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In a farming village outside Jamkhed, in Maharastra, India, a Village Health Worker and the Mobile Health Team check the weights and hemoglobin of adolescent girls and test glucose levels in the urine of villagers living with Diabetes.
Here are their supplies:
A test tube
Metal test tube holder
Locally grown cotton
A bottle of ‘Benedict’s Reagent’
A bottle of clear reagent
A plastic container and dropper
A rubber tube and lancets
A hemoglobin reader, and
Today will be a light day. It’s harvest time and most of the villagers, including pregnant women, are in the fields, working in 35 – 40 degree Celsius heat harvesting chickpeas and sorghum.
Ten adolescent girls wait their turn to be tested. Soon, the older villagers with diabetes arrive. One by one each girl is weighed and her weight recorded in the logbook.
The social worker opens a sterile lancet and pricks a girl’s finger to get a blood sample. She puts a rubber tube in her mouth and draws up some blood. She releases the suction and the blood flows into a glass test tube containing a few drops of reagent. She rolls the test tube between her hands and places it in the hemoglobin reader. A minute later, she announces that the hemoglobin is 9.5 and records the result in the logbook. A hemoglobin of 9.5 is too low. The girl gets a gentle scolding and is told that she must eat more spinach and meat. The Village Health Worker will talk to her mother and the girl will be retested next month when the Mobile Team returns to the village.
The Village Health Worker puts two fingers of Benedict’s Reagent in a test tube. She lights a match and ignites a piece of alcohol soaked cotton and places the test tube over the flame. Next she adds 7 to 9 drops of urine and places the test tube back over the flame until it starts to bubble. She removes the test tube and waits to see if the blue liquid changes to green, yellow or red, indicating the amount of glucose in the urine of a villager living with diabetes.
With a comical look of disgust on her face, the Village Health Worker shows everyone watching that the blue liquid has changed to yellow. After a somewhat heated discussion with the gentleman, he admits he stopped taking his medication because he preferred the local healer’s herbs. Now he and everyone within earshot knows that the local healer’s herbs don’t work and they should listen to the Village Health Worker.
Why, you may ask, are they not sending these villagers to a lab to get their blood work done? Why aren’t they using dipsticks to test urine? The answer is, that neither of these is appropriate.
Firstly, there are the issues of accessibility and acceptability. This farming village is a good half hour drive from a laboratory, which would be hours by ox cart. These villagers need to be working their land and tending their crops to earn their livelihood. Many would choose not to have the blood tests done if they had to go to the lab, which could seriously impact the health of the village.
Secondly, there are the issues of affordability and availability. Health care and diagnostic testing is provided on a fee for service basis at health care facilities, and many of these villagers are living well below the poverty line and would chose having money for food over spending money on doctor’s visits and lab tests. The Village Health Worker lives in the village where she works and is available whenever needed. She and the Mobile Health Team offer, free of charge, testing and care that can be carried out close to home and fairly quickly.
Also, long-term external funding would be needed to have a sustainable source of urine dipsticks. Even if the funding was available and the village health workers started using the dipsticks, what would happen if over time, the funding source dried up and no more dipsticks were available? All the village health workers would need to be retrained in the original testing techniques leading to confusion and extra training costs, and would mean time away from the village for the Village Health Workers to be retrained.
So, although the technology may seem archaic to some, it gives the Village Health Worker the information she needs to care for her community, within the community, and to refer villagers to the hospital only when absolutely necessary.
Comprehensive Rural Health Project www.jamkhed.org
Author’s Contact Information
Lee Mantini RN, MHScN
Health and Development Consultant
RR3 Picton, Ontario Canada, K0K 2T0