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Ekalaavynagara Health Clinic #1

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The clinic was sponsored by Prerana and coordinated by local community leaders. They provided us with an enclosed space to do examinations, a bed, desk, and chairs. All these items came in handy throughout the 5-hour clinic. Praba and Selvi handled the intake, Rani assisted Purnima, while Jana and I owned the 'pharmacy'. Jana's Kannada is far superior to mine, so besides counting pills, I was only good for giving old women Tylenol and vitamins. I would say "One-do tablet belige. One-do tablet rahtree." (One tablet in the morning, one at night). The sentence was consistently followed by a smile and,unfortunately, a hand-scrunch to the face.

Hundreds of people came to see our ONE doctor, and despite our best efforts to triage, there were some thrown elbows and arguments at the front of the line. Dr. Purnima was great, seeing about 80 patients, without a break. The sheer number of sick infants, children, and women demonstrate the needs of this community.

We quickly realized that we were understaffed and inadequately supplied. Almost every child seen in the clinic had some sort of bacterial infection; from superficial skin infections to lower respiratory tract infections to enteric diseases, these children need antibiotics. For this clinic, all we could do was write them a prescription or refer them to the hospital. We also need to develop a way provide nutritional supplements to the children that are chronically malnourished, as it is hard to fight off infections with an 'undersupplied' immune system.


(A little girl, following her mother's lead, carryies some sticks for a fire)

Overall, the health camp was a great start to a promising, long-lasting service to this community. We learned a lot, which we will carry through to our future clinics. We should improve with each and every clinic.

Ekalaavyanagara

A couple of weeks ago, while we were on outreach, we happened upon a squatter settlement just outside of the city. We decided to make an extra stop to see if there were any TBAs in the community. I stopped the van before we entered the village, so that we could get pictures from just outside the settlement.

While taking these pictures, we were confronted by several village people, who did not approve of us taking pictures of them. We told them who we were and why we were there. They took us to their Anganwardi center, which is a pre-school facility during the day and a multi-purpose room in the evenings. There we met with the Anganwardi teacher and several other older members of the community. These leaders informed us that many people have come to their community and taken pictures, while promising money and aid. However, they have not seen any benefit thus far, and organized themselves against the photographic exploitation by 'outsiders'.

Guilty, was the first emotion I felt, because it seemed I had violated them in some way. However, it was very moving to see them come together as a community to take a stand against these violations. After the meeting, I vowed that I would not be one of those 'outsiders' who just came, took pictures, and left. There must be something that I could do to help this community.

(pictured above: two of the huts with an average of 6 people living inside, the re-blanketed structure outside the right hut functions as the bathroom and is shared by more than one family)

Jana, the team, and I have since been to the village several times. On Wednesday, Purnima, Karl, Jana, and I had a very promising meeting with 4 of their community leaders. The community is made up of tribal people from all around the state, who came to Mysore with the hopes of landing a job in city. It is a quintessential slum community; they are located in a industrial area on the edge of the city, they lack access to sanitation and healthcare, they are living in overcrowded huts made of clay, plastic, and palm fronds. Worm infections are rampant among the children, who also bear the tell-tale signs of vitamin deficiency. The complete lack of sanitation, and subsequent open-defecation are leading to other infections throughout the community.

The leaders are also trying to build an Anganwardi building for their children, see pictures above. The current facility is completely dilapitated; a palm-frond roof characterized by gaping holes rendering the structure useless during monsoon season. They have organized the community and made this their priority. Plans are drawn up for a new Anganwardi center, and the foundation has been laid. Our goal is to raise enough funds to ensure that this project is completed and subsequently maintained by the community.

The health problems facing the children were paramount to this group of community leaders. These leaders are incredibly organized and devoted to their community, but with little resources they continue the struggle to provide a better life for the children. A compelling story to be sure. To help, we are going to raise money for monthly health camps, where the women and children will be given access to primary care. A massive de-worming project will begin in the community and this will bring better health to the children. Further down the line, we will work with the community to develop toilet blocks or household latrines. Sanitation is required to break the cycle of infection/re-infection among community members.

I will keep everyone posted on the status, but don't be surprised if I come to you to raise money. We have made a commitment to these people and it is important to me that I do everything in my power to follow through on this commitment. Our money can go such a long way in improving the lives of these people.

Mangy Street Dogs!

The much anticipated blog entry is here. Over the past couple of months, I have taken many pictures of dogs we have encountered on the streets, in the villages, and on the road. Most do not have commentary, some of them are cute(ish), but they are all feral dogs.

Puppies

A crew from one of the villages. Sorry for all the limbs in the pictures.


Always looking for food.


Staying out of the heat. There were actually multiple dogs under this hut.


Pumba?

These dogs resemble my dog back home. She would be happy to know she's actually cleaner than another dog, a feat I thought to be impossible.

Another pumba-looking dog.



Randoms

This was the territory-marking dog. Picture taken before it peed on our van and I was the one who was yelled at (From a previous blog post).

Eating some left-overs and patiently waiting for left-overs.

The puppy was really cute, but I was a little too close. Mother = not happy


Watchdog.

Some mother dogs are obscenely full of milk.

Some rather rabid looking village dogs coming to check us out.

Marase

MARASE- TBA PROJECT

Marase is one of the villages on our Mysore taluk map and the experience in this village is worthy of a blog post. We arrived at the village, about 25 km outside Mysore City, and Praba met with some of her local contacts. The woman was so ecstatic to see us and informs us that there are three TBAs in the village, a gold mine for us! Praba and Sattya went to interview one woman, while Mercy and Fazila went to the another, and this left Rani and I to do the 3rd. One catch, they don't really know where she is, but they assure us we will find her in '2 minutes, no problem'. Rani, our village contact, and I head out to the fields to find this TBA.

Rani thinks she sees her, and the local woman concurs.



Somewhere by that big plume of smoke, I think.



The pictures do not quite grasp the wetness or the wildlife present in these fields. You guessed it, more snakes, my favorite. We finally reach the group of farmers, who are doing some 'slash and burn farming' and lighting fields of dry grass on fire.



Turns out the woman is not here and these people have not seen her recently. So, we're off for some more walking through the farm fields. Right next to these fields were some coconut and palm tree orchards. Very nice, but really muddy. Rani was wearing her nice shoes and was not at all happy.





As we were walking, the woman asked me if I liked sheep. I responded "Yeah, of course I like sheep, especially the small ones. So cute." After these words were out of my mouth, she took off towards a flock of sheep, and snatched one up for us. I did not know this is what she had in mind.



After some more walking, we finally reached the TBA. She was out tending to her flocks of sheep and goats, but she did not mind doing the interview out in the field.



The TBA was great, but has not done many deliveries recently. She was eager to answer our questions and gave some interesting responses. The data will be good, even though it may not be completely up-to-date.



Dogs and chickens were hassling Praba while she was finishing her lunch. I decided to 'protect' her with my stick. Don't worry, I didn't actually hit anything, but there is some truth to the saying 'Speak softly and carry a big stick'.



(This dog had a limp leg, so he was allowed to stick around. He would be embarrassed knowing there is a picture of him doing this on the internet.)

Lorry Drivers, RHD update, and TBA questionnaire

Lorry Drivers

Monday was last day of HPV outreach. The PHRI crew was presenting to a father's group, mostly made up of lorry workers. From what I could tell, there was a leader of a local union that worked with Satthya to organize the group. Overall, there were about 60 men that attended the presentation.

The leader wanted to show us around the area. We were located on a main road, but there was a whole new 'world' right behind the buildings that line the street. A world with huge trucks, enormous bags of produce, and scores of men jumping on and off the vehicles.

Tomatoes, cucumbers, melons, and cauliflower are just some of the different produce they were shipping. It gave one a feeling of a 'farmer's market' back home, times 10 and I'm sure the prices are a bit more reasonable.

To be expected, there was also a fair amount of raw vegetable wastage. Naturally, a small herd of cattle keeps the wastage in check.

The lorry drivers have been in the news recently. There was a nation-wide strike among these workers, as a protest to rising petrol prices. The strike was on Wednesday, and the city was eerily quiet. Naomi and I went down to the market, a place normally crowded with people, cars, and animals, but found the streets close to empty. It is remarkable that the city could almost come to a complete halt on such a short notice.

You can read more here: http://news.bbc.co.uk/2/hi/in_pictures/7486984.stm

RHD study update

The preliminary chart review at Vikram is done. The next step is to contact the patients by phone, in order to gather data about their living conditions. Since I do not speak Kannada, I will be relying on some staff help with the interviews. In the meantime, I am going to begin doing the same chart review at KR Hospital, the local government hospital. We are interested to see if some neighborhoods have a higher incidence of RHD and have been using Google Earth software. Here is a map of Mysore, which is overlayed onto the satellite image of Mysore provided by Google. Pretty cool. (not sure if you can see with this resolution, but the two yellow pins in the upper left side of the map are Vikram and PHRI)

TBA Questionnaire

Over the past week or so, we have developed a beta version of the questionnaire that will be administered to Traditional Birth Attendants. The first day was a bit rough on everyone. We were editing the questionnaire right up until the time we left for the village. Since this was the first time the interviewers had seen the questionnaire, they needed to translate it into Kannada. Due to time constaints, we didn't finish this part. The interview took a little too long, and the TBA was a bit tired towards the end. Here is the TBA trying on a glove from the birthing kits we give each of them.

However, we were able to get some good information. Things could have gone better, but I will chalk it up to being the first time using a new questionnaire. Once the interviewers get accustomed to the questions, things will run a bit smoother. Here's the team!

Some cute kids from the village.

Karl took PHRI out to lunch the other day. It was nice to visit with everyone, and I think it was a lot of fun for everyone else. We'll have to get one more picture with Purnima, the director, once she comes on the 17th.