I remember vehement opposition by some of my own colleagues saying that it is only another outpatient service that we are going to start…nothing is going to happen, it should not be started..it is a waste of time and all that. It took me two or three meetings to convince them how the villagers are suffering, the specialty is not accessible to them and they cant even afford to buy drugs..so therefore we should do something..and then in principle we agreed…...
Thus started the extension service clinics by NIMHANS in various thaluk headquarters situated at varying distances from 60 to 120kms from bangalore in 1981 and these clinics are running successfully till today. Sharing these thoughts with us is none other than G N Narayana Reddy (GNNR), former Director of NIMHANS who was the guiding force behind making extension services (satellite clinics) an official program of the premier institute.
It was an idea which he had pioneered in his native village of Gunjur by starting a neuro-psychiatric clinic way back in 1970. In an article titled Innovations in Neuro Psychiatric Services published in the inaugural volume [1(1):January 1983 pp 1-14] of the now defunct NIMHANS JOURNAL, GNNR lists starting of the satellite clincs as one of the eight innovations at NIMHANS during his stint at the helm of affairs; the others being the organization of out-patient services, family psychaitric services, rehabilitation services, community mental health services for rural and urban population, training of school teachers and lay volunteers, domiciliary care program and self-help group of parents. In the July 1986 and July 1988 articles in the same journal GNNR backs the innovation with evidence of effectiveness of these satellite clinics with service utilization data. He writes
Under existing circumstances and poor resources available,the professionals can effectively provide services to neglected population of the rural areas by starting extension camps. (July,1986)
Continuity of care and long term follow-up are highly essential for improving health status of patients attending these centers (July,1988)
The community psychiatry team grabbed the opportunity to interview GNNR at the Gunjur monthly clinic this Monday (Dec 1st). GNNR graciously agreed to sit before the camera. He had infact come over to be part of the meeting (see a brief video clip below) which the team organised to felicitate Mr. Mariappa Reddy, a volunteer who acts as the medical records manager and onsite-coordinator and who continues to offer hospitality to the visiting team at the Gunjur clinic since past three decades. Mr. Mariappa has never missed a camp day in the last 30+ years is what Mr Mohankrishna says!
And here are excerpts from the interview with GNNR in Q&A format.
1. Sir, you had introduced extension services (satellite clinics) as an innovation in the official service delivery program of NIMHANS in the early eighties. Can you share your memories about about how you planned it and how it came into being.
2. It is sometimes believed that the camp approach was relevant in the eighties when doctors and psychiatrists and drugs were not available in rural areas. Now with urbanization things have improved. Do you think the camp approach still has a role? Is it relevant now?
3. It is now widely believed that in extension clinics one can only give medicines and that comprehensive care is not possible. How do you see that aspect. Is it a limitation of the camp approach in mental health care?
4. Another belief about the camp approach is that it has limited reach and from a public health perspective at the national level it has limited scope. Is it possible to scale this approach at a national level?
5. One of the salient feature of your satellite clinic model was community participation and volunteer-body involvement. It was quite futuristic as you had though about it many years before the NGO Bandwagon really took off. Your views on involvement of volunteers and NGOs in mental health service delivery.
And finally a brief video clip of the felicitation function.
Addition on 7.04.2013 -Related reading on similar services which were being tried out in England during same period. See 1984 article titled A survey of psychiatrists in primary care: the silent growth of a new service.