Iron deficiency anemia is a social disorder. The attitude of the society, not only that of men but also that of women towards each other, is what matters the most. Symptoms of anemia are commonly dismissed as being part of womanhood. “A woman must suffer”- is a horrible notion that must be completely erased from the minds of Indian women. Dietary education needs to be emphasized, especially when dealing with harmful customs, such as not eating sour foods like lemons due to religious beliefs. Lemon and other citrus foods contain vitamin C which helps with iron absorption. The food distributed by women in most households is not favorable to the women themselves. Good medical treatment is often equated with taking expensive medications. General wisdom prevalent in today’s lower economic strata will tell you that if the medication is free (as it is in the government clinics), it must be useless! This led to the decision by the anemia project team to charge at least Rs.5 for the follow-up card given at the time of hemoglobin checking.
I realized that checking hemoglobin only is putting a band-aid on their medical problems. But most of the time this is all they could afford. At least, because of this activity they came to the medical attention.
The ultimate goal of the Anemia project is to give basic preventive health care free to the Indian women. We may not be able to include every little thing that is being done in USA for prevention of common, treatable and curable health problems but a yearly package may be offered to every woman aged 16 to 75 years, that will consist of complete physical exam including breast exam and pelvic exam and Pap smear, testing blood for hemoglobin, kidney function and liver functions, and urine for protein and infection, stools for worms (even in asymptomatic women) checking for diabetes and hypertension. Mammograms (for breast cancer) and DEXA scan (for osteoporosis) are expensive, need experts to read the results and may not serve our purpose.
One anecdotal story must be shared. A schoolgirl aged 17 years who was still in the 8th grade came with her friend because she came to know that blood is being tested for free. She had been having symptoms such as dizziness, shortness of breath, fatigue; she was not doing well in school because of her poor concentration. Her family did not heed any of these complaints. Her hemoglobin was 4gms! She refused going to the hospital for blood transfusion or to a specialist. She took iron tablets regularly for several months along with anti-worm medication, vitamin B1 and folic acid injections. After about 10 months of regular treatment, her hemoglobin came up to 9 gm%. She had tremendous symptom relief. She graduated from her class easily. Better health has brought happiness to her young life. She has been encouraged to go to a specialist for further care. We need to help this hidden part of India.
I also come across a middle class woman, wife of a college professor who had good prenatal care during her preganancy and few moths after the childbirth. But later she was not sure if she should still go back to a doctor! She had never regained her stamina after her delivery; now her child is 6yeras old. Her hemoglobin was 8gm%. This is the confused section of Indian society ; well-to-do but unguided in simple medical matters due to the lack of basic health care.
The medical team running this project voiced that this activity (each camp) should be kept on a smaller scale, catering to smaller communities at a time so that the personal touch and warmth are not lost. The camps at MSS were held once a month at the facility and at other sites once a month on a different day. By doing this, women were getting more chances to come forth and get tested.
If , the seemingly trivial factors in a small town such as distance on foot, time when the municipalty tap water runs, festivals, etc are not taken into account, then the compliance level of the women is affected tremendously; something governmental programs have been fighting against since inception. Nutritional anemia is a hidden epidemic going on for decades in India. Oral iron and folic acid tablets are being supplied free of cost to the rural population of india by the government for the past 40 years (1971), yet the prevalance of anemia in India has not significantly reduced. If we have found the problem (i.e. non-compliance) we need to work on this issue first to find out why the women are noncompliant ,instead of pouring money into a bottomless pit. The education regarding nutrition, home gardening and the competitions held for the iron rich dishes generated a palpable interest and excitement among the women of this small town, Hinganghat and compliance increased accordingly. Now this camp is on auto-pilot. Advertisement is not needed any more. The face of compassion is always more inviting and comforting than the faceless hand dispensing free medications from a pharmacist’s window in a government facility.