Mobile Clinics

Hello!

I'm blaming my week+ absence of posts on my GI tract... you don't want to know the details...

Anyways, I still managed to have a very busy second week at the hospital, including going on two more Mobile Clinics into the forest area.  As you may know, I spend a lot of time back at school coordinating the UI Mobile Clinic, so it's been interesting to see the similarities and differences between these two clinics with the same mission half a world apart.

All of the Mobile Clinics here have a similar structure, but each day of the week they cover a different set of villages. We travel in a large ambulance van with a well-stocked pharmacy in the back, which also serves as the exam room.

The van stuck in the mud. Took half an hour and 10 men to get it unstuck.

Kabini Dam + cow

On all three of my excursions, we've left the hospital in Sargur around 9 am, then driven to Kenchanahalli, the smaller (original) SVYM hospital to pick up an ayurvedic doctor. Kenchanahalli is quite a beautiful spot, tucked away on the east side of the Kabini reservoir, but the villages I've been to have all been on the west side of the reservoir, which means a long drive around the lake. It's quite the scenic trip so I enjoyed the long hours in the bumpy van. Along the way we also picked up another community health worker to complete the team. This map shows the general area that I've been through- from Sargur to Bavali.

Kabini reservoir on a rare partly sunny day

After assembling the full team, the van leaves the well-traveled roads and heads deep into the countryside. My very first clinic experience was confusing, to say the least. The van drove down a gravel path 1 km, turned around, stopped, and started the siren. Everyone started watching a cluster of houses about half a km away, until people started trickling down the path towards the van. Apparently this is a universal clinic sign:) At most stops, only a few people would come to the van with concerns, but at some villages, we had over 20 patients. The patients crowd around the back of the van, and one by one come in to speak with the doctor while everyone else (including some curious children) watch. The most common complaints are fevers, coughs, and colds, since it is monsoon season- the coldest part of the year (I'm not complaining), but I've also seen wound infections, scabies, hypertension, diabetes, heart murmurs, anemia, dizziness (which they call 'giddiness'), and prenatal visits not infrequently. My role was taking blood pressures and auscultating. Every patient gets a prescription for something- often just PCT (paracetamol aka acetaminophen aka Tylenol) or an Ayurvedic cough syrup. They also give out a lot of vitamin supplements and are fairly overgenerous with their use of antibiotics. The cost of the visit is always 2 rupees ($0.03), no matter what is given. Occasionally, patients were referred to the hospital, where they also get subsidized care if they are tribals.

You never know who'll be coming by for a clinic.

Not everyone comes crowding up to the van, however. Sometimes the community health worker would have to go and talk to people, asking if anyone in their family was sick, and other times, they seemed to know about certain patients who should be coming for chronic disease follow up. At a Grand Rounds case presentation last week, an intern presented on a baby with meningitis, but the discussion took a turn as a few of the doctors shared their experiences of getting to know the child's mother, who used to run and hide or climb a tree when the mobile clinic came to her village. A few of these doctors slowly built her trust by talking to her week after week, and eventually coaxed her into coming into the van and getting her blood pressure checked. Then, there was another long struggle of trying to get her to accept anti-tubercular treatment for her TB, and eventually enough trust was built that she took her meds and would come to the hospital for all of her prenatal visits before delivering this child. The doctors emphasized the extra effort it took, and the delicate nature of such a relationship, but throughout the entire discussion, I was thinking about how extremely worth it that effort was. If she had continued to distrust healthcare, she personally would most likely still have active TB, she probably wouldn't have come to the hospital for her delivery, and her baby would not have gotten the care it needed when he developed meningitis. In going the extra mile for one patient, the doctors also helped her family in the long run, and as this one woman tells her community about how the hospital saved her baby (as she sees it), she will plant the seeds of trust in many more people. This point is important in a place like Saragur, where resources are limited and patients have very low health literacy, but can carry through to practicing in the US, where it is important to remember that every patient is worth the extra effort, every time.

Cricket by an old cement factory with the Kabini river in the background.

Back to the clinics- each day, the van stops at 9 or so villages, and sees around 40-50 patients, in my experience (although I've heard about days with close to 100 patients). We stopped for lunch alongside the southern Kabini river, near Bavali, which marks the border of Karnataka with Kerala, and had an impromptu game of cricket with some boys...by we, I mean the others played and I watched. I have yet to learn any of the rules. Stopping for tea is another important part of the late afternoons that I enjoy. They take their tea in small metal cups, heavy on the milk and sugar, light on the tea. The same goes for coffee, so I may have trouble adjusting back to my large mug of black coffee every morning when I return home.

In addition to being interested in seeing patients and promoting health at the most basic level during these clinics, I can't help but enjoy the beautiful scenery. On Fridays, the clinics are all within Nagarhole National Park, where I've seen a variety of wild deer, elephants, and monkeys. Even outside the park, the rice paddies are bright green, cotton fields are covered in white flowers, and there are fields of bright orange marigolds that glow even in the rain. I wouldn't mind having a commute like this everyday, notwithstanding the bumpy, muddy roads.

I have at least three more blog posts in my head, as well as a somewhat important personal statement to write for residency applications, so I'll most likely post again soon (and procrastinate on the personal statement). Let me know if there is anything in particular you'd like to read about!