Andippati

Driving to Andippati

Banana trees!!
Water tap

The RMHC--the one with the sign out front

After all that fuss getting rid of the TV...it followed me to India....
Bathroom and shower
The closet with all our Indian clothes

It's hard to remember that this morning started out as the hottest one yet on the track. It's cold now. And, as a disclaimer, take that with a grain of salt. My computer reads 89 degrees, but a storm is rolling in, it's breezy and I'm wearing a sweater. Wonderful. With the lightening and all...perfect way to process the day.

So we talked in depth about India's public health system in class this morning. So comprehensive! So universal! So in line with the (crazy, I know) idea that health care is a right and is a social issue!

...on paper that is.

We talked about some of the challenges facing rural populations and providers, as well as overall systemic issues. From what I gathered, a lot of this has to do with the fact that India is very different depending on where you are. So here in Tamil Nadu, there are far more providers that are accessible. In the north, people have to travel much further to see a medical professional. Which costs time that could be spent working and money that has to be spent on transportation. And when you have these differences, it's hard to have a comprehensive overall plan.

Another example, so in India there are 5 different types of medical providers randing from allopathic doctors (like an MD in the US) to more traditional medical professionals. All have their own philosophy, training programs and certifications. Well this means that, depending on what type of provider you see, you will probably get a different diagnosis or treatment. In turn, there is very little protocolized care. And protocolized care, apparently, has some benefits. Given this, ICTPH has been very deliberate in designing protocols for care so that it can be standardized in all of their clinics.

We got to see some of this in action today in Andipatti. We visited the ICTPH RMHC (rural medical health center) and the local PHC (government run primary health center). The staff at both clinics spent a generous amount of time answering our questions and sharing their thoughts.

We saw how PHCs really are able to do an impressive amount of work with very limited resources. I mean, yes, it's very different from what we would see in a doc-in-the box in the US. Or even an urban ER in the US. But there are no chickens in the exam rooms and only one dog was lounging under the fan in the waiting room. Which is to say that the clinic was more sophisticated than what I observed in west Africa. There is a room for labor and delivery, vaccinations, operations and outpatient treatments. There is also an ambulance bay so that patients who cannot be treated at the PHC can be transported to a secondary health center (the geographic area shares a few ambulances, and waiting times may be long, though). The nurses on staff said they see around 150 people per day.

The PHCs do a good job of referring patients to secondary care centers when their conditions cannot be treated on site. But they lack some of the necessary resources to really provide some of the preventive and outreach care necessary for monitoring and treating certain conditions (for example, diabetes, cardio-vascular disease, etc). This is where ICTPH steps in. Like I mentioned earlier, ICTPH uses technology to register patients and monitor their care They know who they treated and how they treated them. They also have staff who specifically work as community guides. It will be fun to see how we can capitalize on the organizations strengths when designing our interventions.

We also had the opportunity to interview a few people in the town. Granted they were short chats, and it was probably sort of awkward for the people we approached to have a gaggle of Americans walk up to them. Still, we learned a few interesting things. We saw a water tap and how the family used it and then stored water in their home for the day.

Overall, it was interesting to learn about some of the similarities and differences between Andippati and Allakkudi. Andippati is a bit wealthier. It also (according to the few people we interviewed) has fewer water contamination problems. And, something I totally didn't expect to learn was in Andippati, most GI issues are upper GI issues. Adults aren't eating properly, but they are drinking tea and alcohol, which upsets their stomachs. This throws a whole new aspect into our project. I just assumed we would be focused exclusively on water and sanitation. Go figure when you actually ask people questions about them, they can tell you really informative things...

Oh and there were some requests for pictures of the room (Natalie...) so they are posted here too.