about their children's education and would at least need a city or town.

Considering the totality of these related or interconnected issues, it was concluded that these modern diagnostic equipment, made small in size but having multiple capability can be housed in a mobile bus along with a vibration free power generator in the bus itself. If can start from a town, go to a number of villages over a week or ten days and return. Thus hundreds of villages can be covered effectively.

A system is working in Uttaranchal very effectively so far servicing more than 50,000 people.

Know more about it. You can replicate in several parts of India. In fact many other developing countries can follow the model.

TIFAC, an autonomous society under Department of Science & Technology, is mandated to look ahead in technology development and technology now being identified as a tool of economic development, it was desired that TIFAC should develop a long term forecast for technology development in India so that India becomes a developed nation by 2020. Accordingly, TIFAC conducted the Technology Vision 2020 (TV 2020) exercise for India covering 17 technology sectors having socio-economic impact on the national economic development. This exercise was accomplished with the inputs from 5000 experts from different parts of the country.

One of the sectors covered in this exercise was HEALTH CARE. A document titled HEALTH CARE: TECHNOLOGY VISION 2020 was brought out by TIFAC wherein the status of wide range of preventive, diagnostic and curative health technologies was covered. It also brought out a Vision and Action Plan for these areas. With the realisation that one of the basic cause for the inefficient health facilities is the poor diagnosis, the panel suggested the appropriate diagnostic tools for different levels of health care facilities Viz. Primary, Secondary and Tertiary. This document played an important role in finalizing the specifications of the Mobile Hospital.

This is essential to ensure adequate reach and coverage of health services even in the remote areas of the State. Since the hilly terrain lacks adequate infrastructure of road connectivity it was desired to provide health services through Mobile Clinic with latest equipments for common diagnosis and treatment to those who are mostly unreached and cannot afford the medical facilities available in cities. At the request of Government of Uttaranchal, TIFAC initiated the project of Mobile Hospital and Research Centre in Uttaranchal (Kumaon).

It is worthwhile to provide medical care on wheels on regular interval basis which will not only benefit large number of population it will also save the government large expenditure on maintenance of permanent medical establishments, besides such arrangements will also provide opportunity to medical staff to keep their families at district head quarters (permanent base of the mobile hospital) so as to offer decent education to their children a very important aspect as non availability of decent education to the children has been a major cause of reluctance for the doctors to serve in rural/far-flung areas.

Though the concept of Mobile Hospitals is not new, most of the mobile medical units available so far cater for a particular requirement i.e. cancer, heart, eye, etc. The present mobile clinic is probably unique, as it has been designed to augment the diagnostic medical services of needy people located in far-flung inaccessible terrain of Uttaranchal, as this has been identified as a crucial requirement for further preventive and curative health care. In addition, the mobile clinic also collects data, which may help in formulating health policies for the region.

PROJECT OBJECTIVES: -
  • Help the health care system to reach the remote areas serving primarily the underprivileged and economically backward communities.
  • Generation of research data on health profile will help to understand the long-term preventive action.
  • Direct benefits of the project include the curative and diagnostic treatments for the patients.
  • Serve as a unique model to be replicated in other parts of the country, which severely lack the basic health care services.
PROJECT COMPONENTS: -
  • DIAGNOSTIC FACILITIES Quick, on the spot.
  • CURATIVEPrescription and on the spot dispensing of medicines for common ailments and referral to hospitals for other cases
  • DATA COLLECTION & ANALYSIS ON HEALTH PROFILES.
  • EDUCATIONAL AND HEALTH AWARENESS PROGRAMS.
ELEMENTS OF THE MOBILE HOSPITAL: -
INFRASTRUCTURE
  • Chasis TATA LP 1512TC 42 with rear air suspension
  • X-ray cum gynae cum ultrasound couch with 1 set of lithotomic crutches with swivel brackets
  • Auto cop central locking system
DIAGNOSTICS
  • 2.5 KW HF X-ray generator with Vetrix 1 column with chest stand dark room accessories
  • Automatic film Processor
  • Multichannel ECG
  • Semi automatic chemistry Analyzer
  • Binocular microscope
  • Ophthalmoscope, otoscope & streak battery retinoscope
  • Ultrasound scanner with 1 no. 3.5 MHz convex transducer w 12" monochrome monitor and thermal printer
  • Miscellaneous items like Stethoscope, Laryngoscope, Laboratory centrifuge, BP apparatus, Hot air Oven, Water bath, pH meter, Manual needle cutter
AUXILIARY
  • Air Conditioner
  • 15 KVA DG set with acoustics and mains panel
  • 20" TV, DVD player & LCD projector with portable projector screen
  • Laptop Think-pad 2659 with printer & web-camera
  • Refrigerator, PA system with cordless microphones with receiving stations, roof mounted speakers, tape deck with 4 internal speakers, Weighing machines, Water pump, intercom system with 4 handsets & 2 speaker phones, Hot plate, Neubauer's chamber, Haemocytometer, Emergency lights
COSTS: -

The total capital cost for the complete mobile unit (inclusive of supporting van, taxes and octroi) had come around Rs. 66.00 lakhs.

The total operating cost (including the cost of fuel, salaries of doctors, consumables and cost of medicines to be disbursed to BPL people) on an average comes out to be around Rs. 35.00 lakhs per year and if considering the number of patients attended by this unit, the approximate cost comes out to be around Rs. 200/- per patient.

THIS MOBILE CLINIC HAS THE SPECIAL FEATURES: -
  • This is a joint project of TIFAC and Department of Health, Government of Uttaranchal and being implemented by Birla Institute of Scientific Research, Bhimtal. The capital cost was borne by TIFAC and the operating costs are equally shared by TIFAC and Government of Uttaranchal.
  • The mobile clinic has been developed on Tata chasis 1512 with rear air suspension, a 24 feet in length (maximum permissible in the hills). The entire mobile clinic runs on 12.5 KVA sound proof and vibrations proof generator, however in case of availability of power alternate arrangements have been also made.
  • Onboard facilities of X-Ray, Ultrasound, Lab and ECG along with dispensing.
  • The X-Ray equipment is capable of doing X-Rays of almost all parts of the body specially X-Ray chest in diagnosing and monitoring cases of pulmonary tuberculosis, rampant in Uttaranchal. The fully developed dried films are available in 3 minutes time avoiding all the hassles of wet films.
  • The provision of state-of-the-art ultrasound helps tremendously in the diagnosis of diseases of large number of female population having no access to modern medical technology.
  • The pathology lab besides doing routine blood, urine tests is being provided with semi automatic analyzer capable of doing almost all the blood biochemistry i.e. sugar, cholesterol, urea, lipid profile etc.
  • Availability of ECG machine helps to evaluate patients suffering from various heart ailments.
  • The mobile clinic is supported by a team of Doctors (Lady M.O., Physician and Radiologist), Paramedics (X-Ray, Lab, ECG technicians, Pharmacist), drivers and multi-utility worker.
  • The vehicle has provisions to impart health education through audiovisual facilities.
  • It is also integrated with the national preventive health programs including mass immunization so that large number of population in far-flung remote areas are benefited.
  • One Qualis van supports the mobile hospital for carrying the staff.
  • The medical data including the patient's registration is being fully computerized so as to generate medical profile of hitherto inaccessible terrain thus providing a great input to the planners for future projections.
  • Every month, 15 camps are held on predetermined dates (irrespective of Holiday/Sunday) and the same place is visited once a month on same date.
  • A patient (including BPL category) is required to register by paying a nominal fee of Rs.10/- (Ten only), which is valid for two visits.
  • The people who have been issued Below Poverty Line (BPL) ration cards by Govt. of Uttaranchal are being offered all facilities free of cost (Consultation, Ultrasound, X-Ray, Lab, ECG and Medicines), the people above poverty line are being nominally charged. Free medicines are also provided to people BPL.
  • During the transit from one place to another, the arrangements are made with Kumaon and Garhwal Mandal rest houses for comfortable stay of the Medical team.
NUMBER OF DISTRICTS COVERED: -
  1. Champawat
  2. Nainital
  3. Almora
  4. Bageshwar
  5. Pithoragarh
  6. Chamoli (Garhwal region)
ROUTES: -

The routes for the Mobile Hospital were finalized in consultation with the Government of Uttaranchal. The Mobile Hospital follows two routes/ circuits in one month with fixed schedule and camps. The two routes are:

Route no. 1
Lohaghat-Devidhura-Bhimtal-Gairsain-Bhikiyasain-Dwaraghat-Barecheena
Route No. 2
Someshwar-Garur-Gwaldham-Kanda-Gangolihat-Berinag-Didihat-Thal
DISEASE PROFILE:

The data on the following ten most prevalent diseases has been generated through this project:

  1. Acute Peptic Ulcer
  2. Anaemia
  3. Ante Natal Check up
  4. Chronic Obstructive Pulmonary Disease
  5. Hypertension
  6. Pelvic Inflammatory Disease
  7. Pulmonary Koch's
  8. Renal Calculi
  9. Upper Respiratory tract infection
  10. Worm infestation

The data is generated based on gender, age, season and various campsites/ districts. The data collected is now in process of getting analyzed so as to provide an input to the planners for future projections.

STATISTICS (20.10.02 to 30.06.05) : -
  1. Total no. of district covered by mobile hospital van - 6
  2. Total No. of sites covered in one month - 15
  3. Total patients check up - 42654
  4. Total no. of revisits - 5754
  5. Total male patients check up - (34%)
  6. Total female patients check up - (57%)
  7. Total children patients check up - (9%)
  8. Total BPL patients check up - (48%)
  9. Total other patients check up - (52%)
  10. Total No. of Ultra sound - 9611
  11. Total No. of X-ray - 5431
  12. Total No. of E.C.G - 1705
  13. Total No. of Lab tests - 19583
IMPACT:

Seeing the overwhelming response of MHRC, a similar Mobile Unit is being introduced for Garhwal region of Uttaranchal. Himalayan Institute of Hospital Trust, Dehradun, will implement this project.

TIFAC has set the pace for bringing modern health care services in rural areas. Its adoption on wider scale through out the country will immensely benefit the rural population leading to their overall development particularly in health sector.

(This Mobile Diagnostic Centre is working very well in Uttranchal. And have treated more than 50,000 patients - about 40% below poverty line. This system can be run in an economically viable basis even while giving certain concessional rates for the poor. Also it can be a good model of philanthropy-cum-business. A few persons from a geographical area can contribute to the capital cost and some can contribute to the running cost even while bulk of the earning is opted by patient services. Imagine each of the district is having one such unit by private people alone or through government - private partnerships. Even local governments can adopt it making a few young entrepreneurs and doctors to actually execute and manage. There are several possibilities. I also understand that there are now a few other companies who are able to put such a system with some modifications. There is a great business opportunity for many people. One of the key persons who initiated this thought and built is Dr ( Col.) C S Chandra Shekhar Pant.)

[Note by Y S Rajan on 22 August 2006]