After my experiences during my research project last summer (Investigating the barriers to asthma care in the government sector in India) it really put into perspective the state of the government healthcare system in India. My research showed many issues, some institutional/governmental such as funding and resource allocation, and others more social like health education. I realised that I wanted to have a real impact on the health landscape in India and so rather than a more traditional LiA experience with a single charity or organisation I chose to take on something more personal and wider reaching…
As a single individual it would be impossible for me to make any changes with the Indian Government. Things like better funding and supplies in free medication dispensaries which are often undersupplied, forcing people to buy medication privately. The costs for buying medication, especially for those with very little income, can be a heavy burden and people often skip buying medicine so that they have money for food. However an area that I would be able to have an impact on would be helping to improve health education around asthma, so this is what I decided to target.
Asthma symptoms usually first manifest in children between the ages of 5-9, however there is a deep-rooted stigma in rural Indian culture that asthma is a condition of old age and is a terrible diagnosis. This means that even when children are taken to the doctor and given an asthma diagnosis the parents try to ignore medical advice and search for something else. Secondly, the large private health sector domination in India means that the public must choose the right doctor to visit for a particular problem. Without a robust primary care system people with asthma symptoms should be able to recognise the problem and have the knowledge to see a pulmonologist, but this often does not happen. From my own conversations with patients, they often go to an ENT specialist first, many are incorrectly managed and the doctors that they visit don’t refer to the correct specialist because it means they lose a ‘paying customer’. Patients have been stuck being incorrectly managed for years before they decide to visit a different doctor, all the while their condition gets worse.
For my Leadership in Action project I had 2 main goals. The first was to conduct asthma awareness workshops in a few schools. The second was to develop and launch an app to help educate people about asthma. The workshops were to be targeted towards the ages of 12-14 and I aimed to teach the students what asthma is and how it affects the lungs, how to identify the key symptoms of asthma, what kind of doctor to see and what to do during an asthma attack. I contacted 3 different schools, 2 in the city of Mysore and 1 in the outskirts of a small town called Anantapuram. I planned to spend around 3 weeks developing the app and 3 weeks in India, visiting the schools to run my workshops.
In the planning phase I started by thinking about designing the workshop and how to make it engaging for the target age group. From my own school experiences and remembering what kept me engaged when guest speakers, I created an interactive and informative 30-minute plan for the sessions. I included some interesting facts about Indian celebrities and cricket players who have asthma and a short animation to visualise the changes that occur in an asthmatic airway. However, I also wanted more active engagement in the session rather than just a fun lecture, so I planned to have a 5-6 minute interactive segment with a tool called a peak flow meter. It is a simple device that doctors use to find our peak expiratory flow to help with an asthma diagnosis and I felt it would be the perfect activity to keep the children engaged and active. I started by contacting some charities in the UK and medical device manufacturers to find out if they would be able to donate some peak flow meters for this project. I got a reply from Medi Tech Trust, a UK based charity who sent me 6 peak flow meters along with some spacers, inhaler case and oxygen mask. Thanks to their donation I only needed to buy 14 more peak flow meters and the disposable mouth pieces. I managed to get 400 mouth pieces (students would be able to share the peak flow meter but would need to have their own mouthpiece). I spoke with the principals from 3 different schools; Excel Public School, Hari Vidyalaya and Zilla Parshad Government School. With that I was all set for the first of my goals.
For the first week I started planning the app. My vision for the app was to be a resource for people to learn more about asthma even if they didn’t have a diagnosis yet. The target users are very wide ranging due to the large differences between different populations in India. People have varying levels of education, technological proficiency and existing health knowledge and often speak one or two of many major languages in India and I aimed to capture as many people as possible. These requirements helped me plan the key features of the app:
- Accurate translations into all the major languages spoken in India (Hindi, Bengali, Marathi, Telugu, Tamil, Gujarati, Kannada, Malayalam, Punjabi)
- Two levels of informational details to accommodate people with lower levels of education
- Information expanded to medications, how they work and why they are important
- The app should work even when offline to accommodate access in areas with inconsistent internet connection
- Use images and animations as visual cues to help users better understand the changes that occur with asthma and improve engagement with the content
In the second week I started building the app itself, making the home, information and about page. App development was something very new for me as a medical student. I had some experience in coding through school and some previous projects, but this was my first attempt at app development. I chose to use React for the UI as it uses a native library and is based on JavaScript which I have a little prior knowledge with. I spent some time getting up to speed with the language before building out the base of the UI.
Approaching the second week I had a basic UI (not very glamorous) but it was good enough to start populating with information. I then started drafting the English version of informational text which would form the basis for further translations. By looking at a range of guidelines internationally such as NICE in the UK, FDA in the US and IMC in India I was able to collate information from multiple different sources. Regulations and guidelines for asthma are very similar internationally as they usually are made from recommendations established by GINA (Global Initiative for Asthma), but there are important regional differences between countries and their own guidelines. I took general information from these sources and wrote them in simpler language that is much easier for people to understand. By using non-technical jargon, I had to describe symptoms in simple terms or making comparisons to common experiences, for example describing the airways like a pipe and various asthmatic changes result in blockage and reduced air flow within the pipe.
Moving into the 3rd week I was almost done with the content. However, I realised that there could be much more I could do with the framework I had already built. I was focussed just on asthma, but the app could hold much more information and so I decided to expand the project to encompass health education and wellbeing. This meant that I would not be able to deliver everything within the 6 weeks of the LiA, but it will be something I will continue working on.
For the last few weeks of the LiA I was in India to deliver the workshops I had been planning earlier. I travelled to Mysore and was ready to deliver my first few workshop sessions at the first school, Hari Vidyalaya. This was a small government (free) school and I was going to be teaching years 8 and 9. I had prepared a presentation but the school did not have access to a smartboard, so I made sure I knew the content I was going to teach and also printed out some image handouts to help me. It started a little rocky, without my presentation I forgot to talk about a few points. But I got into the rhythm, and the rest of the sessions went very well. After 10 minutes many of the students were less shy and would engage well with my questions. The peak flow meter activity was the highlight of the workshops as everyone was up and actively participating, asking me questions as I walked around and competing with their friends to get the higher peak flow reading. Each session improved my own confidence and flow in delivering these sessions and I was very happy with how the first school turned out.
I carried this confidence into the 5th week at Excel Public School. This was a much larger private school and is well known in Mysore. This time I was going to be teaching Year 8 covering 7 different classes. The school was equipped with everything I needed including smartboards which made the whole experience much easier compared to the first school. Nevertheless, with some experience already under my belt the week went smoothly as I went through the classes. I was shown around the school and had the opportunity to see some of the unique projects the students were making in their innovation centre. The students were also intrigued by my presence, but they engaged well with the workshops, asking questions and as always, the peak flow meter activity was the highlight of each session. Many of the students also came to ask me more questions at the end of each class showing their interest in asthma. At the end of the week I met with the principal of the school who thanked me for giving these sessions. He also mentioned that he would gladly welcome me back to give more sessions to other year groups as well, an offer that I would consider to come back in the future.
Looking back over my LiA I was very happy with how it turned out. Although I did not manage to achieve the second goal I had planned, I have developed the project into something more that I will continue to work towards. Regarding my first goal I would say it was very successful. As an experience I learnt a lot about teaching slightly complicated material to younger students in a language that wouldn’t be their mother tongue effectively enough that they can easily understand everything. The students engaged well with the workshops, and they learnt a lot about something they aren’t formally taught in their curriculum. I am also waiting on some feedback from the teachers and students at Excel Public School which could provide deeper insights into the strengths and weaknesses or my sessions. The feedback would be greatly beneficial to adapt and improve my teaching skills for the future.