M.Sc.Community Health Nursing
Community Health Department
Christian Institute of Health Sciences and Research, 4th Mile
Its 6:30 am in the morning and my phone is ringing. It is from Mrs. Alem, the Acredited Social Health Activist(ASHA) from Village A, which is within our area of service. She informs me that one of our patients from there, who is a hypertensive, has not been keeping well since the previous night. I enquire if they can bring him to the hospital. However, due to lack of good public transport system and financial constraints it turns out that it will be difficult to bring him to the hospital. I quickly tell her a few basic first aid measures and I also tell her to watch for signs of deterioration of his present condition. I tell her that we will be visiting her village today as part of our Village Health and Nutrition Day (VHND) schedule and we could visit him.
At 8 am I reach my office and get ready for the day. Our team for the day consists of a Community Health Specialist Doctor, 2 Community Health Nurses and a Driver. We have our medicine box packed with the basic medicines, emergency kit, first aid box, etc. Our driver is already waiting for us. Loaded with all our equipments, we head for Village A. Driving on the pot- hole filled roads of Dimapur is no joke and our journey of 30kms seems to take more than 2 hours (by then some other people would have even reached Kohima from Dimapur!) .We sympathise with those patients who have to drive through these bumpy roads to reach a hospital here in Dimapur. However bumpy the road is and no matter how arduous the journey, the village trips have become a much awaited part of our routine and we have become very familiar with the twists and turns in our routes.
On reaching the village, we are greeted by the ASHA, Anganwadi Worker (AWW), the staff from the nearby Health Center and a crowd of villagers who are eagerly waiting for us. We are scheduled to have our Village Health Nutrition Day(VHND) today at the Anganwadi Center. The VHND, apart of the National Health Mission, aims to provide for health and nutritional benefits, specially to the pregnant women and children. So we have a group of pregnant women and a bunch of young children staring at us as we unload our articles and equipments for the day. We set up our makeshift registration area (where all vital parameters are checked), consultation area, drug dispensing area, health education area and we are set to start the VHND.
Once the registration has begun, the flow of patients begins to increase. The large turnout indicates that the ASHA, AWW, the Village Committee members, and other local leaders have done their job, of informing the villagers about the VHND, very well indeed. The AWW gets busy with distributing the nutritional supplementation packages to be distributed to the children, pregnant and lactating mothers. As the place starts buzzing with activities the pregnant women get their awaited antenatal check-up done. They are examined for their duration of pregnancy, high risk pregnancy conditions, danger signs of complications which can come up during pregnancy and also provided with individual health education and counselling. The also get the benefit of getting their blood checked for blood group, Haemoglobin, and a few blood borne diseases. The Government of India recommends that all pregnant women should go for at least 4 antenatal check-ups and for those who cannot reach a health centre, they can easily avail the benefit of the VHND held in their own villages and get themselves routinely checked and immunized.
The young children in their fright of getting immunized cling to their parents as they see the Health Centre nurse drawing up the vaccine to be given from the vaccine vials. Completing immunization and monitoring their growth is an important component in any health care service targeted for children.
As the hours go on, an elderly gentleman, who has come along with his wife, reports that he is feeling better than before. He has meticulously brought all the records of his visits from the previous two years. He has come over today to get his routine medicines for Diabetes mellitus and for his wife to get her eyes checked. Chronic diseases such as hypertension, Diabetes mellitus, Arthritis etc. require continued medication and for such patients in rural areas their age, financial constraints, bad roads and lack of affordable public transport systems makes it extremely difficult for the patient as well as their care givers to ensure compliance to the treatment, a fact which most medical professionals often fail to understand. So it is no wonder that we have a lot of people in Nagaland ending up in complications from such chronic diseases such as stroke, heart attack, kidney failure etc. Being a Community Health Nurse I always believe the famous quote “Prevention is better than cure” but to make this prevention reach all levels of the community is still a challenge. I hope that one day we will be able to find some answers.
Coming back to our VHND, as the day wears on and the sun’s intensity begins to decrease, so do the number of patients piling in. We manage a hurried lunch in between the busy hours and are ready for another round of home visits to the bed ridden and chronic patients in the village. The ASHA guides us to the house of Mr. Y who is bedridden for the past 4 months. The family members welcome us warmly as we meet Mr. Y whose contractures seem to have increased from the previous visit. We assess his condition, his current medications and teach some active and passive exercises to the family along with health education regarding his nutrition. Mr. Y, along with many others in his village, has been followed up by us on a regular basis to ensure that they get the required check-up and medications. His condition is reported to his primary treating doctor at the main hospital for any further specific management.
The day seems to have been long but for sure it has been fruitful. Though it may seem to be another long and tiring day, the gratefulness in the eyes of the villagers coupled with the innocent smile of the healthy children makes us go back home with a feeling of satisfaction that our job, in a small way, would have made an impact in the lives of the communities with whom we are working. Very often people curiously ask me what exactly I do as a Community Health Nurse and some even ask me why I took up Community Health Nursing as a profession. I hope through this brief account of a day in my life, some of their queries would have been answered. It has not been easy but it has been fruitful and promising so far. I hope that in the days to come these communities whom we are serving will be transformed to healthier communities. Our work may just be a ripple in the ocean but I hope that with more awareness, more people will come forward to take up such challenges for a healthier Dimapur and a healthier Nagaland.