The weekend + Beginning of our rural posting

Hello all! Since we were in the rural area, I had a lot of time to update my blog while I was away, so this week's is a bit lengthy and detailed. Bear with me if you can!What an interesting week we've had.  Unfortunately mine started off on Saturday afternoon with some sort of vicious stomach illness that left me sick all afternoon and night. Luckily the nausea stopped by Sunday and I was able to go visit Golconda Fort in Hyderabad, a 500 year old fort that housed the palaces of the Muslim kings who ruled Hyderabad. It was really cool to walk through and we had a guide who was able to fill us in on cool details like how the acoustics of the fort were built such that if someone clapped at the entrance of the fort, it could be heard as a signal way up the hill. Probably the most interesting thing we saw was a goat being sacrificed. We didn't really know what was going on, but there was a Hindu festival occurring that day and all of the sudden two men grabbed the goat and there was a knife and the rest is history I guess! Jessie and I were both quite disturbed by the experience, especially since I personally haven't gotten that used to eating goat here, or mutton as they call it. I think it's because all the butcher shops hang the entire animal's meat in the front of the store with a metal hook and there are plenty of flies and no refrigeration. Anyways. After the fort we made our way to some tombs, which were not at all what I was expecting. The tombs are huge-like stories and stories high-and each house only one Muslim king or his wife. There were seven total in the yard which seemed to go on forever. It was very tranquil and we were far enough away from the traffic to not hear the constant horns which are normally inescapable. After, we grabbed dinner and I had some KFC which was just the thing I needed to get my appetite back!

Jessie and I after seeing the goat being sacrificed

The whole group hanging out at the fort

The massive tombs we visited neaby the fort

The following day we woke up early and went back to JMJ College to pick up the MSc students and the lecturers before we headed to the rural area for the week. We were told that the area was actually semi-rural and not rural, but considering that it'd be about a 30 minute walk to the village from where we are staying, I'd say it's pretty rural. It was nice to drive through the country for a change of pace and I'm always interested in seeing what people are growing. We saw lots of green fields and rice paddys along the way, as our driver somehow navigated along the narrow road, dodging cows, water buffalo, goats and whatever else came along our way. Our first stop was at the District Medical Officer's Head Office (DM HO). Basically, the state of Andra Pradesh that we're staying in is divided further into districts. Each district has a heck of a lot of bureaucracy it seems, with the head district medical officer having an incredible amount of power. We listened to a talk by a different officer, who explained how the district was set up, how primary health care services were delivered, and how they were developing various programs in the community to improve health. He talked a lot about the presence of corruption in the system, and about how it is relatively easy for doctors working at primary health centers to not show up for work, or only show up for half of the time they are supposed to. It seems as though people are not punished for absenteeism here, if your position is high enough-perhaps this is because these people have they have the means to pay people bribes, which, from what I can tell, is very common here. Today, actually, we heard from one of the MSc students about how the Indian Nursing Council has some corrupt members who are allowing some very sub par nursing schools to be accredited despite the students not being prepared to be nurses, just by having the owner of he school pay the council member. Corruption, it seems, exists everywhere in India, from the highest to the lowest levels of government. While I know corruption exists to some degree in Canada, it is much more widely known and accepted as a part of life here. Anyways, the man who have the talk was really on the ball with recognizing some of the problems with corruption in the system and was implementing some accountability measures to help with the problem. He also talked about how he had undertaken some disciplinary measures when a medical officer demonstrated negligence which resulted in death. Not that big of a deal to discipline by Canadian standards, but I am pretty sure this doesn't occur very often here. Some of the important things he told us about were similar to programs at the UFWC, like encouraging all women to deliver at the primary health centre instead of in the home, as these births are often not attended by any skilled attendant, resulting in a higher infant and maternal mortality rate than in Canada. In the primary health centre, if the delivery is uncomplicated it will be attended by a nurse midwife, who is at the centre 24 hours a day providing care. If there is some complication, then the delivery will be referred to a hospital or centre who can perform a safe delivery. One thing thats interesting, though, is the fact that some centers don't offer 24 hour C-sections, and so women who medically need one are forced to go to private hospitals and pay 8000 rupees for the section. The man who gave our talk talked about one initiative where the women only have to pay 3000 rupees to the hospital to help mediate the costs. Still interesting though, and points to how the public healthcare system here is not nearly as universal as it is in Canada. After the presentation we were off again, and stopped along the road for a picnic lunch of rice, potatoes, curry and egg. When we finally reached our destination, we learned that there was some problem with the accommodation that had been arranged. The sister who had accompanied us said she would've felt bad leaving us there as there were no fans and many mosquitoes due to the rainy season and stagnant water in the fields. So, she arranged for us to stay at a convent with sisters in training. The convent is much more comfortable and clean. Though we are sleeping on the floor for the week, we've been given mattress pads, which are similar to an outdoor chair cushion, and we brought enough blankets to be comfortable. Plus, there is running water and fans! We have also all strung up our mosquito nets, which are getting good use here. While in the UFWC one of the nurses told us that although the government had declared that malaria was eradicated, cases still exist. We learned that in the past year, this district had 20 cases, which doesn't seem like too much but considering how many districts there are in Andra Pradesh, I guess it's high enough.

The entire group who went to the DM & HO Office

Our roadside picnic feast

On our first full day of placement, we awoke to a wonderful breakfast of toast (which we had all desperately been missing) and omelets. My appetite was finally back and I certainly ate my fill. After, we made our way from the convent to the PHC where we'll be observing things daily. We had to walk down the country road a bit to get a rickshaw, and once we did we were surprised to learn that all 14 of us would be going in the same one. While this was a larger than average rickshaw, with a small trunk of sorts, the whole thing cannot be any bigger than a mini Cooper. So just try to imagine the squishiness that ensued! It was fun though, and riding in crowded rickshaws has become part of our daily routine now. Once we arrived at the PHC we learned that the doctor was 3 hours late-big surprise! We toured ourselves around the small centre, which serves the entire sub district of Toopan. It has an immunization clinic, delivery room, 6 bed ward room, an Integrated Counselling and Testing Centre for HIV, a TB DOTS Clinic, as well as regular drop in services. If the patient comes and no doctor is available, the nurse can dispense medications for simple cases. We had a listen to the doctor once he arrived on the activities of the centre and the types of programs it provides. Afterwards, we made our way back to the convent and had a delicious lunch of grilled cheese sandwiches, which also quite pleased my tummy. It is not that I haven't been liking the food, but more so that I needed a break from the same taste that had made me so sick. I hope to be back on curry soon though!

Nicole, Michelle and Jo-Ann getting comfy in their mosquito netted beds