New Delhi: The village of Aragonda gets its name from the Ardhgiri temple. Ardhgiri means half the mountain. Legend has it that as per the Hindu epic Ramayan when Lord Hanuman was carrying the mountain where the magical herb of sanjivini grew, a portion of the mountain fell here. Today this village in the Chittoor district of Andhra Pradesh is home to 53708 number of people. In 2013, the Apollo Foundation launched the integrated rural healthcare service delivery network here. The objective was to create a healthy and happy living environment through prevention and management of diseases. While delivering the health care services at Apollo Hospitals, the ‘Total Health’ initiative focuses on disease-related to inadequate water, sanitation and hygiene.
Prior to the launch of this initiative in 2013 the health indicators of this region were poor. ‘Total Health’ has been delivering preventive and primary health care services across villages in and around Aragonda, Thavanampalle Mandal of the district. From nutrition centres getting supplementary nutritious food along with health care services and institutional deliveries to total wellbeing and school hygiene curriculum. G. Mehar, who works in Aragonda as ASHA worker (Accredited Social Health Activist), told NDTV, “Healthcare was very poor earlier now this mother-child programme is liked by all and is benefitting them.”
She further adds,
Earlier there was no awareness about health, the haemoglobin levels (main parameter to determine anaemia) for most women were low, most deliveries happened at home at great risk to the life of mother and child. But now things have changed. Today 100 per cent deliveries take place at a health facility and so are institutional deliveries and the nutrition centres provide them with many facilities.
The 11 nutrition centres have supported nearly 400 anaemic mothers so far. The mission of Total Health is focusing on nutrition, hygienic, nutritious supplements like a glass of milk, an egg, dates and a peanut+jaggery candy six days a week, to expectant and lactating mothers, for a total of 27 months from conception. “ said, Bhavyashree, Project Associate, Arogya Rakshak.
Only a healthy mother can give birth to a healthy child. Good maternal nutrition during pregnancy promotes healthy weight of the newborn and with the implementation of the nutrition programme pregnant and lactating mothers have access to nutritious food and regular health checkups.
23-year-old Chukkamma‘s low hemoglobin levels were the cause of mild anaemia which could have passed onto her children too. But with regular visits to the nutrition centre, health check-ups and better diet, when she gave birth to twins in August 2015 and they were both healthy.
Before coming here my HB level was barely 10 gms but today my HB level is 12 gms and it’s only by consuming nutritious food in the nutrition center. I delivered twin children with a weight of 2.5 kgs so I am feeling happy to be here in this nutrition center, shared delighted Chukkamma.
To make primary healthcare more accessible and awareness has increased, at are regular checkups have become a norm through mobile medical clinics, satellite clinics which are static clinics established in the community with objective to deliver primary health care with future plan to connect with specialist at Apollo hospital at Chennai, along with weekly clinics and general health screening in schools and Anganwadis. Lekha Sri, Medical Officer, Total Health Mobile Clinic II told NDTV,
We have a schedule of 15-20 villages and we visit them once in 15 days. We have more diabetic and hypertension patients. For older patients and women patients it’s convenient to come here because they can’t go to faraway places for BP and sugar checkups.
While the first 1000 days starting with the conception of the child after birth are important, old age too is a phase where elderly people need extra care and comfort to lead a healthy life without worries. As part of the Total Health programme, Geriatric nutrition centres are a unique initiative to provide healthy meals and regular health care services to the elderly. Lt Gen Mandeep Singh, Former DG Hospital Services, Armed Forces and Adviser, Total Health said, “The population of the elderly population is increasing and we need to take care of them.”
61-year-old Shaikira and 69-year old Damodara are among the senior citizens of Aragonda village, who are availing the facilities at these centres. Shaikira who comes to the Geriatric Centre to get her blood pressure checked also earns a living from the centre by making paper bags. “I spend my time well here and earn some money by making these paper bags,” says Shaikira. Similarly for J. Damodara Reddy and his wife love to visit the center, one of the main draws being, playing caroms or enjoying a game of chess. “We have facilities here like TV, some snacks to eat and good company so we come here often to relax”, said Damodar.
Clean water is a basic right of every citizen. To make it easily accessible for all RO (Reverse Osmosis) plants and rapid sand filter plants have been put up in the 12 villages and this has brought a decrease in cases of diarrhoea and other water-borne diseases.
Around 35,000 people across Aragonda get 600 litre of drinking water for 100 rupees a month. The Water Plant which was installed on Panchayat land is being run and maintained by the Panchayat. “We found that said NRR of 2.1 that means its a replacement population so number of people in the elderly population..in nuclear family they are not looked after, feel neglected ad they need care, medical help and social help so we must address this population right now”, shared Lt Gen Mandeep Singh, Former DG Hospital Services, Armed Forces & Adviser, Total Health.
39-year-old Baboo has been using the water to five years now and feels the difference through the improvement in their health.
Not only me but all of us at home feel lighter on our stomach like no pain or gastric issues occur and also a pain in our body has completed gone, said Baboo.
Under the NDTV-Dettol Banega Swachh India campaign in March 2019, Reckitt Benkiser partnered with Apollo to start a project “Arogya Rakshak- Swachhata Se Swasth” aims to help people adopt good hygiene practices like handwashing through awareness initiatives in schools.
The baseline study is a survey done prior to the stated intervention so that one can understand what was the status is prior and post-intervention so to understand the knowledge, attitude, and practice on water And sanitation, Health (WASH) among the beneficiaries along with a Hygiene Curriculum. Teachers are being trained at school on the TOT module who will take hygiene sessions with help of curriculum and butterfly kits.
There have also been Infrastructural changes like Hygiene corners that have been set up in all 14 schools… There are Wall paintings in 15 sites that showcase the message on WASH with an aim to bring about behavioral change. Children Parliaments on Hygiene and health committees take ownership of the programme and review the progress every fortnight, aiming at making a social, economic and health impact on the ground.
Ravi Bhatnagar, RB told us that how we are trying to put the checklist in place and training medical professionals so that hospital infection acquired rates go low and working with school kids you reduce diarrhea cases and school absenteeism improving the quality of life.
Dr Pratap Reddy also spoke about the significance of handwashing and the partnership.
Half the illnesses can be cured if people follow hand wash and Dettol is an addition because it kills germs. Dettol comes back to the original thing saying if you have cleanliness you can avoid the majority of diseases. Previously every Indian has some worms in their body, then with deworming, it only left is a property for the villagers… People in the towns their vegetables were fresh they did not have this problem and problems related to defecation have improved, said Dr Reddy.
Children are agents of change and so they were the target audience for the hygiene curriculum that focuses on WASH (Water, Sanitation and Health) facilities has been implemented in 14 schools of Thavanampalle reaching out to over 2,500 students. The NDTV team visited the Apollo Isha Vidhya Niketan where children took the pledge to keep their environment clean as well focus on hygiene.
N. Jayani Sree Reddy, Head Girl, Apollo Isha Vidhya Niketan said,
I have not only learned about hygiene for myself but also the pledge makes me want to contribute towards thinking about cleanliness like if someone throws garbage on road I pick it up.
Madhavi, Teacher, Apollo Isha Vidhya Niketan who went for the teachers training course about the hygiene curriculum, feels that children are excited about learning through games. “I went for the training and was a great learning experience and what is unique is that all the subjects are taught from textbooks but this is interactive so children look forward to the classes”, said Madhavi.
Maintenance of hygiene and cleanliness of toilets, regular monitoring of handwashing along with behavioral change has seen is an improvement in attendance as well. “With the hygiene classes, attendance has gone up, diarrhoea which was common here has seen a reduction and the best thing is that students are taking a keen interest in learning about hygiene”, said Beena Rani, Teacher, Aragonda Zila Parishad Girls High School.
The Arogya Rakshak programme not only works to ensure schools have adequate water and sanitation facilities but also, aims to strengthen the infection control practices in health care. Hand hygiene in hospitals plays a crucial role in reducing clinic induced infections in healthcare providers and Patients. The Apollo Dettol Curated Curriculum which is on lines of the Checklist Manifesto by Dr. Atul Gawande ((who is)) training Apollo health clinics staff on the same. To deliver quality health care, a nursing college was started in 2003 in Aragonda, giving employment opportunity to youth from a rural background and to zero down the cross-infection while delivering the healthcare services, the programme focuses on hand hygiene.
As part of the Arogya Rakshak survey we are training them and then we also take them to the field and do a one on one interactions with students, villagers and schools, shared Vanisree, Project Associate, Arogya Rakshak who is training the nurses at the college on the scientific approach of handwashing and its importance.
Besides allopathy, Apollo also moved to AYUSH, a programme that does includes Ayurveda, Yoga, Unani, Sidha and homeopathy leading towards a holistic healing approach. “The integration of allopathy with Indian way of healing is being done here at AYUSH so it’s a holistic approach. Since the inception in 2015 over 7000 patients have benefitted from regular health issues to complicated diseases”, added Dr S. RajaGopal, Deputy Medical Director, Total Health.
Ravi Bhatnagar, RB, added,
The vision of total health talks about holistic health and overall wellbeing is at the core and the best thing this programme takes care of all age group from neonatals to geriatrics.
Another aspect of the total health is to overcome non-communicable diseases (NCDs) like diabetes, hypertension, cancer and cardiovascular abnormalities, which are common in the rural areas as well.. Preventive checkups are the key. The first step in the direction was conducting surveys using the World Health Organisation’s (WHO) Stepwise approach to Surveillance (STEPS) to collect, analyze and disseminate data.
DR Reddy shared,
India is going to become the diabetic capital of the world, China holds the portfolio now. We are rapidly increasing and they are decreasing because of the child norm. We have already become the heart capital of the world, many young people are dying of heart disease. We are cancer capital of the world because our cancer is growing at 36% and then infectious disease we are the capital of the world. Infections are because of the place not being clean… why do people get dengue or H1N1? Because places are dirty and flies and mosquitoes grow and they bring in these infections.
The baseline surveys organised by Total Health between December 2013 and June 2018 covered 30600 people in 11349 households, 69 government schools and 65 Anganwadi Centres, helping classify the population into low, moderate and high risk for diabetes, hypertension, and cancer. Bharthi was screened for cancer and was in stage 1 but timely action helped her and today she is free of cancer.
Similarly, 16-year-old Jagdish was diagnosed with a Congenital Heart disease in a school health check-up camp… No symptoms ever appeared so parents also had no clue. “Apollo committee conducted a health camp in Zila Parishad High School in Thavanampalli and did heart scanning for me where I learned that I have a problem so they did surgery for me and I am totally healed leading an absolutely normal life”, said P.Jagdish.
In another case, 5-year-old Devika was diagnosed with cerebral palsy and is being treated using Panchakarma, a therapy in Ayurveda along with internal medicine and physiotherapy. The result is that she is walking, the drooling of saliva has completely stopped and there has been an improvement in speech. Devika’s mother is really happy with her daughter’s treatment and progress. “My daughters’ health has improved tremendously and I am so happy with the treatment and we see hope” said, Devika’s mother.
As a part of LifeStyle Modification, Yoga is being introduced in the rural community of Thavanampalle Mandal along with the focus on sports. Skill development which has empowered women to be independent and participate in the decision making process of her family, and helping them lead a happy life.
Total health initiative is a Comprehensive programme which includes happiness that can only be achieved when the physical, mental, spiritual, financial and ecological needs of an individual’s life are met. This holistic approach also shows a way forward for public-private partnership and how Corporate Social responsibility could be channelized making this successful model achieve health for all.