Volume 5 - Issue 07
A Project Management Perspective to Medicare
“History is HIS Story”, saying these words Swami greeted a group of rank students from Sri Sathya Sai Loka Seva Educational Institution, Alike (pronounced as a-lee-kay), located about 50 kms from Mangalore in the Indian state of Karnataka.
Taking the First Few Steps…
The team was informed that as a part of the new initiatives, healthcare seva activities would be treated as a priority area. This meant more villages will have to be included in the healthcare seva agenda. With medical students inducted into the team, the atmosphere was charged with optimism and enthusiasm. Youth Wing and experienced Seva Dal members (including the members of the current Healthcare Seva team) gathered to develop a preliminary roadmap.
Based on the expert judgment and advice of the senior members, seven villages were selected for a preliminary survey, out of which two villages, they decided, would be short listed for comprehensive medical survey and subsequently healthcare Seva.
Visiting the Villages
Detailed discussion resulted in the preparation of a list of parameters that broadly provide a snapshot of the prevailing conditions in a village, and this was called the Initial village survey list. The information collected from each village included the following -
The team visited all the seven villages and gathered the information. The analysis of this data helped the team to define the basic criteria to select the village for health status survey (and subsequently medical camps). They now laid down six basic criteria for selecting the villages to do Medical Camps:
Can Serving Few Villages Solve all the Problems?
For the youth, surveying the villages was a revelation. The lack of basic amenities and the poor level of awareness among villagers changed the perceptions of the youth members. Every one agreed that there is a lot of work to be done. The quantum of work would in fact, require more than a lifetime! Some started even questioning the whole effort: ‘How can few youth participating in healthcare seva activities twice a month, bring about transformation? The answer that came drawing inspiration from Swami’s teachings was: “You are just an instrument in the hand of the Divine Master and you serve yourself by serving others.” Some of the youth still were not convinced; they said, “This is difficult to digest. Can we have a more practical, simple and understandable answer?”
And the clarification they wanted emerged after a few weeks during the course of the healthcare seva activities. All in unison agreed that “it is quite difficult to achieve even the smallest milestones in seva projects, but Swami has brought about so much of transformation and progress in such a short span of time. How could Swami build the massive Super Specialty Hospital in ten months? The answer clearly lies in Swami’s approach. By participating in seva projects, we learn how to manage time, resources, situations and expectations. This skill makes us effective in our career, home and just about where ever we go.
“A volunteer, for example, may be given a task at food distribution counter in the village. Just standing at the counter he can do a lot more. He can calculate the time spent by each recipient in the queue. He can assess if the quantity of food is sufficient? Are there any alternatives if there is a shortage of food? Is the food being served properly in a hygienic way? Is the recipient happy? What would be the checklist for food counter? What are the other requirements in terms of time, resources and expectations? Finally, what are the expectations of the Divine Master Himself?”
So effectively, every task becomes a confluence of duty, devotion, dedication, determination and discrimination along with project management, task related skills, expert judgment, continuous knowledge update and progressive improvement in quality.
It enhances the way seva projects are managed. It also results in the personality improvement and creates greater balance in life. It increases the emotional quotient, self confidence and self esteem. The volunteer also learns to do his duty and leave the rest to God (though not an easy task to do always!). One should do the work to the best of their abilities and avoid having grandiose plans like eradicating a disease from the face of the planet … It is good to have ambitious goals as long as it is practical and achievable. In the end, being effective Sai Youth, apart from the obvious personal growth, is a passport for professional growth too! As we approach the state of excellence, we begin to see God everywhere. We attain the state of MBA (Mind in Baba Always)”. To put in a nutshell paraphrasing Swami’s words, “You are not serving in order to solve the problems; you are serving in order to make an offering to God and to improve yourself.”
The youth were now very clear about the ‘why’ of their activities. The discussion next was on the ‘how’. “We need to develop standard seva methodologies,” they agreed. Soon, the team seriously incorporated the Project Management guidelines alongside medical domain knowledge into the Sai Healthcare activities.
And the first step in this approach was the Data Gathering Phase.
I. Health Status Survey - Data Gathering Phase
Health status survey marked the beginning of data gathering phase. Earlier we saw how the youth selected six basic criteria to select the villages for Seva, now they conducted a full fledged health status survey in these villages in order to gather inputs on the prevailing health status scenario in these hamlets. Principally, they sought to draw the village health profile by finding out the following about the village -
During the survey, as the medical students in the team were looking for signs of malnutrition, chronic disease, anemia, and the like, they discovered that one of the villages was actually having an epidemic of Chikungunya (a viral disease)! Similarly, in some villages the sanitation system was appalling.
They used various established procedures and techniques to collect the information. For example, the nutritional status of children below five years of age was assessed by measuring the mid arm circumference.
What Kind of Data Did The Survey Reveal?
It gave valuable information on many aspects like -
II. Brainstorming - The Planning Phase
After data collection, this next stage of Planning was surely the most decisive phase. The first brainstorming session among the youth did throw up many possibilities but no conclusion could be reached. It was the case of ‘newer solutions bringing in newer problems’. The suggestions were varied, from daily nutrition scheme to combat malnutrition; eliminating the usage of alcohol and tobacco to fluoride removal from drinking water; conducting medical camps frequently to improving sanitation status, etc. To accommodate everyone’s ideas meant complete disarray of the whole healthcare implementation plan. Even though the team agreed to disagree on many issues, love and mutual respect prevailed under all circumstances. They knew they needed an ‘out of the box’ solution and prayed for Divine guidance.
Lead coordinators now revisited the entire exercise and developed a model based on the health status survey data. They decided to classify all the requirements of the village into what is required immediately, what can be implemented over next eighteen months and what can be implemented in a time span of a few years. Such classified and phased approach fitted perfectly with the Treatment – Prevention - Awareness model proposed by the medical students.
This meant that immediate priority (Treatment) is to detect diseases and provide treatment to all diseases in the village. Over next eighteen months (Prevention) the team aimed at implementing preventive measures systematically which included comprehensive vaccination (as per national immunization schedule), improving sanitation in the village, encouraging hygienic practices among villagers and creating disease prevention related awareness. Finally, the Long term initiatives (Awareness) included sustained awareness campaigns along with infrastructure upgrade to improve the quality of life in the village. And added to this was the Spiritual Dimension which kept all the activities in the right perspective.
With this framework it was possible to accommodate all the suggestions over a period of time. It also improved the team spirit because each member felt that their individual point of view was accommodated in a collective framework of ideas and plans. This increased the belongingness of each member to the team.
The progress achieved so far was summarized as -
During the survey the team encountered a story which reflected the prevailing scenario in most of the Indian villages. This story in fact, influenced the team to redefine the camp methodology.
Nanjaiah, a 40 year old illiterate farmer who was the sole bread winner of the family, visited a doctor in the neighboring village when his fever persisted even after ten days. The doctor there gave him Paracetamol and referred him to the district hospital for a blood test. Typically, persistent fever requires further investigation, but Nanjaiah ignored the doctor’s advice as going to the district hospital would cost his family a day’s wage. The fever now persisted for a longer duration and soon, his condition became life threatening. Finally, one day when it became a question of life and death, he was brought to the district hospital. Nanjaiah was actually suffering from typhoid initially (a water borne disease) which progressed to intestinal perforation, requiring emergency remedial measures.
From this story the team analyzed that the outbreak/spread of typhoid could have been avoided by:
How to Balance Family, Service and Office?
The team together was now generally convinced of the big picture evolved so far, but still there were few teething problems. Some members due to other commitments were unable to give more than four hours a month; they felt de-motivated. Here, the team leadership convinced them that the four hours of their time was very precious for the team, and moreover, it is the quality of work not quantity that mattered most.
Office and family commitments are facts of life and seva activities become more effective only when office and family situations are balanced. So, the senior youth members advised that one should focus more on achieving balance rather than count the number of hours in service. By careful planning and thinking, one can surely take time out for seva activities which will eventually act as a catalyst to speed up transformation (individually and collectively). A balance in all spheres of life is possible only through transformation.
It may not have been the best answer, it was convincing nevertheless. Many members still had questions about job rotation, skill sets, self goals vs. team goals, etc. It turned out that everyone was looking for a point of confluence of everyday life, spirituality, role as an individual and role as a team member.
Here, the team did a detailed study and interpretation of Swami’s teachings and restated some of the action items and keywords within the context of the Youth Wing activities.
The individual roles were redefined as administrator, budgeter, planner, negotiator, organizer, communicator, manager, mediator, supervisor, leader, etc.
The team at this stage also developed detailed seva implementation plan with objectives, milestones, activity breakup, task details, scheduling, guidelines and checklists, etc. This helped the team to manage the entire healthcare seva activities more systematically and manage the resources more optimally and effectively.
Defining Priorities – What Kind of Medical Camps to Concentrate on?
Based on the analysis of data of the Village health profile and ground realities of villages, the team developed a list of priority areas for healthcare seva. These critical health concerns were juxtaposed against the constraints (in terms of what was practically achievable) and what emerged was a list of nine priority camps/programs:
The statistics also revealed that women and children needed special emphasis in the healthcare activities because -
III. Health Care Camp in Action - Implementation Phase
In this last stage, the team decided on the nitty-gritty of conducting a medical camp starting from camp layout to patient follow up and referral camps. They laid down clear guidelines for each activity in an actual medical camp. To begin with, they said that the lay out of the camp should facilitate a streamlined flow of people from entry to exit points. This sometimes might require imaginative thinking and experience in crowd control but this is important as bad layout would create confusion, disharmony and make the medical camp activities inefficient.
It is great to start the medical camp by first creating positive vibrations in the village by spiritual activities like group singing, chanting hymns, etc. It brings the villagers together and also adds more vigour to other value-addition activities like Bal Vikas, Study circle, etc. being done in the villages by the members of the Sai Organisation.
A patient enters the camp, through the registration section. This is an important area from the impression and perception management perspective. The patient and the accompanying people have to be greeted and invited into the camp. Volunteers managing this section should be cheerful, polite, helpful and informative. They should provide a correct and context sensitive answer to every query. If they are not sure they should ensure that some one more knowledgeable handles the query. There is no harm in requesting the patient to wait for a while till someone else provides the correct answer. It is also a very good idea to give the patient some idea of the camp procedures. The crucial thing to remember for every volunteer is that they are actually interacting with a manifestation of ‘Sai Narayana’ in the form of the patient.
Every patient is given a case book that contains his personal details like name, age, gender, address, etc. This book is used by the doctors to maintain the case history of the patient. The patients are requested to return it so that the healthcare team updates all the information into a database for further reference by doctors. This data would be very useful for statistical analysis like the frequency of disease occurrence, the duration of treatment, healthcare costs per person, etc. which will help in taking right decisions.
After registration, patients are seated in the waiting area, which should typically accommodate about twenty people comfortably (unless of course it is a big camp). This area could be made more ambient by playing soothing instrumental music. Pictorial charts displayed here demonstrating personal hygiene, sanitation, immunization, nutrition, awareness about major diseases, hazards of smoking, alcohol and drug abuse would be an added advantage. Volunteers to handle queries and availability of drinking water and washroom facilities here are a big plus.
The checkup area is typically a room with good lighting and ventilation. Cleanliness in this room is an essential prerequisite. It must have an examination couch with a screen to provide privacy.
Doctors here are to be provided with the minimums ancillaries like BP apparatus, weighing machine, torch, pen, paper, a box of tissues, surgical spirit or hand sanitizers and a list of the medicines (and quantity) available at pharmacy counter.
Pharmacy is tasked with medicine distribution as per prescription. It is typically managed by a pharmacist but volunteers need to explain the dosage to every patient in detail in their own language. Pictorial description of dosage and medicine usage is an added advantage.
The dosage, the timing and the way in which medicines have to be taken is explained again in this stage. Doctors and volunteers (trained in counseling) need to interact with patients and their family members to assuage any of their doubts, provide emotional support and also improve their health awareness. Every age-group needs counseling of a different kind, like -
Certain patients require additional investigation, diagnostic tests and specialist consultation in better equipped medical centers; such cases are called as referral cases and they are the neediest among all patients. Such individuals are to be identified and taken to the higher medical centers (typically district hospitals). Referral management team has to ensure that referral patients are taken to the bigger and better hospital and are provided with support and assistance to the extent possible. Without proper monitoring of referral cases, the healthcare seva may often become ineffective; hence this is an important activity. To quote one example, here is the case of Ms Jayalakshmi.
A 10 year old girl, Jayalakshmi, from Kamarahalli village (in the outskirts of Mysore ) complained of a mass in the abdomen. The doctor at the medical camp diagnosed it as a ‘massive enlargement of spleen’. This condition required a blood test by a pathologist and the team members took her to the government Hospital in Mysore for further investigations. The blood test at the Government Hospital, Mysore revealed that she was suffering from a type of blood cancer. She was then taken to Kidwai Institute of Oncology, Bangalore, by the Sri Sathya Sai Samithi, Mysore . After the investigation, the oncologist provided the details of the treatment which included chemotherapy.
This story is a clear example which underscores that the Referral Management System is an indispensable component of healthcare seva.
Unfortunately, the girl's family refused chemotherapy in spite of having been counseled in detail by oncologists. Her family went by the advice of the village elders that chemotherapy side effects would affect her marriage prospects! The most important lesson learnt here was, the objective of the service is to do the duty to the extent possible and to facilitate treatment as much as possible. The ideal goal of providing a cure to everyone may not happen always. Acceptance of this reality helps to visualize the healthcare seva with a more realistic and practical perspective.
Specialty camps are to be organized to address health care issues beyond the scope of an ordinary medical camp. It has to focus on diseases that require specialist care. It also targets the vulnerable sections of society: Women and Children.
Post camp review
After every camp the team members need to conduct a review meeting to revisit the events of the camps. The problems encountered could be subjected to root cause analysis in this session. Feedback from the volunteers, doctors, and patients are to be analyzed as a part of the efforts to improve the quality of the camp on continuous basis.
Other Salient Activities
Improving Awareness through Street Plays
Street plays are an effective way to communicate and drive home important lessons on health awareness and disease prevention. The youth team here developed street play in the colloquial language and enacted it in the village covering themes like cleanliness and hygiene, preventive care, etc. One of the highlights is that the team improvised the play by including farm animals to recreate an authentic rural situation. This scene had a wider impact. It revealed that improvising the play to tune it to the local environment really heightens the impact of the presentation.
Village Youth Motivation
Village youth motivation sessions are meant to establish communication with village youth to feel the pulse of trends in the village. Based on the assessment of the aspirations of the youth, career guidance and mentoring, targeted awareness program are to be conducted to help village youth to transform the village, be a partner in healthcare activities and improve the quality of life. The story of Sri Cheluvaraju is a case in point.
Sri Cheluvaraju, was a Balavikas student when his village was first adopted by the Mysore Samithi, twenty years ago. Today, he has achieved success in his work and is successfully leading a team of volunteers in Seva activities conducted by the Sai Samithi in five nearby villages. He says, Cheluvuraju
Urban Service Camps - Blood Donation
As a part of the activities for the urban areas, the team focused on voluntary blood donation as the current scenario in India is not very encouraging. There is chronic shortage of blood with a major shortfall during summer. Non-availability of blood during treatment costs life in many cases. This is principally due to lack of awareness about blood donation and poor infrastructure.
Some pertinent facts about Blood Donation that inspired and helped the youth were:
They decided that camp must be arranged with an accredited and non-profit blood collecting agency and the donors are to be informed of directions to camp venue with timings.
As per the camp ambience, it should have a cordial and a soothing atmosphere with proper seating arrangements and minimum waiting time for donors. And refreshments provided to the donors should be nutritious, palatable, hygienic and adequate. In the end the donors are to be given a token of appreciation (typically a small gift along with blood donation certificate). The Youth Wing in Mysore have so far conducted 4 blood donation camps and collected 248 units of blood.
‘Yuva Spandana’ – Sharing Knowledge Through Healthcare Workshop
The Sai Youth of Mysore conducted a unique healthcare workshop to discuss practical Medicare issues and spirituality. Senior and eminent devotees like Sri B N Narasimhamurthy, Warden, Sri Sathya Sai Boys’ Hostel Brindavan Campus, Sri Nagesh.G Dhakappa, State President of Sri Sathya Sai Seva Organization, Karnataka and Sri. R.K Subramanya, Karnataka State Youth Co-ordinator provided many practical insights and expert opinion on various aspects of service and spirituality.
Being His Loving Instruments…
With Swami’s Grace, the Mysore Youth conducted many healthcare camps in villages around Mysore City . Happy to be part of these service opportunities, they say,
“The experiences made us Better human beings by teaching how to be compassionate and to show concern to fellow human beings; Better healthcare providers by teaching us the cardinal principles of community medicine; Better leaders by teaching management perspectives and leadership skills; Better Sai Students by teaching the spiritual aspect of seeing God in everyone; and finally, Better Sai Youth by translating Swami’s teachings and management techniques into Effective Healthcare Seva.
Ekalavya Drama – Huddled At His Lotus Feet
Even as the Sai Youth healthcare activities kept the team busy, there were memorable situations that constantly reminded the team of the Divine Presence, encouragement and blessings.
“Bhagwan bestowed Mysore youth a golden opportunity to perform a drama in the divine presence of Swami during the Karnataka State Youth conference – Yuvavandana at Brindavan. We used to begin all the practice sessions of the drama with three bhajans and end it with a prayer and Mangalarati,” they reminiscence.
“On the day of drama we were ready with the costumes and make-up; we did the prayer back-stage in the Sri Sathya Sai Kalyana Mantapam, Brindavan, where the drama was going to be staged. No sooner we had finished the prayer, Swami started reciting the invocation prayer of our drama in His discourse and explained the meaning! He also mentioned about the drama and gave a brief introduction about the story and the characters coming in it. It was a thrilling experience for us. It was then that we realized that Swami was present in each one of our practice sessions as well as the service activities.”
Putting their learning from the play in the divine presence in the form of a poem they say -
Sai Teachers – Swami Inspires Through Them
Sai’s Schools – Serene and Shining
The Sri Sathya Sai Loka Seva Institutions are located today in Alike and Muddenahalli. While Alike is situated in a valley surrounded by hills, 46 kms from Mangalore, in the Dakshina Kannada District of Karnataka; Muddenahalli, nestled in the sylvan surroundings at the foot of the reputed hill station, the Nandi Hills, is at a distance 7 kms from Chikkabballapur, along the highway from Bangalore to Puttaparthi.
It was christened by Swami Himself as ‘Sathya Sai Grama’ in 1973. Both these schools are now trend-setters in academic excellence as well as Character education. Isn’t this so heartening?
- Heart2Heart Team
Dear Reader, did you like this article? Was it informative and inspiring? Do you think this will help you in organising medical camps and other service activities more effectively? What suggestions you have for future seva stories? Please tell us at [email protected]
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Vol 5 Issue 07 - JULY 2007
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