ARSH and Yuva Clinic

"Adolescents (10-19 years) in India represent almost one-fourth of the total country's population. A large number of them are out of school, get married early, work in vulnerable situations, are sexually active, and are exposed to peer pressure. These factors have serious social, economic and public health implications. Adolescents are not a homogenous group. Their situation varies by age, sex, marital status, class, region and cultural context. This calls for interventions that are flexible and responsive to their disparate needs. Some of the public health challenges for adolescents include pregnancy, excess risk of maternal and infant mortality, sexually transmitted infections and reproductive tract infections in adolescence, and the rapidly rising incidence of HIV in this age group. Thus it is important to influence the health-seeking behaviour of adolescents as their situation will be central in determining India's health, mortality and morbidity; and the population growth scenario."

-- Official MOH&FW statement, Govt of India

Adolescence Reproductive and Sexual Health Project (ARSH)

The Department of Community Medicine, Patna Medical College, became part of a major collaboration undertaken by the Ministry of Health and Family Welfare, Government of India, wherein personnel are being developed and resources mobilized for the development of healthy, progressive and socially competent adolescents who can contribute to the development of the individual, the society and the nation. This mega-collaboration is Project ARSH.

Dr Ranjeet K Sinha and Dr Ajay Krishna, Assistant Professors from the Department, were trained in 2011 and 2009 respectively, in ARSH training programmes conducted by Mamta (an NGO), New Delhi and Lund University, Malmo, Sweden. They gained knowledge and understanding about the strategies and methodologies, by interacting with trainers and other trainees, and by visiting healthcare setups that cater to the needs of the adolescents in both nations. During phase one of the programme, they formulated an individual assignment identifying challenges in implementing Youth Friendly Health Services (YFHS) as related to young people in the state of Bihar, focusing on particular issues and area relevant to the Patna Medical College.

Dr Krishna's "Change Project", Establishing ARSH Clinic in Patna University, was brought to practicality by Dr Sinha's Change Project Establishing ARSH Clinic at PMCH. Both their Change Projects covered the same catchment area, but the ARSH Clinic in Patna Medical College Hospital had the advantage of a strong referral system of the hospital setting. Only with the efforts of Dr Rashmi Singh, HOD of Community Medicine, further developments were made.

A meeting was conducted on 25th October 2012 to sensitize Principal Dr (Capt) NP Yadav, faculty and other members of the department of Community Medicine towards the problems and challenges that actions for ARSH bring. Dr Sinha and Dr Krishna delivered presentations for the same. Requests were made to allow the provision of the necessary resources upon receipt of funds. The principal assured HOD Dr Rashmi Singh that appropriate measures would be put in place for the ARSH Clinic.

The World AIDS day was chosen as a platform to promote YFHS in Patna Medical College. In an event conducted by the Patna Medical College Teaching Unit on 1st December 2011, Dr Sinha and Dr Krishna made presentations for the awareness of undergraduate students about the programme. The event was also attended by members from National AIDS Control Organization (NACO), the Bihar State AIDS Control Society (BSACS) and the Red Ribbon Club of PMCH.

With the provision of funds and the efforts of members of the Department of Community Medicine, Yuva, the ARSH clinic was opened to the public by Principal Dr (Capt) NP Yadav and Superintendent Dr OP Choudhary on 8th February 2012. The event was attended by State Project Officer Dr MP Sharma, representatives from the UNFPA, doctors of all departments of PMCH, representatives from the Print and Electronic Media and the general public. Principal Dr Yadav encouraged the Faculty Members of the Department of Community Medicine to continue their service to the society. Professor and HOD Dr Rashmi Singh spoke on the necessity of such a clinic in the hospital and the state, and put before the dignitaries, the plans to strengthen the clinic to meet the needs of the target population in the coming years.

Yuva - the ARSH clinic was accepted by the public of Bihar with great applause. Adding to that, over 100 adolescents were catered to within an unexpectedly short timeframe after inception. The Department runs a regular clinic schedule, 1pm to 4pm, Monday to Saturday. Under the able guidance of Prof Dr Rashmi Singh, Dr RK Sinha and Dr Ajay Krishna, doctors attend to clients and help them to solve their problems and dilemmas, whilst also attending to nutritional demands and referral services.

In accordance with guidelines prescribed for ARSH Clinics, the details of patients attending to the Yuva clinic are kept secret. Thousands of IEC materials have been distributed and awareness made through massive media coverage of the activities of the Yuva clinic and the services provided therein. (Online reports by TOI, Telegraph; the story also remained at the top of PMCH news search results from TOI for over 2 months) Awareness is also being created by signboards posted throughout the College Campus. The walls of the Yuva Clinic also have posters for creating awareness about the various issues encompassed by ARSH.

The department announced the opening of the online Yuva Portal on 12 April 2012 for addressing concerns of clients through the internet (Yuva - The ARSH Portal of PMCH), and helpline number (+91-612-2300041 [11AM-2PM]).

Meanwhile, schools were approached, and faculty members interacted with over 2000 adolescents on common problems and their solutions, improving their perception of adolescence as a period of change, and the way they must channel their thoughts for progessive outcome, and dealing issues of nutrition and STDs. Dr Sinha and Dr Krishna along with faculty and postgraduate students of the Department conducted interactive sessions and drove the movement further.

Dr Ranjeet K Sinha attended the National-level ARSH Review Meeting at Shimla from 16 to 20 April 2012, and presented to the review committee a detailed description of the developments made, challenges encountered, constraints faced and future scope. The PMCH presentation was crowned the biggest success story of ARSH in the year. The review committee, including personnel from Lund University and Mamta, proposed to visit the state and conduct a detailed study of the project pattern implemented here. Communications with the team from Mamta were made frequently to drive the movement further. A meeting was conducted on 19th January 2012 wherein experts from the UNFPA and Mamta, came from New Delhi to the department and discussed finer details of the establishment process, refining of referral systems, organizing drug- and service-provisions and handling major challenges ahead. The team was appreciative of the efforts made so far, and promised all support in the future.

As of February 2017, about eleven to twelve hundred clients are known to visit the clinic annually. In addition, every year, the clinic participates in the Health Mela (Exhibition) of Patna Medical College in order to reach out to the public and spread the message of ARSH. A dedicated stall of the Yuva Clinic is set up and the doctors and counsellors appeal to adolescents and assist them with consultations, appointments, question box etc. The stalls witness hundreds of visitors and are a grand success each year.

The clinic has a long way to go, and the Department of Community Medicine is committed to ensuring public health for adolescents just as it is, for the general public. It is imperative that a new story of Social Change is being written.