Minister urges medical students to participate in government service
At the convocation, Mr. Subramanian narrated about his visit to the remote hill hamlet of Maatupattikottai in Halahalli panchayat in Dharmapuri earlier that morning, where he assessed the reach of the State Government's flagship schemes. The Minister said he had arranged for cochlear implant consultation for a 23-year-old hearing and speech impaired woman at the Stanely Medical College Hospital, and designated a doctor in-charge of taking the woman and her family to Chennai.
The Minister sharing nuggets of his visit to the hamlet of barely 50 families said, 'the residents said no politician had ever visited that village. A nurse makes monthly visits under the Makkalai Thedi Maruthuvam scheme for the physiotherapy of a woman, who was fighting stroke.' That was how the scheme touched lives, Mr. Subramanian said.
Mr. Subramanian also spoke about a medical college graduate, with tens of gold medals to his name, who collected his degree at his hands in 2021. 'Today, he is Dr. Prashant S. IAS, Additional Collector of Coimbatore,' he said.
Mr. Subramanian also lauded Dharmapuri Government Medical College Hospital that has carried out 26 organ harvesting procedures, a unique feat for a non-metro government medical college hospital, on a par with those in Madurai and Coimbatore. Similarly, the hospital also carried out 80 cochlear implants for children, a remarkable feat, the Minister added.
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The Hindu
3 hours ago
- The Hindu
Makkalai Thedi Maruthuvam, beneficial to lowest income groups, has severe lacunae in system
A bed-ridden former ward member's wife S. Vasanthi, 70, of Sakkimangalam, a Narikuravar community habitat in Madurai east taluk, lives on the diabetic medicines supplied by the Women Health Volunteers (WHVs) of Makkalai Thedi Maruthuvam (MTM), a novel initiative of the Tamil Nadu government. For the widow, who lives in a shanty house made of plastic and torn bedsheets, if not for the two-months of medicines supply by MTM volunteers, her sugar level would shoot up endangering her life. The MTM scheme has saved her life and penny; however, it has failed to identify any new diabetic person in the same locality. Chinapaapa, 75, who lives alone in her hut in the same locality, says she was not tested nor has any health volunteer visited her to identify any health problems. Her other neighbours, recollecting a health camp which was arranged at the village mid-point near a ration shop about a year ago, say they could not walk up to the camp as most of them were not informed or alerted earlier. The prime aim of the MTM scheme started in 2021 was to enable home-based screening and drug delivery at the doorsteps of beneficiaries. Though the scheme through its 20,000 workforce reportedly reached 5.50 crore individuals through screening - one crore first-time beneficiaries and 3.20 crore repeat - service beneficiaries – the actual follow-ups would be lesser, as per World Health Organization (WHO) data. By focusing on Non-Communicable Diseases (NCDs) like diabetes, high blood pressure, psychological problems, mouth and breast cancer, Chronic Obstructive Pulmonary Disease (COPD) and Chronic Kidney Disease (CKD), the WHV, under the scheme, were mandated to visit every household falling under their jurisdiction and carry out the tests required for identification. According to the Tamil Nadu State Planning Commission's survey report on the MTM scheme, the scheme has halved the out-of-pocket medical expenditure for the lowest income groups. The report added, 'Before the scheme started operating, the poorest income group in the survey had to spend over 10% of their monthly family income on treatment of diabetes and hypertension. Once the scheme rolled out, spending on the treatment has more than halved.' Though the scheme has recorded remarkable achievements like bringing the low-income population with diabetes and hypertension under the ambit of government record, keeping them in the government medication records, slowdown of the works owing to insufficient volunteers and irregular medicine supply have derailed the system in certain areas, if not all. A WHV at Keelavalavu, requesting anonymity, pointed out the practical difficulties in achieving the assigned duty like dispensing hypertension, diabetes and other essential medications in colour coded paper bags and checking BP and blood glucose at the time of drug delivery at the households. 'Many a times, due to the workload coupled with the absence of essential drugs and devices, people will be asked to visit nearby health centres like PHC, Health Sub-Centre or Community Health Centre for getting their monthly medical supply and routine check-up,' she adds. Barring a few, many fail to visit the hospital due to several reasons, she notes. A differently abled person named R. Rajasekar, residing in Malaipatti panchayat, falling under Madurai West Panchayat Union, says that a year ago, a medical camp was conducted near his village and he too took the test and learnt that he had diabetes at its initial stage. 'Tablets were given, and I was given diet instructions to keep the blood glucose level under control. I also receive the monthly tablets through a volunteer or a neighbour, who visits the nearby hospital for their routine check up,' he adds. As the volunteers would not visit his house for monthly check-up and he would be asked to visit the hospital, he has not undergone the blood glucose level test for more than a year, he says. It is the lacuna in the system that obstructs the otherwise achievable result of the scheme, says a PHC doctor near Melur. The ground-level difficulties for the WHVs, who are paid close to ₹5,000 per month, were that they would be asked to screen at least 50 people per day in their region, the doctor adds. 'In addition to screening, they should also update their data and deliver medicines according to the public needs every day. This much is expected from the volunteers with just a bare minimum payment,' the doctor states. Resonating with the doctor, the Keelavalavu WHV says, at times when the device to screen patients gets repaired or the battery drains off, they had to spend their own money to buy new batteries or to repair it. 'As there is no travel allowance, that also goes out of our pockets,' she adds. Moreover, the doctor says that the on-ground issues like non-availability of the working population in the households and unavailability of men in houses for screening or periodical checking leave them out of the cycle. An interim report of the State government intended to address the gaps specified carrying out campaign mode of screening for early detection and increased screening in the industries through collaboration with labour department to cover the working population, the doctor notes. Such far-reaching aims of the scheme, in the absence of a vigorous working plan and scheduled supply of medicines and equipment, cannot be achieved, the doctor observes. A. Veronica Mary, a health activist based in Madurai, says: 'Though the scheme gives a perception that it is a success, it could only be for a short term.' 'Our State's rural health system, which is structured around a network of PHCs, CHCs and hospitals, is already well-connected and is robust enough to cover the villages,' she adds. As the 1,700 plus PHCs and more than 8,500 HSCs in the State were based on the 2011 population census, only doubling it would enhance the overall coverage of healthcare. 'The MTM scheme linked with the PHCs will fail if the PHCs workforce is not enhanced and monitoring is not improved,' she notes. PHCs, which are already reeling under an acute shortage of doctors, nurses and health workers, were additionally burdened with documenting and data recording works. In this situation, MTM scheme may not be successful in a year or so, if the PHCs and CHCs are not strengthened with necessary staff and resources, he notes. 'The government should review its performance and release a white paper on the scheme. Only through it, the reach of the programme could be studied and improved,' Ms. Mary states. Many of the villages and rural households were still untouched by the scheme and covering it all would require self-evaluation and introspection, she adds.
The Hindu
a day ago
- The Hindu
Kerala needs to support transplant patients for immunosuppressive therapy
Last July, 13-year-old Anushka with severe cardiomyopathy, her heart's pumping capacity reduced to just 18%, was nearly dying at Sree Chitra Tirunal Institute for Medical Sciences and Technology, when a donor heart saved her life. This first paediatric heart transplant at SCTIMST was a much-celebrated event. A year later, Anushka is doing very well. But the last one year has been marked by anxiety, along with financial and emotional distress for her parents, Ramesh and Vijitha. They had to uproot themselves from their home town at Engandiyoor, Thrissur, to a small rented house in the capital city for her treatment. Anushka's case is just one example of how life-transforming and positive an experience organ transplant can be, for a patient and his/her family. But the road ahead is tough and scary for the family which is already in dire straits and which has to find close to Rs. 30,000 a month just for life-long immunosuppressive therapy to ensure the survival and best post-transplant outcome for their child Catastrophic health expenditure and rising out of pocket expenditure on health has been pushing families into impoverishment in Kerala . Post-transplant care is one such catastrophic health expenditure causing much financial distress to many families. Organ transplants are life-saving and life-transformative but it is just the beginning of a long road ahead, for the patient as well as the family. The high cost of immunosuppressant drugs a patient has to take for a lifetime, post-transplant, is not an affordable proposition to most families. The State Government has been promoting organ donation and transplantation in a big way since 2012-13 but even a decade later, there is no universal State-wide project which provides immunosuppressants free of cost or takes care of the financial burden incurred by organ transplant recipients for the same. There have indeed been some isolated initiatives by some district panchayats (Kollam, Ernakulam and Kannur) or NGOs and a token support through Kerala Social Security Mission for transplant patients, but this has not been enough. Kerala has fairly good survival rates for solid organ transplants, with the five-year valid kidney transplant survival rate pegged at 85.3% and that of liver transplants at 77.3%, according to a 2018 study. But non-adherence to immunosuppressive therapy because of financial constraints of families is increasingly becoming the single most cause of poor transplant outcome and organ rejection, which is extremely distressing, says Noble Gracious, Executive Director of K-SOTTO. Shammy Sajeev, a 43-year-old housewife from Changanassery, who underwent a renal transplant two years ago at Alappuzha Government Medical College Hospital is now back at the hospital because her transplanted kidney has failed. 'My father is an auto driver and he had donated one of his kidneys to my mother. We had to spend close to ₹14 lakh for her treatment, transplant and medicines. Her medicines cost about ₹10-15,000 every month. Because of extreme financial hardships, we were unable to buy her medicines for the last four months,' says her son, Abhishek, a Plus Two student, who has temporarily discontinued school now. The family knew that the immunosuppressants were important but they were in no position to borrow money anymore. Shammy will now have to go back to dialysis till another related donor as well as funds for the transplant can be arranged, he says. Maintenance immunosuppression drugs with antibacterial, antiviral prophylaxis varies from Rs. 20-30,000 per month in the first year for renal transplant patients, which stabilises to Rs. 8,000- 15,000 per month for subsequent years, for life. For liver transplant patients too, the approximate monthly medicine expenses would be around 15-20,000, according to doctors. The transplant patients would also have to spend another Rs. 10-15,000 per year for the routine check ups and blood tests that they need 'The State will have to think about a comprehensive project to ensure equitable access to free immunosuppressive therapy for those who really need it,' a senior Health official says. In Kerala, a majority of patients undergoing maintenance haemodialysis have some form of financial assistance or are being subsidised by the Government. But the care needs of a minority which has access to transplants is something the State has to prioritise. Non-adherence to immunosuppressive therapy because of financial barriers resulting in the waste of precious organs is not something that any health system can afford, he says. A recent national review meeting on organ transplantation activities, jointly by National Organ and Tissue Transplant Organisation and the Union Health Ministry had pointed out that the high cost of immunosuppressant drugs was a significant concern as patients often do not get financial support for drugs beyond the first year. 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The Hindu
2 days ago
- The Hindu
External quality assurance laboratory set up to ensure quality of tests at govt facilities
To ensure the quality of tests conducted at government laboratories across Tamil Nadu, an external quality assurance laboratory has been established at the State Public Health Laboratory (SPHL), Directorate of Public Health (DPH) and Preventive Medicine. Set up at a cost of ₹1.13 crore, the laboratory will ensure the quality of tests conducted in 2,177 Primary Health Centres (PHC), 300 government hospitals and 36 medical college hospitals across the State without any cost to the participating government labs. Pilot launch As a pilot project, the DPH-EQAS (External Quality Assurance Scheme) programme is being rolled out at 116 PHC laboratories in Tiruvallur and Chengalpattu districts. According to an official release, laboratory services are essential for the diagnosis of diseases, surveillance and to initiate preventive and control measures. Currently, the Integrated Essential Laboratory Services (IELS) being implemented has further strengthened the scope and services in the State. Under IELS, samples are being referred from spoke labs to hub labs for various investigations. So, patients need not travel unnecessarily, and it reduces the out of pocket expenditure as well. So far, laboratories under DPH and other health institutions were sending samples for external quality checks to Christian Medical College, Vellore for an annual expenditure of ₹52 crore. Based on the participation of EQAS programme and other parameters, 1,622 PHC labs in Tamil Nadu are NABL certified under MELT programme. From now on, the SPHL can conduct the quality EQAS laboratories are not available in other government or their allied institutions. Hence, it was decided to establish the DPH-EQAS lab at SPHL. The National Health Mission, Tamil Nadu sanctioned ₹90 lakh for the procurement of laboratory Minister Ma. Subramanian inaugurated the DPH-EQAS lab and launched the pilot programme in the two districts. He also launched a mobile app developed for the project to upload laboratory results. After the successful implementation of the pilot project in Tiruvallur and Chengalpattu districts, ISO 17043 will be obtained from NABL and from January 2026 onwards, all government laboratories in T.N. will be participating in the DPH-EQAS Program, the release said.
