It’s about 7,000 miles from Cambridge to the village of Ganiyari in central India, where a group of idealistic doctors is trying to improve the lives and health of impoverished farmers and other rural residents. Here in Cambridge, an Indian-born physician at Cambridge Health Alliance has organized an unusual partnership between the Ganiyari doctors and specialists at the Alliance.
Dr. Priyank Jain links the doctors in India to specialists at the Alliance, who help with difficult and complicated cases where patients may need specialty care. Since 2011, he has fielded questions from Ganiyari and enlisted volunteers at the Alliance to answer them.
Jain sees many similarities between the goals and strategies of Jan Swasthya Sahyog – People’s Health Support Group – in Ganiyari and the mission of the Alliance to care for poor and uninsured patients and improve community health. “The work they do shares many of the values of Cambridge Hospital, such as access to health care for the underprivileged” and tackling “issues of policy that lead to bad health,” Jain said. “Both of these things are very common in both places.”
In fact, Jain decided to work at the Alliance because its ethos resembled the idealism of Jan Swasthya Sahyog, he said. After attending medical school in India – the same school where some founders of JSS studied – he came to the United States for further training, then volunteered at JSS after finishing his residency in 2006.
“I discovered what values [the doctors there] bring to their work,” Jain said. “I was inspired by that. That is how I found CHA.”
Community health care
JSS was founded in 1996 by a small group of young doctors who gave up the prospect of a conventional career and high earnings to try to change rural health care in India by establishing a low-cost “community-based health care system,” according to the group’s website.
They chose to settle in the Bilaspur district in Chhattisgarh state in central India, where there were few medical resources and many people are undernourished and suffer from malaria and tuberculosis. JSS operates a hospital, pharmacy, lab and main outpatient clinic in Ganiyari, and three smaller clinics serving 150 outlying villages. It has also trained scores of women who provide frontline prevention and care in 60 villages. And the organization lobbies for policy changes such as more generous food subsidies distributed to families on the basis of evidence of malnutrition rather than just low income.
After Jain came to the Alliance in 2009, he kept in touch with JSS doctors. When he asked how “we could support the work they’re doing,” they told him they needed advice from specialists for “patients with advanced or complicated diseases,” he said.
Developing a system
Jain was a hospitalist – a doctor who manages care for patients in the hospital – but not a specialist. Doctors at JSS started sending questions. “Then I would try to marshal my resources over here,” he said. Those resources included neurologists, dermatologists, radiologists and oncologists at the Alliance.
The ad hoc consultations started in 2011, Jain said. About 10 Alliance specialists are now involved, with five giving advice most frequently as Jain gets questions two or three times a week. He also can call upon about 30 doctors across the United States, most of them fellow alumni of his medical school, to help.
Communication is via email or applications such as Google Hangouts, the group messaging system, but Jain said he hopes someone with technology skills develops a Web-based communication method that won’t depend on one person – him – taking questions and funneling them to specialists.
Exchange of knowledge
The issues presented by JSS doctors can range from questions about a patient with unusual symptoms in his chest to one about a man “who was having difficulty walking, and the signs didn’t make sense,” Jain said. In that case, Cambridge Health Alliance neurologist Dr. Rachel Nardin identified it as a spinal problem, Jain recalled, and he found a neurosurgeon in Florida “to give input about what the neurosurgery options were.” The patient ended up being sent to a hospital in New Delhi.
“It changed the course of a patient’s care in India,” Jain said. “I learned from it. The doctors at JSS learned from it.”
The help goes both ways. Doctors at the Alliance are becoming educated about infectious diseases they have rarely encountered. “Some of the doctors here started getting interested in hearing about these cases because we see patients who have immigrated here,” Jain said. The diseases are unusual even in immigrants “but they are important for us to recognize,” he said.
The Alliance might also adopt some methods that JSS uses to improve health care access and help patients manage their illnesses, Jain said. Village health care workers in India can provide diagnosis and treatment, while similar frontline workers here “are used as coaches,” he said. JSS has also organized “self-help groups” of patients around specific chronic diseases, helping them follow treatment instructions.
“Over time what we started learning is that there are innovations that come out of resource constraint that might not have occurred at a place like Cambridge,” Jain said.
A stronger
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