On June 13, we accompanied Manju Bajiya, Operation ASHA’s Deputy Director of Operations, to visit a DOTS center in Tekhand, a slum in Okhla. We left the office at 10 AM in order to reach the center at a time when most patients would drop by to take their dose. Morning is a popular time at Operation ASHA’s urban DOTS centers, because most patients stop by before starting their days. On the drive over, Manju gave us an introduction to the area we were about to visit and OpASHA’s role in that community.
The DOTS center we visited was located in a community doctor’s office. This is one of the most important features of Operation ASHA’s model — DOTS centers are located in places people in the community already trust. The doctor who offered his space to Operation ASHA had been working in this location for ten years, succeeding his father as the community doctor. Both the space and the doctor held the community’s trust and respect; by associating their DOTS center with this establishment, Operation ASHA established a similar relationship with the community. Additionally, by sharing a space with a pre-established medical resource, Operation ASHA is able to reduce one of the largest barriers to TB treatment adherence — stigma. When a patient enters the office, they are not necessarily revealing that they have TB.
We walked into the office to see it full of patients, some waiting to see the doctor, and some taking their TB medication under his supervision. Manju took us to a side room past the doctor, where the OpASHA provider, Bhuvneshwari, keeps all her supplies. This includes a scale to weigh patients, over-the-counter medications to mitigate side-effects of the TB drugs, a chart summarizing the patient-load of the center, and most importantly, a box containing the entire course of TB medications for each patient. We were impressed by the organization of the space, especially the process for storing the TB medications; Operation ASHA and RNTCP require providers to keep the empty blister packs to provide further proof that each and every dose was taken.
After Manju finished showing us around the space, the provider arrived at the office, having just returned from a house call to a patient who recently missed their TB dose. This was a really interesting process to encounter — one of Operation ASHA’s most unique and valuable practices is following up with patients who miss doses. Bhuvneshari’s meeting with the patient who missed a dose and was struggling to stick with the rigorous treatment schedule resulted in the patient resuming treatment, and taking a dose at home under Bhuvneshari’s observation.
Bhuvneshari explained to us that the Android tablet Operation ASHA provided her with, and the apps loaded onto it, are what make such intimate patient care possible. When a patient misses a dose, the system sends an SMS both to Bhuvneshari and to the patient themself. Bhuvneshari then uses the system to locate the patient, and visits their home within the next 48 hours. This, she emphasized, is crucially important to providing the best TB care; one of the biggest barriers is losing patients to follow-up, and Operation ASHA’s technology greatly decreases the chances of this happening.
While Bhuvneshari was explaining this to us, another patient entered the office to take their scheduled dose. He brought his water bottle with him, although Bhuvneshwari showed us that water was available for patients who did not have it. It struck us that Operation ASHA’s model addresses every possible barrier to proper treatment, down to providing water to swallow pills with, which could be easily overlooked. The patient confidently greeted Bhuvneshwari, and she placed her finger on the fingerprint scanner, logging into Operation ASHA’s eCompliance app. While casually exchanging pleasantries, the patient scanned his own finger into the system, and Bhuvneshwari quickly found his box of TB medication, passing him the pills he needed to take that day. The entire interaction was comfortable, casual, and quick; Bhuvneshwari, like other Operation ASHA providers, is approachable and friendly, and is from the community she serves. As we were able to see during our visit, the process establishes a positive, understanding, and trusting relationship between patient and provider.
TB has a strong stigma, and its treatment process is long and demanding. When we visited Bhuvneshwari’s DOTS center in Tekhand, we realized that Operation ASHA is fully committed to levelling every possible barrier to treatment adherence, whether it be lack of access, or reluctance to continue with such a difficult treatment. Operation ASHA’s model places DOTS centers in the heart of the communities they serve, and through providers like A and tech like ecompliance.
— Hema Venkat and Caroline George