The Public Health Research Institute of India (PHRI) was founded by FIU’s very own Dr. Purnima Madhivanan and works to offer healthcare services to tribal women who without these efforts would suffer the consequences of inaccessible and unaffordable healthcare. PHRI offers two mobile clinic services: cervical cancer and antenatal care. I had the privilege to tag along on the antenatal visit where we spent the day shadowing the PHRI staff. My knowledge about the difficulties of making healthcare accessible and affordable could not prepare me for physically experiencing the strife of delivering care to a marginalized population. Not only is it the mobility of these clinics and resources needed to fund the camps but also the reality of acquiring trained staff members willing to work hard in a job that does not promise instant gratification.
By offering interventions like HIV screening, ARV’s in order to prevent mother to child transmission, counseling, pre-natal vitamins and more, PHRI goes above and beyond to serve communities that without them would have limited access ability to healthcare. The doctors, lab technician and counselors take a two-hour bus ride into the village a few times a week to offer services. This is a total 4 hour round trip to draw blood from stubborn patients to return and hope they digest the knowledge given to them about their health. I mention the stubbornness of the patients because PHRI staff members have to literally go door-to-door sometimes to find the pregnant women. Unfortunately, due to past incidents where medical procedures were done without the consent of tribal members (common events in vulnerable groups worldwide i.e. The Tuskegee syphilis experiment), they have grown fearful of foreigners and distrust science and medicine. It has taken years for PHRI staff to get to know the community and every new pregnancy means yet another person to win over. There are extraneous factors that also make delivering care difficult for example the autonomy of the woman. In a study, women’s autonomy was associated with greater use of pregnancy care services, particularly prenatal and postnatal care (Mistry et al. 2009).. The effect of women’s autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in South India, which also had the highest level of self-reported women’s autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure were associated with pregnancy care use.
The antenatal camp was separated into three different stations beginning with counseling. The pregnant women sat in a circle where the PHRI counselor educated them on the importance of pre-natal care, vitamins and ARV’s. She patiently answered their questions and reassured them of any doubts. Next the ladies went one by one to be screened by a doctor. The general wellness check was done behind a portable curtain that was set up moments before. The final stage was their blood work. This was the most challenging part of the day. Like anyone else, these women were sometimes fearful of the needle prick and made even more anxious if they didn’t fully understand the importance of having their blood drawn. We were told that some of the women believed their blood was going to be used to sell and therefore did not want to participate. Even after counseling, there was a woman who refused services. After a few minutes filled with patience and encouragement by PHRI staff, she returned to have her blood drawn.
The patience, selflessness and compassion by the staff members is what true community building and sustainable change is about. There’s no romanticism to it. The very notion of building a strong rapport is the foundation of change. In a study on the patient perspectives on primary healthcare in rural communities they found that having a continuous relationship with a regular provider was important for participants across communities in order to ‘feel comfortable’ receiving care, having confidence in the provider’s recommendations about treatments and developing trust (Wong & Regan, 2008). It’s through efforts like this that small changes are made. These small changes accumulate over time and sometimes revolutionize entire life paths.
Mistry, R., Galal, O., & Lu, M. (2009). Women’s autonomy and pregnancy care in rural India: A contextual analysis. Social Science & Medicine, 69(6), 926-933. https://doi.org/10.1016/ j.socscimed.2009.07.008
Wong, S., & Regan, S. (2009). Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency. Rural and Remote Health, 9, 1-12.