The CHAD rotation

Hello. To my friends and family just a warning, this is a medical post about my first rotation here in Vellore.

So my first rotation was at the CHAD. The CHAD stands for Community Health and Development. It is basically the secondary referral hospital of the CMC Hospital. I am really glad that I did this rotation first as it gave me a good overview of medicine in India as well as how their health system works.

First of all there is what they refer to as the Community Health Aide. Each health aide is responsible for one village, which is generally the village that she lives in. She is responsible for knowing the census of the village (any births or deaths) and basically everything that is going on in the village. If someone just got married, if someone is pregnant, if someone has become ill or how someone with a chronic medical condition is doing. She keeps track of all this information and reports to one of the CHAD nurses. Each CHAD nurse is responsible for several villages (30,000 people). She goes to each village once a week and sees any prenatal visits, postnatal visits, chronic illnesses and new illnesses. She sees these patients and dispenses chronic medications as well as decides if they need to be taken to the CHAD hospital. A doctor will come to the village once a month and see any new illnesses and examen chronic patients. I have been very impressed with how this whole system works. They really seem to cover the entire area and make sure to know everyone that needs their help.

There were so many areas you can work in the CHAD, it was a bit over whelming. You could go to labor and delivery (i avoided that one), the ER (which they call casualty which i think is pretty funny), the outpatient clinics, TB clinic (I am crossing my fingers that I do not have TB now), the ICU, the medicine wards (where I spent a lot of time), the pediatric wards and the villages. I just wanted to share with all of you a few of my observations and some of the patients that touched me or that I found medically interesting.

- The Hospital: its kind of what I expected. I have worked in a hospital in Nicaragua and it was a lot like this. Open air, lots of beds in a room, no A/C, bugs and animals in the wards but the patients are very well cared for and don't seem to mind all these things that stand out to me and that you would never see in the US.
- The patients: they are so grateful for your attention. They really respect the doctors and listen to what they say. Funnily, they are a lot like American patients, and do not feel like they have been treated unless they are given an antibiotic or some kind of medication. They all receive care for free if they cannot afford it. The intern I worked with a lot could not tell me exactly how this is all funded except there are lots of donors to the CMC. If the doctors feel that a patient will not take care of themselves when they leave the hospital they will keep them in the hospital as long as the patient is willing to stay, free of cost. The Indian villagers are the most welcoming people. On the days that I went into the villages I was amazed. Here I am a stranger walking into their home and I cannot even explain to them why I am there and that I may even be qualified to be there. But it doesn't matter, they welcome me into their home, insist that I sit down in the one chair they have in their home (one lady didn't have a chair so she brought a mat for me to sit on), hand me their children and allow me to see any ailment they may have. Many of the homes even offered little gifts of candy and flowers. Incredible, so trusting and friendly.
- Apparently Diabetes isn't unique to America: I had always kind of felt that diabetes (I am referring to type 2) was such a huge problem in the US because we don't eat well and we eat too much (especially of fast food). I always thought it was a problem of developed countries where food and money is plentiful but apparently I was wrong. I was so surprised by how many patients are diabetic. You walk down the streets here in India and you see that the majority of people are painfully skinny, you can see their bones and yet Diabetes is a major problem here. Even worse is that a lot of people can't afford shoes and so they live their lives barefoot and develop severe foot infections that never heal because they are diabetic and have no shoes to keep their feed clean. Amazing. But I guess its kind of the same scenario that we have in the US: the cheaper foods are the ones that are less healthy. Here rice is a major part of one's meal and one of the cheapest things you can buy so I guess I understand why diabetes continues to be a problem here.
- Being in an outreach type of hospital I expected to see lots of bizarre illnesses that I do not see in the US but instead I saw lots of seizures, HTN, diabetes, etc. However, these 'typical' diseases pose a whole other set of problems in this country. For example, one patient that really struck a cord with me was this young woman who was admitted for burns. It turns out she has a seizure disorder and during one of her seizures she fell into the fire where she continued seizing until someone was able to pull her out. Horrifying! I cannot even imagine the everyday things that are such hazards to her.
- My very first day I walked in on a code blue. A patient had been found unresponsive and CPR was started. They regained a heart beat and breathing but she was brain dead. I asked the doctor about what the family wanted and he said they just wanted her to die. He said that it is very common here that once you are considered "elderly" you are not really valued anymore. That they feed you and take care of you but that it is viewed that you will die at some point and therefore there is no need for medicine. Quite the eye opener on your first day.

It is impossible for me to relay to you everything that I experienced in such a short time. I believe is was the perfect way to start my work here in Vellore: I was able to get an understanding of the health system, refresh my memory on areas of medicine I have not seen in a while, and see some basic differences in the way that medicine is approached here versus in the US. It was a really great experience and I am excited about my next rotation: Ophthalmology