Nurse Rounds

Men readying their boat to fish in the morning.








hello all -
I am going to postpone my leprosy blog once more because I need to do some more research since it will be part of my grade. So, instead I will share about our nursing rounds on Friday and our great trip to Mumallapurum.

The Jist:
I have started my last week at CMC, now rotating through the PM&R department. I will blog on that after I have been there for a few days. I leave on Saturday for Dubai, where I will stay until returning back to the states on Tuesday.

The Medical:
CMC has an outreach program called Community Health and Development (CHAD). Part of this program includes nursing rounds. A group of villages have a health aid, a group of groups of villages has a nurse, and then there is a head nurse who covers around 20,000 people and visits the villages as needed, hitting each village about once every two weeks. The purpose is to field any minor problems to prevent patients from having to go the the ER. They also keep records of deaths and births along with pregnancies. Many of the visits are for prenatal care. That is just a quick summary, but pretty much they check on people in their homes. Doctors rounds, as blogged about earlier, is really a mobile clinic and there are no home visits.

It was an eye-opening day and the nurse who was with us was very open to questions and ready to teach. Our first visit was to a home (see picture above) to investigate a recent death of a 65 yo man. The family and other members of the community gathered to recount what had happened and this quickly became an argument, forcing the daughter to leave the house as she disagreed with the details given by others. It was a tense encounter, though in another language I could sense that this was a difficult situation. This picture is one of my favorites because it tells a story. On the right sits the nurse, recording the details of the death and turning her eyes towards someone speaking about the circumstances. The middle lady is the wife of the man who died. For seven days after the death of the husband she is allowed to wear bridal clothes, expensive jewelry and other decorations - including the traditional necklace she is wearing which she acquired at her wedding. On the seventh day her family will remove these objects and she will no longer be allowed to dress in anything other than a plain sari. She will never again wear jewelry or a red mark on her forehead (called a bindi, signifying a married woman - but more recently young unmarried girls wear bindis as a fashion mark). Widows are considered bad luck. In the past, widows were known to throw themselves on the funeral pyre of their husband because life as an unmarried woman is harsh. That is less common, but the stigma still persists.

We also visited the home of the young boy who is pictured. He suffers from juvenile rheumatoid arthritis, quite a disabling and progressive condition. His father carries him everywhere. All who know him comment that he is one of the smartest children in the village. His older brother suffers from seizures and is mildly mentally retarded. This is quite a burden for a farming family and I wonder how they make it but they do. The love for their children is palpable. Just as we were about to drive away the mother approached the car in tears, asking for medication of some sort for a pain, but I had this feeling maybe she felt she could express to us safely that she was a bit overwhelmed herself. The nurses talked with her for a while and handed her some pills, likely vitamins or something.

We visited more villages and the nurses performed several prenatal exams. We examined one child for malnutrition. The nurse saw a patient who just two weeks prior was laying in the street unresponsive. She had a stroke and was left for dead by her family, but they took her to the hospital with the nurses encouragement and on this day at least she was walking and smiling as we encouraged her to take her medication.

I really enjoyed the change in scenery, being out in the rural areas reminded me of the place where I grew up. I had quite a chuckle when the other students were snapping multiple photos of the cows and goats. Smells were very familiar to me and I felt proud to have grown up around nature. I noticed a bag hanging from a tree (pictured above) and soon found out it is tradition to hang the cow's placenta in the tree to encourage cow fertility. Now, I don't remember seeing that as a child but whatever.

I like the system because it has layers of intimacy between the medical community and patients. Each village has an aid that seems to know the business of everyone in the area since that is her job. She was able to predict who would be home when based on their habits and whether or not they were seeing family for Pongal season. She is even able to coax out of them the truth of their medication compliance, since it is fairly common for them to not disclose noncompliance to their doctors.

CHAD was something I heard about during the presentation by the students from last year that made me want to come to CMC. My feelings were justified, it is a unique and privileged experience. People will invite you into their home and make a place for you to sit. It is like seeing patients up close and personal, on a real life level. I can't recall doing anything similar in the states which is a shame.

The Beach:
We had a great, restful weekend in Mumallapurum - a beach town south of Chennai. I was able to get a one hour massage for $12. A four course feast runs about $5. I am thankful to be in an area with such cheap prices, I have decided Europe is way too expensive and money can go a lot farther in places like India. For one meal I was teased by another student for ordering something "safe" - a vegetable coconut curry. I asked the waiter to bring me the hottest thing on the menu, and he brought me something called Devil's Chicken. I ate the whole thing and am still alive with no intestinal difficulty.