Part Time Community Health Workers (PICHW)

The "Peetchu" has existed in the villages of Vellore for many, many years. She used to be the primary (and only) health care provider and midwife in the village. Traditionally, she was the barber's wife and would pass her skills onto her daughter in law. She is in charge of 70% of deliveries. However, the government is trying to pass a law that all births are to be done in a hospital because of concerns over HIV transmission, early detection of HIV, and female infanticide.

Now the PICHU primarily cares for chronically ill patients. There are 69 villages in Vellore, each with their own PICHU. They help keep statistics on community health, birth and death statistics. In addition, each community gets its own health aid to help with record keeping and health education. As a result, the CMC has created a degree program (masters) for doctors interested in community health.

The nurses are identified by their Sari colors. The nurse wears a light blue sari. Each nurse is in charge of 15,000 patients. The health aids wear a pink sari.

An interesting piece of history...

When the director of the CHAD was explaining the structure of the PICHW system to us, he described things before the system was created. Later, in reading a very interesting book by a former New York Times correspondent, I learned that there were some widespread health practices that later became incentive for the government to intervene in the system. Prior to PICHUs, there was a village dais, or midwife. Her position was ultimately abolished because the traditional practices helped keep India's maternal mortality one of the highest in the world. Some of the dangerous practices include pushing on a mother's stomach during labor, risking uterine rupture, and cutting the umbilical cord with an unsterile knife or a stone. On the wound, they would put cow dung, which they believed was antiseptic. Now, I know that India is definitely not the only place where some traditional practices clash with the preservation of 'clean' and safe health practices. But it was certainly interesting to read about something I just heard about from the CHAD guy!

In case you are interested, the book is called "May you be the mother of a hundred sons," by Elizabeth Bumiller. It's a really fabulous account of women and Indian culture.