Monday, February 11, 2008

Out in the villages

Last week I rotated in CHAD- Community Health and uhh, something that starts with a D-
basically it is the part of the Christian Medical College (CMC) that does outpatient and outreach to outlying villages and rural homes

Seema and I went on "Nursing Rounds" with head Nurse Nancy, nursing student Pricilla, (lots of Indians, especially christian ones, have names much like ours!) and a driver. Somewhere along the way we picked up the community liason for that area, a women who started out as the birthing attendent or midwife of that area, who was later trained by CMC to be the health liason to that area, and to be a more educated midwife in an emergency.

So we set out in the car- really feeling like we were on safari , with holey dirt roads, speeding through an area with countless rices paddies, banana trees, cows wandering, goats playing, dogs napping, with the ocassional small house in the middle.

I noticed that many of the rice paddies had women dressed to the nines in beautiful saris, all hunched over in the knee high water, working away- so asked Nancy why it seemed only women worked in the rice, and no men? She then told me that men did the "hard labor", so mostly women did the rice- well, about 60 seconds later, after having seen easily 50+ women working the rice in that area, we came upon the men- probably 25 or so of them, literally laying on the ground half asleep in the shade, doing nothing!! The whole car got a great laugh over that.

So we went to visit a few women with newborn babies (I'm talking 5 days, or 10 days old), and the nurses spent time with them discussing proper care, feeding, diapers, signs of sickness, etc. Then we checked on a few women who were close to term, like 36 weeks and up, to be sure all was well, and the nurses instructed them about how to know when they should come in to the hospital.

Well woman and well baby check ups are nothing new for me, but the old fashioned feel of house calls out in the banana fields made it seem like I had gone back in time, we were even using umbrellas as parasols since each home was a good walk away from even the worst dirt roads, and the sun is really unrelenting out here in the afternoon.

Later in the day, we got down to some more depressing duties. We visited two elderly seeming sisters, who lived alone in a makeshift shack out in the middle of a field. They were both widows, and both suffer from seizure disorders. We brought them their medications, and the nurses had a long talk with them, as the younger sister was clearly malnurished. By malnurished, I literally mean she appeared much like the photos you see of starving people, like in concentration camps or african drought camps. She is shockingly poor, however, she was getting some rations from the government, as a widow. Unfortunately, as her husband had died a year before in an accident, and her only child lived somewhere far away and never visited or sent money, she was so depressed that she had been refusing to eat anything, and was literally starving herself to death in front of her sister, who was crying as she explained all of this to the nurses.

The nurses agreed that the woman needed to be admitted to the hospital, so they planned this with the sister- she would take her by bus (only a few rupees) to CMC and they would treat the sister inpatient.

Later, we went to a small village to do a death inquiry. The CHAD nurses and village liasons do all of the paperwork involving births, deaths, etc, for all of the villages. So we sat on the floor in a two room hut while a widow and her mother explained to us what had happened to her husband a few days before. The young couple, who have two children, came from another place to this village to attend a funeral of an old man. They came by motorcycle, as this is how most families travel, you'll see the dad driving, with one kid on his lap, with the mother behind holding another child! Funerals here are a celebration, with music, fireworks, and lots of revelry. Everyone follows the cart with the dead on it through the streets.

So the young father had gone on his moto alone to fill up gas, fill up a portable gas container for a friend's moto, and pick up fireworks for the funeral. Sadly, the festivites had already begun, so when he returned with a full tank, an extra portable tank, and new fireworks, some other had already been setting off fireworks, and a stray hit his gas tank, making all the fuel and firworks explode, with him still on the bike- as such, he had third degree burns on 40% of his body, and since he was on fire, no one would come near enough to help him put it out- so he ran to a pile of sand and put the fire out himself.

He died in the hospital 10 days later, after infection and organ failure set in. THe wife kept telling the nurses that the doctors had told her he would be fine and get better, but the nurse tried to explain to her that with burns of that magnitude, and considering he apparently had red urine for several days before he died, that he really never had a chance, and that she was sure the doctors did all they could. When the body was given back to the family for the funeral, all of the villager noticed he had incisions on his side, so, considering the biggest news story in India is not currently cricket, but rather a kidney stealing ring led by an indian doctor who stole kidneys from poor country people, the poor widow wanted to know how she could begin a formal inquest into the stealing of her husbands kidneys, as she was sure that was what killed him, not the burns. Nurse Nancy spent well over an hour with the poor woman, doing her best to educate her about how serious burns are, how a recovery (in India especially) was never really an option, and how her husband had been far to sick to be able to get usable organs from.

Once that conversation had taken its course, the woman then begged the nurses to talk to the village mayor of sorts, as he was refusing to give them the mans death certificate, which she needed to start getting widow benefits for her family. The nurses then explained to us that india is inherently corrupt at that level, and the only reason to have such a post is to get bribes from people, even a poor widow in these awful circumstances.

The last stop of the day was a gypsy camp, however, since these particular gypsies had been camped in one place over 20 years, we weren't so sure that this place was still a "camp"! It was a collection of makeshift huts, some made of rice sacks and tarps, a few with concrete walls and thatched roofs. All kids under 6 or 7 were naked, a slew of other young kids, 7-15 were running around, even though it was still school hours, and all the parents were just hanging around, seemingly doing very little. I gave the kids some crayons I had, and they went nuts, wanting more and more, but I had given all I had. All of the gypsies had dark skin, probably a biproduct of basically living outside in southern india, but many of them had haunting light eyes, a genetic remider of sorts that their ancestors spent time as gypsies far far away to the north somewhere before settling down here. As we were leaving the camp. a whole new batch of kids came running down the street- all wearing clothes and backpacks- I realized these were the kids that had gone to school- it was mabe a fourth of the kids in the little community. I wondered to myself if these motivated few would be able to perservere and stay in school, or if they would be forced into work or some sort of gypsy style scam by their parents. I guess I will never know.

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