It's been one week since you looked at me...

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

Written: 6/8/09, 8:45pm

After my first week in India, it was nice to have the weekend to unwind and process my first impressions of the country. On Sunday, we went to a beautiful pool located right next to the medical school campus. It truly was a hidden oasis tucked behind the highway next to a shabby church and some deserted land. As you can see from the photos, the pool looks like it belongs in tropical St. Anywhere-but-India Island. It is surrounded by lush foliage and has views of the surrounding mountains. The day was perfect weather for tanning (Don’t worry Mom, I wore SPF 45!), throwing baseball, reading, and hanging out with the international students. They even served pizza and fries which was a lovely reminder of home!

Pool in Bagayam

Nice place to spend a Sunday afternoon (notice the mountains!)

Now I'm just boasting!

On Friday of last week, we went to visit a Primary Health Center (PHC) located about an hour outside of Vellore. India has a very decentralized health system that tends to direct care to clinics and village health centers instead of tertiary care hospitals. Only the sickest patients end up seeing specialists inside of the hospital. Each PHC serves a patient population of around 30,000 individuals. The PHCs provide the following services: daily outpatient clinic, a few inpatient beds (usually only 5-10), prenatal, delivery, and postnatal care, newborn care, immunizations, family planning (BCP, IUD insertion, condom distribution, tubal ligation, vasectomy), emergency ambulance transport, school health programs, lab services and referral services.

On the day that we visited the PHC, they were running their weekly diabetes clinic. Patients received various medication including insulin injections and information about managing blood sugar (which must be difficult considering I didn’t see a single glucose meter). In addition to the diabetes clinic, we were able to see some babies that were born the previous night and their mothers. They were so precious!

People waiting in line at the PHC

We were able to take a tour of the surgical theater (operating room). This was quite a shock for me! I have had the privilege of seeing several surgeries in the US (thanks Dad) and I’m familiar with the extreme emphasis placed on sterile technique. When entering the OR we were asked to remove our sandals and replace them with communal “surgical sandals.” The surgical instruments were sitting on a table in the open air. There wasn’t an autoclave in sight. I imagine that sterilization occurs using bleach or boiling water. I am hoping that I can watch some surgery while I am here (however, I have been told that this may not be an option for international students).

The operating theater at the PHC

The sandals that are worn when entering the OR

One thing that I find fascinating about the Indian health care system is the complete acceptance of alternative medicine. On the campus of the PHC there was a Siddha unit. Siddha is considered to be the oldest system of medicine in the world (http://en.wikipedia.org/wiki/Siddha_medicine). It utilizes completely natural remedies to treat disease. Patients are free to use Western medicine or Siddha (or a combination of the two). The incredible thing about India is that both the alternative medicine and Western medicine therapies at the PHC are free to patients. As you may imagine, there are several types of alternative medicine practices in India. Collectively these are known by the acronym AYUSH: Alternative, Yoga, Unani, Siddha, Homeopathy. There are ways for all patients to access these various practices under the umbrella of government-sponsored health care. In the US, most physicians consider “natural medicine” an oxymoron, or at the very least a crock of you-know-what. The positive benefits that these methods have for patients in terms of the mind-body-spirit connection are worth considering. The Siddha pharmacist told us that many patients like to try the natural remedies first because they do not have the same side effects that come with Western medication. If the Siddha meds don’t work, patients are usually willing to add Western practice to their treatment.

Two of the natural drugs offered at the Siddha pharmacy

Following the PHC visit, we went to see a Subcenter (SC). Each PHC is affiliated with 5 Subcenters. These SCs are located within the villages. The role of each SC is to manage the health problems of the village. The SC that we saw was a 2-roomed building. They employ a Sector Health Nurse, a health supervisor, and a social worker. Together these employees keep immunization, birth, death, and disease prevalence records. They also help run a nutritional center where children under 5 and pregnant women receive caloric supplementation daily (a ball of grains for both, folic acid and iron pills for the women). Each SC receives government funding to ensure that all villagers have access to the care they need. If a woman goes into labor in the middle of the night, money from this fund can be used to transport her to the nearest hospital (and pay for the delivery if that hospital is private).

The Indian healthcare system is nowhere near perfect. In fact, I have found myself saying (more than once) “Wow, I would never be treated there.” However, the infrastructure is quite strong. It focuses on preventative services, community education, decentralized points of care, and minimizing expenses for those who can’t afford care. The main thing missing from the system is obviously capital. This is quite different from the US. In the US we spend more on health care per capita (and have more to spend) than any country in the world. We have the best schools, doctors, and facilities, the most modern technology and we’re on the forefront of research in every field. How is it that India can provide some treatment to its poorest citizens while so many in the US go without care (or are put into tremendous amounts of debt accessing it)? This first week has certainly been an incredible learning opportunity. It has also further motivated me to advocate for and support universal access when I return to the States.

Cute children at the PHC