Sevak Project: Access to Care in Rural Sevak Project: A Model for Access to Care in Rural India

Thakor G. Patel, MD, MACP, Chairman, USA Ranjita Misra, PhD, Co-Chairman, USA Viren K. Patel, India Prakash Goswami, India Jivraj Damor, MD, Consultant

Affiliates American Association of Physicians of Indian Origin, USA WHEELS Global Foundation Inc., USA M.S.University, India Bhartiya Seva Samaj, India Sevak Foundation, Inc., USA Raina Foundation, USA Sevak

• Sevak Project is based on the U.S.Navy model of Independent Duty Corpsman • A village per district (33) was selected from the state of , today there are over 100 villages in the Sevak Project – The average population of the village was about 1500-2500 – Sevaks were identified with average education of 12th grade and above Sevak Project: Developing the Requirements. How It Began? • Study of Indian American in the USA • Study of Indians in 6 Tamil Nadu Villages • Study in Karakhadi, Gujarat By Dr. Padmini Balagopal • Had 300 patients with hypertension, question was what to do? How It Began (Cont)

• Moral dilemma how to help the people in the villages • After two months of soul searching, found the solution: Independent Duty Corpsman of the U.S.Navy • Important on developing requirements for the project. U.S.Navy example How It Began (Cont)

• Develop curriculum • Length of course • Size of the project • Make a pilot project to make sure it will work Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study • Ranjita Misra,⁎, Thakor Patel , Purushotham Kotha , Annaswamy Raji , Om Ganda , MaryAnn Banerji , Viral Shah , Kris Vijay , Sundar Mudaliar , Dinakar Iyer , Ashok Balasubramanyam

• Journal of Diabetes and Its Complications 24 (2010) 145–153 Requesting Permission from Hon. Mr. Modi

Sevak

• The Sevaks are in their respective villages doing screening for diabetes and hypertension along with recording other health care problems • They are required to educate the village folks about the merit of having in house toilets and smokeless stoves ventilated to the outside WHY Sevak Project?

• Sevaks live in the village • They know the people and problems of the village • Locals respond to their own • BP and Diabetes screening is new to them and need someone to explain and trust • Data collection is on income, work, type of water(source), source of cooking fuel, education, chronic diseases, vaccinations etc WHY Sevak Project?

• Many new diabetics and hypertensive patients have been identified by the Sevaks • They are referred to the Primary Health Clinic • Special cases identified by Sevaks are referred to the cities, Sevaks accompany them • They know houses without toilets and have pushed them to get toilets through government grants. Today over 85% of the families have in house toilets in all Sevak villages with some at 100% WHY SEVAK PROJECT?

• Ten RO plants have been installed in the Sevak villages by partnering with WHEELS Global Foundation USA ( an IIT Alumni organization) • In one village 250 out of 1000 had kidney stones, today only 12 • In one village WHEELS and Habitat for Humanity helped build toilets –reaching 100% of the villagers Sevak Project: TB Free Sevak Villages

• Sevaks were trained by CETI, Indore and in partnership with AAPI have instituted a program to make all the Sevak villages TB Free. This will help write the road map for rest of India. • They have already started to identify many new patients with TB, overlooked by the TB Surveillance program. Sevak Project: Maternal-Child Health • All girls from age 11 to women 40 years old are screened for anemia and if they have a hemoglobin level below 10, will be treated. • Working on fortifying the family food with iron. • Breast Feeding Training being conducted by Drs.Padmini and Rupal • These initiatives will help decrease maternal-child morbidity and mortality and lead to healthy children and healthy India. Telemedicine/Telehealth

• Many of the PHC’s are not staffed adequately • Telemedicine may be the solution for this critical need to prevent patients having to travel to cities. • In big villages with over 10,000 population telehealth with Sevak training maybe viable • Sevaks form the foundation for preventive health and with training other health solutions can be implemented. Sevak Checking Hb with TouchHb Machine COVID

• Sevaks were asked to take the government online training course, they complied and now educate the villagers on the principles of prevention of COVID Anatomy class for New Sevaks Sevak seminar Sevaks 2018 with the Chancellor of Maharaja Sayajirao University, Rajmata Shubhangini Devi Gaekwad and Dean, Baroda Medical College Sevak training center, Sevak training center, Vadodara Anemia Chart Sevak Visiting Patients in Khatichitra Sevak Collecting Data Sevak conducting an education class Rajendra in Navalgadh, Surendranagar Ramilaben in Sonalnagar, Kutch Ramilaben in Sonalnagar, Kutch Rajubhai checking BP Ramilaben donating food in Kutch Electrician received 460volt current and became a triple amputee Patients toilet After Sevak Project helped get the new seat Insulin Dependent Diabetes Patient in Kundal A blind patient getting his BP checked Sevak Jalpa is also running an RO plant after her vision was surgically restored Work to date

• AHA trained all the Sevaks in “How to Save Children’s Lives below the age of 5” in Dec 2014 in Vadodara. • WHEELS has installed Reverse Osmosis Water plants in 10 villages and two more are in the planning stages. • The water is sold at a nominal price of Rs. 5 per 20 liter bottle to offset the maintenance cost Work to date

• Installed a Sanitary Napkin manufacturing plant in Motakalavad, Devbhumi Dwarka Dist., to create hygienic condition and create jobs for local women. • In Navalgadh, Surendranagar Dist. village installing two sewing machines to train and create jobs sewing clothes • Working with Cancer Center, Civil Hospital, on a plan to screen women for breast and cervical cancer in the Sevak Villages • Sevaks are screening girls 11 years old to women 40 years for anemia with ToucHb machine, so far they have screened over 13,000. Sanitary Plant, teaching local women to make the napkins Sanitary Napkin Manufacturing in Motakalavad, Devbhumi Dwarka Sewing Class in Navalgadh, Surendranagar District Learning to Sew Location of insulin vial storage GENDER DISTRIBUTION EDUCATIONAL BACKGROUND

Total 60197 INCOME LEVEL Dietary intake Overweight and obesity levels Tobacco use and smoking Village information: drinking water

Total 60,197 Participants DIABETES Status (based on fbs) CHRONIC DISEASES-HYPERTENSION AAPI Award Ahmedabad 2014 AAPI AWARD India Abroad Jan 2014 Gujarat Samachar Dec 2013 Gujarat Samachar TIMES of India Dec 2012 Times of India Dec 2017 Gujarati News www.wheelsglobal.org www.sevakproject.org www.tgpatel.com Thank You