Some interesting things I've seen since last post:
District Hospital, Chittorgarh
Saturday night I visited the District Hospital in Chittorgarh. This is basically the highest level of service that a public clinic/hospital can provide. Kiran and I went to the generic medicines shop outside the hospital to pick up some stuff (this is an initiative Prayas helped to start: pharmaceutical vendors that actually sell at reasonable prices. It has brought down the prices in a lot of the private chemist shops in the area too!) Afterwards, Kiran brought me in to show me around a little bit, and we were lucky enough to run into a GNM (General Nursing Midwife)-in-training, who just got off his shift. He showed me the entire hospital: surgical operation room, post-operation recovery room, women's ward, men's ward, etc. Some interesting features:
- There were a lot of minor user fees for services like diagnostics, ICU stays, etc. Kiran said these were way lower than at corporate hospitals, though.
- The hospital has a "BPL" counter, where poor people below the poverty line can get access to reduced or free services.
- There was a separate room for BPL patients in the in-patient wards, so as to prevent confusion on cheap/free services to the right patients. I would be concerned though about different treatment standards.
- There was a stray dog hanging out near the patient wards. Kiran said he's seen district hospitals with a lot more dogs, and that this one was relatively clean.
- The ICU had oxygen and heart rate monitors for almost every bed. This is apparently is really rare for government hospitals, which usually have just 1 or 2 for the whole ward.
- No doctors stayed overnight in the wards, but there were some on call at their homes. Kiran said that at corporate hospitals, there would be overnight shift doctors.
- There was a separate ward being built for people who wanted to pay a high price (I think around 500 rupees a night), which had 1 to 2 beds per room, air conditioning, private bathrooms, and generally luxurious accomadations. These were sort of similar to some of the US hospitals I've been in. Dr. Narendra is not so happy about this kind of unequal accomadations initiative.
The GNM was going to look for a job in Canada when he graduated. Woohoo brain drain! He was a really nice guy, though.
Immunization Day, Rajpura Village
On Monday I went back to Chotisadri, where one of the field workers, Manganlalji, picked me up on his motorcycle. I knew I should have been concerned when he wore a helmet and bandana covering his mouth. He is the only person I've seen wear a helmet. As I soon figured out, this is because his motorcycle is like twice as fast as everyone else's I've been on. Also, he doesn't particualrly like to slow down, even when the road turns into dirt/gravel, or kind of generally vanishes and becomes more of a foot path. I'm really happy I held on, but my fingers were kind of cramping by the end of the short 15 km ride.
Anyway, he brought me to one of the Prayas field offices, near the village of Rajpura. Every month each village has 1 immunization day, where they immunize children and pregnant ladies for things like measles, TB (BCG), diptheria, tetanus, and more. They also give iron folic acid to pregnant ladies, and test for malaria by dropping blood on slides and delivering to the local CHC lab for processing. The ANM/GNM, ASHA, Anganwari worker, and local NGO worker all take part. Every Monday and Thursday an ANM/GNM from the local Sub-Center arrives at a new village with the vaccines, and they rotate until the month is complete, then going back to the first. I went to the Anganwari center at Rajpura village, where all these folks were hanging out waiting for people to come by. Rajpura is a tribal village with about 680 people. Apparently the immunizers dont go house to house, they just wait for people to come. They only do about 3-4 immunizations a day. I talked to the GNM for a while, who showed me all the vaccines and explained their use. Here's a picture of him with his vaccine cooler:
He apparently used to work for a couple of corporate hospitals, but then applied for a government job because his parents thought it was more prestigious. He said he was really bored though because he didn't really have an interest in village health, and found the work much more interesting at the corporate hospital. Sigh.There is usually a Village Health and Sanitation Council meeting after the immunization day, but this one was going to take place late at night because most of the people were away on a NREGA (National Rural Employment Guarantee Act) project. Manganlalji did take me, however, to meet the president of the VHSC, who was a pretty goofy guy. Here's a picture of him and another woman who run's the village's women's self-help group:
Manganlalji is on the right, and they are holding a Prayas banner. Manganlalji has been working with Prayas in the area since 1999. Before Prayas worked there, the health problems were much worse, but apparently now they currently weren't that bad. (Disclaimer: Manganlalji spoke almost no English, so once again some communication difficulties on details) There's no HIV/AIDS in the village, and Manganlalji said you only really find it outside of the "Tribal Belt" that Rajpura belonged to. About 10% of people got malaria in September/October every year, but the treatment was good and accessible now, so nobody died. I think 4 people had tuberculosis in the village. Apparently diahrreal diseases were not a problem (although maybe this was a communication difficulty, because I find that hard to believe). The main health problems seemed to be viral stomach illnesses.As far as education, about 15% of boys and 10% of girls could read and write to some degree. There was a primary school in the village, but it had only 1 teacher to teach 8 grades. About 15% of kids went through 6th grade, 8-9% through 8th grade, 2% through 10th, and pretty much nobody further than that. The people who go through 10th have to go to a secondary school in another village. I think Manganlalji said nobody over the age of 20 there could read or write.
In between these visits, I have been finalizing some of the documents and office work I did at Prayas. I am now going stay with my cousin Maneesha in Delhi until Friday, when I will fly to Bangalore and stay the weekend with my cousin Aman. I then begin volunteering at Karuna Trust/VGKK next Monday. Apparently the head of the project, Dr. Sudarshan, is really awesome: http://en.wikipedia.org/wiki/Hanumappa_Sudarshan
I am really excited to eat a brownie sundae in Delhi, which I have been craving for about 2 weeks. Maneesha has promised me one.
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