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7^th Ideal Village Conference, IMS-BHU�Panel Discussion�12^th November 2022

DR. VIJAYA NATH MISHRA

PROFESSOR & HEAD

DEPARTMENT OF NEUROLOGY

INSTITUTE OF MEDICAL SCIENCES

BANARAS HINDU UNIVERSITY

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Introduction

70% population resides in rural India.
Health care challenge – Limited resources, Underutilization of available services, poor participation by locals.
Treatment gap.
Lack of health awareness.
Non functional Primary health centres.

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Varanasi, oldest living city of World situated at banks of Ganga river.
Ganga, lifeline of North Indian population is major source of water in city.
Still after 30 years of Clean Ganga projects, Ganga water remains polluted.
Sewage pollution to river is biggest challenge.
High incidence of Contact dermatitis, Hepatitis, Protein Energy malnutrition, Epilepsy, Parkinson’s Disease have been noted.
Of these, Neuro-cysticercous is major cause of epilepsy.

Our Study

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Contd…

We took an Upstream Village (Ramana), another downstream village (Saray Mohana), and another village, which is 51 Kms from Varanasi city (Jangle Mahal) for comparison.
Regular epilepsy camps have been conducted among these villages by our group since 2012, approx 1 camp /month had been regularly visited by Prof. V N Mishra.
Till date, 78 such camps have been completed.
Our team have regularly updated the community case findings along with free treatment.
The present investigation involved a door-to-door survey.
In the present survey, neurologists conducted a complete census and administered the questionnaire in the local Hindi language to every household.

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Methodology

The objectives and rationale of the survey were discussed with local village heads, responsible seniors, and officials to enlist their cooperation and support.
Questionnaire comprised of questions aimed at disclosing the presence of epilepsy and was modified from the WHO questionnaire.
The medical social workers (neurologist) who were recruited to participate in the survey were trained in epilepsy by lectures and videotape demonstrations of seizures and the proper interview method and were taught how to complete the screening questionnaire.
They administered the screening questionnaire.
The interview method and filling out of the questionnaire were supervised and crosschecked by the study neurologists.

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Our Ongoing Rural heath outreach program…

Population Screened – 3,500
35 Epilepsy Patient with Neurocysticercosis (NCC).

Ramna

(Varanasi)

Population Screened – 4,500
20 Epilepsy Patient with Neurocysticercosis (NCC).

Saray Mohana

(Varanasi)

Population Screened – 800
15 Epilepsy Patient with Neurocysticercosis (NCC).

Jangal Mahal

(Chunar)

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Our objective…

Increase the health habits and behavior of families
Strengthen their confidence in government services
To identify the existing knowledge, attitude towards epilepsy and current practices they are conducting for prevention and treatment for treatment of epilepsy and other neurological diseases.
Organize mobile health teams to regularly visit and provide health services to marginalized communities and mobilizing the un-served or marginalized communities to participate in responding to their identified health needs
Respond to basic needs of the people through education, training and services

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Our other rural heath outreach program

The present study is conducted at the Department of Neurology OPD of Sir Sunder Lal Hospital, IMS, BHU, Varanasi. We categorizes all the patients according to the native place they belongs (Ramna, Sarai Mohana, Chitrakoot, Deoria, Ghazipur, Jaunpur, Jungle Mahal and Mirzapur).

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Types of traditional treatment	Ramna	Sarai Mohana	Chitrakoot	Deoria	Gazipur	Jaunpur	Jangal Mahal	Mirzapur
^{Burning Pyre walking}	--	--	--	7 (1.03 %)	11 (1.62%)	--	2 (0.29%)	1 (0.14%)
^{Hot Rod Skin Burning}	1 (0.14%)	--	1 (0.14%)	--	24 (3.55%)	2(0.29%)	--	1(0.14%)
^{Bread from burning cremation woods}	2 (0.29%)	-	3 (0.44%)	19 (2.81%)	73 (10.81%)	2(0.29%)	--	--
^{Religious water bathing}	3 (0.44%)	--	4 (0.59%)	134 (19.85%)	75 (11.11%)	42 (6.22%)	4 (0.59%)	3(0.44%)
^{Religious water drinking}	4 (0.59%)	2 (0.29%)	5 (0.74%)	106 (15.7%)	107 (15.85%)	62 (9.18%)	5 (0.74%)	4(0.59%)
^{Eating bed bugs}	--	--	--	--	--	--	3 (0.44%)	3(0.44%)
^{Drinking milk from black cow}	--	--	2 (0.29%)	12 (1.77%)	34 (5.03%)	--	2 (0.29%)	4(0.59%)
^{Wearing religious threads}	4(0.59%)	5 (0.74%)	5 (0.74%)	250 (37.03%)	146 (21.62%)	74 (10.96%)	2(0.29%)	6(0.88%)
^{Be-heading cock and lamb}	--	--	1(0.148%)	100 (14.81%)	53(7.85%)	82	3(0.44%)	2(0.29%)
^{By giving monkey child}	--	--	--	--	--	--	--	2(0.29%)
^{By depositing epilepsy tax}	--	--	--	--	--	--	--	2(0.29%)

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Efforts done by myself

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Efforts made using digital platform

We have created an awareness movie “Ek Naya Din” for spreading awareness about epilepsy.
Till now more than 10,000 shows has been organized in India, Nepal, Sri-Lanka, Bangladesh, Australia, Sweden, Canada and New Zealand.
We have published a manuscript in Lancet (2013)

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Jangal Mahal Village (Mirzapur/Chunar)

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S.No	Myths in Rural Population	Ramna (%)	Saray Mohana (%)	Jangal Mahal (%)
1.	Faith healer can treat Epilepsy	18-20	20-25	30-35
2.	Epilepsy is the Possession of Evil Spirit	17-20	18-20	20-25
3.	Marriage can treat Epilepsy	8-10	7-10	5
4.	Smelling Chappal/Shoes, Iron bar or key in hand can treat Epilepsy	30-35	28-30	35-40
5.	Hiding the disease during Marriage due to fear of acceptance	30-35	27	35-37
6.	Epilepsy patients can marry	72	68	56

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Efforts made for COVID-19 Pandemic

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S. No.	Status	India	Uttar Pradesh	Varanasi
1	(April’2021) Confirmed Deceased	65,41,311 45,403	3,64,682 13,121	42,975 199
2	(May’2021) Confirmed Deceased	88,82,565 1,17,247	4,37,692 7,776	15,634 271
3	(Total cases till 28^th July’2021) Confirmed Deceased	3,14,83,463 4,22,055	17,08,226 22,754	85,419 971

Total number of deceased individuals (5402) in nearby cities of Varanasi till date

Bhadohi-163
Jaunpur-233
Chanduali-355
Mirzapur-116
Allahabad-1064
Mau-80
Lucknow-2651
Balia-233
Azamgarh-228
Ghazipur-279

Work

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Milestone

Since April 2021, 19 Villages covered.
40234 patients screened by oximeter, thermal

scanner, COVID antigen.

92 patients with hypoxia were detected.
42 hypoxic patients, required urgent hospitalization.
Out of these 37 patients saved.

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The “Oxygen Pheriwala” effort recognised by various media houses

Article published in Amar Ujala dated May 13, 2021 [Source: Amarujala.com, Varanasi region]

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Efforts made by volunteers

RAMNA

SARAY MOHANA

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Work done for stroke management

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Efforts made for Women Empowerment

We have approached the Green Gang (a group of village women activist; who primarily work for anti-alcohol movement in the village) for spreading awareness across the different village group.
These women motivate other female to join the group and take stand against different kind of ill-practices going in the society.

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Go Clinic:

Patient treatment in rural areas and on the Ghats's of the Kashi

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Epilepsy-village camps

Around 14 epilepsy camp has been conducted in the remote areas of Deoria, Ballia, Varanasi, Mirzapur and Sonbhdra and screened 213 patients.
We have found 100% treatment gap in the remote areas such as Jangal Mahal (Chunar), Sonbhdra, Ballia, Deoria. The reason of 100% treatment gap is poverty, illiteracy and their social belief.
We have approached the Green Gang (a group of village women activist; who primarily work for anti-alcohol movement) for spreading awareness about the epilepsy.

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Thank you…