I was exhausted from the day before so I ended up falling asleep at 7pm and didn't wake up until 6am today. Usually I feel sluggish after sleeping for that much but I actually woke up feeling refreshed. After getting ready, skyping with a few people and wasting some time on facebook it was time to start observing at the hospital.
Mondays and Thursdays are the days reserved for non-tribal patients to come in with any problems. The day started at 8am for Dr. Menon and I went over around 8:30. By the time I got there he had already seen 3 patients. There only 3 doctors responsible for seeing the 130 odd patients that came into the hospital today. One of the other doctors had gone on a site visit with the mobile van. The 130 some patients were seem over a 6 hour period. There were patients everywhere you turned. The doctors on average spend between 5-10 minutes with each patient. It was amazing to see the number of people that they saw throughout the day. The patients are given a book to bring with them every visit that serves as their medical history. The hospital does not have a copy of the book so if the book gets lost along the way so is the patient's medical history. To an observer things may seem very hectic but after watching the doctors, nurses and patients interact it's easy to see the order and efficiency that is in place as well.
Dr. Daylon with a patient Dr. Menon with a father and daughter
(both for checkups)
Dr. Mridula with a patient
The set-up consists of one room with two tables. Dr. Daylon at his own table seeing patients as they are called in and Dr. Menon and Dr. Mridula sharing a table seeing patients at each side. Very very different from the US. I feel like paperwork tends to bog down doctors in the States so they don't end up seeing as many patients. Paperwork is important but doctors shouldn't be spending more time on paperwork compared to seeing patients.
We did see an interesting potential sickle case today. There is another population in the Gudalur area, the Chetty population, different from the Chettiar population that people usually think of in Tamil Nadu, that have a high SCD rate. A mother brought her 8 month old daughter to the clinic for a check up today. The mother is half-Chetty and her husband is full-Chetty. The baby had needed a blood transfusion, somewhat common in SCD patients, two weeks earlier so a confirmatory testing for SCD couldn't be done today but according to Dr. Menon there is a good change that the baby has SCD. He explained to her that testing will be done once the effects of the transfusion have cleared her system to prevent false results.
It seems like every individual that works in the hospital is fluent in both Tamil and Malayalam because the community members speak both languages. I'm getting good at understanding Malayalam, though I couldn't speak to anyone in Malayalam.
The entire hospital is focused on the well being of the patients. Money is not a concern. Pretty much anywhere else you go, doctors work for money but that's not the case here. The doctors are focused on the patients and making sure they get better. If patients can't afford to pay the Rs.10 charge then there is a special fund that will take care of it. Medicine is drastically cheaper compared to pharmacies in town. The importance is put on the well being of the individual and not on whether or not the person can afford the care. The hospital makes sure that every person is taken care of. Everything is made affordable and accessible. All of the doctors, staff and nurses live in quarters surrounding the hospital.
The hospital also has it's own nursing program. They train local adivasi girls that are interested in being nurses so that they can work in the hospital and the centers in the local villages. They also trained someone as a genetic counselor to explain to families what all of the different conditions are and what they need to do. They hospital has the funds to hire individuals but they have had difficulties in finding people that are willing to come and serve as permanent staff so they have turned to training community members to perform the necessary tasks which has surprisingly been working out very well.
After the morning clinic, Dr. Menon and I sat down to discuss my schedule for the rest of my stay and what I would be doing. I am going to go on a field visit to one of the villages an hour away tomorrow with him and another doctor to see how they do the sickle cell testing. He has given me the task of talking with the children and explaining Sickle Cell Disease to them. He wants me to talk with them and see what they know about the disease, and to help explain things to them that they aren't sure about.
We have also decided to put together some educational material that can be translated into Tamil and Malayalam. That's going to be my big project before I leave here on Tuesday. I want to leave a "booklet" of sorts with them that can be given to the community.
Saturday and Monday, I am apparently going to be in the mobile van with one of the doctors traveling around visiting different villages and centers. Sunday I believe is reserved for working on the pamphlet and getting all the information I need together.
The Gudalur Adivasi Hospital
(it's actually very big-the outside is deceptive)
Mondays and Thursdays are the days reserved for non-tribal patients to come in with any problems. The day started at 8am for Dr. Menon and I went over around 8:30. By the time I got there he had already seen 3 patients. There only 3 doctors responsible for seeing the 130 odd patients that came into the hospital today. One of the other doctors had gone on a site visit with the mobile van. The 130 some patients were seem over a 6 hour period. There were patients everywhere you turned. The doctors on average spend between 5-10 minutes with each patient. It was amazing to see the number of people that they saw throughout the day. The patients are given a book to bring with them every visit that serves as their medical history. The hospital does not have a copy of the book so if the book gets lost along the way so is the patient's medical history. To an observer things may seem very hectic but after watching the doctors, nurses and patients interact it's easy to see the order and efficiency that is in place as well.
(both for checkups)
The set-up consists of one room with two tables. Dr. Daylon at his own table seeing patients as they are called in and Dr. Menon and Dr. Mridula sharing a table seeing patients at each side. Very very different from the US. I feel like paperwork tends to bog down doctors in the States so they don't end up seeing as many patients. Paperwork is important but doctors shouldn't be spending more time on paperwork compared to seeing patients.
We did see an interesting potential sickle case today. There is another population in the Gudalur area, the Chetty population, different from the Chettiar population that people usually think of in Tamil Nadu, that have a high SCD rate. A mother brought her 8 month old daughter to the clinic for a check up today. The mother is half-Chetty and her husband is full-Chetty. The baby had needed a blood transfusion, somewhat common in SCD patients, two weeks earlier so a confirmatory testing for SCD couldn't be done today but according to Dr. Menon there is a good change that the baby has SCD. He explained to her that testing will be done once the effects of the transfusion have cleared her system to prevent false results.
The mom with her 8 month old daughter
The entire hospital is focused on the well being of the patients. Money is not a concern. Pretty much anywhere else you go, doctors work for money but that's not the case here. The doctors are focused on the patients and making sure they get better. If patients can't afford to pay the Rs.10 charge then there is a special fund that will take care of it. Medicine is drastically cheaper compared to pharmacies in town. The importance is put on the well being of the individual and not on whether or not the person can afford the care. The hospital makes sure that every person is taken care of. Everything is made affordable and accessible. All of the doctors, staff and nurses live in quarters surrounding the hospital.
The hospital also has it's own nursing program. They train local adivasi girls that are interested in being nurses so that they can work in the hospital and the centers in the local villages. They also trained someone as a genetic counselor to explain to families what all of the different conditions are and what they need to do. They hospital has the funds to hire individuals but they have had difficulties in finding people that are willing to come and serve as permanent staff so they have turned to training community members to perform the necessary tasks which has surprisingly been working out very well.
After the morning clinic, Dr. Menon and I sat down to discuss my schedule for the rest of my stay and what I would be doing. I am going to go on a field visit to one of the villages an hour away tomorrow with him and another doctor to see how they do the sickle cell testing. He has given me the task of talking with the children and explaining Sickle Cell Disease to them. He wants me to talk with them and see what they know about the disease, and to help explain things to them that they aren't sure about.
We have also decided to put together some educational material that can be translated into Tamil and Malayalam. That's going to be my big project before I leave here on Tuesday. I want to leave a "booklet" of sorts with them that can be given to the community.
Saturday and Monday, I am apparently going to be in the mobile van with one of the doctors traveling around visiting different villages and centers. Sunday I believe is reserved for working on the pamphlet and getting all the information I need together.
This is all so interesting :) Raj's dad is a doc in his own rural practice in Tamil Nadu and says the same thing about paperwork- he sees a crazy number of patients every day and does minimal documentation- just a few lines on progress. Sooo much more efficient.
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