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Role of nurses in delivering healthcare services to marginalized communities

Shanti Teresa Lakra
Wednesday, June 7, 2023, 08:00 Hrs  [IST]

Nurses play a critical role in delivering healthcare services, particularly in communities with limited access to medical facilities. As a nurse myself, working with particularly vulnerable tribal groups (PVTGs) in the Andaman & Nicobar Islands of India, I have seen firsthand the challenges and rewards of working in marginalized communities.

Role of nurses in improving healthcare services
The first thing I noticed when I started serving the marginalized community was that pregnancy and deliveries were handled by the elders of the community. These are elders who gained their experience and learning from elders and didn’t know much of the new-age pregnancy and childbirth related problems. Due to the unavailability of antenatal care (ANC) checkups in these areas, many complications were faced during labour, and many mothers and newborns lost their lives.

The infant mortality rate (IMR) of the marginalized community in Andaman & Nicobar had a drastic difference, decreasing by more than 50 per cent due to the efforts of nurses and other healthcare workers. The infant mortality rate was around 18 per cent during the 2001 census, which came down to 8 per cent by 2010. This reduction can be attributed to the availability of antenatal care (ANC) checkups, safe deliveries, pre-natal and post-natal checkups, and the avoidance of complications, all of which are provided by nurses and other healthcare professionals.

However, working in tribal areas as a nurse is not an easy job. One has to be sensitive towards their socio-economic culture, spend time listening to and understanding their premises. Outsiders are generally not welcomed into their areas, and nurses have to gain their trust and convince them of the potential outcomes of untreated medical issues. In areas like these, even a simple fever or respiratory tract infection can become severe pneumonia, which can turn fatal without medical assistance. Nurses have to exercise patience and explain disease patterns to convince the community of the importance of seeking medical attention.

Impact of technology on healthcare delivery
The majority of India's population lives in villages, and providing healthcare facilities to the interior areas of villages is a great challenge. In many cases, people have lost their lives without receiving treatment because there were no proper transport facilities to refer patients, and during emergencies, there was no communication available to evacuate patients in time. Fortunately, with the introduction of mobile phones, video conferencing apps, and other telecommunication devices, healthcare facilities have been able to improve. This technology enables healthcare services to be provided directly to patients' doorsteps, and the sharing of any form of data has become much easier.

Technology has been particularly helpful during the Covid-19 pandemic. When basic facilities were unavailable, and physical contact was prohibited, the only safe method of communication for awareness was through telephonic conversations, video conferencing, and photo sharing. We provided awareness classes to the field staff near the communities/tribes, and they were asked to show videos and pictures to the tribes for effective sensitization. As a result, the tribes isolated themselves from the outer world and moved towards the forest. This action prevented any tribe from being severely affected by Covid-19, and we can proudly say that we did not lose any lives during the pandemic. The impact of videos and pictures was 100 per cent effective in vaccinating all eligible tribal members, even those in far-flung areas.    

In the marginalized community of Andaman & Nicobar Islands, the population of particularly vulnerable tribal groups (PVTGs) is around 1012, of which all eligible PVTGs (698) were provided with all three doses of vaccination.

Using technology to support nurses in their work
Technology can also be used to support nurses in their work. In tribal areas, approaching people to provide healthcare facilities is a great challenge. If they are nomadic tribes, with their socio-economic culture and language barriers, communication gaps, and no proper transport services, the situation becomes even more difficult. In these conditions, the networking of mobile services can really help to some extent by showing the good and bad impacts of health through pictures and videos.

During the pandemic, we used various apps like WhatsApp, Zoom, and others for sending Information Education Communication (IEC) material and having video calls to sensitize the ground-level workers. With the availability of 4G services in Port Blair, we were able to utilize these technological advancements effectively. In the future, we would like to see the implementation of more advanced technologies like telemedicine, remote monitoring devices, and artificial intelligence-powered healthcare systems. These technologies can help in remotely monitoring patients' health, providing timely interventions, and improving healthcare outcomes. With the right technology, we can bridge the gap between healthcare services and tribal communities, leading to better health outcomes and a healthier population.

Empowering marginalized communities
The nursing profession is a selfless one, and for many nurses, receiving awards for their service is unexpected. Such recognition is a testament to their hard work and dedication, motivating them to continue their work with even more enthusiasm.

I have been nominated as a member of the Indian Nightingale Council since 2011 and also serve as a member of NEC in INC. This has given me the opportunity to participate in several policy decisions related to nursing education and attend national and international workshops, conferences, and general body meetings to improve and develop the nursing fraternity of India.

Regarding the Aster Guardians Global Nursing Award, if I win, the prize money can play a vital role in uplifting minority communities from Bihar, Jharkhand, Orissa, and Uttar Pradesh who have settled in the Andaman jungles for generations. These communities have been living without basic health facilities and have developed harmful habits like tobacco and substance addiction due to their difficult living conditions.

As someone hailing from these communities, I can play a critical role in utilizing the prize money to improve their lives. One way to utilize the prize money is to create awareness programs and provide access to rehabilitation centers to help community members overcome their addiction to tobacco and other substances. The prize money can also be utilized to establish health centers that provide access to basic medical facilities and medicines.

Additionally, the prize money can be used to provide vocational training programmes to equip community members with skills to improve their livelihoods. The training programs can include courses on sustainable farming practices, animal husbandry, and fishing techniques to help them generate income and improve their food security.

Utilizing the prize money to improve the living conditions of the scheduled tribes in the Andaman jungles can make a significant impact on their lives. As someone who belongs to these communities, my input and involvement can help ensure that the prize money is utilized effectively to uplift my community.

Nurses play a critical role in delivering healthcare services, especially in communities with limited access to medical facilities. Their work is vital in improving the health and well-being of people, particularly those in marginalized communities. As healthcare evolves, nurses must continue to adapt and learn new skills to meet the changing needs of patients and communities. Nurses are uniquely qualified to help improve the quality of health care by helping people navigate the health care system, providing close monitoring and follow-up across the care continuum, focusing care on the whole person, and providing care that is culturally respectful and appropriate. Nurses can help overcome barriers to quality care, including structural inequities and implicit bias, through care management, person-centered care, and cultural humility. Nurses work to address the root causes of poor health. As the largest and consistently most trusted members of the health care workforce, nurses practice in a wide range of settings. They have the ability to manage as well as collaborate within teams and connect clinical care, public health, and social services while building trust with communities.

Technology has made healthcare delivery more accessible and effective, and it has the potential to support nurses in their work in many ways. From telemedicine to mobile health apps, technology has the ability to connect nurses to patients, provide vital information and resources, and streamline healthcare delivery. However, while technology can be incredibly helpful, it cannot replace the human touch and compassion that nurses bring to their patients. Nurses are not just healthcare providers but also educators, advocates, and supporters for their patients and families. The human element of nursing is what makes it such a rewarding and fulfilling profession, and it should always be at the forefront of our efforts to improve healthcare.

As we look towards the future of healthcare, it is important to remember the critical role that nurses play in its delivery. We must continue to invest in nursing education and training, as well as in the development of technology that supports nurses in their work. By doing so, we can ensure that everyone, regardless of where they live, has access to high-quality healthcare services and the support they need to lead healthy and fulfilling lives.

{Author is working with G. B. Pant Hospital-Port Blair (India)}


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