Medical Home Care Service - a community-led program
Status: 
Time needed:
Two weeks or more
Step:
1
Caring for elderly relatives who suffer from chronic illness and/or Alzheimer's Disease is a huge burden for the very poor of Vijayapuram. The quality of life for the bed-ridden elderly patients can be miserable, as the financial burden of taking relatives to seek medical attention can be too much for some. This Task seeks fresh ideas, links, advice and fund-raising ideas around setting up a community-programme where medical and palliative care can be provided to bed-ridden patients, by locally trained community volunteers and trained medical staff such as Nurses and Doctors. See Joseph's personal letter below to all Neighbours.
Dear neighbours,
My project is medical home care for the poor and the needy old patients especially the Alzheimers patients in my village. First of all I may invite your attention to the fact that in our country there is no practice of Medical Home Care Service for the old patients by Doctors and nurses. So the poor and old including the Alzhiemers patients do not get proper attention and nursing in their homes. The poor families are unable to provide them with nutritious food sufficient medicines and medical care. Even though there are Multi Speciality Hospitals, they are out of reach for the poor as they are expensive and profit motivated. In Government Hospital also there are no facilities for better treatment to the poor due to the corruption among the Doctors and other staff. Considering these financial problems the poor families do not care to take sick old patients to hospital. This is very miserable and sympathetic. The poor people are unable to provide their dear ones with the expensive treatment. In these circumstances the poor old and chronic diseased will become victims of huge debt poverty and disappointment. So it is my great wish to help the poor sick old patients by providing them with free medical care nutritious food, treatment, as well as medical supplies. I was inspired to help the sick and old people by my parents.
But at present, even though I have good will to do all these I require some help out side to run this just like the vehicles need four wheel to run.
Thanking you
yours
Joseph
Picture:
Project: Medical home care service
Hi Jospeh, hello- I am new to your project and I have some questions.
Can you please calrify who your target group is: is it poor elderly who have Alzheimers or is it generally poor eldery people?
At the moment - what happens to an elderly poor person who has Alzheimers? Is he/she totally reliant on his/her family to look after them?
How much information is there amongst the poor people in your community about the disease Alzheimers? Is it a good understanding, or is it below basic? Is there a need for education- especially for the carers?
What is your ultimate goal with your project? Can you please give us a bigger picture of what you'd like to achieve?
It's early days yet but the more info you give us the better opportunities we will have to assist you.
Thanks Jospeh!
Carolyn
Madam Carolyn,
I got your reply while I was very much disappointed about the fact that I am unable to start the project of Medical Home Care Service as I wished. Thank you for your willingness to help my project. I was inspired to do this project by seeing the sufferings of the poor as well as by my personal experience in this field. I wish to achieve my goal as a humanitarian one. I wish to do my part of duty in this world of humanity without any barriers, and with the co-operation of others, as the human race cannot exist without co-operation and mutual help.
According to your reply now I may give a brief description about my project, 'Medical Home Care Service' for the poor and the needy old patients especially the Alzhimers patients in my locality. Through this service I wish to help the poor sick and elderly people including Alzhimers patients who suffer most. I also wish to help other needy patients on a humanitarian consideration. I may also invite your attention to the fact that in our country there is no practice of Medical Home Care Service for the old and bed ridden patients by Doctors and nurses. So the poor and old including the Alzhimers patients do not get proper attention and nursing care in their homes. The poor families are unable to provide them with nutritious food sufficient medicines and medical care, medical materials like water bed, tena bed, urine bag, necel tube, gloves etc. Even though there are Multi Speciality Hospitals, they are out of reach for the poor as they are expensive and profit motivated. In Government Hospital also there are no facilities for better treatment to the poor due to the corruption among the Doctors and other staff. Considering these financial problems the poor families do not care to take sick old patients to hospital. This is very miserable and sympathetic. The poor people are unable to provide their dear ones with the expensive treatment and conveyance. So I wish to provide them with a free Ambulance service to the disabled and bed ridden the poor patients especially the Alzhimers patients. There are about 12 persons among 100, above the age of sixty five are Alzhimers patients in our country.
The Alzhimers patients usually do not get full attention of the poor families because the family members are unaware of this disease. They think that it is a mental disease or otherwise caused by evil spirits. So they neglect the treatment of The Alzhimers patients and do not care to take them to the hospital. They are left to lead a very miserable life till the end of their life. So the family members of the Alzhimers patients should be given awareness or education about this serious disease. In our country the family members are looking after the old and sick patients as it is very expensive to hire a Home nurse at home. Due to the long term treatment of the patients will lead the family to debt and disappointment. This will impoverish the poor families.
The home care service, according to me, requires a full time doctors, nurses and Attenders in the office to attend the sick old people as an when necessary. The service should be for 24 hours. The people are given awareness about this project of Medical Home Care Service. Those who want the service of the doctors and nurses will contact us through phone call and they will visit the patients and will do the necessary help. For the purpose a mobile medical care service in an ambulance is necessary. In the case of very serious patients, they will be admitted in hospitals which are linked with special service to this. Arrangements will be made to give the patients special care and attention in those hospitals with the help of the medical home care service. So also the free service of trained home nurses will be made available to those who are in urgent need of it.
My ultimate goal to provide medical help to the poor sick old patients and there by make them not a burden to the families as well as to the society as a whole. To provide the families of the patients are to be given sufficient help to lessen the poverty and mental tress. The bed ridden old patients should be made available the services of Doctors nurses lab technicians, at home. To extent the life span of the patients in the poor community by providing them with better medicines and medical care and to enable them to live long in the society.
I think that the services among the poor will be an alternative to lessen the royal and business mentality of the Multi Speciality Hospital and the Doctors.
I hope that you will be able to assist me as early as possible.
Thanking you
Joseph A M
Hai Carolyn,
I have read your reply dated 17.1.09. I am thankfull to you for the same. I hope that you have read the project deatails. But no reply was found till date. Again I affirm that if there is any assistance I am willing to work hard for the poor to the best of my ability.
Thanking you
Joseph A M
Hello Joseph, I apologies for not responding to you sooner. Sometimes work on Nabuur works quickly, sometimes a little slowly. Try not to be disappointed..these things do take time although I understand that your needs are very urgent.
Thanks for trying to explain a bit more about what you want your project to look like. I don’t have answers yet- maybe others out there do…but I do have some more questions to help build the picture
I think that educating the people in your locality about Dementia/ Alzheimers is a very important step foreword. If you do not understand the nature of the disease then how can you begin to care for the person who suffers from it??
On a personal note my grandmother has Alzheimers so I too am having to understand this disease and what effects it has on a human being. Especially someone you love dearly. So one of the first things we all need to do is start gathering information about Alzheminers in India, and start to build relationships with the relevant groups in your country that can begin to provide education tools. Educating your neighbors will not happen overnight. it sounds like there are many superstitious barriers that need to be broken down, but as I said- people need to understand the disease first.
The second comment I’d like to make is about your Ambulance idea. Is it your idea that the ambulance will take the elderly patients to a special clinic that treats people with dementia and other diseases associated with age? What is the priority here? To find modes of transport to get the elderly to a doctor- OR to build a clinic where a free ambulance can go to? I would be very cautious about aiming to build a clinic with doctors/ nurses as this is a very large goal and I’ not sure Nabuur is the right place to be trying to achieve this goal. But that’s just my opinion- others may disagree.
In regards to Home Medical Care…that is probably something more realistic we could work with. Do you know if there are any examples of this kind of service in India or southern India?
One final thing for now…if we to a free ambulance service…where would the truly sick be taken to? If it is a hospital- will the hospital accept the patient without payment? Based on the information you have given us in your background info page it doesn’t sound like the hospitals in you locality would always accept the very poor and elderly patients. Can you please explain what happens if a poor elderly patient is taken to a hospital?
Thanks
Carolyn
Hello Carolyn,
Thank you For your kind response. I was unable to send this reply in time because I was busy with the hospitalization my mother who is an Alzheimer’s patients for long years. So I am an experienced one who has been close contact with the various stages of the Alzhimers disease. I am thankful to you once again, that you have understood my problems and ready to assist my project.
Now I wish to clarify your doubts about my project. It is my great wish to help the poor old sick patients especially the Alzhimers ones and therey lessen that hardships of them as well as that of their families. This is from my long term experience. As mentioned above my mother has been suffering from Alzhimers disease for a long term. But very recently only it was confirmed after various tests in the hospital now also the treatment is continue. From last July on words she could not take food through mouth. So the a nasal tube is used to give her liquid food. She has lost the ability to speak also. We have contacted an Alzimers association in Bombay to know more about this disease but it was in vain. So also I have contacted a doctor for Alzimers association; but there was no response at all.
As you have said Indian’s are not at all fully aware of Alzhimers. Only very recently the doctors even diagnosed this disease. So there is no Alzhimers care unit in the Indian hospitals. Now a days two or three organization have developed for investigating this disease. But the society is even now not at all aware of this disease. So the poor old patients are suffering a lot in their whole life. Proper care cannot be given to them as the families are also unaware of this disease. So there is need for educating them. So I wish to part with my experience to there families. The families will become depressed and impoverished due to the long term treatment of their dear old ones. I wish to give counseling and advice to the family members.
Secondly the poor people are not having any conveyance of their own. In emergency case they have to depend on a hired vehicle. It is very costly and difficult to hire a one in time. So I wish to have an ordinary ambulance belonging to the Medical Home Care to carry the poor old patients to any of the hospitals near by in emergency situations. So also for visiting the bed ridden patients at home and replacing their Urine tubs and rice tubs, the medical staff are to be aken with help of this ambulance. It will be an ordinary ambulance without having any modern medical facilities, which is of low cost.
In our country there are no special hospitals and Medical Home Care service for the Alzhimers patients, as it is only diagnosing very recently. I wish to meet the hospital charges for the poor old patients and to provide them with nutritious food to
lessen the hardships of the patients as well as that of their families with the help of this medical Home Care service. Engaging a doctor and nurse in the Medical Home Care service centre its self is very expensive. My own experience has persuaded me to think about such a project.
Thanking you
Joseph
Hi Joseph, that's a lot of good information...I guess from my perspective trying to get someone kind of education strategy which would help the people of your area would be the first step. Whilst you have tried to contact the professionals with no luck, doesn't mean we shouldn't keep trying! I'll start some research and see if we can make any meaningful links.
As for the ambulance service...I'm really not sure where to start with that. Does anyone else have any ideas?? I agree with Bram that perhaps a day clinic could meet the needs of the elderly..but we would need experienced people and good connections to help set something like that up. And funding.
Carolyn
Hi Carolyn,
Thankyou for your discussion of my project with Doctor Bram. The first step I belive is to start one. I aim at educating the family of the patient side by side with helping the patients at time of visiting. I also wish to conduct education compaigns for the locals occassionaly. The day clinic you have proposed is OK. But there is one practical difficulty in this. If a patient becomes serious at night the helpless poor family is forced to hire a costly privet vehicle to take the patient to the nearest hospital. So I wish to have an ordinary Ambulance for the clinic to take the patients freely to the hospital as and when necessary. The Ambulance can also be used by the doctor and nurse of the clinic to visit the sick old patients at their homes. If the project (Medical Home Care Service) can be started then I will be able to try to contact any other local organisations to help me to have an Ambulance, as this is a charitable work. I don't no wether it will be a success or not. It is reality that the root cause of poverty and debt is the long term treatment of the diseased family members. If we I can start this project, It will be great helpfull to the locals for ever.
Thanking you,
Joseph
joseph A M
Hi Joseph
to start with: it must be burdensome to care for your mother in the state she is, and maybe you will have bitter feelings sometimes knowing elsewhere much more organized support is available.
About dementia: I had a friend with Alzheimer starting at a young age, she died in a nursing home as unabled as your mother is now, My father who died in 2000 suffered from a vascular dementia, my mother kept him home as long as possible, but the last year before he died he did not recognize her anymore and developed delusions about her, trying to expulse her from their apartment now and then. She became fully exhausted not withstanding the help she got from professionals and her children.
You asked about delirium.
Delirium in demented people is caused by general dysfunction of the brain resulting in lowered / altered conciousness, confusion, (optical) hallucinations, unrest. Caused by the disease itself (fe Alzheimer / vascular dementia, especially at night) but often by some intercurrent disease fe an urine tract infection, heartfailure, systemic diseases fe anaemia. Even an overfilled bladder can trigger a delirium. Treatment consists of treating underlying causes and treatment of symptoms (often with a medicament called haloperidol, in a low dose).
I give you a link to the internationally accepted protocol for diagnosing and treating dementia:
http://www.nccconline.org/about/alzheimers.htm
plus a PDF document especially about care:
http://www.nccconline.org/pdf/CCN-AD_tools6-03.pdf
You will see some items are not realisable from your situation but by reading it you can judge about what IS realisable compared to the “ ideal” situation and you will get an idea how to realise step by step goals you set (also in educational matters)
Now about your project. You can never realise anything I think at your one. So: do you have some people in your environment who want to work together with you to improve care for the elderly? If not you should try to find them.
About professional assistence. You told a lot about what is NOT available, but I wondered what IS available and could be a starting point to improve diagnosis, treatment and care.
Maybe my questions will appear a bit naïve, but: when people in your village get sick, is there a doctor to consult in the vicinity? Or are people obliged to go to some hospital far away? Can some nurse be consulted, fe to change a catheter? Do people have an insurance or do they have to pay every consult and treatment? Are the local authorities interested in matters of health and sickness?
I mean: if there is some qualified doctor who can be consulted he should know about the dementia protocol. An insurance compagny might be interested in paying some care, also to prevent expensive acute care given by first aid departments of hospitals. Some authorities might be interested etc. I m curious what the Alzheimer association can do (I understand Carolyn is making a search about that).
About the ambulance: need it to be an ambulance? Or could you set up some use some other automobile which can be rented at low costs for medical purposes only?
All the best again: Bram de Waard
Hello everyone,
I’ve started my research into existing support and education structures in India around Alzheimer’s and Dementia. I believe that tapping into existing structures will be easier than trying to start anything from scratch. Joseph, you may feel that your previous experience with Alzheimer’s Organisations have not been very good or helpful, but we can try again. I also understand that your people do not always get the same treatment as others who are of higher caste etc, You have the support of lots of people on Nabuur to get you to the first step.
The first orghanisation I want o explore is Alzheimer’s and Related Disorders Society of India (ARDSI) which is a national voluntary organization dedicated to the care, support, and research of dementia.
http://www.mykerala.net/alzheimer/ardsi_today_01.html
I found this quote from the site…I though it was good news for you and your local people Joseph:
Alzheimer’s and Related Disorders Society of India, launched a new project in the name “Comprehensive Dementia Care Program” (CDCP) in Cochin Corporation with an objective of making Cochin as the first “dementia friendly city “ in India.
The Main activities undertaken by the ARDSI are:
A. COMPREHENSIVE DEMENTIA CARE PROGRAM AT COCHIN
(Funded by Sir Dorabji Tata Trust, Mumbai)
» Day care
» Domiciliary care
» Memory Clinic
» Geriatric Care Training
» Awareness programs
» Care givers’ meeting
» Guidance and counseling
» Research
» Dementia Care Fund
B.DEMENTIA RESPITE CARE AND DAY CARE AT KOTTAPAY, NEAR GURUVAYUR
(Supported by Rotary Club of Kunnamkulam (Dist.3200), Rotary Club of Boulder, Colarado, USA.(Dist 5450) and Rotary Foundation, Eisai Pharmaceuticals, Japan and Josephine Hague, UK)
There are 2 programmes provide by ARDSI which are very helpful:
AWARENESS PROGRAMMES
Regular awareness lectures about dementia are conducted in schools and colleges. Members of Kudumbashree, Anganwadi and other community workers were also included in the program. Notices, brochures, newsletters and other publications are distributed at frequent intervals among public. Also wide publicity is given through mass media. BPL Help lines are extensively used for dementia awareness programs.
CARE GIVERS’ MEETING
We organize caregivers’ meetings at regular intervals. The meetings are conducted for the caregivers at the dementia care center. Formation of Support Group was discussed in the last meeting in addition to normal discussions. Such Support Group could act as care givers and offer their services working in the field of dementia.
These are 2 areas where you could get involved Joseph- and also help you further develop your skills and understanding of this disease.
I found out that there are several Chapters of this organisation in the Kerala area. Can you please tell me if you have already contacted any of them? If none- I will contact the head office first and then go from there.
ARDSI Calicut (Kozhikode) Chapter,
ARDSI Kochi Chapter,
Dr. Mathew Abraham, President Neurological Clinic
ARDSI Kottayam Chapter,
Mr. Mathew Joseph Kanamala, Secretary,
Grace Medical Centre,
ARDSI Pathanamthitta Chapter,
Mr.Sasidharan Nair, President
YMCA Building
ARDSI Thiruvananthapuram (Trivandrum) Chapter,
Mrs. Meera Pattabi, Secretary,
Vanchiyoor, Thiruvananthapuram
My compliments for the search you did Carolyn! Bram de Waard
Thanks Bram!
In other good news (it's amazing what you find on the internet!) I have come across a PhD student here in Australia whose thesis is very much about what we are trying to solve here. I am going to email her today with the view that we can talk over the phone and perhaps she can give us some good leads- or in the least- give us a better understanding of what is going in in India in terms of care services for dementia patients, and government policies etc,
The abstract is below:
Age, invisibility and madness: Understanding dementia care in India
This project will contribute to knowledge about dementia care in India by investigating how
families provide care and interpret the meanings invested in the process. Ms Brijnath will be
working with family members, people with dementia, key service providers and the Alzheimer’s
and Related Disorder’s Society of India (ARDSI) in New Delhi, India. Her research aims to find
out local meanings of dementia causes and management in New Delhi, India; experiences of
providing care; examining how stigma functions in everyday life; investigating support systems
available and the barriers encountered by carers when accessing support. The research findings
will be used to lobby the Indian government for better services for people with dementia, and will
also have relevance for Indian immigrants in Australia.
Hi just wanted to add to my post that Ms Brijnath and I are going to talk with each at the end of this week. I'll let you know what I find out.
Hai Carolyn,
Thank you for your great task in searching out Alzhimers care service units in India especially in Kerala . I am very much thankful for your information about Alzhimers organization.
At an early date we have contacted the Guruvayoor chapter but there was no response at all. Now at present, according to your advice I have contacted Grace Hospital by Ph No: 0481-2517495. They said that there is not special treatment for the Alzhimer patients and gave me another phone No: 0481-2505156 contacted with that number and they gave me yet another No:0481-2517676 I from there also I could not any Information except another No: and it was the mobail Phone No. of Sri Mathew Joseph Kanamala, ARDSI Kottayam Chapter, Secretary, Grace Medical Centre Kottayam. I contacted him and he told me that at present there is no Doctor and nurse there. He also told me that there is no practice of attending the bed- ridden patients at home and remove the catheter etc. This is the nearest place to my locality.
I have also contacted ARDSI Pathanamthitta Chapter and got some information about the work. They are also attending the Alzhimers patients at homes. This centre is far away from us and so it is impossible to get their attention to my mother. So also the Cochin ARDSI chapter is far far away from us.
So it is impossible for the poor families to get the services of any of these chapters because they are too expensive to be reached. Over and above it is not sure that there will be any consideration for the poor.
In these circumstances I was inspired to give free service to the poor old and chronic diseased people including Alzhimers patients in my locality, through the project of Medical Home Care Service. I believe that I will be able to start one unit as early as possible only with the help of my Nabuur friends. Thus I wish to save the poor families from disappointment and debt caused by the long term treatment of their old ones. Till now, even the Government or the multinational hospitals have no idea about this situation of debt arising from the longterm treatment of the poor patients.
Once again I am very much thankful to you for the great efforts you have made towards our project of ‘Medical Home Care Service’
May God bless you
Joseph
Joseph, it must be very frustrating that you've made so many contacts yet no one has been able to really give you any answers.
I guess from my understanding and general experience of providing health care to the masses, this is not something you can do alone. And not without training.
I have identified three separate parts to your ideas. Please correct me if I am wrong.
1- is to provide education to the local people about caring for the elderly who are sick, how to care for Alzheimer patients and what is Alzheimer's?
2- is to provide a transport system for this sick and elderly to be taken to a hospital or health facility - for no cost
3- is to provide a home medical service where a nurse and/or doctor can attend to the medical needs of a poor elderly patient in their home.
Each part of this idea requires a different approach. The first part (education) requires you to skill yourself (and others) to learn more about Alzheimer's and to work with the local community to help them understand that It's not just 'old age" but is in fact a disease and sufferers require special attention at the later stages of the disease. Keeping contact with ARDSI ( or other similar organisations) would be very helpful.
Whilst you do have the personal experience of knowing what happens to an Alzheimer's sufferer, there is a lot to learn about how you educate many people about this subject and about how they can care for their relatives. Therefore connecting with an existing organisation is a reasonable way forward. The Chapter of ARDSI in Pathanamthitta that already offers home care- they are the ones to really be asking questions to. OK they are far away from your local village- but if they already have a service up and running then surely they are in the best position to give you more information, guidance and tips on how to begin this process.
I would urge you to continue communicating with them. You cannot do this alone and there is still a lot to learn from the experts.
Your second idea about the ambulance/transport service requires funding and equipment (eg.car/ van). Again you need to connect with the right organisations who might be able to provide you with a car or the money to purchase a car. And you also need to find a driver. This driver may, or may not require payment. And how will people alert the driver that they need the ambulance? Mobile phone? Do the people who need this service have access to phones? Who will pay to maintain (look after) the vehicle? Whilst Nabuur Neighbours can definitely help to research and find organisations or charities who can help , it’s not common that Neighbours will send funding to you directly. IF you took out a loan then you would have to ask people to pay money each time they used the ambulance service. But from what you have written it sounds like you want to provide a free service as the poor cannot afford to pay. Am I right?
The third part of your idea requires a much bigger financial investment. It requires a paid Nurse and a paid Doctor. You would need enough money to provide at a minimum 1 years salary or at least 2 years to get their commitment. It also requires building up a service and being clear about what type of service they will provide? How will they get access to medicines? Where will the medicines be kept? Will the medicines be given freely? If so- how will this be funded? Then there is the cost of catheters and nasal tubes and other medical equipment. A mobile clinic would require approval from local government and health ministries. Again, in my opinion, I would suggest working through an existing organisation such as ARDSI or a community health care provider would be helpful.
You are right to insist that the poor be considered in the discussion in your country around Alzheimer's disease and care for patients with chronic illness. I congratulate you for wanting to change things for you and your mother and your local neighbours. I fully understand that without money the poor cannot look after their health properly and they are severely disadvantaged by this.
From everything you have written to us about your ideas there are many opportunities where neighbours on Nabuur can help you- e.g in research, investigating connections with appropriate organisations in India, talking to these organisations, finding charities that may be able to find funding for the purchase of a car etc. collecting useful education tools etc. etc Is this the sort of help you are looking for or did you have some other ideas?
Regards, Carolyn
21/02/09
Sorry for the delay in sending you the message. Thank you for your advice and efforts towards my project. I welcome your suggestions. From your message I understand that you have also understood the matter thoroughly.
According to your advice I am trying to find out two or three persons to assist me in carrying our my project. I have some experience and also I am trying to get some more training from the Doctors and nurses.
The three parts of the project as you have mentioned is apt.
1. As the first step I wish to educate to the family of the sick elderly about the base of caring the patient and about the disease. The families of the chronic and other diseased persons will be taught about the ways to prevent the diseases. This will be more effective and frootful to the society also to change their attitude towards the diseased persons. Even now our society is ignorant about the Alzhimer diseas. Any hospital has enitiated to give information about this diseas to the society. Even though ARDSI is giving education in this field we are unable to know about this programme. Any how we have planed to give education to the poor people about this diseas from our experience. According to your advice I wish to contact with ARDI Pathanamthitta to get more information.
2. Secondly an ambulance or van is essential for the project to transport the patients to the hospital and also the doctor and nurse to the bed ridden patients’ homes. I am very much thankful to the nabuur friends who are willing to research and find organizations or charities who can help me in this regard. It is also essential that there should be a driver with mobile phone to attend the phone calls from the patients’ families. He should also be a helpful attender. I wish to help the poor people as well as possible, without accepting any money for this service. This can be balanced by rendering services to the rich patients who are capable of paying money for this. I our country, availing a loan is risky due to the high interest rate of 12% and above.
3. As you have said the third par of my project is very expensive. I wish to search for a voluntary doctor. But I am not sure to get one. Otherwise I have to find out money for this, from any other source. I wish to provide medicines and other medical materials to the poor by contacting Medical companies or other organizations. But the practical difficulty in our country is that the common people will not get sufficient consideration for anything. This is the reason for the failure of starting any charitable deeds by common people. I could submit such a project and say the problems freely us you are merely a foreign agency. So it is better for the nabuur friends only to be in contact with other organizations for better response in this matter.
Any have I should try my best to be in contact with organizations like ARDI for help. I should also try to get the approval of the government to start the Medical Home Care Service, if it is essential.
We can only be in contact with other individuals or organizations for further support only after starting of this project.
I am fully satisfied with presenting my idea of ‘Medical Home Care Service’, frankly before the world organization which is willing the help of poor struggling old patients and their families. I am thankful to you all in this regard.
Thanking You
Joseph