# Follow-up visit

# Previous Chapter

# Chapter summary

A follow-up visit to the PHC, a month later. Birender's glucose levels are still high. Dr. Sood is a bit concerned.

# This chapter

On June 4, Birender went to visit his younger brother, Jaikishan. Jaikishan and his wife, Nupur, lived in Saharanpur, about 15 kilometers away from Tikroul. Soon after he arrived, Birender received an SMS. It said, "Your appointment at Tikroul PHC is in three days, on June 7, at 9:00 am." Birender realized that he was due for his 30-day follow-up visit with Dr. Sood.

Agni should notify patients before any scheduled visits.

When Nupur heard about this, she asked Birender to go see their doctor instead. "You know, he was busy doctor in Delhi! He gave all that up and moved back to Saharanpur, where he hails from."

Birender gently demurred. "It's not urgent. I'll go to the PHC right after I get back."

A free checkup and free medicines are a lot better than shelling out hard-earned money to get the same advice in the city, he thought, Besides, what would Dr. Sood say if she found out that I went to see another doctor? In Tikroul, social relationships matter. Not like these town folk!

Agni should enable patients to take control of their medical records, and move between public and private health systems. This raises the need for a patient-facing app in the future.

Birender boarded a bus back to his town on the morning of June 8. He had received two more SMS reminders—one on June 6, and another on the evening of the 7th. These two messages also informed him that he ought to come on an empty stomach.

If the PHC staff schedules lab tests along with consultations, then the notification message should inform the patient about preparation needed, if any.

As he dozed off, Birender wondered if getting a phone was a good idea. Now everyone and their uncle sent him messages all the time. And Simran got quite annoyed when he didn't answer his phone. But the phone allows him to talk his grandson, Rajat, everyday. That makes it worth the hassle.

Shortly before he reached Tikroul, Birender's nap was interrupted by his phone ringing loudly. It took him a while to find which pocket it was in. The call was from an unknown number, but he picked up anyway—just in case it was Simran. Instead, it was Gayatri, the Staff Nurse of the PHC.

She sounded a bit peeved that he had not come to the clinic on Friday. Luckily, the bus rattled a lot, and Birender was able to quickly conclude the conversation, with the promise that he would be at the clinic on Monday, at 9:00 am sharp. A minute later, his phone beeped. Another message. It read, "Your appointment has been rescheduled for Monday, June 10, at 9:00 am. Please come on an empty stomach."

Birender scowled at the phone, and put it away. "Infernal device!", he grumbled.

Sunday came and went all too soon. Simran brought Rajat over for a vist, but Birender could barely keep up with his games. At lunch, he looked forward to savoring Simran's pindi chole¹. Birender thought Simran's cooking was much better than Janaki's. He was wise enough never to make this observation loudly.

The next morning, Birender arrived at the PHC at 8:45 am. He had no intention of irking Gayatri any more than he had. It was a busy morning at the clinic, and it took an hour—during which he gave a blood sample for fasting blood glucose—before he was called in for his consultation.

Dr. Sood reviewed his blood pressure—checked by Gayatri earlier that day—and the random blood glucose results, which had just reached her.

Agni should enable rapid data flow from one PHC workstation to another. Such a system should work offline, because within-PHC workflow does not require internet connectivity.

She said, "Your blood glucose levels are still high. I am increasing your medicine dosage, but please come back in another two months, or if you feel unwell." Birender felt worried. "It is serious, doctor?" Dr. Sood reassured him, "We have to monitor carefully, that is all."

Agni should provide clinical decision support by incorporating established protocols, like the World Health Organization's PEN and HEARTS packages.

Birender walked over the Pharmacy. Imtiaz always had a joke to share — that would definitely make him feel better.

A popular dish made with whole chickpeas, or chole. The pindi apparently comes from Rawalpindi. And the pindi in Rawalpindi comes from pind—one's village or hometown, and more generally, where one's roots are. So, pindi chole might be thought of as 'chickpeas that remind you of home'.↩