Hi Everyone,

Dr. Malpani has highlighted some excellent points that could help us
with health education in this country as well, especially in poor, urban
communities. This is an example of how we can learn from the ways that
other countries address health literacy issues, and I'd like to focus
this week's Wednesday Question on the points he brings up.

1.  People are our most valuable resource. 
2.  Video and TV is accessible to poor communities and to audiences with
little or no literacy skills.
3.  Microfinancing can enable people in underserved areas to become
advocates and educators for their own communities.

So how can we use this in our own efforts? Is anyone out there getting
micro-loans or small grants to create networks of community health
workers or video libraries? (We heard about the community workers in the
Deaf community last week!) How else can we tap into regular people as a
resource? How are libraries offering health education in the style Dr.
Malpani describes? Where can we find collections of graphic, animated or
video health education, and how are we promoting access to people who
need this information?

I know this is broad, but it opens our minds to so many ideas...

All the best,
Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> "Dr Malpani, MD" <malpani at vsnl.com> 10/16/07 12:20 PM >>>


The dismal state of healthcare delivery in rural India has been
documented 
many times, but comparatively little attention has been paid to the
plight 
of the urban poor. Even though Bombay is India's medical capital,
healthcare 
services for the poor here are even worse than they would be in a remote

village. It is true that there is no shortage of doctors and hospitals
in 
Bombay, but most of these are in the private sector, which means they
are 
simply unaffordable for the poor - a tragic example of famine amongst 
plenty.

The poor mostly live in overcrowded slums where they are afflicted by a 
double whammy. Not only do they fall prey to the common infectious
diseases 
which are the bane of poor countries, they are also increasingly
afflicted 
by the chronic diseases usually associated with richer nations, because
of 
urban stress, pollution and an unhealthy lifestyle.

While the government does provide free medical care, this care is often
of 
poor quality. Government clinics are under-staffed and are always short
of 
supplies. This means that a poor slum-dweller may have to spend the
better 
part of the day waiting in line to see a doctor at a government clinic. 
While the doctor's consultation is "notionally" free, the patient still
has 
to spend money on buying drugs and medicines. Even worse, because the
system 
is so inefficient ( lines in the OPD ( outpatient department) of
hospitals 
are extremely long and the wait to see a doctor can be interminable),
most 
people simply cannot afford to take a day off in order to seek medical 
attention. Since they are daily wages earners and live from hand to
mouth, 
making a trip to the hospital to get "free medical care" exacts a huge 
financial toll in the form of lost income.

This means that they are forced to put off going to the doctor and they 
often live in the hope that the problem will improve on its own. However
, 
because of inadequate and delayed medical attention, simple medical
problems 
become complicated and minor illnesses become major diseases. When
matters 
get out of hand and they are finally forced to go to the free hospitals,

insult is added to injury, because the doctors criticise them for not
having 
come earlier ! Not only are healthcare workers at these hospitals rude,
they 
are often burntout themselves, because of their huge workloads, as a
result 
of which a bad situation just becomes worse. Many poor patients prefer
going 
to private hospitals, because they are looking for "value for money" and
are 
willing to pay for it, even though they cannot afford it !

So, what is the solutionsubsidised medical care. This is not an effective long-term solution,
and is 
simply a form of " band-aid medicine".
The only effective solution will be to rely on the one resource which is

almost inexhaustible—the people themselves. It is within these millions
that 
we can tap India’s greatest resource for combating diseases. The
principle 
is simple - educate them so they can manage their own problems.

Of course, this is easier said than done. This is a daunting task, and
the 
challenges are enormous. However, the biggest mistake we make is to
assume 
that the poor are incapable of tackling their own problems. We forget to

give them credit for the fact that they have the street-smarts to
survive in 
conditions in which most of us would not be able to last even one week !

Surely they are capable of looking after their own health if we give
them 
the right tools to help themselves .

That's the rub - we need to adapt what we provide, so that it makes
sense to 
them and is useful for them - and this is something we have failed
miserably 
at, because we do not respect them enough to ask them for their opinion
or 
feedback.

The barriers are numerous and these include:


  a.. The fact that literacy skills are limited
  b.. Time is at a premium for most of the men
  c.. There are very few educational materials designed for their wants
  d.. They have a very limited ability to pay

On the other hand , there are a number of hidden resources we can tap
into
  a.. The numbers are huge, and women , children and the elders who stay
at 
home will have plenty of time
  b.. Even though they may be illiterate, they are street-smart
  c.. They are easier to reach, because they are concentrated in small 
localities - slums have extremely high population densities
  d.. Labour can be extremely inexpensive, which allows us to implement 
solutions which can never be cost effective anywhere else !
  e.. The potential ROI ( return on investment) is huge, because we can 
affect such a large number of people.
We need to change our focus. Instead of trying to provide healthcare 
services which need specialists and doctors, we need to tap the people 
themselves. The poor are smart and motivated , and are very capable of 
solving their own problems, if we give them the right tools and teach
them 
how to use them.

An excellent example of this is the revolution which has occurred in the

area of microfinancing.
When given money and the freedom to use it as they see fit , poor people

come up with remarkably innovative ideas which could never have been 
planned, designed or anticipated by outsiders !

Information Therapy - the right information at the right time for the
right 
person - can be powerful medicine ! The key is to develop materials
which 
are right for them - and the right information is information which they

will want to watch and can learn from. People prefer watching graphics,
so 
we need to develop materials which are graphic intensive - either in the

form of animations; or videos.

The good news is that modern technology has made creating and sharing 
graphics extremely easy, so patient educators ( from the community
itself) 
can build their own customised health video libraries with ease ! A
simple 
example would be to find an articulate doctor with excellent
communication 
skills, and to record a doctor-patient consultation with her about the
top 
ten common clinical problems. These videos could then be watched on
cable 
TVs, which many slums do have . If the programs were entertaining, they 
would be a very valuable means of educating people and could be used
over 
and over again. Patients would find them much easier to relate to, since
the 
videos are in their own language; deal with their immediate personal 
concerns; use local characters they can identify with; and provide local

solutions which they are familiar with .


Chronic diseases such as diabetes, cancer and heart disease are now
becoming 
an increaspatient" who has learnt to live well with their chronic disease. We need
to 
find these success stories - and this patient can then be interviewed on

video, so others can learn from his experience.

Videos could also be created on how to talk to doctors and how to
navigate 
the healthcare system if hospital care is needed.


Another simple example would be to publish a series of animated graphics
and 
cartoons about common health problems and how to treat them. An example
of 
this is at http://www.drmalpani.com/health-videos/. One way of looking
at 
this would be to think of it as a video version of the classic text -
Where 
There Is No Doctor . A modular library of such graphics could then be 
published online as "open source content" ; and patient educators could 
download and dub these in local languages . This version can then again
be 
uploaded to google video - and shared with other patients from all over
the 
world. In fact, these could even be adapted for each slum's local living

conditions. As the technology improves, it will soon be possible to
deliver 
this graphic educational content on the third screen which is quickly 
becoming universal even in slums - the mobile phone.

Isn't all this too expensive ? In fact, it's too expensive not to do it
! 
Human capital is India's most precious resource and we cannot afford to 
squander it ! Patient education, if done properly, can provide a
terrific 
return on investment. We have the technology , the tools and the
manpower - 
let's do it !

---------------------------------------------

This is the game-plan for which I need your help.


1. Create a library of graphic modules related to healthcare. This will
be 
both in the form of both cartoon images; and animations

2. Allow people to use these animations so they can design their own
videos 
and their own graphic novels/comics

For videos, we would upload the videos to google video. They can combine

clips and add voice in their local languages, and add their own clips,
using 
services such as www.bubbleply.com


Similarly, they could adapt the basic graphics we provide using tools
such 
as http://www.toondoo.com and http://plasq.com/comiclife to create their
own 
materials, as adapted to their local conditions.

We would use the book, Where There is No Doctor at 
http://www.hesperian.org/publications_download_wtnd.php as our basic
text 
book
and create graphics to support this.

HELP - the Health Education Library for People, India's first Consumer 
Health Education Resource Center , and one of the world's largest
consumer 
health libraries ( as determined by the Medical Library Association ,
USA ) 
was established in 1997 to empower people by providing them with the 
information they need to promote their health , and prevent and treat 
medical problems in the family in partnership with their doctor. We are
a 
registered charitable trust and a non-profit organisation.
We offer the following facilities:

1. Airconditioned reading rooms, with a seating capacity for 20-25
people
2. An upto date collection of over 5000 consumer health books, 10000 
pamphlets, and many magazines and newsletters
3. Audiovisual educational media, including over 600 videotapes. Videos
can 
be viewed in privacy in the library
4. Computer software , including over 30 CD-ROMs on all health and
medical 
topics
5. Photocopying facilities, at Re 1 a page
6. A lecture hall ( seating capacity of over 70 people) with a
big-screen 
projector which we give free to NGOs for health talks.

We have access to information on every health and medical topic under
the 
sun - explained in terms which the layperson can understand.
HELP has become a prototype of the modern digital library. Our website
at 
http://www.healthlibrary.com is India's leading health portal, and
receives 
over half a million hits a month !
We are a public library - everyone is welcome ! Entry to HELP is free !
We are open Monday through Saturday, from 10 am to 6.30 pm. Foe-mail. This is an innovative service called MISS-HELP ( Medical
Information 
Search Services from HELP ) which allows us to provide medical
information 
to users from all over India .

We feel patients are the largest untapped healthcare resource and that 
Information Therapy is Powerful Medicine !

Please do come and visit HELP !


Dr Aniruddha Malpani, MD
Medical Director
HELP - Health Education Library for People
Excelsior Business Center,
National Insurance Building,
Ground Floor, Near Excelsior Cinema,
206, Dr.D.N Road, Mumbai 400001
Tel. No.:65952393/65952394
helplib at vsnl.com
www.healthlibrary.com


Helping patients to talk to their doctors !

PS Read over 20 books on health online at
www.healthlibrary.com !

Read my blog about improving the doctor-patient
relationship at http://doctorandpatient.blogspot.com/



 

----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy
Email delivered to julie_mckinney at worlded.org