Our time at JMJ College of Nursing

Hello All! Lots of updates to tell regarding our second week at CHAI. Well, actually, this week we were not staying at CHAI, but at a nursing college called JMJ (Jesus Mary Joseph). We stayed there from Monday to Saturday, living in dorms similar to what the BSc Students would stay at.  Our hosts there were very accommodating and lovely to be around.  They were able to adjust the spice of some of the food to make it more tolerable for our Western bellies. Each day at JMJ, we spent the morning doing a community placement alongside the BSc students, and spent the afternoon taking a brief class, then exploring Hyderabad.  One thing that this experience has taught me is how much more formal school is here in India. We learned that the professors had very high academic expectations for us, such as doing presentations and writing a report on our experiences.  Since I am a bit pressed for time here, I am going to cheat and incorporate some of that report into my blog here. Promise that I will try not to bore you too much! Another interesting thing about the college is how little freedom the students have. Basically, from the time they wake up until 8 in the evening, they are busy either in school or studying. Then, for about an hour each night, all the Catholic students spend time praying, and they also do a procession, or a walk, through the campus each night, saying prayers over and over again, and holding candles. The students are only given free time during one afternoon of the week, during which time they are supposed to go to the Internet cafe across the street to do research. The weekends are also spent studying or in clinical placement. Definitely not the typical undergrad experience by Canadian standards!

Jessie and I in our Saris!

On our first day at JMJ College, we visited an Urban Family Welfare Centre with the year 4 BScN students and some MScN students. The UFWC services a population of 60 000, all of which are urban dwellers. The UFWC provides primary healthcare services that are prioritized towards woman and children.  The clinic provides drop-in services for minor ailments like cold or cough, as well as antenatal and post natal checks, well baby checks, immunizations, family planning services, uncomplicated deliveries, TB DOTS clinic, lab testing and post partum ward services. The first thing I noticed was that the students were wearing purple saris-we were told that nurses working in the community do this as community health nurses are one with the people. This is similar to Canada, where in a community setting we wear plain clothes in community health to lessen the power difference between nurse and client. Once at the centre we learned that simple care provided here was actually far more complex that what would be done in Canada. For example, deliveries and simple surgeries are not done in the community. Additionally, the government provides incentives for people to undergo certain health behaviours. For example, woman receive an incentive of 500 rupees for having a tubal ligation after they’ve had 2 children, as the government is attempting to control the population. Also, if a family gives birth to a daughter, the family receives an incentive of 60 000 rupees for 2 female daughters once they turn 18. This is to compensate for the cost associated with providing a dowry for daughters when they are married. We also learned that is illegal to do prenatal sex screens to determine the gender of the baby, as male babies may be preferred and families may abort female pregnancies due to the high cost associated with providing a dowry for marriage. The UFWC was actually conducting a sterility clinic today, and women would line up to get their tubal ligations, kinda like it was no big deal. They bring a surgeon in from outside, and after the procedure the women quickly go home. So interesting. 

After our time at the UFWC, we went to a nearby market, and I of course spent too much money, but am now well outfitted with a couple of Indian style shirts and some other cool trinkets we found along the way!

On our next day at JMJ, we did a community scan and home visits. I found it interesting to walk through the neighbourhoods where community nurses work, as we were able to get up close and personal with the community of Borabanda. I found it interesting that nurses will follow up with clients who had visited the UFWC in their homes for things like blood pressure monitoring and health education. The part that I enjoyed most about today was the opportunity to see inside of people’s homes and how they lived. I was surprised by the lack of natural light and ventilation in many homes. I also found learning about family and neighbourhood dynamics and structures very interesting, such as renters vs owners, how people utilize the healthcare system and who tends to use the public system, and how people take care of daily activities like cleaning and cooking. I was pleased with how readily people welcomed us into their homes, despite not knowing us or being able to communicate with us. Also, it was interesting that most of the homes contained little to no furniture-there were no beds, tables, chairs, etc, despite the homes being very clean and some, very modern. This may in some cases be because once you fit the entire family in the home there is little room leftover for furniture.  Soo interesting!

A picture of the community we visited

The following day the UFWC held an immunization camp. Some interesting things that occurred include the fact that the nurse cleans the area using a cotton ball and friction only-in Canada, we use alcohol also to sanitize the area. Additionally, I also observed the TB Directly Observed Therapy (DOTs) clinic today. The clinic is run by the TB officer.  Known TB patients come in approximately 3 times a week to receive their medication. They are given their medication in the clinic, and the officer observes them take it.  TB diagnosis occurs based on sputum testing.  The sputum is tested in the centre using gram staining, much like in the microbiology labs we have taken in undergrad. The lab technician visualizes the stain on a microscope slide, and counts the number of acid fast bacilli present to determine whether the patient has TB, and the severity of TB as well, based on the density of AFB.  If the sputum is inconclusive, we learned that the patient may be sent for a chest X-ray outside of the UFWC. For treatment, the patient is treated for 6 months at the TB DOTs clinic if it is their first occurrence, or 8 months if they had TB previously and there was not cure.  I found it interesting that the TB officer did not don personal protective equipment when treating TB patients. 

Inside the Urban Family Welfare Centre, our MScN friends dispensing medications!

Us sporting our bindis from the BSc students

In the afternoon, we decided that we wanted a break from the hustle and bustle of markets, and so decided to go to a park. A little miscommunication later and we ended up at a place called NTR Park- a sort of strange amusement park located near the big lake in Hyderabad.  We decided to might as well go for it, admission being only 20 rupees (less than half a dollar) and all. The only way one can describe this place is that it is like being in a dream. As soon as we walked in we descended down these stairs to a “time machine” which was basically an old basement with a ton of old arcade games, a bowling lane, weird bumper cars, and men shouting at you trying to get you to play their games. It was like being in a different world, with old machines and games lying everywhere in a dimly lit basement.  The grounds themselves were immaculately kept, but there were these larger than life figurines of bugs and spiders spread throughout. We also decided to go on the pirate ship ride, for only 30 rupees. Scariest thing ever. Basically, there is no safety bar to hold you in, and our butts were definitely off our seats as the creaky old ride went higher in the air than we ever expected. Also, before we got on the ride, we hadn’t seen anyone else on it. After we got on, the ride seemed to instantly get busier.  We have noticed this a bit-lots of people asking to take their picture with us, and an entire family rushes in to get in for the shot. We asked one guy why he wanted a picture, and he told us, “to upload to facebook.” Huh? I guess this is something I may not understand, but c’est la vie. On our way out of the park, we stopped to get our first henna. I got a beautiful design done on my hand, which is sadly starting to fade now, about 4 days later.  On our way back to JMJ, we were feeling adventurous and decided to go 7 people in the rickshaw. O my god. It was a squishy ride for sure, and we weren’t happy to get charged more at our final destination because our driver got lost. Often we’ve found that when drivers get lost or confused they bump up the price. It’s really annoying at the time, but with some perspective we realize that it usually amounts to paying about$1 extra, so its not THAT big of a deal.

Michelle, me and Jessie before we knew we were risking our lives taking the pirate ship ride at NTR Park.

My first henna in NTR Park

On our next day, we attended an inservice put on by the MSc students at the UFWC on waterbourne diseases. Unfortunately, the presentation was in Telugu, so we didn’t understand it. In the afternoon, we had the opportunity to take a tour of St. Theresa’s Hospital, the hospital located on the same campus as JMJ College, where the students have their clinical placements. The tour was probably one of the more informative experiences we’ve had here, especially since we’re been learning a lot about the healthcare system in lectures, but hadn’t seen too much of it ourselves. Some interesting things that happened on the tour include the fact that we were introduced to the hospital’s chief administrator. Also, in order to see basically anything in the hospital, including the ICUs, NICU and operating theatres, the nurse guiding us just basically told people the Canadian nursing students were here for a visit, and in we went.  The hospital was so different from that in Canada. There are windows EVERYWHERE. There are also people and families everywhere, congregating and eating in the dimly lit hallways. Hand sanitizers are no where to be seen, and cloth curtains form makeshift doors between units.  The beds look to be hard an uncomfortable. Also, when we saw the delivery room, it kinda looked like something out of a horror movie. The mother was lying on a stainless steel bed with a hole in the middle of it. Interestingly, she was on an electronic fetal heart monitor. Aside from that, the use of technology as we know it in Canada is so limited. The emergency room basically just had oxygen on the walls-no other technology was in sight. We also got to see the CT and MRI machines, and I would have to say that they were comparable if not better than the equipment used in Canada.  Lots of interesting things to see, but unfortunately I didn’t bring my camera so no pictures to share!

The next day was the antenatal check day at the clinic. We observed the flow of patients, and came to understand the types of checks that are provided. Women come to the clinic once every month on Fridays for examinations. They bring with them a record of their health, or their own chart, which the nurses use to record information and given back to them. When women come to the clinic, their blood pressure, weight and height are checked.  When they present initially, blood work and urine testing may be done. If these are found to be normal initially, usually no further testing needs to be done. However, we have learned there is a high incidence of anemia in India, so many women will receive additional testing, health education and treatment regarding this.  Additionally, nurses will check the fetal heart rate using a cone shaped device called a fetal scope pressed to the woman’s stomach. We had the opportunity to listen to the fetal heart rate using the device, which was interesting! During our time off, we went to a market selling handmade goods in a part of the city called HiTech city. It is a world of difference from the rest of Hyderabad, where all the multinational corporations call home. The streets are lined with trees, the skyscraper’s yards are well kept, even the traffic seems more civil in these areas. We drove past magnificently huge homes-one was actually shaped like a diamond! When we got to the market it was basically pouring rain but we had a good time regardless. I had to budget the money I brought, and bought just 2 pieces of beautiful art. Our plan is to go back, though, as there were many things we saw and wished we bought, had we brought more money!

Phew, that was a long one. Congrats to those who actually made it reading to the end. Wish I had been able to do a better job on this one, but I am feeling ++tired right now. I promise that I’ll try harder come next week. Until then…!