Table 3.

Case stories illustrating diverse ways in which NDAPs engaged with patients

Case 1: Ashok, (name changed) has been practicing in the urban informal settlement for ten years. He has a degree in Unani medicine. He shared that people mostly sought his advice for getting immediate relief from bothersome symptoms like fever, cough, and weakness. He also treated minor cases that could be easily dealt with symptomatic medicines as he feared negative publicity in the community due to any adverse event in dealing with serious cases. He expressed satisfaction with his practice, highlighting that it was enough to cover the clinic rent and provide for his children’s needs. In the case of diabetes and hypertension, he did advice people to get themselves tested for diabetes or hypertension from specialists, but he also acknowledged that people did not always listen to him. In his opinion, people did not take initial symptoms seriously and avoided testing since they feared that diagnosis may necessitate long-term medication. “I am here to take care of people for basic issues and also to provide immediate care during any emergency. I do check blood pressure when necessary, but people are reluctant to go through any further process of testing. They’ll say just give something for today, we’ll see about everything else later. They just don’t want to worry about such things.”

Case 2: Raza (name changed) has been practicing in the urban informal settlement for six years. He has a degree in Homeopathic medicine. He keeps small diagnostic machines like digital blood pressure, glucometer, and ECG set-up, and uses these tools to screen patients, refer, or prescribe medicines accordingly. Before opening his clinic in the area, he had worked in a big private hospital nearby. This experience, he shared, had helped him connect with senior doctors in the locality, to whom he refers patients, and who in turn, support him with medical advice. Raza also guides patients who get diagnosed elsewhere in understanding their medication better and advises on future course of treatment. “Once patients tell me about their symptoms like excessive thirst, urination or feeling too sleepy or restless, I check their blood pressure and sometimes sugar with my machines. In primary testing if a patient has an increased level of sugar, I tell them to do a random blood sugar test, then I decide whether they require medicine or not. After checking the report of fasting sugar, I decide which medicine should be started.”

Case 3: Shaheen (name changed) has been practicing in the informal settlements for the last eight years and holds a degree in Unani medicine. She has observed a rise in cases of diabetes and hypertension in her practice. She shared that patients often do not disclose their complete symptoms, making it challenging to understand underlying conditions like diabetes and hypertension. Whenever she suspects such cases, she promptly measures blood pressure or refers patients for blood sugar testing. After confirming her suspicions, she reported initiating basic medication and advising dietary control. If symptoms persisted and did not come under control, she referred patients to a senior doctor. She mostly left the choice of senior doctor to the patient but noted that having a proper network with good senior doctors would help her continue managing the patients in the community. “I have a big dilemma about referral. Which doctor should I refer to? I have to think a lot about it. I can’t get satisfied easily. Those who are very good are very costly and patients don’t want to go to them and those who fit into their budget are not very qualified.”

Case 4: Nadeem (name changed), a resident of the area himself, holds a degree in Unani medicine. He has been practicing in the area for the past 1.5 years. He received patients with minor ailments including common infections, which he treated using symptomatic medicines. He reported receiving a few diabetes and hypertension patients who regularly visited his clinic. These patients were diagnosed elsewhere mostly by a senior allopathic doctor, and they brought their prescriptions with them. They came to him for regular check-up of blood pressure and sugar for which he used his digital equipment. After checking, he informed these patients to either continue with the prescribed medication or to visit the senior doctor if he felt that their readings were abnormal. He shared that patients often do not take their medication regularly, leading to fluctuations in their readings. “I get diabetes and hypertension patients. I test but I don’t write any medicine. They mostly have their own prescribed medicine which I tell them to continue. If I see that their sugar levels are high, I tell them to go to their doctor. I personally don’t send them anywhere; they can go wherever they want to.”