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Training Paramedical Workers at THI
1. TRIBAL HEALTH INITIATIVE
Sittilingi, Tamil Nadu, India
Experiences in training Para-medical Workers
Dr. Lalitha Regi
Presentation at ARSICON2008
Wardha
Helping tribals heal themselves……
3. Sittilingi Valley …..enveloped
by the Kalrayan and Sitheri hill
ranges
Sittilingi and the Avalur valleys
have 21 hamlets which are home to
about 10,000 people of whom 95%
are tribals
4. Need of the area
Remoteness – nearest referral centre was
100km away
No “modern” facilities
Staff need to understand and empathise
with the tribal population
Villagers need to feel comfortable with
health care providers
5. Selection
Initially looked for
educated girls – 8th Std
Now we send out
information – applicants
have a written test on
basics of language and
mathematics; then
interview
Selection based on
aptitude, attitude, region,
income levels
6th batch in progress
7. Training – general principles
Design according to the need of the area
Emphasize student’s role as educator
How things are taught is more important than
what is taught
Caring , respect and shared concern
Balance classes with practical work
Understand social causes of ill health
Make people more self reliant and less
dependant on institutional health care
Participatory training
8. HWs’ manage most of the Hospital
•See Out patients 4 days a week
•Conduct deliveries and assist surgeries
•Manage Ward and emergencies
9. Deliveries & Neonatal Care
Advanced Neonatal care
About 30 deliveries a
month and 3 - 5 for
neonatal care per month
11. Surgical training
· 1. How to do basic dressings
· 2. Injuries – how to examine, clean, debride and do the
suturing if needed.
· 3. Check ante-natals, monitor and assess labour and
conduct deliveries including some of the abnormal
deliveries like breech delivery
· 4. Examine and do incision and drainage of abscesses
5. Surgical removals of small swellings like sebacious cyst,
lipomas etc.
· 6. Local anaesthetic blocks, giving and managing of drugs
like ketamine and thiopentone
7. Manage spinal blocks and intra-operative management
of general anaesthesia
17. Laboratory
Technician
Basic tests we taught – practical & theory
Biochemistry & maintenance – other hospitals
Government recognised lab – TB & HIV
Seniors train juniors and we check – 5 have skills
All Health Workers learn basics
TB/HIV – Government uses our lab as an example
18. X-ray/ ECG technician
1. Theory taught by us
2. Practical learnt in large hospital
1. Seniors train juniors , theory we teach
2. 5 Health Workers know
19. Pharmacy
Drug names and actions taught – to all
Basics of dispensing taught – to all
Stock keeping and ordering – one person
specialises, one assistant
20. Advantages/Disadvantages
•Brings down workload
•Treatment inexpensive
•Knowledge passed onto community
•Increased confidence & self esteem
•Gives us time to look into other problems in
the community
LEGAL PROBLEMS !!!?
Non – Recognition from other hospitals
21. Achievements
No maternal death – 5 years
Infant mortality – from 147/1000 to 32/1000
Malnutrition – down by 50 %
Antenatal mothers check up – from 11% to 95 %
Almost 100% completion of treatment in TB
Hospital attendance from our area – decreased from
50 % to 20%
23. That formal education is mandatory to do
health care is a myth
Help people heal themselves…..
24. References
Health for all-Alma Ata declaration and
after
-N.H.Antia
The Alma Ata declaration and goal of
health for all
-David Werner
Health Care in India ‘a profile’
-Devraj Chauhan,N.H.Antia,Sangita Kamdar
25. Thank you
For more information check out
www.tribalhealth.org