CHAD

Week 2 -- Community Health and Development (CHAD) Rotation
4 of us in our group did CHAD this week along with an Australian couple. CHAD has a clinic where the see the very poor who could not afford CMC pricing as well as the village population. So two days we were able to go into the villages and see the patients there and the other days we worked at the clinic.
We quickly were informed that this was not the best week to be doing CHAD due to Pongal - the Hindu festival of the first harvest of the year. I hear it's like Thanksgiving. From what I have gathered throughout the week, Monday is the day of first harvest. So they bring in the first harvest, make all this rice and pray to the sun gods for thanks. Tuesday is the big deal -- the bulls have their horns painted and sharpened and all the villages get together. I think there is also some running of the bulls kind thing as well. Wednesday is when all the family gets together. So not many people wanted to come see the doctor during this time in the clinic.
Monday Paul and I did Outpatient Pediatric Clinic. It was pretty interesting - lots of seizure disorders here. I am not sure why there are so many people with seizures here, but we saw alot of people this week with this diagnosis.
Tuesday - TB Clinic -- eesh. Most the patients we saw were patients on treatment that weren't coughing. But one lady come in with a hoarse voice and later we looked at her chest x-ray and she had a nice infiltrate (spot in her lung) and the doctor thought she was probably pretty contagious at this point, since she was not on treatment yet. So hopefully I did not breathe too deeply when we were seeing her. We also saw 2-3 patients with Leprosy. It is so sad to see their hands and feet that have been destroyed and deformed as the result of this disease.
Wednesday - Prenatal clinic. Lots of pregnant moms. I learned how to listen with my stethoscope to hear baby's heart sounds. Something I never tried in the states as we just use the Doppler that is just sitting next to the bed. But they cannot afford one here or maybe it is just not vital as they are able to use the stethoscope.
Thursday- Doctor's Rounds. So CHAD takes care of the small villages around Vellore. They have a pretty nice system set up. Each village (which is about 1000 people) has a health aid that is assigned to about 5,000 people - about 4-5 villages. They go to the villages every week ( some go daily) and tend to the villages medical needs. Than there is a nurse who is over 15,000 people. She goes to the villages twice a month and sees all the pregnant mothers in the last trimester and tends to any needs, as well as bringing medications to the village. A doctor is assigned 50,000 people and goes to the village once a month. At any time, they can send a patient to be seen at the main CHAD clinic for further work-up or treatment.
The people pay as they are able to -- the system looks at how poor a family is and decides if the medications are totally free or what price (which is very very small -- less than a dollar for a month's supply of medication).
So Thursday was Doctor's Rounds -- also Pongal day. We went to four villages and went by bus. The bus was the clinic. We would set up a table next to the bus with 4 chairs. The exam table was in the little bus- where the prenatal exams are done. And the back of the bus has a desk for the nurse to hand out medications and give immunizations. Very impressive. We ended up seeing alot of people this day, because the last doctor's rounds were cancelled the month prior due to rain.
I really enjoyed being able to go to the people's homes, see how the live, interact, and understand more about the culture.
They have their bread and butter diagnosis here just as we do at home. They see alot of hypertension, diabetes, and seizure disorder. I think those were the three things we saw the most... oh yes and being pregnant. Overall, a very educational experience.
Friday-- Well Friday we were supposed to go on Nurse's Rounds but I think they overbooked who could go and so were got booted. Scott and I stayed at clinic instead - which was awesome. It was ENT clinic. The doctor we worked with was a great teacher. She would draw a picture of what we would see in the person's ear, for example, and what has wrong and than have us look in his ear. I learned alot from her. The ear is a hard thing to look in and appreciate problems, especially in kids who may give you a split second before totally freaking out. So this was very good for me. We saw some ruptured Tympanic membranes (ear drums), neck cancer, vocal cord palsy, and lots of nasal issues- deviated septums, sinusitis, nasal polyps and such.
And Friday we left for Mamallapurum - a beach city. = )