Mobile clinics in Delhi

Filling the gaps

The van, which has been operational for a year, is the first of six mobile clinics that Save the Children hopes to run for the urban poor, an effort to fill gaps in government run public healthcare services visible even in India’s capital.

Twice a week, the clinic rolls into Holambi Kalan and its neighbouring settlement Holambi Khurd. Together they have an estimated 11 000 households and population of around 50 000. A government “dispensary” is only a 10 minute walk away, and the state run Raja Harishchandra Hospital is about 6 km away. But queues of patients always form outside the vans.

The mobile clinic is equipped with an x ray machine and medicines—antipyretics, analgesics, antibiotics, and anti-allergy drugs. “Respiratory infections and gastrointestinal illnesses seem to account for the majority of cases,” said Dr Jain. “When patients with serious illness come in, they’re asked to go to a hospital.”

“We get 30, 40, sometimes more than 50 patients visiting the clinic at each site,” said Geeta Mann, a community health worker with Child Survival India, a non-government partner of Save the Children that is running the mobile clinic.

Ms Mann is the bridge between the local community and the mobile clinic. “Many people here prefer mobile clinics to government health centres. They are closer to their homes, and they save on transport,” Ms Mann said.

A study by the Urban Health Resource Centre in New Delhi five years ago had outlined other reasons why even primary health services, despite proximity, do not reach India’s urban poor. These include perceptions of unfriendly treatment at government facilities, timings that do not suit working people, and a lack of sensitisation among service providers. “Health service providers are often rough in their behaviour towards slum dwellers,” the study noted.1

“At night, there’s no transport to take even expectant mothers for delivery,” Ms Mann said.

Unaffordable care

Several mothers from poor communities in the capital’s urban areas spent three hours earlier this month with senior officials of India’s Planning Commission, a government think tank, narrating experiences with public health services.

Munni Devi, aged 40, recounted how she had taken her son who had a high fever to a large government hospital. Doctors there prescribed medicines not available in the hospital’s own inventory of drugs, and something that she could not afford. Mrs Devi said the doctors told her that they would not treat her son if she did not fetch the medicine. Her son’s condition worsened, and he died. “Hospitals need to have special emergency medicines—no child should be lost like this,” Mrs Devi said.

“We have two Indias in this country,” said Rajiv Tandon, a paediatrician and adviser on maternal and child health with Save the Children. “We have an India where you measure economic growth and see this incredibly shining superpower in the making, and you have India represented by the experiences of women such as Munni.”

India’s health ministry has in the past discussed the possibility of an urban health mission, but no such programme has taken off yet. “The population of India’s urban poor is rising fast, and we urgently need greater government investment in urban health,” Dr Tandon said.

But as community health workers associated with the mobile clinics have discovered, it’s not just healthcare services that are lacking. Crucial health messages for maternal or child health aren’t reaching those who need them.

Ms Mann encountered a household last week where a mother was refusing to give her newborn baby breast milk nearly three days after birth. “It’s frustrating when we see this,” said Ms Mann, who coaxed the family to take the baby, who had become ill, and the mother first to the mobile clinic and then to a hospital. “Many mothers remain unaware of the importance of giving colostrum to their newborn,” said Sushma Sharma, a coordinator with Child Survival India. “They wait for up to five or six days before offering breast milk.”

But even the mobile clinic has limitations. Not far from where the clinic was parked in Holambi Kalan, a 16 year old girl named Suman sat outside recuperating after getting her arms and thighs burnt on a stove in her kitchen.

Her mother pointed to a nearly empty bottle of an antiseptic ointment containing iodine. “We’re supposed to apply this on her wounds every day,” she told Ms Mann. “The government dispensary doesn’t give this; nor does the mobile clinic.”