By Vinodkumar Rao, Puja Solanki & Sheela Patel
Traditionally, medical camps by non-governmental organisations (NGOs), corporate sponsors, foundations, and other charitable institutions are seen as acts of charity. The communities that the camps support also see them as short, solidarity events. Weak public health systems, particularly those in preventive health, necessitate such acts of charity.
Such camps continue to play a crucial role in helping individuals access better health primarily because the demand for decent and affordable healthcare outstrips its supply. In our experience, however, apart from fulfilling the immediate, short-term needs of individual citizens, medical camps can also become an important research tool, aimed at strengthening the larger public health system.
ARISE partner Society for Promotion of Area Resource Centers (SPARC) India works with the National Slum Dwellers Federation and Mahila Milan, a women’s collective. Together, we have over three decades of experience working on tenure security, access to sanitation, housing, etc. for the urban poor, which is aligned with the larger goal of improving health, dignity, quality of life and wellbeing of poor urban residents across the country. However, working directly with the public health system is a first for the alliance.
At first, the engagement of resident communities in conversations around health and health systems could, at best, be described as passive. We then experimented with using medical camps as icebreakers with our resident slum and slum relocation communities to generate conversations about their personal and community health. In our experience, these camps proved to be far more consequential than we expected – they did a lot more than simply ‘break the ice’.
Understanding the reality
The experience of arranging the logistics around a medical camp, along with the actual execution of a camp, was an important learning. Each participant was weighed, their height measured and noted, their blood pressure and random blood sugar levels checked with portable devices, and then referred to the doctor to help demystify these numbers. Participants then had a one-on-one conversation with the doctor about how they feel, and any challenges they are facing. Accordingly, everyone was advised to access a few basic free medicines that were dispensed by a staff member.
Since staff members were themselves involved in these activities, everyone developed an understanding of what it takes to run a health centre, similar to a clinic. While a regular local clinic may not see such high patient loads, such an understanding helps in gauging the types of activities, along with the cost of screening for and treating minor illnesses.
Deeper and evidence-based understanding of the problem
The data from the camps gave us deeper evidence-based understanding of the extent of specific challenges within the communities. In particular, it revealed a surprisingly high prevalence of both hypertension and elevated blood sugar levels across all age groups, including the young. For instance, 87 per cent of all individuals screened in the age group of 20-29 in Ahmedabad were prediabetic or diabetic. This was starkly different from what we found in Mumbai – while younger individuals seem comparatively less likely to have high blood sugar, this problem peaks in the age group of 50-59, with 45 per cent of all tested diagnosed as prediabetic or diabetic.
These numbers correlate well with body mass index (BMI) for these age groups, calculated using the collected height and weight information. Rampant malnourishment was prevalent among communities in one city, as was the consumption of tobacco by boys as young as eight and nine years old. Almost a quarter of all adults screened in Ahmedabad were underweight.
While screening at any camp does not provide conclusive evidence of the underlying conditions, these results provide us with a ballpark understanding of the reality of hypertension and diabetes prevalence among the urban poor. In the absence of regular screening, which should be an essential feature of public health that has focus on these non-communicable diseases (NCDs), people usually get diagnosed after the secondary effects of underlying condition become visible, increasing the likelihood of incurring catastrophic health expenditures. Such data-based findings from medical camps can serve two equally vital purposes – promote and provide direction to relevant health-based conversations within our underserved communities and compel our municipal health systems to undertake necessary action steps.
Uncovering new areas of action
Most women participants in the medical camp brought their children with them, while the men usually came alone. Women openly shared their problems around menstrual health, mental stress, and visible signs of physical abuse from domestic violence. We draw two lessons from it: –
- Public health action needs to prioritise and accord specific focus to women’s issues and recognise the role of women as central knowledge providers for engagement and action around family health.
- Action against domestic violence and violence against women in all forms needs to be an essential part of public health.
Trust and cooperation – Essentials for a strong public health system
In all camps, turnout was at least 100 people each day and across all ages, received by a team with one doctor. Women participated more than men, often bringing their children along. Participants willingly shared their health problems with the doctor and sought his advice. Observations like these indicate a clear willingness among people to actively use primary preventive healthcare systems when available, to improve health outcomes for themselves and their communities.
A partial reason for the high turnout at these camps was the trust that resident communities have in the federation network. For each camp, organised resident groups made local arrangements, such as sourcing a location and communicating to ensure residents were aware of the camps. Their direct involvement added to the trust among the people. This indicates that investing in trust-building between public health systems and communities has had a positive impact, and further justifies the need to create a formal role for organised or federated local community networks in the fight to strengthen local public health systems.
Medical camps: a tool for research
In our experience, these medical camps have worked as a ‘research tool’, offering insights and learning around health issues in particular localities, and knowledge on areas of intervention to strengthen public health more broadly. It has worked as a diagnostic tool in understanding local health challenges and, in the process, built further conviction among residents in working with us towards strengthening our health systems. It has also helped to shape conversations around improving prevention, early detection, and management of NCDs and other stigmatised illnesses, like tuberculosis. Lastly, medical camps provide avenues that helps knowledge building and curiosity among resident groups, who begin to look at gaps in health care within their neighbourhood and seek accountability from the duty bearers in filling them.
Alongside other interventions, medical camps can become tools to promoting health and health service challenges as a collective problem that neighbourhood groups will see value in investing time and collective effort into.