I was supposed to spend 3 days this week to attend the village clinics, but only managed to attend 2; missed the 3rd one due to some miscommunication. It didn’t bother me too much as it would be much similar to the others that I had attended earlier.
CFH runs various village clinics, which is basically a community outreach program. The concepts of these clinics are practically similar to general practice in rural areas: to provide primary care to the villagers who otherwise may have difficulties in accessing to healthcare services at CFH (due to various reasons like ill health and transportation problems) and at the same time to reduce the workload burden at the extremely busy hospital.
Thumichampatty – Monday (07/09/09)Thumichampatty is a village about 15 minutes bus ride from the hospital. In the morning, I spent time with the nurses doing home visits. The aims were to identify sick patients who need to be seen by the doctors; to ensure that patients were compliant to their medications, whether they required further prescriptions or not; overall to ensure the well-being of patients and their families at home. T2DM and hypertension were the 2 most common problems I encountered. Most of the villagers were welcoming; offered me a seat on the chair instead of the floor (which I politely refused); and seeing me as a foreigner, enquired lots about me (in a good way) from the nurses. I learnt a bit of Tamil from the nurses and tried to converse with the villagers, only to find out that I articulated the language in a very funny way!
Most of the homes I visited were small and very basic – an almost empty lounge room with no couch or table save for a little old TV set in the corner of the room; 1 or 2 bedrooms – some with beds without mattresses, others without beds at all; a kitchen; and a bathroom/squat toilet, some outside of the house and drained directly into little gutters. Many of the houses were erected with bamboos, the walls made of woven coconut leaves, covered with huge leaves. Yet, these people were very grateful to have shelters over their heads.
Thumichampatty village
In the evening at 1500, after having lunch at the mess, I accompanied the doctors back to the village for the clinic, which was held in a church building. Patients were already queuing to be consulted, the nurses sang hymns and the doctors immediately started their work. Most of the cases encountered were primary in nature: coughs and colds; headaches; fevers; repeat prescriptions; long term management of T2DM and hypertension etc. Consultation fees were charged at the discretion of the doctors according to the patients’ socioeconomic status; drugs were dispensed carefully as many patients could not afford them, some received a significant discount. The clinic ran until 7pm, when we then packed up and made our back to CFH.
Church building where the clinic was held
Gandhi Nagar – Tuesday (08/09/09)Another clinic today, this time in the village of Gandhi Nagar which was about 10 minutes by van from the hospital. There was no home visit; instead it was a full day clinic, run by a registrar and a consultant, who had recently returned from Melbourne after spending a few weeks there for work. The cases I saw were not dissimilar to the ones I had seen yesterday. I was totally surprised that almost every 2nd patient who I met had T2DM, many with its horrible complications, especially nasty diabetic foot ulcers. I thought I would see more exotic diseases of India but was told that they were more prevalent in poorer areas which were mainly in Northern India.
I asked the consultant why T2DM was so common here: poor diet and sedentary lifestyle were the leading factors. With government subsidy, 1kg of rice only cost Rs1 (i.e. 35kg for Rs35 = AUD1) – how cheap is that! On the other hand, 1 kg of vegetables costs about 30 times more. Obviously, being the much cheaper option, rice is eaten in huge quantities here. In fact, some have rice only, nothing else – they are contented as long as their stomachs are filled up. Rice, if taken in large amount is bad given its high GI value; that is, it is digested much faster, causing the blood sugar level to shoot up quickly and the poor pancreas has to overwork to secrete more insulin. Over time, the pancreas wears out and no insulin is produced to control the blood sugar level; hence diabetes develops.
