DR. RACHNA AGARWAL
Assistant Professor
Indira Gandhi National
Open University

Technological advancements, ICT and upcoming state-of-the-art institutions in urban areas have revolutionised the delivery of healthcare facilities. There is a need to target the larger chunk of rural population, which is still struggling for basic healthcare facilities.

In a country like India with vast socio-cultural and economic diversity, health has been a much debated issue. The rural-urban imbalance has given rise to distinctly different healthcare requirements. While most of the urban population suffers from life style disorders besides other health problems, the focus of the healthcare industry is more in the urban areas. The technological advancements, ICT and upcoming state-of-the-art institutions in urban areas have revolutionised the delivery of healthcare facilities.

What is required to be targeted is the larger chunk of rural population, which is still struggling for some very basic healthcare facilities. With the present constraints prevailing in most of the rural areas, it is going to be a very challenging task. Nevertheless, an initiative in terms of community awareness, healthcare education and periodic mobile clinic service by some of our leading healthcare institutions would come as a divine shower for the much parched areas.A research study that was basically undertaken to study the impact of air pollution on pulmonary function revealed some astounding facts about the status of women’s health in a small village located about 50 kms from Delhi. A large chunk of women complained of joint pains and gynaecological problems.

Pulmonary function tests conducted on 74 rural subjects (age group 25-55 yrs) revealed mild to severely impaired small airways function (FEF25-75) amongst all subjects. Also, a mild to moderately impaired overall lung function (FVC & FEV1) was observed amongst the 26 rural subjects in the age group of 36-55 yrs. Use of bio-fuels for cooking purpose and poorly ventilated, closely clustered houses can be held responsible for the impaired lung function status of the residents.

In India it is estimated that about 62% of households use firewood and agricultural waste, 15% use animal waste, 3% use coal or coke while the rest 20% depend on LPG (GOI, 1992). It is also estimated that combustion for about 30 minutes produces about 18,300µg/m3 of suspended particulate matter (SPM) from animal dung cakes, 15,800µg/m3 of SPM from wood and 5,500µg/m3 of SPM from charcoal combustion (Gordon & Murray, 2003). With the National Ambient Air Quality Standards (NAAQS) being 140µg/m3 for SPM in the residential areas, one can imagine the havoc that can be caused to the exposed lungs. The Respirable fraction of SPM (RSPM with size <2.5µm) is capable of entering deep into the smaller airways and getting deposited there resulting in decreased small airways functioning.

In an attempt to study the effect of air pollution on respiratory diseases, it was observed that two pollutants viz., SPM and RSPM had a significant positive correlation (r=0.474; p≤0.01 and r=0.353; p≤0.05 resp.) with chronic obstructive pulmonary disease (COPD) cases. The study findings revealed that the risk of having COPD was directly associated with the levels of the particulate pollutants and was further enhanced in winter months (i.e., low temperature conditions) as they often get trapped in the lower layers of the atmosphere resulting in higher concentrations.

When questioned about the frequency of availing healthcare facilities by these rural residents, only a handful had visited for not more than once or twice even though they were aware of the persisting health problems. The most neglected were the women. Almost all houses in the village ‘Kidoli’ (Haryana) did not have any toilet facility and there was a network of open drains to do away with the domestic waste water creating unhealthy surroundings. In such a state, awareness with regard to health and hygiene invites immediate attention of all concerned.

As is well known that ‘Prevention is better than Cure’, it is highly recommended that initiatives must be made to promote the use of renewable energy technology. There is a huge potential of putting up biogas plants, solar cookers/panels and other alternative energy devices in the rural areas. Use of cleaner fuels and alternative energy devices would contribute a great deal in minimising the adverse health effects, especially the respiratory problems. Thus, preventive initiatives coupled with the health and hygiene education and periodic medical check-up camps organised by some of our leading healthcare institutions, would definitely aid in effectively tackling the present situation. An innovative approach to begin with can be adopting a village and providing the required healthcare facilities to its residents. Success of such initiatives would depend on the collaborative efforts of both the public and private sectors together.

Indira Gandhi National Open University has made an attempt to impart healthcare education and training to 10+2 passouts. It has launched a program on Certificate in Hospital Administrative Assistantship (CHAA) in collaboration with Apollo Hospitals. This six months full time program being conducted at Apollo Hospitals aims at providing employment opportunity to individuals as ward secretary, medical assistant, front office staff or as patient care utive. It comprises of two courses: I. Personality and Skills Development and II. Hospital Support Services. While the first course educates one in hygiene aspects, communication skills, customer service standards, conflict resolution and computer skills, the second course trains one in hospital structure and functioning, medical terminologies, out-patient and in-patient care, medical record keeping and health insurance. A trained medical assistant would surely be an asset to the society. IGNOU has also launched a six months certificate program on ‘Health and Environment’ which addresses most of the health issues related to air and other pollutants.