1. TRIBAL HEALTH INITIATIVE
Sittilingi, Tamil Nadu, India
Experiences in training Para-medical Workers
Dr. Lalitha Regi
Presentation at ARSICON2008
Wardha
Helping tribals heal themselves……

2. Invocation
To the tribal Gods who protect our people

3. Sittilingi Valley …..enveloped
by the Kalrayan and Sitheri hill
ranges
Sittilingi and the Avalur valleys
have 21 hamlets which are home to
about 10,000 people of whom 95%
are tribals

4. Need of the area
 Remoteness – nearest referral centre was
100km away
 No “modern” facilities
 Staff need to understand and empathise
with the tribal population
 Villagers need to feel comfortable with
health care providers

5. Selection
 Initially looked for
educated girls – 8th Std
 Now we send out
information – applicants
have a written test on
basics of language and
mathematics; then
interview
 Selection based on
aptitude, attitude, region,
income levels
 6th batch in progress

6. Health Worker Training
Caring , respect and shared concern
Balance classes with practical work

7. Training – general principles
 Design according to the need of the area
 Emphasize student’s role as educator
 How things are taught is more important than
what is taught
 Caring , respect and shared concern
 Balance classes with practical work
 Understand social causes of ill health
 Make people more self reliant and less
dependant on institutional health care
 Participatory training

8. HWs’ manage most of the Hospital
•See Out patients 4 days a week
•Conduct deliveries and assist surgeries
•Manage Ward and emergencies

9. Deliveries & Neonatal Care
Advanced Neonatal care
About 30 deliveries a
month and 3 - 5 for
neonatal care per month

10. Surgical Work
About 20 – 30 surgeries every
month including emergencies .

11. Surgical training
· 1. How to do basic dressings
· 2. Injuries – how to examine, clean, debride and do the
suturing if needed.
· 3. Check ante-natals, monitor and assess labour and
conduct deliveries including some of the abnormal
deliveries like breech delivery
· 4. Examine and do incision and drainage of abscesses
5. Surgical removals of small swellings like sebacious cyst,
lipomas etc.
· 6. Local anaesthetic blocks, giving and managing of drugs
like ketamine and thiopentone
7. Manage spinal blocks and intra-operative management
of general anaesthesia

12. Surgical Training
Simple surgical procedures like cysts and other swellings

13. Surgical Training
Assisting Major surgeries
Dressings, I & Ds

14. Anaesthesia training
Spinal Blocks
General Anaesthesia

15. Community Health
Health Care at the doorstep
– postnatal care
Health Workers
now plan and
implement the
Community Health
Program

16. Field Clinics
Health education is the key

17. Laboratory
Technician
 Basic tests we taught – practical & theory
 Biochemistry & maintenance – other hospitals
 Government recognised lab – TB & HIV
 Seniors train juniors and we check – 5 have skills
 All Health Workers learn basics
 TB/HIV – Government uses our lab as an example

18. X-ray/ ECG technician
1. Theory taught by us
2. Practical learnt in large hospital
1. Seniors train juniors , theory we teach
2. 5 Health Workers know

19. Pharmacy
 Drug names and actions taught – to all
 Basics of dispensing taught – to all
 Stock keeping and ordering – one person
specialises, one assistant

20. Advantages/Disadvantages
•Brings down workload
•Treatment inexpensive
•Knowledge passed onto community
•Increased confidence & self esteem
•Gives us time to look into other problems in
the community
LEGAL PROBLEMS !!!?
Non – Recognition from other hospitals

21. Achievements
 No maternal death – 5 years
 Infant mortality – from 147/1000 to 32/1000
 Malnutrition – down by 50 %
 Antenatal mothers check up – from 11% to 95 %
 Almost 100% completion of treatment in TB
 Hospital attendance from our area – decreased from
50 % to 20%

22. Tribal Hospital – Staff pattern
Non tribals Locals
 3 doctors  14 Health Workers
 1 Administrator  2 Lab Techs
 1 X-ray tech
 2 Pharmacists
 3 Admin assts
 2 Drivers
 7 HW trainees

23. That formal education is mandatory to do
health care is a myth
Help people heal themselves…..

24. References
 Health for all-Alma Ata declaration and
after
-N.H.Antia
 The Alma Ata declaration and goal of
health for all
-David Werner
 Health Care in India ‘a profile’
-Devraj Chauhan,N.H.Antia,Sangita Kamdar

25. Thank you
For more information check out
www.tribalhealth.org