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Referral to another PHC
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Previous Chapter
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What this story covers
Another follow-up visit, which results in Birender being referred to Nanauta PHC.
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This Chapter
June and July were swelteringly hot. Instead of staying all day at the shop, Birender started spending his afternoons at home. Seeing his newfound love of napping, his wife, Janaki, commented that he had become more sedentary. Privately, she was a bit worried, and Janaki shared her concerns with their daughter, Simran.
Birender was due for his checkup on Monday, August 12. This time, he was determined not to miss it. He also had a few updates to share with Dr. Sood. On Sunday, Rajat had come over for his weekly visit to dada-dadi. Birender has convinced Rajat to try out tic-tac-toe instead of his usual game of hide-and-seek. While Rajat picked up tic-tac-toe quickly, Birender had trouble playing. His mind felt foggy. Even lunch was not as enjoyable as usual—there was an odd taste in his mouth, and it came and went through the following week.
While Agni is focused on healthcare providers, early observations mostly take place at home. A system that enables patients and their families to record their observations would be valuable for healthcare providers—enabling them to intervene early. What Agni can contribute now is to offer a structure that patient-facing apps can use.
On the day of the checkup, Birender reached the clinic at 8:30 am. He wanted to see Dr. Sood early, before other patients got there. Luckily, he was the first in line. While Dr. Sood checked his blood pressure, Birender recounted his Sunday. When he mentioned having trouble playing tic-tac-toe, Dr. Sood's head snapped towards him.
"Have you been feeling more tired than usual?", she asked.
"Yes", he said, and recounted his past week.
Dr. Sood picked up her phone, and started tapping away. She asked him another half-dozen questions, including whether he had a metallic taste in his mouth.
Birender confirmed her suspicion. In a worried voice, he asked, "Is there something wrong?"
Dr. Sood replied, "I want a more thorough checkup. Only glucose measurements are not enough. Can someone accompany you to another health center for a check-up?"
"Yes, I can ask my daughter, Simran."
Dr. Sood proceeded to refer Birender to Nanauta PHC, about two kilometers away. "They are better equipped to run tests for heart and sugar. And the doctor there, Dr. Vandana Bhargava, was my instructor during my residency. I would like her opinion."
Even if facilities are all designated as 'primary healthcare centers', their capabilities vary, because of differences in resources—staff and equipment. Agni has to accommodate this by enabling administrators to fine-tune the capabilities of, and the services offered by, each facility. For a more detailed discussion about capability mapping, see our blog about designing population-scale health systems.
Independence Day was around the corner, so Dr. Sood urged Birender to visit Nanauta PHC the very next day. Birender was easily convinced—he wanted to spend the holiday teaching Rajat to fly kites, not worrying about an upcoming appointment. As he walked out of the clinic, Birender got a message with details of his appointment. He decided to call Simran, and ask if she could take tomorrow morning off.