Alakudi

Alakudi

Today we had our first field visit to the village of Alakudi. The village is very small and the mos

t rural place we have been to as of yet. We had the opportunity to visit the ICTPH RMHC (rural micro health center). In the ICTPH model, RMHCs provide primary care and preventive services. What's really interesting is the behind the scenes work that goes into doing this. ICTPH hires local "guides" to visit homes in the service area. The guides use smart phones to record basic demographic data, and in some cases, basic health data. Families are then given a card, so that when they visit the clinic, the card can be scanned and their information will be available.

We spoke with Dr. Uma, the physician at the RMHC. She said that she sees about 8 patients per day. She mentioned that cardiovascular disease is one of the most common conditions that she sees. The RMHC specifically focuses on such chronic conditions. Patient follow up is an important component to this model, especially as patient follow up is difficult in some of the PHCs (primary health centers, which are government-run clinics that provide free primary care). ICTPH RMHCs also are deliberate in recording their patient data and each patient interaction with a nurse or doctors so that care can be carefully managed. These two components, follow up and data recording, help to fill a service gap in the strained PHC system.

We also had the opportunity to interview a physician at the PHC. She said the most common illnesses she encountered were upper respiratory conditions. She also expressed an interest in working with ICTPH to address the problem of open defecation, which presents serious sanitation problems. My classmates, Sengeetha, our GI team leader, and myself spent some time discussing this. Sengeetha explained to us that a problem such as open defecation cannot be solved by counting on behavior change. For example, closed latrines had been built, but people do not use them because it is uncomfortable and unfamiliar. Thus, as our instructors Ravi and Ramesh elaborated on, supply-side interventions are more effective.

The challenge here for me is that we know what needs to be done on the supply side, but do not know how to do it. So, the water points in Alakudi (as some of you may know, in many rural areas water is pumped at pumping stations throughout the village and brought into the homes in buckets, etc) are served by broken pipes. And the government is responsible for fixing the broken pipes that are facilitating this contaminated water being pumped by the town residents. And petitioning the government to repair the pipes will probably not result in any change.

So what else can we do? Clean the water once it gets into people's homes via chlorine tablets. Well that was tried and it didn't work. Apparently it makes the water taste horrible and people don't like bad tasting water (go figure). So what would be a way to clean the water at the source that is acceptable to the consumers? I'll let you know as my group members think about this and many other questions.

This work is really exciting...there's just so much going on. It's like a giant puzzle, trying to fit all the pieces together. I do wish I had been able to take a course on Epidemiology before coming here. Many of the concepts are familiar from my undergrad work, so I hope I can pick up some of the logic of it pretty quickly. I'm really excited to keep soaking in more and more. Not only is this material fascinating, it's real. And that is pretty awesome.

Other than that a few of us visited the track at the medical college this morning. Gotta practice what we preach. And it just felt good to sweat because of physical activity instead of pure human hating sun rays (or Erin-hating sun rays. But still burn free!). I ran a measly two and a half miles, but hey, the air was super heavy and the sun was already getting hot at 6:15am. And I felt great!! It was a bit uncomfortable because I only brought short running shorts for working out, which are way too short to wear in public here. So I wore a long skirt until we got the track. The few students there didn't seem to mind my scandalous outfit, although I was constantly aware of how people may perceive it. I was easily distracted though by our running buddies the peacocks! They just hang out and chill while we sweat. They do make weird caw-ing sounds though.

Back to it tomorrow morning. Then lots of work to do for our project. I haven't felt so engaged with a school assignment in quite some time and I'm very much looking forward to moving forward.