Asha’s Chronic Non-Communicable Disease Management Program
Respiratory Diseases in Slum Dwellers
Asthma and chronic obstructive pulmonary disease (COPD) are second only to traffic accidents as a cause of death in India, with 42 million cases out of a total of 65 million found in the slums. Cases continue to increase, given that smoking and air pollution are the main causes. Contributing factors include the absence of a separate kitchen (which leads to filling poorly ventilated spaces with smoke), the types of fuel used for cooking, and the locations of slums locations next to roads, highways and railway tracks.
The most common forms of the progressive and incurable conditions which define COPD are emphysema and chronic bronchitis; many people have both. Patients with COPD often cough, wheeze, and are short of breath. Despite its high levels of pollution, India stands out as a country with the lowest level of community awareness of COPD.
Diabetes in Slum Dwellers
Diabetes has emerged as a major health challenge in India due to a rapid rise in the number of diabetes cases, often associated with other comorbidities like hypertension, especially among the urban poor. Delayed diagnosis and inadequate or improper treatment lead to poor disease outcomes, and premature mortality.
Factors which increase the risk of obesity, high blood sugar, hypertension and other cardiovascular diseases in the slums include the availability of cheap sugar-rich junk food, Public Distribution Systems which provide only carbohydrate-rich, low-protein foods, and high levels of physical and mental stress due to the social, economic, and livelihood challenges of the environment.
Hypertension in Slum Dwellers
In patients with high blood pressure (hypertension), the long-term elevated force of the blood against artery walls can eventually cause kidney and heart disease, or stroke. About 33% of urban Indians suffer from this “silent killer”, and its management among the urban slum population has been quite poor.
Asha’s Interventions to Manage Chronic Diseases in Slum Dwellers
Asha’s comprehensive three-tier model of primary, secondary, and tertiary healthcare provides slum dwellers with direct access to the diagnosis and management of chronic diseases.
The Asha healthcare team uses home visits to screen for and follow these conditions, accompanying patients to the Asha clinic for diagnostic testing, medication monitoring, and periodic check-ups.
The team also regularly educates the community with the goals of prevention and behavioral change, through the use of interactive community meetings, workshops, and counselling.
Based on the severity of their condition, patients are treated with bronchodilators and inhalers. Rotacaps are preferred over inhalers. Nebulizers are used as needed. Team members explore triggers such as occupational hazards and advise a change of occupation if necessary. They explain the value of a balanced and nutritional diet that includes fruits and vegetables, and advise patients to avoid cooking with biomass (wood and animal waste) fuel when possible
Bronchodilators helps to open lung airways to make breathing easier, and steroids reduce inflammation and promote tissue growth and repair. Medications is given through rotacaps and nebulization as necessary. Oral medication can also be helpful.
The Asha healthcare team regularly advises COPD patients through home visits and workshops on effective strategies for self-care, including breathing exercises, and reductions in the use of tobacco-related products.
Asha provides therapeutic oxygen to support the lungs of patients with breathing problems. Its centers have been equipped with oxygen concentrators for emergency use.
Measures to support recovery and fitness include exercise, nutritional counseling, and education.
Staff educate patients on how diets low in carbohydrates reduce carbon dioxide production and which help COPD patients better manage their health. Diets rich in proteins are encouraged.
Asha Interventions in Diabetes and Hypertension Management
Treatment Staff monitor fasting and PP blood sugar levels, as well as the more accurate measure of the average blood sugar level, HbA1C. Hypoglycemic drugs are given as needed. Patients with comorbidities are carefully monitored and treated. CHVs emphasize that a balanced diet, proper lifestyle management, and exercise are as important as with medication for diabetes control.
Treatment: Treatment is given with anti-hypertensive drugs. Asha teams monitor blood pressure and medication adherence at home visits, and work to reduce cardiovascular risk through smoking cessation and efforts to lower cholesterol. The CHVs recommend diets rich in magnesium, potassium, and fiber; reduced salt intake; and regular exercise.
Asha’s Impact on Chronic Diseases in Slum Dwellers
- Early diagnosis and treatment resulting in reduction in undiagnosed cases across Asha slums
- Better disease control by providing free treatment, regular medicines, follow up and monitoring
- Timely access to care and treatment via increased linkages among supports
- Better health practices by addressing factors causing disease
- Better quality of life by improved adherence to treatment
Within the congested and tiny lanes of Ekta Vihar slum community lies the home of Gurmukhi, a 62-year-old woman. She has spent all her life within the lanes of this slum. Gurmukhi was barely a teenager, when she was arranged to be married and relocated to New Delhi from the state of Uttar Pradesh.
Life got busy as Gurmukhi became a mother to 5 children and that occupied her time. Her husband also held a decent position at a government office, his pay was minimum but the large family managed to survive on it. However, over the years, Gurmukhi picked up the bad habit of smoking from her husband. She started by consuming cheap local tobacco cigarettes once in a while, which eventually let her to become habitual smoker.
To make matters worse, Gurmukhi’s husband passed away due to a lung disease. However, even after facing such tragedy, it was very difficult for Gurmukhi to let go of this habit.
Soon, Gurmukhi soon started to face difficulties in breathing, she visited the Asha polyclinic in Ekta Vihar to consult with the doctors and nurses. The Asha team identified Gurmukhi immediately as a high-risk patient who was suffering from Chronic obstructive pulmonary disease (COPD). She was displaying all the symptoms such as, emphysema, chronic cough, shortness of breath, chest tightness, and a high lack of energy along with swelling in her ankles, feet and legs.
The Asha doctor provided Gurmukhi with the necessary medications and interventions that she needed to start immediately. The Asha team made sure to highlight the seriousness of this disease to Gurmukhi and her family.
The Asha nurses visited Gurmukhi’s home regularly to nebulize her regularly. This intervention by Asha started to improve Gurmukhi’s breathing within a few days. She started to breathe better and was motivated to quit smoking and improve her health. ‘Asha helped me when I was beginning to lose hope in myself. I thought I was destined a fate as my husband’s, but now I can see a better future for myself’ says Gurmukhi with a smile on her face.