To the semi-rural area we go! Our first placement in Karunalayam

Early Wednesday morning we awoke for our first train ride in India! We got on no problem amongst the seemingly 1000 other people also at the train station at 530 in the morning. Our seats were comfortable enough, and we ended up talking to a young man about travel tips in India for most of the duration of the trip. There are at least 3 classes of train tickets that you can buy, with the lowest being free for all, non-ac seating, and then various levels of ac seating. When we arrived in Kazipet, the small city of half a million near the town we’d be staying, we were met by Father Jyotish, the priest who is basically in charge of the centre and is also a doctor at the hospital, and another volunteer who had been working there from Scotland named Kathleen. The rural area was so different and refreshing in a way from Hyderabad-fewer cars occupying the streets, less honking and madness, more trees. We arrived at the centre, which is basically a large piece of land that a priest purchased with the hopes of various charities having space to develop there. Aside from the orphanage for children infected and affected with HIV/AIDS and the HIV hospital that we were involved with, there was also a leprosy rehabilitation centre, and a high school for the deaf, to name of a few.  Kathleen toured us around the plot, and afterwards we took our afternoon siesta.  The area was soooo much hotter than that of Hyderabad, and it was routine for the workers to take a siesta from lunch til tea time, around 3:30 pm. So, we took a nap in our hot, but comfortable, rooms.  Afterwards, we were introduced to the children in the orphanage. They are split into boys and girls, and there were about 25 girls and 45 boys ranging in age from 18 months to 17 years. Some of the children attend school at the centre to catch them up before they are able to join the others and go to school in the town.  Many of the children had superb English, and we were able to play and communicate with them quite a bit. One thing that was so inspiring was the amount of joy the children had.  It seems as though they were not unlike any other children, however these kids were without parents and had a serious disease.  I found it very inspiring, and reflected on how sometimes the issues we think of as so important at home can be so miniscule compared to the things some of these children had experienced. It was a fun, but sobering experience to play with these children on the daily.

                                               Me, Jo-Ann and Michelle on our first train ride!

After cleaning up and taking dinner, it was basically pitch black out. It seems to get dark here much earlier than at home, so we spent our evenings playing endless rounds of president, or reading.  The first night spent there was a restless one for me.  The rooms were quite hot, and while they had a ceiling fan, electricity regularly cuts from these areas and the rooms became even warmer during this time.  Additionally, each time I looked down at my mattress I’d see many bugs, which meant I kept having a creeping crawly feeling each time I tried to close my eyes to rest.  Regardless, slept some I did, and before long we were heading to the hospital to help out the nurses in the morning.  I was surprised to find that many of the medications had the same name in Canada, which made it easier to understand why they were being given. The nursing station was very well organized, and mostly everything was in English. We assisted the nurses in taking vital signs only, which in itself was a learning experience.  We used a manual blood pressure cuff, which was no problem, but the non-automated thermometers took some getting used to. After the patient would hand us the thermometer, two of us would stare at it and confirm the reading before documenting it.  Also, the way vitals are done themselves is quite interesting. Instead of nurses going room to room like in Canada, patients congregate in the hallways and wait their turn in a makeshift line to have their vitals done. Also, there is no identifying armband on the patient-the nurses knew the names of the 25 men and women staying there, and therefore, identified them for us.  There was also significantly less talking between nurse and patient, which for us was due to a language barrier, but we also didn’t observe much conversation between the clinic’s nurses and patients either.  Morning medications are done in a similar fashion, with the nurse rolling a stock med cart into one of the ward rooms, and calling out patient’s names and handing them medications. We noted that privacy and confidentiality was basically lost in this setting, but wondered how relevant or important patients felt this was. Maybe this was a necessary concession for receiving care at a publically funded centre, which overall appeared to be surprisingly well resourced. Clean needles were used every time, and they have a machine that burns off the tip of the needle after it’s been used. Adequate sterilization and cleanliness was also able to be maintained by the nursing staff as well. Overall, I would say that based on observation, the centre appears well equipped and well run, even by Canadian standards.  However, the patients were undeniably very, very sick, which is likely the condition that they arrived there in.  So, it seems as though to improve the health of these patients, more services or care may be needed in their communities.  I am unsure whether the patients had access to ARV therapy when in their communities or not, but it seemed as though all who were admitted were very, very sick.  I thought that in some ways, this is not unlike Canada in that patients often fall between the cracks and receive inadequate care in the community for whatever reason-lack of resources, access to clinics, inability to pay for medications-and end up in hospital with acute disease exacerbations. Just a thought…

 

The place we stayed while at the centre!

The medication cart-similar meds to at home!

Hanging out in the nurses' station with our N95s!

Another interesting thing I found, however, was that the patient’s chart had their caste documented as part of the cover page, along with information like marital status and number of children. When I asked Father Jyotish what BC stood for, he simply said “Backwards Caste. This is not something you have in Canada, but its something we have here.” I found it surprising that the caste was so outwardly documented on a patient’s chart. While in Hyderabad, we had asked Ruchika about the caste system, and her response was that the caste system is still relevant to the richest and poorest sectors of society, but mostly irrelevant to others. It seems as though one’s caste may still play a role in terms of their social status and therefore, social determinants of health and access to services and health.

The view from here!

Chilling at our digs after some time in the hospital

Us, Kathleen and father Jyotish

A monkey eating a banana at the train station!

We spent three days in the rural area, and most of us got progressively more ill as time went on.  On the Friday, I was experiencing bad intermittent stomach pains and was soooooo exhausted that I slept most of the afternoon and was still fine to sleep through the night.  My diet changed from trying most things to basically a modified BRAT diet of rice, bananas and bread, which must’ve done something right as I am feeling quite a bit better now as I am writing this. We are now back in Hyderabad, only for 2 short nights, however, before we head to our next placement at a nursing school.  There, we will be staying with the nursing students in their dorms and learning from and with them.  This will still be in Hyderabad, but we’re unsure of what to expect in terms of internet, the comfort of the rooms, and regularity of electricity. More updates to come!