Background:
MASUM or Mahila Sarvangeen Utkars Mandal is an organization co-founded by Dr. Manisha Gupte and Dr. Ramesh Awasthi in 1987. The organization has now expanded and works extensively in the areas of Women’s Right to Economic Empowerment, Right to Health, Right to Life Free of Violence and Discrimination, Right to Political Participation, Rights of Children and Rights of Adolescent and Youth. Each program has specific interventions and all are intrinsically linked together. The focus of our health programme, initiated in 1991 is to enable the most deprived sections in the community to access and demand health services. MASUM is the district nodal agency for Community Based Monitoring (CBM) of public health services, under the National Rural Health Mission (NRHM) programme of the Government of India. MASUM has also been active in the Right to Health movement in India since its inception. The head office is at Hadapsar, Pune and their rural work is concentrated in three different blocks (Taluka) in Maharashtra, viz. Saswad (Purandhar), Daund and Ahmadnagar.
Visit to the rural site
The four fellows of SIIP, Venture Center along with their manager visited MASUM field site at Malshiras, Saswad on 11th of June 2018. Ms. Mangaltai who coordinated this visit has been working with MASUM since last 30 years, showed us around and helped us understanding the work done by her peers under the auspices of MASUM.
First, we visited PHC at Malshiras and interacted with Dr. Abnave, Medical Officer (MO) at the PHC. He shared his experience of serving the rural patients, the issues of awareness regarding the diseases andmthe compliance of medications. Being a PHC, the supply and the storage of the medications and nutrition supplements are managed by the Government. All kind of health programmes like Cataract camps, Polio vaccinations, maternal and child health programmes, neonatal care and so on are managed at PHC and hence it creates burden on the MO and the staff of PHC. Malshiras PHC had basic medical instruments like weighing scale, digital BP monitor, and stethoscope. PHC also had a labour room and baby warmer along with the inpatient ward and a pharmacy room. Laboratory facility was present but was not in juse due to lack of maintenance and the manpower to handle the lab work. the samples collected for the testing were outsourced. Inevitable issues of rural areas like power cut, issue of reaching to the PHC and unavailability of the vehicle in case of emergency were prominent in Malshiras.
After a brief tour of PHC, the fellows gathered at a temple in the village where around 15 senior ladies came and had a talk with all of us. Each older lady contributed to the group discussion by sharing her experience, health issues and her perceptions about getting old. Many of the senior ladies were active and doing fine in spite of having knee and joint pain. The older ladies were more comfortable in going to the private doctor rather than going to the PHC. Ladies were not aware of ill effects of anaemia though they were advised to take iron and calcium supplements but the supplements were too expensive for them and were not available at the PHC at cheaper rates. When asked about use of innovative technologies in their day to day lives, the senior ladies said they would be comfortable in using devices, however not in the public. When asked about use of cane/stick to maintain balance and prevent a fall, the ladies denied the idea of using cane as it depicts ‘disability’ of an individual. ‘Stigma’ attached to the use of such instruments was highlighted in the interactions.
The fellows then had a lunch in the village and proceed towards the office of MASUM in Malshiras. The fellows learnt the simple test of knowing chances of cervical cancer among ladies called VIA or Visual Inspection with Acetic Acid. Pap smears are considered the gold standard for cervical cancer screening. However, the test needs to be performed by the trained professionals. On the other hand, VIA test is simple to perform, can be carried out at home and is cost effective. The ladies suspected of developing cervical cancer are referred to the medical expert at Sasoon Hospital, Pune. Later on the block coordinator of MASUM, Ms. Shabnam described the journey of MASUM and how the villagers were involved in the work and the support they received from other villages when they expanded this programme to other blocks. All the volunteers at MASUM were dedicated towards their work.
Insights from Dr. Awasthi
While coming back to Pune, the fellows had a meeting with Dr. Ramesh Awasthi, cofounder of MASUM at the head office of MASUM in Hadapsar.
Dr. Awasthi is an alumnus of IIT Delhi with a master’s degree in economics, was interested in rural development always. His insights were based on his thorough experience of ground work and hence it was worth meeting him on our way back to home. Dr. Awasthi suggested to observe the senior citizens more closely and understand the social circumstances and social norms that affect the use of novel technologies. He cited examples of mental health issues like Dementia, Alzheimer’s disease and Parkinson’s disease that need many of the technological improvements to lower the burden on the patient as well as the caregiver. He also suggested to think innovations in making the wheelchairs more cost effective, walkers more user friendly and the other assistive devices more comfortable.
Talking about the serious but hidden problems of the elderly, he gave example of bed sores which are painful and could lead to death. Hence, affordable air beds or innovative cushions could be made to solve such a big problem of bed sores. Issues with feeding tubes, problem of swallowing food especially in bedridden patients were discussed in the meeting which provoked new ideas and the fellows gained good insights from this meeting.
