Invited Contribution: Dr.ANOOP.G, Medical Officer, Community mental Health program (CMHP) at Palakkad, reports about a seizure clinic organised at Pallakad and also answers three questions on the CMHP experience.
The Community Mental Health Program (CMHP) of Palakkad district conducted a “SEIZURE CLINIC” at the district hospital on January 5, 2014 (Sunday). It was a joint venture with doctors from Neurology department of Amritha Institute of Medical Science (AIMS), Ernakulam.
From a total of 884 patients who are registered and on regular follow up with the CMHP at its 20 mental health outreach clinics, a separately compiled SEIZURE REGISTRY revealed about 78 cases who suffered from seizure disorder.
It included cases like Juvenile Myoclonic Epilepsy, Landau-Klefner Syndrome and focal seizure disorder cases that are potential candidates for curative surgery. The reason behind the idea of setting up such a one day clinic was mainly to create awareness and alleviate stigma associated with seizure disorder which hampered the marital life and occupational life of many .Depressive symptoms were evident in many and often led to social isolation.
The concept of curability of focal seizures by advanced yet easily carried out epileptic surgery was an eye opener (Thanks to Dr. Siby Gopinath mam of AIMS for her special enthusiasm). A 3 tesla MRI with high quality video EEG monitoring can presurgically evaluate possible cases and can locate the exact focus….which if removed surgically …can lead to permanant cure…)
About 19 patients from the 40 who attended the clinic were identified as potential candidates for surgical cure of which four people who were found to be the most needy were recruited for surgery. It is hoped that the quality of life of these identified patients will dramatically improve after surgery. Optimisation of epileptic medications was done for all patients.
The clinic was coordinated by myself and was attended by three doctors from AIMS -Dr. Siby Gopinath (Epileptologist) ,Dr. Ashok ( Neurosurgeon) ,Dr.Sharath Menon (my friend& senior at Kottayam and presently DM resident in Neurology)
Q & A
1. Dr Anoop , as the MO trained in mental health you have been running the outreach activities of CMHP Pallakad over the last one year. How did this attention towards seizure disorders come into the picture.
Seizure management/epilepsy was initially not under consideration as the major focus is on psychiatric disorders. But considering into account the increasing number of patients turning up at each clinic every month with the hope of free availability of their seizure medications (Valproate, Carbamazepine), we started thinking of including a SEIZURE REGISTRY to access the disease burden. Besides the interaction with Dr.Siby Gopinath, who is currently working in surgical care for refractory focal seizures and her reports regarding permanent cure in such cases led me to think of conducting such a one day clinic. I screened all the 78 seizure patients and those identified as focal seizures (38 cases) were brought to the clinic.
2. I understand that you are in charge of the CMHP as a deputed officer from the health department. I remember you telling something about hardships of being in a deputed post. Can you elaborate…
A medical officer in health service will be receiving his salary in the 2nd working day itself. The deductions like SLI, GI, Provident fund will be duly deducted and net pay will be easily processed by SPARK software. Moreover updates regarding annual increment, increased DA etc will be naturally processed by SPARK and no issues regarding this. I also had charge allowance of Rs.360/-(ok leave it)..but also rural allowance of 3000/- per month…
But when i joined on deputation, i found it shocking……in spite of all other good things… I receive only Rs 40,103/- which was my gross pay as per my LPC then…regarding by subsequent increase in DA / Increment , I had to keep writing to AGs office and wait…..it has been just processed and i expect it will come only by February… increase in HRA is not released, pending reply from the AG. Under NRHM, I should call myself really lucky if I could receive my salary before 9th or 10th of month! From this gross pay, I will have to find myself time to go to treasury to remit all my deductions which were previously through SPARK and now i have to fill up chalans .
I am posted at District Hospital under NRHM with overall control by nodal office at Thrissur medical college…Now during the hectic continuous clinics…..20 clinics per month….I was equally worried about the red line in attendance register and late markings by District Hospital authority… it was often frustrating…. the busy schedule where u have to leave early morning on all days.
The post of team psychiatrist is vacant…..that leads to increased work load with often no breaks…but special thanks to my authorities at Nodal office for providing special arrangements to ease my work in 10+ clinics. We have 1029 registered patients by January 2014…3 clinics out of 20 have more than 100 hits every time…
I HOPE THE WORK LOAD WILL NOT BE AN ISSUE IN COMING YEARS..WHEN TRAINING AND SHIFT TO MEDICAL OFFICERS STARTS…..BUT REGARDING PAY/ALLOWANCES AND SERVICE MATTERS OF DOCTORS…SOME ARRANGEMENT SHOULD BE MADE…ELSE DEPUTATION WILL TURN OUT TO BE A NIGHTMARE AND AT THE SAME TIME DISCOURAGING FOR DOCTORS…THE ISSUE SHOULD BE TAKEN UP AT THE EARLIEST BY STATE MENTAL HEALTH AUTHORITY..is my request…
3. I am sure you will continue to offer mental health services to your clientele once you return to general medical care after your deputation. Any personal reflections on the CMHP experience. Thank you for contributing to the blog and best wishes in your future endeavours especially for the forthcoming All India PG counselling 🙂
Infact I should first thank my teacher at medical college Kottayam Dr. Varghese Punnose sir for kindling the spark of interest, a solid base in undergraduate life… and with Dr. Sumesh T P, my friend and brotherly figure and the same time, my PG then at Kottayam and presently my Nodal Officer for carrying me through with the momentum…
A turning point at Palakkad was the substance abuse screening project (see link) and meeting with a giant in the field, Dr.Shaji sir, HOD, Thrissur medical college who intoduced me to the concept of research and practical management. Working under him so far was a real blessing…It was he who introduced me to use of mhGAP IP guide for management.
I am sure graduate level doctors can really do a lot in this field…..a lot in IEC activities, basic management of several conditions and effective follow up….
The ironical aspect is graduate doctors (who) express fear over prescription of antipsychotics and mood stabilisers and often refer for “evaluation ” to me, who is no more than a MBBS doctor like them but with 3 months training at Thrisur medical college…so I would like to point out that if a graduate doctor with training can do basic management in this field.. that is simply possible with any other doctor…
Now after returning to health service from march 5, 2014………..planning to continue basic psychiatric management in patients if detected in routine general practice and to work along with concerned DMHP/CMHP in district where I may be posted as a support to the team. Also plan to continue with the IEC activities.
Some plans still remains unfinished…….like Ashwasakiranam project Rs 525/- per month to care giver of all dependent MR patients…we have already made MR register…….program for caregivers of Dementia patients…..we have dementia register…seizure management……………………
……after 2 yrs of no exams, no reading….don’t know how I qualified for All India (PG Entrance) and waiting if I can get DPM at least, by my score…even if not….life has much more for someone in health services….Thank u.