Koulath’s beaming face was telling it’s own story when the wheelchair started to move and turn around as in magic. She was controlling the motorised wheelchair with a small knob on the right armrest of the chair. Her family couldn’t possibly afford to buy this expensive movement aid. Now, with the help of state government, she could go beyond the boundaries of her small house without depending on someone.
“I was waiting for this day” she said with the expressions of a teenage boy who has just received the driver’s license!
Koulath was one among the 16 differently abled persons who had been selected to receive theequipment as part of the annual local self governing body (LSGD) project.
This post is related to how we (the team at health-workers at the primary health centre) managed to carry out the project to purchase and distribute various equipments for the differently abled persons. There were lots of hurdles along the way. There were moments when the project had come to a standstill. This is the story how the project became a memorable one for me and my team at the PHC.
For the past three years I have implemented many projects to utilise the state government’s annual plan fund for healthcare activities.Majority of these projects are planned and carried out at the panchayat (village) level every financial year. The palliative care programme, which has been made a compulsory annual project at every LSGD level has already been covered in earlier posts. Some of the other major projects that were implemented were :
- to purchase medicines for the PHC
- do maintenance work at the PHC
- to harvest rain water at the PHC
- purchasing medicines for other government aided AYUSH hospitals in the panchayat
As a medical officer, I am entrusted with the responsibility of implementing the panchayat’s healthcare related projects. One of the duties that has to be carried out by a government hospital medical officer. In my first year of service as the in-charge medical officer, I’ve struggled to learn the trade of doing the proper file work to avoid any kind of audit objections. Understanding the stock purchase rules was a starting step in those days which has immensely helped me later on.
To be honest, I grudged when the call from the panchayat accountant came on the first week of June 2015. The board of members at the panchayat had unanimously voted to initiate a new project for the financial year and had decided to hand over the implementing charges to the medical officer. The new project was roughly estimated at 2 lakh INR and was to purchase aids, equipments or instruments for the differently abled persons residing at the panchayat. When I enquired about this project, I came to know that the CDPO (child development project officer) was the right person to implement the project and that was the norm in several other panchayats. It turned out that there was no CDPO for our panchayat and that’s why the medical officer was being given the responsibility of the project implementation.
In July 2015 a survey was conducted at our panchayat to identify persons with disability. I thought, the data from this survey could be made use in the project. You need to find out the beneficiaries to start the project right! Well, my hopes were crushed when I was informed by the ICDS (integrated child development service) department that the data from the survey cannot be used officially for any purpose before they get published. They were not even sure of when that day was going to be! Fortunately, this particular survey was conducted by Accredited Social Health Activist and multi purpose health workers at our own PHC. Thus there was no difficulty in getting an informal consolidated survey report of our panchayat from them. In fact, I had a list of all the disabled persons residing in our panchayat. But, that wasn’t enough.
A medical camp had to be conducted with the help of specialist doctors in the orthopaedic and ENT departments. The date for conducting the camp was postponed two times due to the LSGD elections in November 2015. Finally, in Feb 2016 when the date for the medical camp was decided, I found it a tedious job to get the service of the specialist doctors on the set date. I had to write three letters to the district medical officer (DMO) to depute doctors for conducting the camp. It was with the help of the junior administrative medical officer (JAMO) that an order was finally made which ensured the service of two specialist doctors from district hospital. I had to write letters to the concerned medical officer to relieve those doctors for camp duty. When I contacted the doctors, they were willing to attend the camp on two reasonable conditions. They had to be given a government sanctioned honorarium and that proper transport facility should be arranged for their conveyance on the set date.
When all that was arranged, I learned that orthopaedic technician and audiologist should also be present at the medical camp site to take measurements and do audiometric assessments. Now, where am I going to find these technicians? Dr Prasheen, one of my batch mates at Calicut Medical College who had previous experience of successfully completing this project helped me out at the right time. I contacted Keltron (Kerala electronics corporation limited), a government of Kerala organisation with Prasheen’s help. Now, there were three advantages of choosing Keltron :
- Appoints the technicians at the medical camp site (free service)
- Provides all the equipments and instruments that has to be distributed at reduced rates
- There is no need to stringently follow the stock purchase rule as Keltron is a government-owned organisation
The disability assessment medical camp was held on the 16th of February at our PHC. The persons in the list had been informed well in advance to attend the camp. Only 40 persons showed up at the camp on that day. Children suffering from cerebral palsy, mental retardation, hearing defects, orthopaedic anomalies were all present along with their guardians. Koulath and Nayana were attracting the attention of others at the camp site. Koulath was paralysed below her waist after sustaining a life threatening traumatic incident. Nayana was suffering from osteogenesis imperfecta, a genetic disease that affects the growth of bones and yet she had cleared the secondary school leaving certificate (SSLC) exams! Two remarkable persons I’ve ever met. There was Mr. Salim who had lost his right hand above the elbow after amputation following a road traffic accident. Refreshments were given for all the persons who attended the camp. I thought most of them would’ve been relieved to see other disabled persons. The overall mood at the camp site was not dull as anticipated.
All the differently abled persons were examined by the specialist doctors. Some of them were advised to use aids, others weren’t. The audiologist conducted pure tone audiometry tests on 5 persons and 3 of them were advised hearing aids by Dr Vijaya, the ENT specialist from Payyannur. The orthopaedic technician from Keltron was the busiest person at the camp site. He had to take measurements of 22 orthopedically challenged persons including children. Dr Maya, PMR specialist from district hospital Kannur had advised 3 motorised wheelchairs for Koulath, Nayana and Sujindran. Mr Salim was advised a functional prosthetic upper limb. Others were getting splints, orthosis, tripod sticks, protective footwear, compression garments, crutches etc. Muhammad, the 8 year old child suffering from cerebral palsy was getting a deluxe wheel-chair custom made for him. The big part of the project was over in just three hours.
A total of 16 beneficiaries were advised various types of movement and hearing aids by the specialist doctors. The next part of the project was to purchase these items. The technicians from Keltron had taken a copy of the doctor’s examination notes and the measurements record with them.
The selected beneficiary list had to be approved by the panchayat board and the decision to purchase equipments for them were to be included in the minutes of the meeting. That alone took another months time. Another meeting of the so called “purchase committee” was held to finalize the decision to offer the purchase contract to Keltron itself. They were given the contract to supply the items in three months time. A supply order for the items was sent within a few days of conducting the camp to Keltron. When all the documents for completing the project was finally obtained at our office, it was the 20th of March 2016.
This project was intended to be completed within the 31 March 2016 because the funds were plan funds of the state government and they could not be withdrawn or utilised beyond the last day of the financial year. The last 10 days of March is the time when all the project funds get withdrawn from the treasuries. It’s a busy time at the government offices in the country. Our fund requisition letter for this particular project amounting to 2 lakh Indian rupees was waiting for the panchayat secretary’s signature. We received the allotment letter for the fund withdrawal on the 28th March and the same had to be converted into a demand draft to be sent to Keltron. The last-minute run for releasing the funds was a tiring one indeed and could’ve been easily avoided. Anyway, the funds were not lost and the payment was made just in time.
It was on 25th May 2016 that we received the three big boxes from Keltron. The motorised wheelchairs were the stars of the lot, costing a whopping 80 grants each! Malayalees who have watched the movie “Bangalore Days” can easily recognise a motorised wheelchair. The one used by the radio jockey! All the items were taken into stock by the hospital pharmacist who is also the store keeper in charge at the hospital.
It was on 30th May that I received the phone call from the panchayat president enquiring about the availability of the equipments. When I told her that all the items had already been received, she was delighted! Apparently, the district collector had agreed to inaugurate the program for distributing these equipments. There were plans to make this event a memorable one and it was scheduled to be held on the 2nd of June. The only thing that I was worried about was the venue of this program. That’s because, the panchayat hall is on the second floor of an old panchayat building which does not even have a proper stairway! The president assured me that the venue for this event will be changed to the ground floor considering the ease of access for the project beneficiaries.
On the day of the program I was literally disappointed when I learned that the venue was at the panchayat hall itself. Koulath was waiting outside the panchayat building in an auto-taxi with her relatives. It was clear that the distribution of wheelchair and other orthopaedic equipments wouldn’t be held at the panchayat hall, but downstairs at the entrance area. The organisers of the program were more concerned about the anticipated rainfall that could spoil an outdoor event which is why the function was being conducted at the second floor.
On the same day, prizes were distributed to about 50 students who had achieved top grades in the last academic year’s school as well as competitive entrance exams. The hall was packed with all the students and their well-wishers. If the program was not coupled with the prize distribution for the students, I think there would have been a drastic fall in the number of persons who had shown up!
The honourable district collector, Mr. Bala Kiran IAS arrived at the venue right on time and the program started with welcome speeches. The collector in his inaugural speech acclaimed the students and told that Kannur was one of the most “disabled person friendly” districts in the state. He had some great experiences to share about the project for the differently abled persons. He made a remarkable announcement in his speech which was greeted with a loud round of applause. He was willing to grand funds to construct an elevator at the old building to make the panchayat an easily accessible one for the differently abled persons. His speech was followed by the distribution of hearing aids and orthosis for five beneficiaries. Koulath and Nayana received their motorised wheelchairs from the district collector afterwards at the entrance area.
When the technician from Keltron gave a demo of how to use the wheelchair, all eyes were on Koulath. Her facial expressions and the tears which rolled down her cheek were telling a triumphant story. That simple moment made all the hardships seem like brittle sticks. How I felt at that moment cannot be described in words, expressions or sentences.
What do you think about this project? Do you have any similar experiences? Share your thoughts in the comments below.
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