More CHAD

Doctors Rounds: On Tuesday, I went on Doctors rounds with CHAD. Doctors rounds is a mobile clinic that goes to different villages around Vellore every two weeks. Basically the CMC is bringing the hospital to its patients instead of them having to come to the CMC. Many of the people in these villages don't have the money or form of transportation to make to the CMC so it is very convienent for the buses to come to them. On the bus was an intern who dealt with general medicine stuff on a table he set up outside the bus, a registrar (AKA upper level resident) did antenatal checks on the bus along with a health aide nurse, and two nurses in the back of the bus that administered hep B vaccinations.

The health aide nurse wears a pink sari and works with a community aide worker who lives in the village. Together they assesses the socioeconomic status of the families prior to the mobile clinics visits to the different villages. They determine how much each patient can pay for their visit to the mobile clinic. If the family is incredible poor, the visit is free otherwise they pay a very small fee.

I first started my day with the intern. Basically, people would form a line in front of his table. The people who had chronic illnesses had "chronic disease cards" that listed the medications they were on or anything important from previous visits to the doctor. The chronic illnesses for the most part DM, HTN, seizure disorders, and heart murmurs. The intern basically would rewrite their prescriptions or change their meds based on their current complaints. He also saw patients with new complaints and gave them refferals to the CMC if it was anything serious.

Our second stop was fly infested and I had to literally put my fingers in my ears to stop the flys from buzzing past them. The villagers didn't seem to be bothered by the large amount of flies and didn't flinch at their presence. I on the otherhand was ready to pull out my hair. After 3 more stops, we stopped to eat lunch under a tree in the middle of no where. They told me that they always put all their lunches in the middle and share all the food that was brought. They all brought different forms of rices and chutneys and shared with each other. The food looked good, but I wasn't about to get sick eating cold unheated rice. So I just ate my yummy, smoshed, cold butter and jam tosted sandwich. I also had a granola bar in my bag that I munched on, along with some biscuits that I had brought with me.

During our meal, we had some visitors: Two young ladies showed up out of no where and walked over towards where we were eating. One of them was drooling severly and had very crocked teeth. The registrar asked one of the nurses what the situation of these two children was. The nurse stated that girl that was drooling was "mad" and their dad was an alcoholic. By "mad," I think she meant the girl was severly mentally retarded. She said that they usually give the girl a bag of calcium pills so that she would leave them alone. I handed the other girl the rest of my food b/c she looked very hungry and she said thank you. The nurse looked really surprised and said, "At least they know their manners."

By the time we arrived at out 4th stop, I was really sick of sitting outside with the intern. So I made myself useful and helped the registrar with the antenatal checks on the bus. She didn't speak Tamil and only spoke a lot of English to me, so I was happy. She let me write the physical findings of the pregnant women in their antenatal charts. While I was doing this, I noticed 3 girls outside the bus staring and pointing at me. So I waved at them and they got really excited and came to the steps to the entrance of the bus to talk to me. Our conversation mainly involved sign language and the 3 or 4 words of Tamil that I have picked up. Then one of the girls pointed at the hand santizer that I had hanging around my neck. So I poured some in her hand, but she freaked out b/c she didn't understand the concept of waterless handsoap and ran outside to go wash her hands with water.

Nursing Rounds: On wednesday, I participated in Nursing Rounds. I will say this is my favorite rotation thus far on this trip. Except for the fact that I went through 2 liters of water that day and had to carry an umbrella over my head to block the heat, I thoroughly enjoyed the rounds. I met up with my team at about 8:30amish. Nursing rounds functions a bit differently from Doctors Rounds. With Nursing Rounds, we go to the patients' actual homes; it is like what we call a "nurse home visit" in the states. The nurse goes directly to these patients homes b/c for some reason or another they are not able to make it out to CMC on their own. She does anything from antenatal/postnatal checks, BP readings, or just education on caring for their newborn. The nurse leading our group (AKA the public health nurse) was a recent nursing school grad by the named of Nancy. She was super cute and the first Indian person I have seen with braces. We were joined by one health aide, a chaplain student, one community health aide, and another Austrailian student. The Australian student had been traveling throughout India since Dec visiting different hospitals. It was so nice to meet someone taller than me for once. She was a good 5'11 and she work a size 12 shoe.

The chaplain student that joined us was doing a study on epilepsy and SES factors that lead to lack of treatment of epilepsy in the villages. Consanguinty is rampant in this city leading to many developmentally delayed and epileptic children. He told me how some of the villagers don't see consanguinty as the problem or even believe that their child has epilepsy. Instead of taking them to the medical doctor they find local witch doctors who hit the child and roll them around on the ground saying they are trying to cure them.

Nancy stated that she ventures out to these villages every two weeks. Most of her time on these rounds is spent educating new mothers on the dos and don'ts of mothering. For example, there is a practice here of feeding babies castor oil or plain water, so she spends many hours explaining to moms that this can cause serious diarrhea in their babies and breastmilk is all that a baby needs for the first 6 months of life. There is also a practice of not bathing a baby for one week after birth. She has to explain to the mother that the baby needs to be cleaned daily just like any other person. Some moms also like to put baby powder all over their babies faces b/c they think it makes their babies look cute. The problem is that babies can aspirate the powder and get pneumonia. Moms also like to put castor oil on the umbilical stub of their babies after birth, but this can lead to umbilical sepsis. CMC encourages women to get a tubectomy after their second birth. If they agree to this, the patient can get certain hospital fees waved. The problem with this is that a lot of families want male babies so they will continue to have more children until one is born even if they are living in poverty.

The first lady we visited was 20 weeks pregnant according to her fundal height, but her LMP was 14 weeks ago. We visited her to refer her to a CMC for an ultrasound to better check her dates. Her Hb was also low and she may need to be transfused prior to delivery. Here they do something called a PCV to check women's Hb levels. They take this PCV number and divide it by 3. If this number is less than 10 they consider her anemic and will first attempt de-worm her with medication, but if this value remains low they will then transfuse her.

One of the first things I noticed about the villagers is how nice they were. Eventhough they still stared at me, they had a warm smile when ever you looked in their direction. They were also quick to offer you food or water whenever you entered their homes. I of course could not take anything they offered me b/c these people lived in pure poverty. The size of their rooms was like the size of a big closet for which 4 or more people shared. They had one steel bed with rice bags as pillow covers with clothes stuffed in them. Of course there was no A/C but most people had one celling fan but that didn't mean they always had electricity. The weird part was that everyone had a television. There was no kitchen and people cooked with metal pots on firewood.
When you walked into their homes you had to take off your shoes and walk on the bareground which was mostly hot rocky concrete. My feet are going to be so jacked up when I leave India, I must get a pedicure on returning to the states.

Another lady we saw refuses to breastfeed her 2 week old baby. She stated that nothing was coming out. She feeds her baby cow's milk instead. Nancy tried to warn her against this b/c she isn't sterilizing the bottle properly and the baby will soon develop diarrhea. Nancy made her bring out her breast so she could check if she truly wasn't lactating. With one squeeze she squirted out breast milk and Nancy and the other nurse started scolding her for lying to them. They think this lady is just being lazy and doesn't want to wait for her baby to learn to latch on to her breast.

The stop pictured to the right really got to me. Nancy said this family is probably the poorest of all the people she visits. We visited a family of 5 with a mother pregnant with a set of twins. This young lady already had 3 little girls. One of the kids was about 3 years old and doesn't talk or walk. Doctors can't figure out what is wrong with this child. One of the other kids already had signs of Kwashiorkor with a protruding abdomen and thin limbs. Their father's job is lifting rocks off of a truck. Their mom refuses to walk 2 mins to collect rice protein balls that her family qualifies for b/c she is "too busy." They resort to eating rats sometimes when they have nothing to eat. Her husband refuses to see family planning and sees the new additions to their family as a blessing. Nancy is afraid that this mother may commit infanticide once the twins are born and she finally realizes she has no money to feed her family. Nancy told me how infanticide is rampant here and families will place a grain of rice in their childs mouths once it is born and try to pretend that the child just stopped eating one day and they found it dead.

The most suprising part was how happy these children were living in these conditions. Their home is shown above. It only has 3 walls with the 4th wall open to the environment. One of the kids was eating a bowl of fly infested rice. She had the biggest smile on her face as she waved and smiled at me. I smiled back and tried really hard to hide my tears. I wanted to give them money but the chaplain student told me not to, b/c he said I would only be helping them for the moment, what will they do after that money is gone.

Pictures above:
1) The purple stuff around the lesion is some sort of indigenous oinment the villagers put on open cuts or abrasions.

2) This is what the mobile clinic looked like on Doctors Rounds. This is the back part of the bus where the nurses were administering hep B vaccinations.

3) & 4) This is a girl we met on the second stop that had some sort of vitamin deficiency. Her skin was pretty much sluffing off her body. They gave her a referal to the CMC. I handed her some biscuits b/c she looked really hungry.

5) Nicolette in the car next to mine on her way to Nursing Rounds with Collin on Wednesday.

6) This is one of the CMC daycares that are in some of the villages we visited on Nursing Rounds. CMC has daycares for 3-5 year olds to prevent malnutrition and help educate some of the kids before they enter real school. These kids were so cute, plus they are my favorite age group. The teacher told some of them to recite their alphabet and numbers for us. It was so cute!

7) This is a picture of a mob of kids that were following me during Nursing Rounds. As soon as I turned around to take a picture they all started running away.

8) See above