Why good home-care health system is needed in rural areas (Comment) By Anil K. Rajvanshi

Last month, my mother, who is 92, fell in the bathroom and broke her pelvic bone. I live in the rural town of Phaltan in western Maharashtra and to get a simple X-ray done was a nightmare.

We called the local orthopaedics hospital and they sent a ramshackle ambulance. How an old Maruti Omni van got permission to ply as an ambulance is anybody's guess. Even a healthy passenger would feel sick and his/her bones would be rattled in that ambulance while going over the potholed roads of Phaltan. Some of the worst roads in the country are in Maharashtra, especially in rural Maharashtra.

The driver of the ambulance also doubled up as the paramedic and his callous and non-empathetic attitude almost broke my mother's heel. He almost threw my mother on the stretcher! Most of the ambulances in rural areas are like that with hardly any facility to help the patient. I had to use an old saree to tie my mother to the stretcher so that her broken pelvis did not shake very much.

At the hospital, after a good deal of arguing, we got her X-ray done quite quickly. Otherwise it takes forever to get it done. Since the pelvic bone was fractured, the doctor advised complete bed rest and told us to take her home. In such cases, there is no surgery needed but just plain bed rest so that the broken bone heals by itself. That is also the reason why I did not take her to Pune for treatment.

We brought her home and were immediately confronted by the stark reality of who will take care of her nursing needs. We tried to locate nursing care in Phaltan but were unsuccessful. Even the hospitals do not provide that facility. The relatives of patients do that in most rural hospitals.

Finally, after great difficulty and searching, we got a 24-hour help (who had almost no training as a nurse) from Pune. This helped relieve our emotional and physical stress.

Searching the net and talking to my doctor friends, I have finally been able to convert my mother's room into a home health-care facility. This includes the adjustable hospital bed with an air mattress and a specially fabricated small wheel-chair, which can navigate the narrow passages of the house and can go into the bathroom. I feel I could get all this done because of our resources and ability to spend time searching for solutions on the net. Most of the rural population does not have this luxury. 

Another tragedy in rural areas is that no doctor wants to do a home visit. No matter how ill or old the patient is, they insist that he/she should be brought to the hospital or their clinic. I was able to get a person who was not an MBBS doctor but could administer saline or do basic dressing for bed sores. That was a partial relief.

Secondly, I was greatly helped by my brother, who is an orthopaedic surgeon in Australia. He constantly advised us on the basic care and his telemedicine greatly helped us. 

Very frequently I have seen that in rural -- and also in urban -- areas, the missing ingredient in patient care is good nursing facilities. Putting a patient in hospital (whether he or she is terminally ill or suffering from non-life-threatening ailments) means endless headache for relatives, who have to stay in the hospital, undertake the nursing care of the patient and run continuously to get medicines and medical supplies. Besides, the hospitals charge exorbitant amounts for surgeries and for lots of unnecessary tests performed on the patient.

The government has mooted quite a number of good schemes which provide hospitalisation for below poverty line (BPL) patients and take care of their bills through insurance cover. Yet I have seen these schemes misused by doctors and hospitals where they admit the patients at the slightest pretext and charge them the full amount even for minor ailments. The money is then paid to the hospital by the insurance company.

Our medical care system in rural areas is, therefore, quite broken with very greedy doctors and hospitals that, in collusion with insurance agents, fleece both the patients and the government.

A hospice or home-care health system might alleviate this problem greatly.

This system will rely on specialised agencies that provide trained nurses (at nominal cost) for homes, simple equipment like small wheelchairs, beds, commodes and the like, and qualified doctors on duty who can respond through the internet or mobile phone to the queries from the nurses - and, in an emergency, make home visits. At present there are no such agencies but they are urgently needed.

For the terminally ill, a home-care system which provides nursing care and basic equipment will be extremely helpful. He/she will be surrounded by family and nursing care given by trained nurses will help relieve the pain.

Financially, this system will be much more viable than having a dedicated hospice facility. The financial arrangements on how the government can help organisations in facilitating such a system need to be worked out. A possible solution could be to provide insurance coverage for such a home-care system. 

Also such a facility can provide home-care for patients who are discharged from the hospitals. Too often, relatives and the family have to provide prolonged post-operative care --which they are ill-equipped to do. Such a facility could be a boon for those patients.

In urban areas, better medical facilities, including good ambulances, can provide timely care. In rural areas, in the absence of such facilities it is very necessary to have a home-care facility.

(Anil Rajvanshi is the Director, Nimbkar Agricultural Research Institute in Maharashtra. The views expressed are personal. He can be contacted at anilrajvanshi@gmail.com )