2.2 Formulation of work methodology

Once the protocol or a study was approved, the concerned section officers designed the necessary data entry forms and recording procedures. It requires skill to design simple and mnemonic entry formats purposively linking different kinds of data with the study objectives. These must not be too laborious and yet must not miss important clues; must be understood by all types of field workers and handled by them without difficulty; must be easy to fill, and amenable for statistically acceptable methods in collection, recording and coding. Since data processing was mostly done by hand sorting, records such as files, forms, cards and lists were designed to suit such methods. With the arrival of punch card machines, the methods changed and large data handling began. Work instructions were written and a briefing session was held to make every participant understand her/his role. It was repeatedly stressed that she/he should follow the procedures step by step and complete all steps. Changes if any should be brought to the notice of the responsible authority. Work procedures were modified or improved after due consideration of several linked aspects. If mistakes occurred, these too were to be recorded, and ways in minimising them later were encouraged.

Most men and women employed were new recruits. Only a few had previous experience in the field of TB but not the kind that would be relevant at the NTI. The NTI had to prepare a perspective based on the findings of how things worked in the field of general health and how it could be effectively used to benefit TB work. To do this, it had to work extensively in places that mattered, i.e. rural areas; and utilise the available infrastructure, the general health services (GHS); and resolve problems encountered. Therefore, everyone participated in evolving a work culture.

Another important aspect while doing field work, was the attitude towards the people. The NTI staff were to be congenial. They were not to force a particular time upon them to suit investigation work or interfere in their private lives. To achieve higher coverages, they must work for longer hours, sometimes even on holidays. To facilitate specific work, house calls may have to be made early in the morning or late in the evening. Fortunately, due to the enthusiasm of the staff everyone cooperated and adhered to these work disciplines despite personal inconveniences. It proved to be a boon in achieving higher coverages. It was also appreciated by the people.

Field work was necessarily a team effort. A special aspect was sharing the work of others. This called for an exchange in the roles depending on the needs. Thus, it was not strange to find the HV going house-to-house to register census data, followed by a MO endeavouring to enlist the co-operation of the members of households registered. In emergencies, everybody assisted everybody. However, only those trained, executed specialised jobs. Thus, a sociology questionnaire would be administered only by a social worker and others would help by locating the patient or assisting in questioning if a language barrier came in. Tuberculin testing was done by a trained tester and others assisted him in holding the patient, if necessary.

In addition, the NTI had innumerable difficulties in procuring the equipment needed for various investigations. Even if the equipment was obtained, there were difficulties in its maintenance and getting spare parts. This problem became worse if the equipment was not made locally.

As narrated by Mr Stig Andersen: Three mobile units arrived, two IGE Scouts and one Philips, bringing the total to six mobile units in NTI. Three of these units are not operational, one IGE Scout has broken down and a replacement part (coupling) has to be manufactured locally, the old IGE (white elephant) lacks spare parts for the generator, and the Philips unit is standing idle for two weeks pending arrival of the Philips service engineers. The WHO X-ray Engineer undertook a considerable responsibility in the maintenance of NTI transport, in addition to his normal work. The government has now sanctioned a post of Transport Officer but pending his arrival, we felt we had to do our utmost to keep our 24 vehicles going, and to work out a system of maintenance for the Transport Officer to take over34.