This story is from May 3, 2017

Mumbai doctors diagnose stroke, epilepsy in Gujarat's tribal hamlets

Mumbai doctors diagnose stroke, epilepsy in Gujarat's tribal hamlets
Dinesh Keshur's left hand hovers over a lime-green pen. He furrows his brow. His fingers clench but grasp only air. He concentrates even harder. Slowly, he grips the pen's cylindrical surface. It's an awkward gesture resembling an automated claw grasping a toy in a videogame arcade. But for Keshur, it's a significant achievement.
Because at age 12, he suffered a head injury leading to neurological deficits or impaired functionality in his left limbs.
After the accident, he could walk but with a stumbling gait and his left hand curled inwards, the fingers stiff and gnarled. Keshur, a tribal resident of Motivahiyal village in Gujarat, went to doctors in nearby Vapi and Valsad cities but they told him his condition would never improve.
Then in 2015, almost two decades after his accident, two community workers visited his home as part of a door-to-door survey to identify individual's suffering from neurological disorders. A few weeks later, a camp was held in his village where neurologists from Mumbai diagnosed his condition. He was prescribed medication and physiotherapy. Now, his fine motor skills are improving.
This story's happy ending can be traced to the Neurology Foundation's community outreach programme 'Aanchal', which covers areas like Dharavi, Worli's BDD Chawl and Gujarat's Kaprada and Dharampur talukas.
In Gujarat, the Foundation trains community workers to identify common neurological diseases like stroke, epilepsy, Parkinson's and generalized weakness with the help of a local body Jashoda Narottam Public Charitable Trust. The subsequent medical camp, diagnostic tests and treatment are all organised and paid for by the Foundation along with bi-weekly physiotherapy sessions conducted by the same community workers, who initially identified the disorders.

"There are only 80 neurologists for the 18 million people living in Mumbai and 1,200 for India's population of 1.2 billion," said Dr Sharmila Donde, who handles community development and training for the Neurology Foundation, which was started in 1998 by Dr Bhim Singhal in Mumbai. "Thus, there's a great need to identify and treat neurological diseases especially in remote areas."
The three tribal villages in Kaprada, where the programme is currently being conducted, have an average household income of Rs 12,000-15,000 and an average family size of six. Farming and manual labour are the main occupations and educational levels are low, said Mahendra Pawar, health coordinator for Jashoda Trust.
Thus, neurological symptoms are often ignored. Ranveer Raju, 7, was born with weak right limbs making it difficult to walk or write but the Motivahiyal camp in 2015 was the first time he'd ever seen a doctor. "We didn't know it could be treated," said his mother. And two-year-old Viren Bhoya gets seizures every month during which his eyes roll back and saliva dribbles from his mouth. But before the camp, his terrified mother was dosing him with 'jangli dawa'.
On a Sunday in March, six Mumbai neurologists visited Arnai Village in Valsad's Kaprada taluka. As soon as they set up their desks in a primary school, the open verandah was flooded with patients. The next few hours passed in a haze of questions and diagnostic tests.
Some cases were more complicated than others. Dr Tejas Sakle, a 45-year-old neurologist from Nair Hospital, had a patient whose family complained that she often wandered off, hit people or mumbled to herself. "The cause could be neurological or psychiatric," he told TOI.
Another patient came in complaining of leg pain. To rule out arthritis and other non-neurological causes, Dr Nitin Lovhale tested to see if he could recognize different sensations like pricks and vibrations. But the clincher was when the patient admitted to constantly losing his slippers while walking.
"That's common for someone with neuropathy (nerve damage) because they can't grip a chappal with their toes," explained Lovhale. "And because there's a loss of sensation, he can't feel when it slips off."
Once the doctors leave, it's the community workers, who follow up with each patient doling out medications and coaxing them to keep up with their exercises. Sangeeta Gavit, a community worker who has been with Neurology Foundation for two years, went door-to-door in Arnai interviewing 2,752 residents over three months.
She can now demonstrate a Cerebral Palsy walk--bent knees like a Bharatanatyam dancer--and Parkinson's slow tread. Of all her patients, she said, Dinesh Keshur has had the most miraculous recovery. "His arm was completely rigid and his fingers immobile," she recalled. "Now, have you seen him pick up a pen?"
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