Rural Health Centre (RHC)

Overview  |  Facilities  |  Infrastructure  |  Research  |  Publications  | Annual Reports | Funding

Voluntary poverty is one thing but compulsory poverty is quite another.
The villagers were poor and diseased …..
the damage wrought by centuries of privation
could not be wiped away in a few years.

J Krishnamurti

Affordable Primary Level Health Care

to Below Poverty Line Rural Families

The Rural Health Centre, an outreach programme of the Rishi Valley Education Centre, was set up in July 1999, when a doctor (an old student) joined Rishi Valley with an intent of working with the rural poor.

• Area covered: Approximately 60 revenue villages with a Below Poverty Line population of 200,000, located in the northern parts of Chittoor, contiguous parts of Anantpur and YSR (Kadapa) districts in AP and adjoining parts of Karnataka state.

• Annual patient load of 22000

• 98% of patients have an annual income of < 48000.

• 2500 children (< 15 years) provided free/subsidised treatment and investigations annually.

• 30 - 50 children treated free at Secondary/Tertiary Care centres annually

• 2500 elderly patients (> 65 years) provided free/subsidised treatment and investigations annually.

• 70 - 80% of adult patient load is Non-Communicable Diseases – primarily Diabetes, Hypertension

• 20 – 30 pregnant women registered annually; Institutional Deliveries; Increase in birth weight and decrease in Infant and Maternal Mortality

Day Care: where patients are cared for obviating the need for admission and transfer to a hospital. We are able to resuscitate and manage most acute illnesses, e.g Acute Severe Asthma, Diabetic Hyperglycemic state, Acute febrile illnesses, Gastro enteritis with dehydration etc, at this centre. 

Treatment Room: Dressings, wound care particularly of diabetic feet are done here.

NON COMMUNICABLE DISEASES – A TEAM APPROACH
The majority of the workload of the RHC is in the management of Non Communicable Diseases (Hypertension, Diabetes, Thyroid Disorders, Chronic Obstructive Pulmonary Diseases, Arthritis etc).

What is worrying is the number of younger adults who present with these diseases .

Nurses as Physician Assistants: All our nurses are trained to interview patients and ask them questions relating to their health and well-being.

Health Education: The importance of education cannot be over emphasized. Our nurses are trained to educate patients and their attendants on topics such as diet, nutrition, emphasizing the importance of millets, home grown vegetables, use of unrefined foods, exercise, wound care, management of sick day for diabetics, insulin injection technique etc.  

Footwear: A cobbler, who visits the RHC twice a week from Madanapalle, has been trained in house (at the RHC) to make orthotic footwear for patient suffering from Diabetic Feet. MCR foot wear is designed/custom built for each individual and could include, arch support, heel wedges, bars/ platforms for off-loading of pressure points etc.

Diagnostic Centre: A well equipped laboratory, with automated / semi semi-automated analysers provides the much needed investigative support for the management of patients. The various services offered are hematology, biochemistry,  Serology, clinical pathology and cytology.
Microbiology unit does bacteriological cultures from various body secretions /specimens like Urine, Sputum, Pus, Blood. Clinicians from Madanapalle also use this facility.

Tuberculosis Cultures. An innovative rapid method for culture of Tuberculosis bacteria (pioneered by Dr Veeraraghavan), is also used. With this method Tuberculosis bacteria are grown within 48 hours, as against 6 weeks for the conventional method.

Imaging: Ultrasound, X ray
Personnel: 3 Doctors and 12 Paramedical/Administrative staff

Epidemiological Studies on Hypertension and Diabetes – Collaboration with Monash University, Melbourne and Christian Medical College, Vellore. These studies started in 2005 and at the present data analysis is going on. A few papers have been published in reputed international journals.

BOOK CHAPTER

 Tensions in Livelihoods – A Rural Perspective: p 377 – 395 in “Handbook of Career Development”, International and Cultural Psychology. Ed G Arulmani etal, Springer international 2014

NATIONAL HEALTH MISSION

Dr Kartik was member of the medicine sub group which laid down Standard Treatment Guidelines for the Management of Hypertension in India.

The guidelines are given in: http://www.nhm.gov.in/nrhm-instate/520-standard-treatment-guidelines.html

Papers

1. Cluster randomised feasibility trial to improve the Control of Hypertension In Rural India (CHIRI): a study protocol. Michaela A Riddell, Rohina Joshi, Brian Oldenburg, Clara Chow, K R Thankappan, Ajay Mahal, Nihal Thomas, Velandai K Srikanth, Roger G Evans, Kartik Kalyanram, Kamakshi Kartik, Pallab K Maulik, Simin Arabshahi, R P Varma, Rama K Guggilla, Oduru Suresh, G K Mini, Fabrizio D’Esposito, Thirunavukkarasu Sathish, Mohammed Alim, Amanda G Thrift. BMJ Open 2016;6:e012404.

2. Potential roles of high salt intake and maternal malnutrition in the development of hypertension in disadvantaged populations. Amanda G Thrift, Velandai Srikanth, SharynM Fitzgerald, Kartik Kalyanram, Kamakshi Kartik, Chantal C Hoppe, Karen ZWalker and Roger G Evans. Clinical and Experimental Pharmacology and Physiology (2010) 37, e78–e90

3. Association between Farming and Chronic Energy Deficiency in Rural South India. Asvini K. Subasinghe, Karen Z. Walker, Roger G. Evans, Velandai Srikanth, Simin Arabshahi, Kamakshi Kartik, Kartik Kalyanram, Amanda G. Thrift. PLoS ONE 9(1): e87423.

4. Gender-specific effects of caste and salt on hypertension in poverty: a population-based study Amanda G. Thrift, Roger G. Evans, Kartik Kalyanram, Kamakshi Kartik, Sharyn M. Fitzgerald and Velandai Srikanth. Journal of Hypertension 2011, 29:443–450

5. Novel dietary intake assessment in populations with poor literacy. Asvini K Subasinghe PhD, Amanda G Thrift PhD, Roger G Evans PhD, Simin Arabshahi PhD, Oduru Suresh, Kamakshi Kartik M, Kartik Kalyanram MD, Karen Z Walker PhD. Austral Asia Pac J Clin Nutr 2016;25(1):202-212

6. Factors associated with awareness, treatment and control of hypertension in a disadvantaged rural Indian population. Doreen Busingye, Simin Arabshahi, RG Evans, VK Srikanth, Kamakshi Kartik, Kartik Kalyanram, Michaela Riddell, AG Thrift. Journal of Human Hypertension 31(5), January 2017.

7. Knowledge about risk factors for hypertension in rural india is even poor in people aware of their hypertensive status. Doreen Busingye, Simin Arabshahi, RG Evans, VK Srikanth, Kamakshi Kartik, Kartik Kalyanram, Michaela Riddell, AG Thrift et al. Journal of Hypertension 34:e463-e464 · September 2016

The RHC has, over the years, established a deep trust with the rural poor who have minimal or no access to medical care. This has been made possible only due to generous contributions from alumni, well - wishers and friends. We look forward to your continuing support.

Annual Report 2018-19

The RHC is looking at raising a General Corpus and separate Corpuses for Vulnerable populations. The interest from which would be used to meet the needs of patient care. In addition, there are specific donations available. Any donation is more than welcome. Visit Funding page for more details.

Please write to Dr Kartik Kalyanram & Team @ ruralhealth@rishivalley.org for more details.