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Challenges of Working with a Government Community Health Center

Tripura is one of the Northeast states in India with a predominant tribal population. The tribal population live in the hills of the state whereas the Bengali speaking population live in the plains and over the years they form most of the Government of Tripura. Agartala is the largest city in the state and has the medical colleges and most of the health care facilities.

Khumulwng is the headquarters of the Tripura Tribals Autonomic District Council [TTADC] and the gateway to Agartala, the commercial capital of Tripura. The tribal population of Tripura feel uncomfortable to go to Agartala as the people there are mostly Bengalis and the language spoken there is predominantly Bengali.


The Kherengbar Community Health Center is a Government Hospital controlled by the TTADC where most of the tribal patients who need surgical treatment come for consultation. Earlier statistics show that less than 10% of the patients referred for surgery to Agartala or elsewhere go for treatment as they are uncomfortable to have treatment other than in their own area.


THE SURGICAL CAMPS AT KHERENGBAR CHC


Earlier the Kherengbar CHC were able to do only Emergency Caesarean sections and other minor surgical procedures as most of the doctors who were posted were from outside. However once Dr. Rati Deb Barma a local tribal doctor took over the hospital, he was very keen to start surgical procedures at the hospital and obtained permission from the Government to work with Rural Surgery Innovations to start surgical procedures at the hospital.


THE SURGICAL CAMPS


The surgical procedures were carried out for two to three days every month for the last 6 months. About 15 to 20 major surgical procedures were carried out during the surgical camp each month. The innovative Gas Insufflation Less Laparoscopic Surgeries made laparoscopic surgeries available at the hospital because they were carried out under the easily available Spinal anesthesia.



Endoscopic Urology surgeries were carried out too as they were possible under spinal anesthesia.


THE CHALLENGES


1. Although very close to the capital city Agartala in a government set up getting the necessary gases for both anesthesia and surgery is difficult (like most of the rural areas). Spinal anesthesia is easier and makes it possible to run two operating tables at the same time managed by one anesthesiologist.

2. Many of the staff are non – tribals and are not keen to help the tribals get operated on at the Kherengbar CHC. They work at various private hospitals in Agartala and feel that when patients are operated at Kherengbar the private hospitals may not get sufficient patients.

3. At the Government hospital the staff are used to start work late and leave early and are not used to working for long hours

4. The cleaning and sterilization of the instruments especially the laparoscopic and endoscopic surgical equipment are carried out in the Operating room only.

5. Most of the staff in the Operating Room had not seen or assisted in any surgical procedures earlier other than occasional caesarean sections.


OVERCOMING THE CHALLENGES


The Kherengbar CHC overcame the challenges with the following.


A. Getting the top Government officials involved in arranging the surgical camps. The local King of Tripura (from the royal family of the erstwhile Kingdom) was very supportive.

B. The innovative procedures like the Gas Insufflation Less Laparoscopic Surgeries and the Laptop Cystoscopy, removal of renal stones through the normal urinary passage, etc. made surgeries possible under spinal anesthesia.

C. The use of WALANT for surgeries under local anesthesia, which were almost totally painless made Kherengbar CHC a popular destination of such patients.

D. The VRiMS video recording of training programs helped the staff in cleaning and taking care of the equipment, assembling the special equipment, etc.

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