Gadchiroli tribals get lower back pain management programme

An intense community-based study of two villages revealed that 53% of adults had lower back pain, and annually 75 % of adults developed backache problems at some point of time. Lower back pain is a major handicap, as it also leads to loss of productivity and income

Gadchiroli: After suffering from severe back pain for six years, Satyabhama Khobragade, 56, a resident of Gevra village in Gadchiroli, was operated on for slip disc at the Maa Danteshwari Dawakhana on July 15. Mumbai-based spine surgeon Dr Shekhar Bhojraj performed the surgery.

Dr Shekhar Bhojraj with Dr Datta Bhalavi checking on Satyabhama Khobragade,56, post spine surgery for slip disc at SEARCH’s Maa Danteshwari Dawakhana on July 15. (HT Photo)

Khobragade, who works in the paddy fields, had avoided surgery till the crippling pain got the better of her. “I used to spend a minimum of eight hours in the field,” she said. “There are certain months that are crucial for paddy farmers, like the transplantation period when we have to bend for hours. During harvesting too, our posture is affected. I ignored the back pain at first but eventually was unable to walk even for 10 minutes.”

Dr Datta Bhalavi, the in-charge of the Maa Danteshwari Dawakhana, said that Khobragade came to the hospital two months earlier with severe pain in the lumbar region, numbness in both legs and an inability to walk. “The symptoms were red flags for immediate spine surgery,“ he said.

Along with Khobragade, 24 more patients with slip disc and spinal problems underwent surgery during Dr Bhojraj’s three-day visit to the tribal village. The impoverished residents of the area have for decades been provided with healthcare services by SEARCH, an NGO set up by Dr Abhay Bang that works in 134 villages and covers a population of 1,10,000.

The postures that are necessary for farming put the entire community at risk of musculoskeletal (MSK) issues. “Since 1995, apart from malaria, child mortality and gynaecology issues, lower back pain was constantly mentioned as a health concern by locals during our health assemblies” said Dr Bang. “We had to take it seriously because it was a community problem.”

The NGO, along with Dr Bhojraj who runs the charitable Spine Foundation, and physiotherapist Dr Gaurish Kenkre, drew up a lower back pain programme for locals. Dr Bhojraj and Dr Kenkre had played a key role in former Maharashtra chief minister Uddhav Thackeray’s surgery and recovery after he was diagnosed with quadriparesis, a condition of muscle weakness affecting all four limbs and torso.

“An intense community-based study of two villages revealed that 53 % of adults had lower back pain, and annually 75 % of adults developed backache problems at some point of time. Lower back pain is a major handicap, as it also leads to loss of productivity and income,” said Dr Bang.

Dr Kenkre said that MSK disorders began when workload exceeded the capacity that the locomotor apparatus could bear. “This capacity is often abused in occupations such as agriculture and farming, which demand long work hours, lifting and carrying heavy loads, repetitive bending and prolonged flexion of the trunk during picking,” he said. “Since 90 percent of the population of Gadchiroli is engaged in either labour or agricultural activities, there is a high prevalence of musculoskeletal-related problems.”

To improve accessibility and treatment options, the two doctors, along with the SEARCH team, developed a multi-tier approach to treat lower back pain, keeping in mind that 85 to 90 % of backaches could be treated with physiotherapy, while the remaining structural abnormalities like compression of nerves or disc prolapse would require spine surgery. “The aim is to improve patients’ quality of life by improving their functional status and decreasing the financial burden they incur when they cannot work or have to pay medical bills or travel to a healthcare facility,” said Dr Bang.

The multiple-tier physiotherapy programme comprises superspeciality doctors, including rheumatologists, spine surgeons and pain specialists at the top. “The second tier involves medical officers trained to identify the requirement for surgery and refer cases to the doctors,” said Dr Anand Bang, joint director, SEARCH. “The other tiers involve physiotherapy programmes, for which we have a dedicated centre at the hospital.”

Going to the doorstep

Anticipating that not everyone would head to the centre for regular physiotherapy, the team has set up mobile physiotherapy units (MPU). “We are trying different approaches to see what works better and will be accepted by the locals,” said Dr Anand. “We are looking at physiotherapy, drug therapy and spine surgery for spine management in the population.”

SEARCH has three trained physiotherapists and has tied up with MGM Hospital, Aurangabad, to provide physiotherapy by resident doctors on a rotation basis. “These physiotherapists are trained by our team. We also have a weekly teleconsultation,” said Dr Kenkre, adding that a physiotherapist, along with the MPU, visits a village once a month for a week. “If these patients are not given prompt treatment at the inception, the condition becomes chronic and riddled with more complications,” he added.

Sunil Bamanwar, 45, a farmer who got picked up for physiotherapy due to back pain during the MPU visits, said that posture modifications suggested by the physiotherapist, like taking small breaks and changing posture, had helped him this season. “The physiotherapist gave me exercises for a week, which I try to follow too,” he said.

The team has also involved community healthcare workers, who refer patients for physiotherapy and surgery. Dr Anand said that lower back pain had emerged as a global problem and was not restricted to farmers in Gadchiroli. “We are fine-tuning our lower back pain programme for the population here,” he said. “All protocols have been scientifically designed with the latest available literature.”

Dr Sakharam Hichamia, taluka health officer at Pendri’s PHC, said there was a need for a physiotherapist at every PHC. “Apart from bad posture while farming, long bike rides and bad roads also aggravate musculoskeletal problems,” he said. “The musculoskeletal problems in the community here are therefore huge.”