A Site Visit to Indira Camp
On 13 June 2018, we went on a site visit to Indira Camp, a slum in Okhla, New Delhi. Upon our arrival, we were led to the DOTS (Directly Observed Therapy, Short-Course) treatment center, optimally positioned near the entrance of the slum. Having an accessible location allowed patients to conveniently visit on their way in or out. At the DOTS treatment center, there was a patient receiving treatment from the provider, Kusum Verma. His fingerprint was taken using the biometric scanning device to log him in with Operation ASHA’s eCompliance system. Once complete, Kusum found the patient’s box of medication with his name on it, giving him his medicine for the day. While watching him take the dosage with some water, Kusum counted out the rest of the medicine strips that he would take home to take on his own. This process repeated for the next three patients that came into the center, all of whom seemed at ease as this visit was just a part of their daily routine.
Against one of the walls of the DOTS center, there was a shelf of different medicines, such as pain and fever reducers, antacids and antibiotics, as well as a rack filled with boxes of TB medication. These boxes were labeled with names of patients, along with the date when they began their treatment. Seeing the active treatment of patients coupled with biometric tracking allowed us to witness the effectiveness of Operation ASHA’s model.
Kusum’s work in the DOTS center is fully integrated into Indira Camp. The center’s accessibility to community members breaks down one of the barriers that restrict many from obtaining treatment. While we were there, Kusum talked about her work with her patients, ranging from detection to following up on missed doses. It is clear that she, along with all other providers, does her best to ensure that patients understand the importance of continuing and completing treatment. Not only does Kusum make sure that her patients understand, but she also works to make sure her patients feel understood. She emphasized the significance of sympathizing with patients, showing support and compassion.
Seeing the functionality of the centrality of the DOTS center helped us realize the true meaning behind Operation ASHA’s last-mile delivery: making treatment accessible for all. Our morning arrival was timed so that we witnessed patients receiving treatment before they left for work. Operation ASHA treatment centers are open early morning and late at night so patients don’t have to choose between earning wages and getting cured. It is critical that treatment methods are designed for patient rather than provider convenience. A system designed with this in mind results in higher treatment success and lower default rates. For this reason, OpASHA has had an unprecedented treatment success rate of 89% and a default rate of less than 4%.
Throughout our site visit, it became evident how critical it is to bridge the gap between the government’s DOTS regimen and the actually delivery of treatment to people in hard-to-reach areas. Many OpASHA sites are somewhat obscure. To illustrate this point, we weren’t able to Uber to the site. The original Uber driver almost led us to a place five hours away, because the Indira Camp slum in Okhla wasn’t recognizable on his digital map. Auto-rickshaws ended up being our best solution.
Our site visit to Indira Camp taught us a great deal about Operation ASHA’s work and mission. The best way to bring TB treatment to underserved individuals is to bring it right to their doorsteps. This philosophy, combined with OpASHA’s innovative biometric tracking system, ensures the full delivery of lifesaving healthcare to those in need.
–Marika Dy and Melanie Rumbel