Our First Health Camp!

Jackie, Anjuli, & Nick at a health camp.
Jackie, Anjuli, & Nick at our first health camp.
We had the fortune on Monday to attend an urban heath camp in action to better understand where technology can improve health workers’ workflow in delivering healthcare to poor communities in urban and rural Kolkata. We visited the Luxuria Heights construction community where iKure had partnered with a local organization to set up a health awareness and screening camp.
Health Check-up & Social Security Awareness Drive
Flyer up outside of the clinic advertising the Heath Check-up and Social Security Awareness Drive
This opportunity to visit a health camp was a fantastic learning space because we were able to get an idea of how the camp was run, how different stations were set up, how information was passed along from the health workers to doctors, and how long the process took.
On average there were 7-10 health workers at the camp at any one time, including at least one doctor (who wore a white lab coat) as well as a few paramedics, lab techs, and pharmacists (who wore lab coats of dark blue). These workers manned 5 major stations: patient registration and height/weight measurements, blood pressure and heart-rate monitoring, general consultation and triage of symptoms, blood testing, and ECG analysis when necessary. Since this was a construction site they did not have a station set up for women’s health in the way that they normally would.
There was a logical flow within the camp going from the basic height and weight measures through to the more in-depth blood tests and consultations with the doctor. From observing individual stations and following individual patients we were able to understand that each patient spent an average of 1.5-2 minutes at each station and that the entire process from registration through check-out took about 6-10 minutes per patient.
 Some of our observations and questions are below:
Patient registration & height and weight station.
Station #1: Patient registration, height & weight measurements.
  • Intake and height/weight: Took about 90 seconds for patients to get through. One health worker gave the patients a white index-sized card to fill out basic information, while he took notes on a clipboard.

  • Query 1: Who asks if these are new or returning patients? Is this a consistent question asked at the health camps? Is there somewhere on the paperwork to check off if a patient is “new” or “returning”?

  • Query 2: Is there additional health information (e.g. health habits) that the health worker jots down at this station?

Stations #2 & 3: Blood pressure, heart rate, and MD consultation.
Stations #2 & 3: Blood pressure, heart rate, and MD consultation.
  • Blood Pressure and Heart Rate:  Took about 90 seconds for patient to get through both procedures, conducted by a pharmacist or paramedic. The results from these vital tests were written on the back of the index-size Health Screening Cards.

  • General Triage: Took about 90 seconds to go through this station. Conducted by a certified physician/clinician, who also wrote down additional free-form notes for patient on a larger paper form, which had information transcribed from the Health Screening Card.

    Nick interviewing the MD at station #3.
    Nick interviewing the MD at station #3.
  • Query 3: What type of questions is the MD asking during the consultation? Are they consistent? Do they vary from patient to patient?

  • Query 4: What notes is the clinician generally taking down on the prescription sheet? Only prescription recommendations? Tailored health advice?

  • Query 5: When do the MDs need to enter the ICD 10 codes? Is this on the prescription form currently, or is it entered at the end of the clinic into WHIMS?

  • Query 6: What is the purpose of having both the Health Screening Card and the prescription sheet? Seems like additional paperwork for health workers, especially if they are transcribing information from the cards to the larger forms, and the patients are not keeping the cards or end up losing them.

  • ECG: No time estimate, since we only saw one patient referred here. We assume this station is for patients with more serious conditions (i.e. pain).

  • Query 7: If women were also attending a health camp, would the OBGYN station be located at this point in the clinic flow?

Station #4: Testing blood for iron and type.
Station #4: Testing blood for iron and type.
  • Blood Testing: About 90 seconds for patients to go through this station. Involves two health workers administering a finger prick, creating blood sample slide and writing down patient information from the prescription sheet and Health Screening Card.

  • Query 8: Do all health camps end with the blood testing station?

  • Query 9: Do patients actually save the Health Screening Cards? What is done with them after this station?

  • Final Data Collection: At the end of the clinic, iKure staff members photocopy the large forms and hand one to the patients, while the other is used for data entry into WHIMS.

  • Query 10: Would having all the information from the Health Screening Card on the prescription sheet (after the blood test station) make data transfer to WHIMS easier/ more efficient?

  • Query 11: What is the process for obtaining prescriptions? Do patients have to mention pain to get paracetamol? What is the process for getting iron tablets?

  • Query 12: On average, how many patients are prescribed paracetamol, versus iron tablets or other medications offered at the health camps? Is this given based on doctors’ notes on the larger prescription form?

  • Query 13: Where are patients getting prescriptions filled?

  • Query 14: What is the supply of medications at health camps? Does this differ between urban and rural settings?

Perceived Issues and Challenges

Transcription at station #4
Transcription at station #4
  • Data entry is time consuming, as every station involves paper forms

  • However, paper forms allow doctors to write more tailored information to patients, which may be challenging with an electronic form

  • Pervasive use of paper records increases chance of human error in data entry, which then contributes to miswritten records stored in WHIMS

  • Duplication of patient records is a big problem

  • Heavy turnover of doctors at health camps means doctors may not know if patients are new or returning to the iKure clinics; they enter patients as “new” and generate multiple PIDs for the same patient

  • Health workers may not be accustomed to ask if patients are “new” or “returning”

  • Trying to identify returning patients by name is an issue… misspelling of names is common, and WHIMS cannot flag a patient’s name as being misspelled

  • Query 15: How else can patients be flagged as returning? By DOB? Age? Site visited? Medical history?

So all in all we learned a lot, but as usual ended the day with more questions than we had at the beginning of the day.

 

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