Department of Community Medicine

Sri Manakula Vinayagar Medical College and Hospital

Kalitheerthalkuppam, Madagedipeth, Puducherry – 605107

Annual Report

(2010-2011)

 

Website: www.smvmch.ac.in

Phone: 0413 – 2643000, 2643031

Fax: 0413 – 2643014

Email: smvmch@sify.com

Undergraduate teaching:

Our undergraduate teaching aims to make competent primary care physician. We follow the norms set by the Medical Council of India and the Pondicherry University. We are in process to develop community oriented undergraduate teaching and to make it relevant to local health needs. Last year, we have developed a ‘hands-on training program on community-based research’ for medical undergraduates and currently we are motivating undergraduates to undertake problem-solving community-based projects and to participate in national health program activities.

Apart from didactic lecture sessions and community exposure visits, we facilitate ‘small group’ interactive teaching to maximize learning on the topics which are relevant to public health problems in India and their university assessment plan. We have communicated our best teaching practices and innovations in the scientific journals of International level. We are developing a program for community-based teaching for medical undergraduates. Such activities are often seen as a challenge due to constraints such as lack of commitment at various levels, shortage of trained manpower and institutional support. We look forward to its successful implementation and its mainstreaming in our routine teaching activities.

On-going plan of sessions for medical undergraduates

Semester	Morning hours activities	Afternoon hours activities
I and II	Theory Exposure visits Sessions on communication skills
III	(Clinical posting) Diet survey Exposure visits to Primary Health Centre, Sub-centre, Anganwadi centre	Theory Sessions on Research Methods (Problem Solving for Better Health)
IV	(Clinical posting) Project-based learning Exposure visits	Theory
V	-	Theory
VI	-	Theory
VII	-	Theory Small Group Teaching Practical sessions
	(Clinical posting) Clinico-social case discussion Epidemiological problems	Theory Practical sessions

 

Success of undergraduates in final university assessment over the period of three years

Year	No appeared	No passed	No of distinctions
2006	112	112 (100)	20
2007	123	121 (98)	12
2008	101	96 (97)	6

Mass Drug Administration (MDA) for elimination of Filaria – A National Health Program activity

Post-graduate (PG) teaching and exposure:

We expect post-graduate candidates to ‘learn by doing’ and become competent to work in teaching and research institutes, and in services of government and voluntary health sectors. Yearly, we admit three post-graduates in Community Medicine. They are exposed to outcome oriented program over the period of three years. Apart from their hands-on exposure to Rural Health Training Centre and Urban Health Training Centre, they are posted at a Primary Health Centre where they get exposure to understand the functions and working of peripheral government health care system.

We have developed a strategic partnership with HelpAge India, which is a recognized national level voluntary body with a mission to work for the cause and care of disadvantaged aged persons and improve their quality of life. Our PGs are actively involved in the field activities of HelpAge, India. The progresses of PGs are monitored through log books. Their performance in academic activities such as journal clubs and seminar presentations are monitored and immediate feedback is ensured.   

Dissertation topics and name of the Post-graduate students

Title of dissertation	Name of candidate
Acute childhood morbidities: determinants and household practices in surrounding villages of our Rural Health Training centre	Dr M. R. Thirunavukarasu
An epidemiological study on alcohol user in rural Pondicherry	Dr V. Vijayaramanan
Active case finding of Tuberculosis among household contacts	Dr. V. Anand Kumar

Post-graduates at a workshop on ‘Qualitative Research Methods’ at MGIMS, Sewagram

Epidemiological unit:

It is led by a teaching faculty and a trained bio-statistician in the department. We have a couple of computers and basic software programs such as Epi_info, Statistical Package of Social Sciences (SPSS), and WHO- Anthro for quantitative data analysis and Atlas-ti (demo version) for qualitative data analysis installed in it. 

This unit plays a key role in day to day data management. It monitors and ensures the daily entry of data collected during passive epidemiological surveillance in our hospital and the data collected during routine field based clinics. This information helps us to initiate preventive measures in the given locality. All internship monitoring formats are entered and stored in electronic formats. The monthly RHTC and UHTC reports are entered and processed here. This unit is active in educating post-graduates, medical students and interns on use of free public health software - Epi_info. 

We have entered and analyzed survey data of 1800 elderly subjects in Tamil Nadu and Kerala. It was a large community-based survey for evaluation of community-managed palliative care program run by HelpAge, India. In future, we envision developing this centre for ensuring better technical support to our post-graduate students, medical students and teaching faculties of SMVMCH.

Elderly clinic at HelpAge, India:

In December 2011, we have extended our partnership with HelpAge, India from research activities to service provision. Under this, fortnightly we are conducting health clinic at elderly village of HelpAge, India at Tamaraikulam, Cuddalore. Our post-graduate, a teaching faculty and medical intern conducts this clinics and offer their medical advice and care. We have started using standard screening tool to identify the health needs of the patient and plan care for the patient. So far, we have conducted four clinics with approximately 15 to 20 patients per clinic. Clinic is held every first and third Saturday at elderly village at Tamaraikulam, Cuddalore.

We have supported HelpAge India in conducting health camps for elderly in cyclone affected villages. The post cyclone activity went on for four days. Each day our team covered two villages offering medical care to approximately 400 patients.

Support to HelpAge, India – A team of teaching faculty, post-graduate and medical interns of SMVMCH supported the field-based mobile clinics for elderly in cyclone hit villages in Pondicherry

Passive Epidemiological Surveillance: Since last two years, we are conducting routine passive epidemiological surveillance in our hospital. Every day, medical interns posted in Department of Community Medicine pay visit to hospital wards of SMVMCH and note down the socio-demographic details, date of onset, laboratory findings and status of confirmed diagnosis of enlisted infectious disease conditions among the admitted patients. We report the cases of Malaria, Cholera and Acute Flaccid Paralysis to the District Health System. Based on this data, we have recently investigated the reasons for high number of enteric fever cases in the last two subsequent years.  

Disease conditions covered under ‘passive epidemiological surveillance’

No	Early warning sign or symptoms	Disease condition
1	Acute flaccid paralysis	Polio
2	Fever with rash	Chicken pox, Measles
3	Fever with chills	Malaria
4	Fever with alerted sensorium or convulsions	Japanese encephalitis, Meningitis
5	Fever with bleeding from skin\ mucus membrane	Dengue Hemorrhagic fever
5	Fever with jaundice	Hepatitis A or C
6	Fever	Do follow up to rule out diagnosis number 2,3,4,5
7	Acute watery diarrhea	Cholera, Tetanus, Diphtheria

 

Distribution of suspected infectious disease conditions admitted in the hospital in last two years

 

Suspected infectious disease conditions	No. of cases, 2010	No. of cases, 2011
Acute flaccid paralysis	2(0.3)	3(0.2)
Fever with rash	2(0.3)	4(0.3)
Fever with chills	7(1.2)	44(3.4)
Fever with bleeding from skin or mucus membrane	1(0.2)	1(0.1)
Fever with jaundice	8(1.4)	2(0.2)
Fever	456(77.3)	953(73.6)
Acute water diarrhea	114(19.3)	288(22.2)
Total	592	1295

 

Orientation of first batch of Post-graduates in research methods:

Last year, we have admitted first batch of post-graduates in 7 pre-clinical subjects and in Community Medicine. Half –a-day sessions over a period of six days from 13 June to 18 June 2012 were conducted for sensitization of post-graduates on research methods. There were 13 participants and sessions were interactive and participatory in nature. Following topics were covered by Department of Community Medicine. We also had a very informative session on ‘how to write a thesis protocol’ by Dr Gitanjali Batnamabane, a distinguished faculty of Jawaharlal Nehru Institute of Post-graduate Medicine and Research (JIPMER), Pondicherry, currently working as Technical Officer at World Health Organization, New Delhi. As reflected in the feedback, the sessions were well received by the participants. There was significant improvement in their pre and post median scores.

Program for Post-graduate sensitization program

Date	Time	Topics
13.06.2011	2.30 pm to 4.30 pm	How to select a topic for research? And how to do literature search?
14.06.2011	2.30 pm to 4.30 pm	Sample and sampling
15.06.2011	2.30 pm to 4.30 pm	Study designs
16.06.2011	2.30 pm to 4.30 pm	Basic statistics
17.06.2011	2.30 pm to 4.30 pm	Test of significance
18.06.2011	2.30 pm to 4.30 pm	Ethical issues in research

Post-graduates doing group work in a interactive session during their orientation program

Retro-pre feedback by Participating Post-graduate students

Questions	Pre median	Post median	p value
I can perform ‘Literature search’ using electronic data base for my research work	2.0	5.0	0.002
I can calculate ‘sample size’ for my research work	0.0	4.0	0.003
I can select ‘sample’ (sampling) for my research work	1.0	4.0	0.003
I can select ‘study design’ for my research work	1.0	4.0	0.002
I can apply ‘ t test of significance’ to my research work	0.0	4.0	0.002
I can interpret 95% confidence interval and p value in the searched literature	0.0	4.0	0.001

 

Positive and negative response of participants of PG orientation program (13 June-18 June, 2011)

Facilitating factors	Barriers or suggestion for improvement
Understood some basic statistics. Concepts of Null hypothesis and p value is clear now	Needs comments on individual PG thesis topics
Making us do group work	Better to conduct sessions in morning hours-3
Provided hard copies of the material	Sessions were purely mathematical, with less practical relevance
Method of approach and planning	Needs a break time
Examples are given	No barriers-2
Good ambience-2	More clarifications on the words used was needed
Group discussion was useful-3	Needs more examples
Very good interactive sessions	Give time to participants to ask questions
Group work and taking comments from everyone, sessions were free – 2	More pictorial and graphical presentation required
Clear-cut presentations
Clarity and politeness
Inspiration from experienced faculties
Easy and concise teaching in simple seven classes
Opening the doors to the world of thesis
Good presentations
Session on ‘how to search literature’ was useful
Exercises, tea, ambience, AV aids and students ‘ involvement
I started concentrating nicely

 

Workshops on Qualitative Research Methods:

Since, last three years, we have been supporting and organizing four and half day residential workshops on qualitative research methods for young health professionals in India. Two sessions were held at Mahatma Gandhi of Medical Sciences, Sewagram, Wardha and one session was held at our department. Our workshop curriculum content is blended with participatory, in-depth and systematic techniques of qualitative methods. It offers hands-on experience on manual content analysis and software-aided analysis of qualitative data. The workshop curriculum is based on our previous experience and participants’ feedback.

A workshop was held at Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry in South India from 28 March to 1 April, 2011. The participants were eleven mid-carrier teaching faculties (Community Medicine-9, Obstetrics and Gynaecology-2) and two first year post-graduate students in the subject of Community Medicine. The workshop participants were registered on first-cum-first-serve basis. The resource persons were two trained Community Medicine teaching faculties. Session plan for the workshop is given below.

Workshops on Qualitative Research Methods:

Since, last three years, we have been supporting and organizing four and half day residential workshops on qualitative research methods for young health professionals in India. Two sessions were held at Mahatma Gandhi of Medical Sciences, Sewagram, Wardha and one session was held at our department. Our workshop curriculum content is blended with participatory, in-depth and systematic techniques of qualitative methods. It offers hands-on experience on manual content analysis and software-aided analysis of qualitative data. The workshop curriculum is based on our previous experience and participants’ feedback.

A workshop was held at Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry in South India from 28 March to 1 April, 2011. The participants were eleven mid-carrier teaching faculties (Community Medicine-9, Obstetrics and Gynaecology-2) and two first year post-graduate students in the subject of Community Medicine. The workshop participants were registered on first-cum-first-serve basis. The resource persons were two trained Community Medicine teaching faculties. Session plan for the workshop is given below.

Workshop on ‘Qualitative Research Methods’ at SMVMCH, Pondicherry

Workshop program:

 

Time	28 March Monday	29 March Tuesday	30 March Wednesday	31 March Thursday	1 April Friday
9.00-9.30	Welcome, and Introduction	Re-cap of day one	Re-cap of  day two	Re-cap of day three	Re-cap of day four
9.30-10.00	Starting the Journey – Ground rules	Free listing exercise	Focus Group Discussion (FGD)	Basic terms used in  QDA analysis	Ethical issues in qualitative research
10.00-10.30	Refreshments	Refreshments	Refreshments	Refreshments	Refreshments
10.30-11.00	Introduction to Qualitative Research	Introduction to Anthropac	Focus Group Discussion	Game: Playing with Candies	How should one report qualitative research?
11.00-11.30	Whose reality count? (Film)	Demo on free listing	Demo on FGD	Instructions for manual content analysis	Experience sharing and Closing
11.30-12.00		Exercise and practice on free listing	Individual work on FGD	Participants apply lessons learned to content analysis of transcripts	Retro-pre feedback
12.00-13.00	What is Participatory Research? Tools?		Sharing of individual work
13.00-14.00	Lunch	Lunch	Lunch	Lunch
14.00-15.00	Social mapping (Demo-case study)	Pile sorting exercise	Key Informant Interview (KII)	Atlas-ti – Use in content analysis
15.00-15.15	Refreshments	Refreshments	Refreshments	Refreshments
15.15 –16.00	Other tools (Demo-case studies)	Exercise and practice on pile sort	In-depth Interview (IDI)	Sampling in qualitative research
16.00-16.15	Feedback	Feedback	Feedback	Feedback

 

Overall, the consensuses for all sessions were good. There was significant improvement in participants’ skills in application and analysis of qualitative data. As perceived by the participants, the facilitating factors in workshop environment were - better care of physiological needs of the participants, good physical environment, and well-planned interactive session.

List of participants for workshop on ‘Qualitative Methods in Health Research’ at SMVMCH, 2011

Name of the participants	Institute of affiliation
Dr Sujata S Pol,	LTMMC, Sion  , Mumbai
Dr Vijay Kumar Singh	LTMMC, Sion, Mumbai
Dr M Surya Durga Prasad	Osmania Medical College, Hyderabad
Dr B Manoj Aravind	Osmania Medical College, Hyderabad
Dr Rajini S	AVMCH, Pondicherry
Dr Vaishali Misale	AVMCH, Pondicherry
Dr Abhijeet Boratne	MMCH, Chennai
Dr Shib Shekhar Datta	MMCH, Chennai
Dr Basanta Kumar Behera and Dr Thirunavukarasu	SVMCH, Pondicherry
Dr M Jayasree and Dr N Fatima Shawthini	SMVMCH, Pondicherry
Dr Bharat Raj	LNIMS, Pondicherry

Supported events organized for Revised National Tuberculosis Control Program (RNTCP) by the Department of Community Medicine:

1.  A CME was organized on 24 March 2008 for the faculties in our college. The sessions were facilitated by the faculties from the Department of Community Medicine, Chest & TB Medicine and Microbiology. The programme was moderated by the Dr.S.Govindarajan, State TB Officer in Puducherry. 61 faculties attended the program.
2. State level RNTCP conference was organized on 24 March 2010 with support from State Task Force (STF), Puducherry and RNTCP, Puducherry. The conference was inaugurated by Dr. Dilip Kumar Baliga, Director, Health and Family Welfare, Puducherry. It was facilitated by the Dr.S.Govindarajan, State TB Officer, Puducherry, Dr. Anil Purthy, Chairman, STF. The sessions were presided over by our Honorable Chairman. Vice-Chairman, Director and Medical Superintendent attended the function.
3. A hands-on training on Guidelines on RNTCP was organized for first batch of Medical Interns. Sessions were interactive.
4. Since last five years, ‘World TB Day celebration’ is being carried out by conducting IEC activities in Community and Schools. 

List of assignments and on-going projects where DCM is\was actively involved

Title of project	Organization	Year	Role of Department
Infant Death Review of two districts in the state of Karnataka	UNICEF, Hyderabad, Andhra Pradesh	2011	Reviewer
Qualitative evaluation of Community-based Palliative Care Plus Project in Tamil Nadu and Kerala	Help Age India, New Delhi	2011	Evaluation team member
Effect of community-based palliative care program on the quality of life of elderly in rural south India	Help Age India Institute of Palliative Care (IPM), Calicut FourX4 Consulting. Ltd, New Delhi Mahatma Gandhi Institute of Medical Sciences, Sewagram	2011	Principle Investigator
Formative research for Infant and Young Child Feeding (IYCF) practices in Bihar	Aga Khan Foundation (AKF), New Delhi	2011	As a member on formative research committee

 

On-going ‘Educational Innovation Projects’

Title of project	Organization	Year	Role of Department
Development of Community-based teaching curriculum for medical undergraduates	PSG – FAIMER, Coimbatore	2010 -2011	Principle Investigator
Characteristics of successful community-based education innovation projects	FAIMER, Philadelphia	2010-2011	Team leader in Investigation

Papers published in last one year

International Journals (Indexed in Pub Med):

1. Ganapathy Kalaiselvan, Amol R Dongre, Mahalakshmy T. Epidemiology of injury in rural Pondicherry, India. Journal of Injury and Violence Research, 2011;3(2):61-66.

2. Amol R Dongre. Photo-elicitation as a tool of public health teaching and learning (Letter). Education for Health, 2011; 24(1). Available from URL: http://www.educationforhealth.net/articles/subviewnew.asp?ArticleID=491

3. Dongre AR, Deshmukh PR. Farmers’ suicides in Maharashtra, India: A qualitative exploration of their perspectives. Journal of Injury and Violence Research 2011Jan;3(1):2-6.

4. Amol R Dongre, Ganapathy Kalaiselvan, Mahalakshmy T. How medical undergraduates do benefit from exposure to community -based survey research?  Education for Health. At - http://www.educationforhealth.net/articles/subviewnew.asp?ArticleID=591

5. Dongre AR, Deshmukh PR, Garg BS. Community Led Initiative for control of anemia among unmarried adolescent girls and children from rural Wardha. Food Nutrition and Bulletin. December 2011; 32(4): 315-323. 

National Journals:

1. Mahalakshmy T, Amol R Dongre. Ganapathy Kalaiselvan. Epidemiology of childhood injuries in rural Pondicherry, India. Indian J of Pediatrics. [Online first]

2. Mahalakshmi T., Kalaiselvan G, Parmar J, Dongre Amol. Coverage and compliance to diethylcarbamazine in relation to the Filaria Prevention Assistants in rural Puducherry, India. J Vector Borne Dis. 47, June 2010, pp. 1-3.

3. Raja Yalla, Amol R Dongre. Vector indices in rural Pondicherry. Asian Student Medical Journal. 2011; 5(3). Available from URL: http://www.asmj.info/archives/astudyonvectorindicesinruralpondicherry

4. Dongre AR, Deshmukh PR, Garg BS. Health needs of Ashram schools in rural Wardha. Online J of Health and Allied Sciences, Vol 10 (1); 2011. Available from URL: http://www.ojhas.org/issue37/2011-1-2.htm

5. Dongre AR, Deshmukh PR, Garg BS. Health Promoting School Initiative in Ashram Schools of Wardha district: An Evaluation. National Medical Journal of India, 2011; 24(3):140-143.

Invitation to faculties as a resource person\facilitator\evaluator

1. Invited as a FAIMER faculty at PSG- FAIMER regional centre, Coimbatore during first on-site session for capacity building of Medical Educators in South Asia during 2 to 10 April 2011.

2. Invited as a resource person for guest lecture on ‘Diabetes Awareness’ at Sri Aravind Hospital, Villupuram on December 17, 2011. 

3. Invited as resource person for facilitating workshop on ‘Application of qualitative research methods in health research’ held at MGIMS, Sewagram Wardha during 16-20 August, 2011.