Search results for: Rajiv Jash

Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

Abstract:

Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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Authors: Mala Mukherjee

Abstract:

Background: India is urbanizing very fast and urbanisation in India is treated as one of the most crucial components of economic growth. Though the pace of urbanisation (31.6 per cent in 2011) is however slower and lower than the average for Asia but the absolute number of people residing in cities and towns has increased substantially. Rapid urbanization leads to urban poverty and it is well represented in slums. Currently India has four metropolises and 53 million plus cities. All of them have significant slum population but the standard of living and success of slum development programmes varies across regions. Objectives: Objectives of the paper are to show how urbanisation and slum development varies across space; to show spatial variation in the standard of living in Indian slums; to analyse how the implementation of slum development policies like JNNURM, Rajiv Awas Yojana varies across cities and bring different results in different regions and what are the factors responsible for such variation. Data Sources and Methodology: Census 2011 data on urban population and slum households and amenities have been used for analysing the regional variation of urbanisation in 53 million plus cities of India. Special focus has been put on Kolkata Metropolitan Area. Statistical techniques like z-score and PCA have been employed to work out Standard of Living Deprivation score for all the slums of 53 metropolises. ARC-GIS software is used for making maps. Standard of living has been measured in terms of access to basic amenities, infrastructure and assets like drinking water, sanitation, housing condition, bank account, and so on. Findings: 1. The first finding reveals that migration and urbanization is very high in Greater Mumbai, Delhi, Bangaluru, Chennai, Hyderabad and Kolkata; but slum population is high in Greater Mumbai (50% population live in slums), Meerut, Faridabad, Ludhiana, Nagpur, Kolkata etc. Though the rate of urbanization is high in southern and western states but the percentage of slum population is high in northern states (except Greater Mumbai). 2. Standard of Living also varies widely. Slums of Greater Mumbai and North Indian Cities score fairly high in the index indicating the fact that standard of living is high in those slums compare to the slums in eastern India (Dhanbad, Jamshedpur, Kolkata). Therefore, though Kolkata have relatively lesser percentage of slum population compare to north and south Indian cities but the standard of living in Kolkata’s slums is deplorable. 3. It is interesting to note that even within Kolkata Metropolitan Area slums located in the southern and eastern municipal towns like Rajpur-Sonarpur, Pujali, Diamond Harbour, Baduria and Dankuni have lower standard of living compare to the slums located in the Hooghly Industrial belt like Titagarh, Rishrah, Srerampore etc. Slums of the Hooghly Industrial Belt are older than the slums located in eastern and southern part of the urban agglomeration. 4. Therefore, urban development and emergence of slums should not be the only issue of urban governance but standard of living should be the main focus. Slums located in the main cities like Delhi, Mumbai, Kolkata get more attention from the urban planners and similarly, older slums in a city receives greater political attention compare to the slums of smaller cities and newly emerged slums of the peripheral parts.

Keywords: urbanisation, slum, spatial variation, India

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