Essential Family Health Care Center for Jaffna – The Island

BY Consultant Family Physician, Dr. S. Kumaran and Viduni Basnayake

This article describes the experiences of a new evidence-based approach that involves patients and their family members in the delivery of health care, medical education, and the conduct of research in a primary care setting called Family Health. Care Centre.

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

While the COVID-19 pandemic had already drained health services of its limited resources, the current financial crisis has pushed the sector to the brink of collapse. This crisis puts patients at additional risk due to power outages, lack of medication and lack of equipment. Another major problem, caused by the economic collapse, is the shortage of human resources. In addition, frequent demonstrations, triggered by political unrest, disrupt the provision of health services.

Primary care is the provision of integrated and accessible health services, by physicians and their support teams, to patients, while developing a sustained relationship with patients, within the family and in the community. Care is person-centred, team-based, community-aligned and designed to achieve better health and care at lower cost. Family medicine is the focal point of primary care, and unlike other specialties that focus on a specific organ or disease, family medicine is a field in which physicians treat most conditions and provide health care. suitable for people of all ages, from newborns to the elderly.

In Sri Lanka, providing primary care is not an easy task. Inadequate human resources, limited infrastructure (buildings, furniture, laboratories and equipment), lack of a multidisciplinary approach in teamwork, inadequate government policies and allocation of funds, and lack of awareness of services primary care, among the general population, are the main barriers. The delivery of health services is made more difficult by patients who have multiple health problems, complex psychosocial problems, problems transporting them from their homes to health facilities and a lack of awareness of their health status. The preventive sector is often neglected in times of crisis, which aggravates the situation.

Research studies play a major role in primary care because the results can be used to improve public health issues. But these studies have become difficult due to inadequate public participation that affects data collection and insufficient funding to conduct research. When the healthcare system is in crisis, clinical medicine will receive more attention than research. Moreover, most doctors also divert their attention from research.

Despite the challenges described above, one of the efficient family health care centers in Sri Lanka has been established in the newly constructed maternity block of Kondavil District Hospital, with the full support of the Chief Medical Officer of district (DMO) of the hospital and the regional director of health services. (RDHS), Jaffna. The authors created the basic structural drawings and the final plan was agreed, after several discussions with the authorities of the two provincial ministries of health and academics from the Faculty of Medicine of Jaffna University, in 2012. The center is an extension of the department. of Community and Family Medicine, Faculty of Medicine, Jaffna University.

The center accommodated young unemployed family members, who had ceased their formal education after high school. Job titles have been created based on identified areas of interest. The professional training provided has contributed to capacity building, as well as to social recognition. These trained community members play various roles in the delivery of FHC services, as outlined below.

Community health assistant in geriatric home care:

Geriatric home care is one of the services provided by Kondavil Family Health Center to patients who cannot come to the hospital due to various reasons such as elderly or bedridden. Young women, introduced through patient forums, were trained to register seniors chosen for home care, locate homes, schedule monthly visits, provide drug delivery dates and maintain bag and equipment home visit in a calibrated way.

Health assistant for community-based geriatric care:

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

Health assistants for non-communicable disease clinics:

As part of involving community members in routine clinical activities, young women were trained to become health assistants in non-communicable disease clinics.

Peer educators:

These staff have been trained to carry out patient education both during FHC clinical operations and during community outreach activities. They teach patients about diabetic foot care, basic breathing exercises, basic physiotherapy for stroke patients and necessary home modifications, proper way to use spacer, etc.

Play Therapy Assistants:

Children, who are on the autism spectrum, exhibit a variety of social, behavioral, and developmental challenges throughout childhood. Therapeutic assistants were trained for a period of six months, by experts, to deal with these children. These young women have been trained to participate in child-centered play activities that help them develop their gross motor skills, fine motor skills, creativity, life and pre-learning. It started with six young women, in 2018, and there are now 10 women in the group.

Healthy Eating Program:

A few self-reliant mothers are involved in improving the availability, accessibility and affordability of nutritious food in the village of Kondavil. They prepare food hygienically and wrap it in biodegradable paper bags or tissues. They also provide food delivery services.

Helpline and telemedicine services:

The hotline was created to serve populations not covered by the FHC, Kondavil. The helpline deals with clinical and non-clinical issues for a population of 10,000 people in the Northern Province, working with NICST, an NGO that provides financial and technical support. This allows for regular follow-ups. People who wish to see the consultant or a doctor can make an appointment on Wednesdays, between 10 a.m. and 12 p.m. and reach out via telemedicine for medical requests.

Satellite center clinics:

Consultants from Jaffna Teaching Hospital, who want to conduct village-level medical campaigns, have partnered with the FHC to organize annual satellite clinics in rural villages in Northern Province, in collaboration with the Faculty of Medicine of Jaffna University. . The satellite center clinics will operate in the divisional hospitals of Thmapuram (Killinocchi district) and Palai (Jaffna district).

Relatives of patients are trained to act as simulated patients. These trained simulated patients are primarily intended to help teach medical students communication, counseling and consultation skills. Sharing their experience with medical students, trained therapy assistants share their experience of caring for autistic children and their parents with medical students. Helpline operators share their experience with medical students. Participate in improving the well-being of medical students and staff. Few parents of trained patients organize regular programs with medical students and staff to improve their well-being. The program includes laughter yoga, forum theater and many relaxation techniques. Additionally, the involvement of patients and their loved ones in writing books and seeking support could also be seen.