Holy Hindi it's HOT!

Location: CHTC Guest House (Bagayam, Tamil Nadu, India).

Time Written: 6/4/09 10pm (Assume India time unless told otherwise)

We have officially arrived in India and have settled in quite nicely. We are staying on the CMC medical school campus in Bagayam (about 15-20 minutes outside of Vellore). The campus is fairly large and filled with beautiful trees, flowers, and lots of animals (including a bat tree!). It houses the medical students (and possibly the nursing, pharmaceutical, and PT students as well), some full-time staff (senior professors), as well as 2 libraries, several dining facilities, a store, an international hostel, lecture halls, and a mental health hospital. I am staying in the CHTC guesthouse with Alicia as my roommate. We are quite lucky, as our room has A/C.

Bat Tree

Bat tree, close up

The first two weeks of our trip here are being spent in a course with the second year medical students.* The course is in Community Health. It is an intensive course (2 weeks, all day every day except Sunday). The course consists of lectures about the health care delivery system in Tamil Nadu and India as well as multiple site visits. The aims of these site visits are to gain an understanding of the interrelatedness of each components of the health system.

On Monday, we visited a small village in Vellore. The students conducted morbidity surveys in homes there. They surveyed the total number of people in each household, those who were sick and causes of illness. They also inquired about recent pregnancies and deaths. We served mostly as observers since the villagers did not speak English (Tamil is the native language in Tamil Nadu). I've posted some photos from that village.

Photos of some houses in the village near Vellore

Man with a cast walking his bike up a hill

Kitchen in one of the houses we surveyed (no running water)

On Tuesday, we were supposed to go to a different village to conduct more detailed morbidity surveying. However, due to some unexpected stomach illness, we decided to skip out on that trip. The food in Southern India is quite delicious. However, it is also quite spicy and takes some time to adjust. I think we were a little over zealous with some of our food choices. Luckily the illness seemed to last only 24 hours.

Today was the best day yet. We went to visit several different sites. First, we saw an Urban Health Center located in a predominantly Muslim part of Vellore. This health center is government sponsored and also receives support through the Rotary Club of Vellore. The clinic mostly handles the prenatal, natal, and antenatal care of this community. Additionally, they help run school health check ups, have a 3X/week outpatient clinic, participate in DOTS (direct observed therapy – short course), run STD clinics/screening, provide family planning options, and immunize the children in this community. The clinic serves a patient population of about 46,000 individuals. The amazing thing about this clinic is that all care is provided free of charge. It is paid for by the government (and also through some donations by the Rotary Club). Another thing that I found astounding is that this center (via the government) actually pays individuals below the poverty line about 6000Rs ($120 USD) to deliver there. This was enacted because many of these women were delivering without the aid of trained workers. This leads to increased risk of maternal and neonatal death.

Birthing room in the Urban Health Center

Muslim woman walking in Vellore

As nice as the clinic is – it is easy to recognize points of weakness in the system. First, this clinic that focuses on maternal health is not equipped with a laboratory, a full-time physician, or an ultrasound machine. After giving birth, a woman is given a 1 night stay in the clinic. If an episiotomy is performed, a 3 night stay is allowed. There are limited resources available for women with anemia (pretty high – especially in this region). Patients who are considered “high-risk pregnancies” are referred to hospitals that are better able to handle these cases. My question is what if a delivery is expected to be normal and midway a complication arises? The nearest hospital is about 15 km away. Given the terrible driving conditions here and the lack of access to vehicles, the chance of this woman receiving adequate care is pretty low. Nonetheless, given adequate resources, the system of public health established in India is in many ways better than the US. The care is focused in community clinics and then diverted to the hospital in complicated cases. The idea of the government actually PAYING women to deliver in a care setting is completely unheard of in the US (and may cause a politician to lose his seat!).

One of many great pictures from this day

Following the Urban Health Care Clinic, we went to visit a nearby preschool and elementary school. Members of the Urban Health Care Clinic go to the school once per week to perform health check ups on the children (height, weight, nutrition). Additionally, the government pays for nutritional supplementation every day through age 5 as well as lunch during the day. Since this program was implemented, the children have gained weight and their parents budgets are freed up. The men in this town made about 130 Rs/Day ($2.60, unskilled) and 250 Rs/Day ($5.00-skilled). Women in the same jobs make much less.

Visiting the school was a great time. The students were quite happy to see us. I imagine that this was their first time seeing foreigners. We took loads of pictures, which really pleased them. They loved to look at the camera screen after the pictures were taken. I am definitely planning on doing a 1 week rotation in Peds while I am here.

Cute toddlers from the preschool in Vellore

Following our 2 week Community Health course, we will be allowed to choose what rotations we want to complete. I am planning on doing: CHAD (Community Health and Development hospital), LCECU (Low cost effective care unit), Peds, Ob/Gyn. I suppose that I will wait to decide what my other rotations will be.

I am glad that we are able to take part in this course. In the US, we have studied public health methods and theory for about a year. However, this is my first time actually going into the field and seeing how public health is done on extremely limited resources. I find it pretty incredible that the entire medical class goes on each of these site visits. It would be amazing if US med schools implemented similar field trips. Additionally, students at CMC have a mandatory 2 year service requirement (servicing a population in need). I think that this should definitely be incorporated into the US training system (especially with our huge focus on specialization – a focus that also exists in India).

Keep the emails coming. Until next time, enjoy the photos.

* In India, medical school begins directly after high school. It is a 6 year program followed by internship. The students that we are studying with are between 19 and 20 years old.