Week 2: CHAD

This week, I transitioned from the main hospital to the community hospital here in Vellore called CHAD. The clinic site is located on the same campus as the medical school in Bagayam, which is about 15 minutes away by autorickshaw. The purpose of the community hospital (which has both outpatient services and a small inpatient ward) is to service the outlying communities and villages around Vellore. The healthcare structure utilized by CMC to serve the rural Indian villages is very intersting and quite different from traditional health care offered by larger urban hospitals. There is, of course, the more traditional services offered at the hospital itself, but a large portion of the healthcare is administered by doctors and nurses who go into the local communities to provide care because so much of the population is poor with limited resources and no ability to come into the more urban centers.

My second day of CHAD, I was able to witness the outreach-oriented healthcare by riding along with the traveling clinic, which basically consists of a large bus that acts as a clinic on wheels. On this particular Tuesday, just as it happens every Tuesday and Thursday, a group consisting of two doctors, two nurses and a driver venture out into the surrounding villages. The healthcare workers visit three different villages each day, spending about 2-3 hours in each spot, depending on the number of patients. The village range from extremely rural, sparsly populated areas to small towns nestled in the mountains outside the city. The first village we visited was very rural, with most of the structures consisting of deteriorating walls with thatched roofs. One of the doctors set up a small folding table with a few chairs under some trees and the patients quickly began arriving (as a side note, Indian people hate waiting their turn....so there was a lot of bickering and cutting in line involved in seeing the doctor). The patients who have chronic illness, such as hypertension and diabetes, carried a white card with them, their "Chronic Disease Card." If they carried one of these cards with them, the doctor would look it over, do a cursory physical exam, take their blood pressure and then decide what to prescribe for them. Once this was accomplished, the patient could then take their prescription over to the bus, where one of the nurses acted as a pharmacist, doling out medications. It was really a remarkably efficient system considering the patient volume and the inaccessibility of most healthcare to these villages. With this system, patients who may or may not even have access to running water or electricity are able to manage chronic diseases with remarkable efficacy. And they are seen about every 4-6 weeks, as the traveling clinic cycles around to every village in about that time period. A doctor visit every 4-6 weeks is more frequent than most US patients managing chronic diseases will have, which is amazing. However, while the community outreach structure works well for managing chronic illness, it is much more difficult to implement an effective system for acute illnesses or ailments requiring diagnostic or surgical interventions. For example, we saw one very elderly woman (she looked about 80 years old, but she didn't really know how old she actually was) who had a nonreducible epigastric hernia (meaning that her intestines had become stuck in this bag of skin protruding from her stomach and could no longer be pushed back inside). This is a situation that requires surgical intervention or eventually, the intestines will become twisted on themselves, cut off their blood supply and die. However, this elderly lady informed the doctor that none of her relatives were willing to drive her to CMC for evaluation and treatment and since there is no system in place to transport these kinds of patients, the hernia may eventually cause serious problems for this lady. So even though CMC and healthcare in India has invented many innovative ways to serve its unique population, there are still large gaps where patients do not receive proper care.

The remaining two villages I saw as I traveled around with the clinic on wheels were very similar experiences to the first. I saw a large number of chronic disease patients who were well serviced, very thorough antenatal care provided by a doctor who examines pregnant women inside the bus, but many acute illness or chronic illness requiring more complex care which could not be treated. However, for such a large, underserved and desperately poor population, I would say the healthcare here is innovative and very effective.