Birth waiting room in 17 tribal PHCs
On analysis of the maternal deaths, it was observed that the tribal mothers find it difficult to reach the delivery point on time. Though 108 vehicles with four-wheel drive facility are provided due to the long distance to be travelled it was observed that if the tribal mothers were admitted in advance, i.e two weeks before the Expected Date of Delivery in birth waiting room established at the foot hills of the 17 PHCs in tribal areas it would ensure that safe delivery happens under institutional care. If referral to a CEmONC centre is required, it can be done well in advance.
Tribal Mobile outreach services
Already there are 396 Mobile Medical Units are being operated throughout Tamil Nadu. To augment the Mobile Outreach Services in tribal areas additional 20 Mobile Medical Units are being operationalized through NGOs in tribal blocks. This mobile outreach team with one Medical Officer / Staff Nurse / Lab Technician / Driver conducts minor ailment clinic, Antenatal screening, Non Communicable Disease screening and lab tests. Free drugs are also distributed. These tribal mobile teams also help in screening Hemoglobinopathies among 10th& 12th Standard Tribal school children and school dropouts.
Referral Services in Tribal Districts
The State has a well-established emergency referral transport system established through TN-EMRI. In order to reach those tribal areas which are inaccessible, four wheel drive vehicles suitably equipped as ambulances have been provided in 76 identified points in tribal / hilly areas considering the issue of reaching the tribal hamlets due to the size of the regular ambulances and hilly terrains. This ensures that timely referral of tribal people to higher referral centre’s. Regular replacement of these vehicles ensures that these vehicles are road worthy.
Tribal Counselors act as ambassadors between the health systems and tribal community. Tribal communities in general and primitive tribal groups in particular are compounded by lack of education / awareness, illiteracy, ignorance of causes of diseases, hostile environment, poor sanitation, lack of safe drinking water and blind beliefs, etc. Hence, Tribal Counselors have been placed in the 10 Government Hospitals in the tribal districts. These persons function as health activists in the institution who create awareness on health and its determinants. They motivate the community towards healthy living practices.
Prevention & Control of Hemoglobinopathies
Tamil Nadu is the first State among the South Indian States to implement this program for early detection of Hemoglobinopathies like sickle cell anaemia, Thalassemia among the tribal population. The timely identification and genetic counselling will prevent the transmission of the carrier from parent to offspring. This breaks the propagation of the disease.
NHM TN along with line departments has implemented screening of Hemoglobinopathies (Sickle Cell Anaemia & Thalassemia) in adolescent children studying in 10th, 12th standard and unmarried school dropouts above the age of 14 in 30 selected tribal blocks in 13 Districts since November 2017. The programme implemented at a cost of Rs 216.00 lakhs in Dharmapuri, Salem, Krishnagiri, Namakkal, Nilgiris, Coimbatore, Tiruvannamalai, Villupuram, Vellore, Thiruchirapalli, Dindigul, Erode and Kanyakumari Districts in phased manner. The programme involves primary screening with NESTROFT & SOLUBILITY TESTs are done with the support of (TMORS) Tribal Mobile Outreach Services and final confirmatory diagnosis at 5 Government Medical College Hospitals with HPLC which is a highly specific and sensitive equipment. The children are provided with genetic counseling at District Early Intervention centers.
This year the programme , will also be expanded to screen antenatal mothers. With the successful implementation of the programme the incidence of Hemoglobinopathies trait will be reduced and the future generations will become free from Hemoglobinopathies.
Establishment of Integrated Centre for Treatment of Hemophilia & Hemoglobinopathies (ICHH) in 5 Government Medical College Hospitals of Tamil Nadu
Estimated Prevalence of inherited bleeding disorders like Hemophilia A & B, etc., in India is 0.9 /1, 00,000 population. (Source: India Journal of Medical Research) . Since case detection of such inherited blood disorders is required and requirement of a comprehensive day care centre to treat children already on treatment is essential, GOI has issued certain guidelines on the issue. Based on the guidelines and reviews by expert teams, it is decided establish 5 Integrated Centre for Treatment of Hemophilia & Hemoglobinopathies at regional zones to benefit such children requiring frequent blood transfusions due to Thalassemia or Hemophilia and also to establish treatment centres to provide Chelation therapy for other variant hemoglobinopathies.
Hemoglobinopathies & Hemophilia are transfusion dependent /clotting factor dependent diseases, resulting in stress and psychological problems not only to the child but to the whole family. Management of thalassemia, Sickle Cell Disease patients and Hemophiliac patients through a Day Care Facility is convenient, economical and provides a supportive environment friendly area for children with a chronic illness. It helps in better compliance and efficient monitoring of patients.
- Integrated Centre for Treatment of Hemophilia & Hemoglobinopathies will provide transfusion facility / ward with 10- beds, where transfusion services on daily basis will take place in shifts to accommodate more patients including night shift for working or school going patients.
- Integrated Centre for Treatment of Hemophilia & Hemoglobinopathies in the General Medicine Department / Pediatric Department will have exclusive management protocols for transfusion therapy, transfusion reactions and chelation therapy/li>
- Trained Pediatrician/Hematologist with nursing staff for treating complications, conducting regular transfusions, monitoring of growth and development and maintenance of records, during the period of blood transfusions with low staff turnover to provide continuity of care will be made available.
- Exclusive Laboratory Diagnostic kits for conduction of regular tests (serum ferritin, viral markers) for evaluation and monitoring purposes &Provision of Drugs like oral iron chelator drugs
- ICHH will have recreational facilities to keep children engaged during transfusion/ other treatment.
Establishment of Comprehensive Integrated Centre for Treatment of Hemophilia & Hemoglobinopathies in 5 Government Medical College Hospitals namely:-
- Institute of Child Health& Hospital for Children , Government Madras Medical College Hospital, Egmore, Chennai 8(Nodal Centre)
- Government Dharmapuri Medical College Hospital, Dharmapuri
- Government Rajaji Madurai Medical College Hospital, Madurai
- Government Theni Medical College Hospital, Theni
- Government Mohan Kumaramangalam Salem Medical College Hospital, Salem
These facilities will be a 6 to 10 bedded day care centre to ensure adequate management and to serve as a baseline of minimum monitoring that is needed for care of these children & to prevent frequent school absenteeism among these children.