Much-needed Family Health Care Centre for Jaffna – The Island

BY Advisory General Practitioner, Dr. S. Kumaran, and Viduni Basnayake

This article describes the experience of a novel, evidence-based approach that involves patients and their family members in the delivery of health care, the delivery of medical education, and the conduct of research at a primary care facility, the Family Health Care Center.

The Northern Province of Sri Lanka is a war-ravaged region that lags behind the rest of the country in economic development.

After the COVID-19 pandemic had already drained health services of their limited resources, the current financial crisis has brought the sector to the brink of collapse. This crisis puts patients at further risk due to power outages, drug shortages and equipment shortages. Another major problem caused by the economic collapse is the lack of human resources. In addition, frequent protests due to political unrest disrupt the delivery of health services.

Primary care is the delivery of integrated, accessible health services by physicians and their care teams to patients while developing enduring relationships with patients within the family and community. Care is person-centred, team-based, community-focused, and designed to achieve better health and care at a lower cost. Family medicine is the focus of primary care and unlike other specialties that focus on a specific organ or disease, family medicine is an area where doctors treat most conditions and people of all ages – from newborns to the elderly – provide comprehensive health care.

In Sri Lanka, providing basic medical care is not an easy task. Insufficient human resources, limited infrastructure (buildings, furniture, laboratories and equipment), lack of a multidisciplinary approach to teamwork, inadequate government policy and resource allocation, and lack of awareness of primary care services among the general population are the main obstacles. Health care delivery is complicated by patients with multiple health problems, complicated psychosocial issues, transportation issues from their homes to health care facilities, and a lack of awareness of their health conditions. The preventive area is often overlooked in times of crisis, which makes the situation even worse.

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Research studies play an important role in primary care because the results can be used to improve public health problems. However, such studies have become challenging due to insufficient public participation affecting data collection and insufficient funding to conduct research. When the healthcare system is in crisis, more attention is paid to clinical medicine than to research. In addition, most physicians shift their attention away from research.

Despite the challenges outlined above, with the full support of the District Medical Officer (DMO) of the Hospital and the Regional Director of Health Services of Sri Lanka, one of the most effective Family Health Centers has been established in the newly built Maternity Hospital of Kondavil District Hospital (RDHS), Jaffna. The authors prepared the basic structural drawings and the final plan was agreed upon in 2012 after several discussions with the authorities of the two provincial health ministries and scientists from Jaffna University Faculty of Medicine. The center is an extension of the Department of Community and Family Medicine, Faculty of Medicine, Jaffna University.

The center took in young unemployed family members who had finished their formal education after secondary school. Job titles were created based on the identified areas of interest. The professional training provided helped with capacity building as well as social recognition. These trained community members play a variety of roles in the delivery of FHC services, as noted below.

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Community Health Assistant in Elderly Home Care:

Home care for the elderly is one of the services offered by the Family Health Centre, Kondavil, for patients who come to the hospital for various reasons such as: B. elderly or bedridden, can not visit. Young women introduced by patient forums were trained to register selected home care elders, locate homes, schedule monthly visits, provide medication delivery dates, and maintain home visit bag and equipment in a calibrated manner.

Health assistant for outpatient geriatric care:

Community aged care is provided by a group of trained members. During the program, screening for NCD/non-communicable diseases and many activities to improve mental health are carried out.

Health Assistants for Noncommunicable Diseases Clinics:

As part of community members’ involvement in routine clinical activities, young women have been trained to become health workers in noncommunicable disease clinics.

Peer Educators:

These personnel have been trained to conduct patient education both during FHC’s clinical operations and during community outreach. They teach patients diabetic foot care, basic breathing exercises, basic physiotherapy for stroke patients and necessary home modifications, proper use of spacers, etc.

Play Therapy Assistants:

Children who fall under the autistic spectrum exhibit a variety of social, behavioral, and developmental challenges throughout childhood. The therapy assistants were trained for a period of six months by experts in dealing with such children. These young women have been trained to engage in child-centered play activities that help them develop gross motor, fine motor, creative, life and pre-learning skills. It started with six young women in 2018 and now there are 10 women in the group.

Funding program for healthy eating:

In the village of Kondavil, empowered mothers are committed to increasing the availability, accessibility and affordability of nutritious food. They prepare food in a hygienic way and pack it in biodegradable paper bags or handkerchiefs. They also offer grocery delivery services.

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Helpline and telemedicine services:

The Helpline service was created to support population groups not covered by the FHC, Kondavil. The hotline addresses clinical and non-clinical issues for a population of 10,000 in the Northern Province in partnership with NICST, an NGO that provides financial and technical support. It helps to have regular check-ups. People who want to see the counselor or a doctor can make an appointment on Wednesdays between 10 a.m. and 12 p.m. and register for the medical inquiries via telemedicine.

Satellite center clinics:

Advisors from Jaffna Teaching Hospital who wish to conduct village-level medical campaigns have teamed up with FHC to organize annual satellite center clinics in rural villages in Northern Province together with Jaffna University Medical Faculty. The satellite center clinics will function in divisional hospitals in Tharmapuram (Killinocchi district) and Palai (Jaffna district).

Patients’ relatives are trained to act as simulated patients. These trained simulation patients are designed primarily to help teach medical students communication, counseling, and counseling skills. Exchange of experience with medical students The trained therapy assistants pass on their experience in caring for autistic children and their parents to medical students. Participation in improving the well-being of medical students and staff. Few trained patient family members conduct regular programs with medical students and medical staff to improve their well-being. The program includes laughter yoga, forum theater and many relaxation techniques. In addition, the commitment of the patients and their relatives in writing books and supporting research could also be seen.

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