One wonderful aspect of the Vellore health system is the community based health care. The delivery of health services in this part of India is better than many places in the U.S! It is certainly a progressive concept to bring health care TO the community. I know the incredible number of hurdles patients in San Antonio have to experience just to get to an appointment, no less access the health system in general.
Today we joined the 'mobile clinic' with the doctors. None of the villagers speak English (they speak Hindu, Tamil, or something else I don't understand). So, even with all the observing, I was even more distanced from the experience because I could not understand a thing. I listened to a few heart murmurs here and there but mostly enjoyed seeing village life. There are a significant number of patients with Rheumatic heart disease. Other diseases I have seen on doctor's rounds include congenital heart disease (ventricular septal defect, Truncus arteriosis), Diabetes, Hypertension, seizure disorder, to name a few!
In Vellore, there are multiple levels of health care delivery for pretty much every health care need (save for the super complicated health issues that need expensive surgical intervention). The mobile clinic takes the Doctors to the community once per month. Each doctor is assigned to a specific community and basically covers a population of 120,000 per doctor. The nurses visit the villages twice a month-- once on the week before the doctors arrive so they can make appropriate appointments and once the week after the doctors to provide follow up and deliver any medications, do blood pressure checks, etc. Patients are charged on a sliding scale, based on level of income, and will receive medications, routine exams, chronic care, and hold on to their own health care record. They have continuous prenatal care beginning at 3 mos and have well-baby checks as well.
The doctor on duty was the Community Health resident (think Family medicine), whom they refer to as the "Registrar" here. He was accompanied by an intern, who is actually pursuing a residency in anesthesia. The "PICHU" (part time community health worker) is basically the locally based health care provider who serves as the midwife. She knows all the details about each family's health and socioeconomic status. She helps determine the sliding scale fee for service.
The mobile pharmacy is stocked with a significant number of medications including chlorquin, Digoxin, Carbamazapine, Cipro. This country (or at least this region) appears to have a pretty sophisticated health care system even at the rural level. The resident did, however, state that these villages are significantly more developed than actual 'rural' communities. Here, they are also able to track the population statistics really well because of the medical college. In all of Vellore, they have every person, death, birth, totally accounted for. It seems like the epidemiologist's dream!
Everyone is so friendly here! The kids LOVE having their pictures taken. The children are certainly a highlight of the village experience. And digital cameras make it even better because the kids just jump up and down at the idea of seeing themselves on camera! Every village is also incredibly colorful. Almost all the women wear colorful Saris. Each one unique and beautiful. Even the women in the villages wear intricate designs. Some of the saris are obviously not as nice as the people who are wealth would wear, but the colors are still amazing.
As an aside, Sarah & I noticed how many of the people have really great teeth here. Not sure if it's genetics or some tradition. They use a particular plant to brush their teeth with-- it's called Neem. Surprisngly, I really have not seen the type of tooth decay one would expect in poor communities. Interesting!
As for my own personal health, I have officially limited my intake of spicy Indian food to once a day. You can't totally avoid a few flavors here and there (which is nice) but the whole all-Indian all the time was doing a number on my tummy. Ow! The breakfast at the hotel is great-- for just over a dollar I get coffee (with thick milk already in there), an egg white (made to order) , toast (only white bread here), fruit, and juice (frothy goodness in a little glass). I could drink the juices here all day. They are so tasty! But lucky for me, they limit my intake to a little 5 oz glass of sweet delight. We had to pack lunch to go out to the community today (tomorrow too). But the portable lunch options only come in the form of indian food. And since you eat with your hands here (right hand only) and since I didn't want to risk the results of the spices in a village, we stuck to fruit and biscuits. Luckily, Sarah brought some protein bars that we could supplement things with. But that supply is limited. We have tried like really hard to find some peanut butter to supplement our lunches. I am not sure that exists here! When we ask for PB, we get lots of blank stares and people trying to sell us regular butter instead.
Tomorrow we'll head out to the community with the nurses. Should be more interesting because they do door-to-door in home visits. It is challenging to spend most of the day "shadowing" since I had so many opportunities more recently to do "hands on" clinical work. It is also challenging to be limited by a language barrier. I appreciate seeing how well the mobile clinic operates and getting some first hand insight into the structure of the health system in Vellore. I am continually impressed by this system!
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