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EVERY WOMAN MATTERS: THE WAY FORWARD
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Dr. Rajesh Chauhan, Consultant, Family Medicine & Communicable Diseases. 309/9 A.V. Colony, Sikandra, Agra -282007. India.
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drchauhanrajesh{at}yahoo.com Dr. Rajesh Chauhan
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Dear Editor, The article by Elisabeth et al [1] is interesting and covers a gray area in the provision of screening. The society now-a-days usually works according to the laid out details at the time of employment, be it in any profession. Any additional burden, however justified and considered essential and progressive, shall be resisted in such circumstances. The isolated clinics could not resist as strongly as the clinics which were offshoots of bigger hospitals; the reason should be obvious enough. The initial reactions of somewhat positive adjustment and volunteering for change, according to the team conducting the research on ‘a state-run federally funded program’, having proper ‘sanction of the University of Nebraska’, done in a 100 mile radius, can be easily anticipated and were on the expected lines. All ideas that were given were accepted in principle and initial enthusiasm was also reflected. Later on, probably after the realization of having to do extra work had set in, the things changed. In one particular case, the long standing partnership also broke up, probably on the issue of who is going to do this extra work, and then what happens to whatever that has already been committed and promised to their patients, prior to this study taking its roots. The authors finally sum up that it seemed unlikely that the changes would be sustained. Perhaps the research should have been done the other way round – how many ladies have visited a practice just to get the breast examination, mammography and Pap smear examination, and how many requests for the same have been turned down or delayed. This would have been a better measure of the compliance of any state-run federally funded program and to assess the level of health awareness raised in the public through other programs and non-medical agencies. As such, I am a strong supporter for screening for diseases and regular medical examinations [2]. However, as I see it, for the program to be effective, the following should be done: • As seen in the results, the compliance was good in the clinics that had on their strength either a Gynecologist or a Preventive Medicine expert, preferably the former. Therefore it may sound reasonable enough to have either of the two sent to clinics, by turns, on fixed dates that are known to the parish well in advance. Let’s say a fortnightly or a monthly visit by a team to every peripheral clinic be arranged. • This team during its visit should be given separate chambers, supporting clerical staff for paper work and paramedics. • Best would be to hire a separate team altogether, along with all equipment and staff that is required. Ideally this team should be mobile and self contained. Their charter can include daily visits, by turns, to all clinics in a defined geographical area so that every clinic can be visited twice in a month. • If considered appropriate, justified remunerations are to be provided along with suitable incentives as deemed fit. • Since the tests entailed will take time, the reports including the laboratory results can be sent by post/email to the parent clinic. • The parent clinic can organize a review of the lady who had undergone the screening earlier so that the visiting team may review the lady along with the results that would have been made available by then. • Further disposal of a patient, in accordance with the advice given by the screening team, can be done by the staff of the parent clinic. • Timings of visit of the mobile team may be displayed at most prominent places and can be made available on the net also. • The clinics may be asked to advertise prominently of this service which shall be provided at nominal rates or even free of cost, as per the directives of the state. • Just for the sake of providing extra benefits to the clientele, desist from flogging tired horses. Supplement the workforce if it can be achieved rationally. With regards. References: 1. Backer EL, Geske JA,. McIlvain HE, Dodendorf DM, Minier WC..Improving Female Preventive Health Care Delivery Through Practice Change: An Every Woman Matters Study. J Am Bd Fam Prac 2005; 18: 401- 408. 2. Chauhan R, et al. Proactive medical check ups for all. BMJ 13 Jul 2005. http://bmj.com/cgi/eletters/331/7508/68-a#112136, 13 Jul 2005 |
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