Appropriate Technology

In a farming village outside Jamkhed, a Village Health Worker and the Mobile Health Team are checking the weights and hemoglobin of adolescent girls and testing glucose levels in the urine of villagers living with Diabetes.

Here are their supplies:

A test tube and metal test tube holder
Locally grown cotton and rubbing alcohol
A bottle of blue liquid labelled ‘Benedict’s Reagent’
A bottle of clear reagent
An old plastic container and a dropper
A rubber tube and lancets
A small black hemoglobin reader, and
A weigh scale

Opps, they forgot the matches….a few words in Marathi are exchanged and in no time, a young boy arrives with a big smile and a small box of matches.

Today will be a light day. It’s harvest time and most of the villagers, including pregnant women, are in the fields, working in 35 – 40 degree Celsius heat harvesting chickpeas and sorghum, one of the top five cereal grains in the world.

About 10 adolescent girls show up at the Village Health Workers home and wait their turn to be tested. They all belong to the adolescent girls group. The older diabetics arrive and ask the girls to sing a Marathi song about what happened to their people during an earthquake many years ago. One by one each girl is weighed and her weight recorded carefully in the Mobile Health Team logbook.

The social worker opens a sterile lancet and pricks the young girl’s finger to get a blood sample. She puts a rubber tube in her mouth and draws some blood up into the tube. She releases the suction and the blood flows into a glass test tube containing a few drops of clear reagent. She rolls the test tube between her hands and places it in the hemoglobin reader. A minute later, she announces for all to hear that the hemoglobin is 9.5 and records the result in the logbook. She will accept a hemoglobin of 10 but 9.5 is too low. The girl gets a gentle, friendly scolding and is told that she has to talk to her mother about making sure she eats more spinach and meat. The Village Health Worker will go and talk to the mother as well and the girl will be retested next month when the Mobile Team returns to the village.

Now it’s time to test an elderly male villager’s urine for glucose. The Village Health Worker puts two fingers of blue liquid in a test tube. She lights a match and ignites a piece of alcohol soaked cotton and places the test tube over the flame to warm the reagent. Next she adds 7 to 9 drops of urine and places the test tube back over the flame until it starts to bubble. Then she removes the test tube and waits to see if the blue liquid changes to green, yellow or red, indicating the amount of glucose in the urine.

With a comical look of disgust on the Village Health Worker’s face, she shows everyone watching that the colour has changed to yellow. After a somewhat heated discussion with the older gentleman, he gets up out of his cross-legged sitting position and walks back to his hut to take the medicine he was given for his diabetes. He had stopped taking his medication because he preferred going to the local healer and taking her herbs instead. Now he and everyone within earshot knows that the local healer’s herbs don’t work and they should listen to the Village Health Worker.

Why, you may ask, are they not sending these villagers to the CRHP lab to get their blood work done? Why aren’t they using dipsticks to test urine? The answer is, that neither of these is appropriate.

Firstly, there are the issues of accessibility and acceptability. This farming village is a good half hour drive from CRHP, which would be hours by ox cart. These villagers need to be working their land and tending their crops to earn their livelihood. Many would choose not to have the blood test done if they had to go to the CRHP hospital lab, which could seriously impact the health of the village.

Secondly, there are the issues of affordability and availability. Health care is provided on a fee for service basis at the CRHP hospital and many of these villagers are living well below the poverty line and would chose having money for food over spending money on doctor’s visits and lab tests at the hospital. The Village Health Worker lives in the village where she works and is available whenever needed. She and the Mobile Health Team offer testing and care that can be carried out close to home and fairly quickly, and it is free of charge to the villagers.

Also, long-term external funding would be needed for CRHP to have a sustainable source of urine dipsticks. Even if the funding was available and the village health workers started using the dipsticks, what would happen if over time, the funding source dried up and no more dipsticks were available? All the village health workers would need to be retrained in the original testing techniques leading to confusion, extra training costs for CRHP and would mean time away from the village for the Village Health Workers to be retrained.

So, although the technology may seem archaic to a westerner, it gives the Village Health Worker the information she needs to care for her community, within the community and to refer villagers to the hospital only when absolutely necessary.