March 10, 2022
Fatima* works with many of her family members in the millet fields of Mandikal, a village (or taluk) in the Chikkaballapur district of Karnataka, India. She was diagnosed with diabetes ten years ago and rarely has time to monitor her illness.
Every few years she goes to her local primary health center (PHC) to have her glycemic levels measured. There, a health agent usually attributes her high sugar levels to something she ate in the morning. She has never received medical advice regarding diet, exercise, or other habits that can impact diabetes. Fatima’s exhaustion after harvesting fields all day leaves her with little energy when she arrives home in the evening to cook. She often consumes high-glycemic foods like fried potatoes and yams, white rice, and sugary tea, which are satiating but leave her feeling even more tired.
The HDSS Field Camp in Mandikal.
The One Health Trust (OHT) India team met Fatima in October 2021. As she was working in the fields, she spotted team members in white coats on motorbikes carrying supplies. They had come to set up mobile camps to provide free cancer screenings and Non-Communicable Disease (NCD) monitoring.
The screenings are part of a larger Health and Demographic Surveillance System (HDSS) Project run by One Health Trust (OHT) India. OHT has brought together 36 team members, including a medical doctor, nurses, lab technicians, and trained ground staff. The team is working in Chikkaballapur alongside local healthcare officials to build a digital database with health indicators and demographic information from women between the ages of 35 and 60 years residing in the region.
Mobile camp set up in a community center (Anganwadi) in Mandikal.
The OHT team set up many screening sites in government facilities like schools and community centers (Anganwadi). However, these sites were not accessible to everyone in the area. The majority of the OHT team is native to Chikkaballapur and understands the living conditions of the local population. Knowing that many of the study’s potential participants labor in fields for long hours, the OHT team brought the labs to them, visiting several farmlands in multiple villages over the course of three months.
Everyone who visited the mobile camps was offered cancer and NCD screenings and medical consultations. No one was turned away for being ineligible to participate in the project. Eligible participants were given consent forms to review and sign if they wished to contribute to the HDSS project in the long term, and for sharing their contact information to allow for check-ins periodically for the next 20 years, with a possibility for extension.
OHT team member examining women as part of a health screening at the Mandikal field camp.
The images that often come to mind when discussing human subject medical research are sterile white hospitals or laboratories. While these facilities are vital to executing many medical tests, exclusively conducting human health research in formal medical settings excludes important demographics from research. Omission of groups and individuals that are impacted by social and economic disparities leaves crucial data out of results and analyses. Research that is used to make public policy decisions and impacts public health resource allocation must include populations that are not in urban centers or do not have easy access to formal research facilities.
Working to make research participation convenient and meeting participants in a familiar space also promotes confidence and comfort for participants. This facilitates the process of building trust and rapport for interviews often covering sensitive or stigmatized topics related to health and habits.
People waiting for NCD and cancer screenings at a Mandikal field camp.
Fatima was one of the screening and study participants. When a nurse in the mobile camp measured her glycemic levels, Fatima was immediately offered a consultation with the physician at the mobile camp, who spoke with Fatima about her medical history and advised her on lifestyle changes she could make to control her glycemic levels. Two weeks later, Fatima returned to the mobile camp and reported a drastic improvement in her energy levels. She was motivated to continue monitoring her glycemic levels at her local PHC and through participation in the OHT HDSS project.
The longitudinal nature of the HDSS project will grant OHT researchers the opportunity to monitor changes in the health and habits of participants over time, as well as factors that may have an impact, such as living conditions and social, economic, and political policies. Individual participants are given the possibility to better observe their own changes in health and build dialogue with professionals who can provide vital health education.
With studies of this nature, on the micro-level, researchers aspire to build a mutually beneficial relationship and give back to individual participants by monitoring their health and providing health education, hopefully improving quality of life, as was the case for Fatima. On the macro-level, OHT expects that the data collected, and impending analysis will amplify our understanding of pressing global health issues and help inform policy action to address them.
*Fatima is a pseudonym. Details of her story may have been altered to maintain her anonymity.
Photos taken by Dr. Giridara Gopal.