The establishment and development of a comprehensive Diabetes centre
in rural South India – A 17-year work in progress

Dr.Pichumani Parthasarathi, Mr.Abhishek Pichumani

Background: About two decades back, poor allocation of resources to generate awareness of Diabetes and the potential complications it could lead to if left untreated – particularly amongst under-served, rural populations -- led to pathetic prognosis and outcomes. The lack of comprehensive expertise to counter the rising menace of a multi-headed disease like Diabetes in a Tier 3 rural town like ours warranted the setting up of a focused facility to address the issue adequately. The step-wise assembling of the essential
elements of a Diabetes care facility (Cardiology, Dentistry, Diabetology, Dietetics, Endocrinology, Fitness training, General Surgery, Intensive Care, Nephrology, Neurology, Oncology, Ophthalmology, Podiatry and Yoga) coupled with extensive end-user engagement activities (Free- and paid-for health screening camps (Blood sugar and eye), Complications screening routines (including Breast and Cervical cancer in women), sensitization workshops for General Physicians and grassroots healthcare workers such
as the Village Health Nurses and paramedical staff of the Integrated Child Development Services programme, Puppet shows for the semi- and illiterate population, publication and distribution of a FREE monthly journal, targeted programmes for school children (Student Diabetes Clubs, Rallies, Speech, Drawing, Essay competitions), college-going young adults (Cookery), patients and the public (Walkathons, Cookery, Go Blue for Breakfast event) is chronicled.

Aims: Proactively improving the Diabetes Awareness Quotient of both patients as well as non-patients, thereby reducing the burden of the disease in these populations over the long term is the converging aim of all these programmes. 

Method: Modalities that allowed tele-access to high-quality, Diabetes-centric interventions in specialities such as Intensive Care and Ophthalmology, were efficiently integrated into the everyday practice. Being a low-resource rural setting, such skills would otherwise have come at unaffordably high premiums. The use of Continuous Glucose Monitoring System provided valuable insider information that aided in the informed decision making of the medication regimen for appropriate patients. Non- pharmacological, lifestyle-changing interventions like physical exercises and Yoga were creatively integrated into the Care Plan, thereby reducing the pharmacotherapeutic load on the end user.

Results: A holistic and comprehensive approach towards preventing and managing Diabetes in a rural environment, spanning many different touchpoints in the everyday life of the common man, has been showcased. 

Discussion: Working collaboratively over the last twenty years with government authorities such as the District Collector, NGO’s such as the Rotary and Lions Clubs, heads of villages, panchayats and schools, we have sustainably raised the awareness of Diabetes amongst this rural population and the villages around. Thanks to the many government initiatives and the proliferation of teaching institutions in this area, basic awareness of Diabetes amongst our rural population has grown manifold. However, challenges remain in providing affordable and appropriate treatment for the myriad co-morbid conditions.

The establishment and development of a comprehensive Diabetes centre in rural South India – A 17-year work in progress