What is ‘lost to follow-up’?
If exposed to the medical or public health world, you may be familiar with this phrase. For the others, I will illustrate what this means with an example. Let us say Ms.’X’ is in Mumbai for a work meeting. She falls ill due to the food she eats at a street vendor. She consults a private clinic in Mumbai, which treats her for the food infection, but also discovers that she has a raised blood pressure and high blood sugar (chronic conditions that last a lifetime). Now this private clinic has a good practice of maintaining the records of the patients seen at the clinic and sends them regular text messages/calls them up (a process termed as ‘follow-up’) to ensure care is continuous and all aspects of chronic disease care are well taken care of. When the nurse at the clinic calls up Ms. X to schedule a complication-screening appointment for diabetes, and hypertension (as a part of her routine protocol), she realizes that Ms. X is not a permanent resident of Mumbai and was only visiting when she consulted at the clinic three months ago. The nurse will then label Ms. X’s case file as ‘Lost-to-follow-up’ with the reason for the same. This will help the doctor to understand the follow-up status of his patient.
Why is follow-up harder for women in rural areas?
Over the past 6 months, our organization has worked with and for about 100-200 women from rural areas of North Solapur, Maharashtra. We have conducted medical camps, attended microfinance meetings, and done home visits. Women have come to our ‘Streearogya Kendra’ as well, for out-patient consultation. One of the aspects we want to incorporate in our work is the continuity and comprehensiveness of caring for our fellow women. This means that we have a neat record of their medical, nutritional, and social scenario and that we step in for their care in a timely and informed manner. This also means that we look at them as a whole person. I realized (from my experience here in Maharashtra and having worked in rural and tribal areas of Karnataka and Tamil Nadu) that simple things like setting up the next appointment or checking on the progress or reduction of symptoms, checking if they got an investigation done or took the recommended vaccine, etc. can be super-challenging for women in rural areas. For one, most families have 4-6 members but only the male member has a phone. The male member is likely to own the phone and generally, he is out at work during the day when we make our follow-up calls. A lot of the homes in the villages are field huts, in the middle of agricultural farms, which means internet connectivity is very poor. Some of the women who have their separate phones, work as daily wage farm laborers and work in the farms from morning till late evening. On the rare occasion that we can speak to the woman on the phone, she has most likely not taken her medications/ vaccine, not done the investigation recommended, or is not yet feeling well due to reasons like no transportation or no money to go to the lab or not being able to go alone to the health facility, etc. Trying to establish the continuity of care may not feature in their priority list as they are often the default caregivers at home for children or the elderly. No wonder, the healthcare system often fails at managing chronic health/disease conditions. Especially a system that is heavily privatized, unregulated, expensive, and fragmented.
How did our team attempt to follow up with the people who had abnormal lab test results from the medical camp?
In October 2024, we facilitated the organization of a free medical camp in Pathari through the government medical college in Solapur. As a part of the camp, free screening for Type-2 Diabetes mellitus was done. The reports showed that 10 people had very high blood sugar and 11 had borderline high blood sugar. We coordinated with the village ASHA, and the public health staff at the sub-centre to try and get in touch with these people. Unlike in cities, most people know most of the other residents of the village and know who lives where. This helped to some extent. Yet, we have been able to reach only a third of them so far and the attempt to avoid ‘loss to follow-up’ is ongoing.
