Today I to the Diabetes unit at KEM Hospital, Pune. My goodness - they are doing a ridiculous amount of incredibly interesting research. Including the massively important Maharashtra Maternal Nutrition study - which is basically following a huge cohert of young women through pregnancy and then following their children as they grow. Incredible stuff.
Can't find a wesite link... but basically they're loving Vitamin B12 - and love to wax lyrical about how great it is... and lots of very scholarly stuff too!
Thursday, 22 May 2008
Wednesday, 21 May 2008
time's on my side...
a little random point... to illustrate that despite the good times, being alone in Sindhudurg leaves much time for contemplation and lying around... in the last 8 days I have read 'Captain Correlli's Mandolin' 'God of small things', Mohammed Younis' autobiography and 'purple hibiscus'...
ridiculous.
ridiculous.
Monday, 19 May 2008
The Alma Ata approach - working?!?
It seems mad, indeed it is.. but here in Sindhudurg there seems to be, at least the skeleton, of the PHC approach in action. This, for the uninitiated, is the approach to providing healthcare services using the state, using comprehensive health systems..in a way that provides equity of access.. more here..http://en.wikipedia.org/wiki/Alma_Ata_Declaration
So, the point is - here there is a real referral system, which appears to be in use. There are village workers, then PHC centres, sub-centres, regional health centres, and finally district hospital. It's quite incredible actually.
Now, in terms of a reality check - lots of these facilities don't function as they should, some workers are more motivated than others, and there is a MASSIVE private sector which doesn't have any involvement in the healthcare system...
But - it's definitely a structure, and definitely better than some!
So, the point is - here there is a real referral system, which appears to be in use. There are village workers, then PHC centres, sub-centres, regional health centres, and finally district hospital. It's quite incredible actually.
Now, in terms of a reality check - lots of these facilities don't function as they should, some workers are more motivated than others, and there is a MASSIVE private sector which doesn't have any involvement in the healthcare system...
But - it's definitely a structure, and definitely better than some!
Friday, 16 May 2008
Chilling out a bit
Yesterday evening I "found the new Goa".. really, I did. The beach is absolutely beautiful, there's some great hut/tents to stay in, food's great - and it doesn't suffer the affliction of tourism that Goa has unfortunately succomed to. Not gonna name the place in public, though...
Today I went to visit a project that I'm really interested in - it's called 'homestay' and is all about creating a sustainable alternative to the "build 'em big" model of tourism that is normal. There's quite a few places to stay in Sindhudurg and I went to visit the deluxe one. Absolutely stunning. Apart from a great room in a rural area, you get to eat with an Indian family, be introduced to local cultural activities... basically, a nice way to see the 'real India'...http://www.cultureaangan.com/homestays.htm
Today I went to visit a project that I'm really interested in - it's called 'homestay' and is all about creating a sustainable alternative to the "build 'em big" model of tourism that is normal. There's quite a few places to stay in Sindhudurg and I went to visit the deluxe one. Absolutely stunning. Apart from a great room in a rural area, you get to eat with an Indian family, be introduced to local cultural activities... basically, a nice way to see the 'real India'...http://www.cultureaangan.com/homestays.htm
Thursday, 15 May 2008
"He has COME FROM AMERICA..."
One tip for anyone travelling in India... pop in to peoples houses around meal-times... they're bound to give you food. Think of it as 'skipping' or 'freeganism' today's breakfast was obtained in that way... delicious!
Today was a big day of interviewing... headed off to a village with Prof Hindelekar. When we arrived it turned out to be her village - so we spent the first hour sitting drinking chai and eating mangoes with her family. I like this kind of research.
Spoke to lots and lots of women - they are completely baffled at the idea that a man could be interested a) in women's nutrition and b) in anything to do with pregnancy at all. The men, in turn, are apparently quite confused that such a subject even exists...
At lunch time I was guided to a large house near the middle of the village. It has just been built, and so they were having a puja, with prayers, food etc. It was great to sit on the floor with all these people eating beautiful Indian food from leaf plates. However, the most memorable point has to be when an elder gentleman stood up, silencing a portion of the crowd, and boomed out -
"HE HAS COME FROM AMERICA",
to which there were many smiles, and much extra food was doled onto my plate...
Today was a big day of interviewing... headed off to a village with Prof Hindelekar. When we arrived it turned out to be her village - so we spent the first hour sitting drinking chai and eating mangoes with her family. I like this kind of research.
Spoke to lots and lots of women - they are completely baffled at the idea that a man could be interested a) in women's nutrition and b) in anything to do with pregnancy at all. The men, in turn, are apparently quite confused that such a subject even exists...
At lunch time I was guided to a large house near the middle of the village. It has just been built, and so they were having a puja, with prayers, food etc. It was great to sit on the floor with all these people eating beautiful Indian food from leaf plates. However, the most memorable point has to be when an elder gentleman stood up, silencing a portion of the crowd, and boomed out -
"HE HAS COME FROM AMERICA",
to which there were many smiles, and much extra food was doled onto my plate...
Wednesday, 14 May 2008
Is this on the syllabus?
I hate that phrase... it implies that the only important things are those which are going to be examined, or those which can be questioned through tick boxes...
Yesterday whilst doing interviews, I was stopped half way through. What was this woman saying, I asked the translator? She was saying:
"Okay, I've answered the questions you asked, now look at my child Doctor... he's ill"
She carried on...
"Is it my fault? Because of the foods I ate during pregnancy?"
What have I done? I thought. Thinking on my feet, looking around, assessing the situation. I said, okay got to deal with this... turned off my recorder and explained to her that there are many reasons that a child can get ill - one is nutrition, but there are many reasons... and I explained various of them. I then explained that it wasn't her fault, and that a good thing to do would be to take her to the local primary health centre. Unfortunately, this family refuse to go anywhere but the civil (district) hospital, transportation to which is beyond their means unfortunately. So - that child won't be seeing a health professional.
What was the right thing to do? Should I have pretended to examine the child? It would have given them so much reassurance - but it's not right. What if I'd said that everything was fine, and it wasn't? "Doctor from UK said..." etc.
It's a tough one, being partially medically qualified. The partial bit being the most important. As a medical student I think limits come very very quickly...
"A little bit of knowledge is a bad thing..."?
Yesterday whilst doing interviews, I was stopped half way through. What was this woman saying, I asked the translator? She was saying:
"Okay, I've answered the questions you asked, now look at my child Doctor... he's ill"
She carried on...
"Is it my fault? Because of the foods I ate during pregnancy?"
What have I done? I thought. Thinking on my feet, looking around, assessing the situation. I said, okay got to deal with this... turned off my recorder and explained to her that there are many reasons that a child can get ill - one is nutrition, but there are many reasons... and I explained various of them. I then explained that it wasn't her fault, and that a good thing to do would be to take her to the local primary health centre. Unfortunately, this family refuse to go anywhere but the civil (district) hospital, transportation to which is beyond their means unfortunately. So - that child won't be seeing a health professional.
What was the right thing to do? Should I have pretended to examine the child? It would have given them so much reassurance - but it's not right. What if I'd said that everything was fine, and it wasn't? "Doctor from UK said..." etc.
It's a tough one, being partially medically qualified. The partial bit being the most important. As a medical student I think limits come very very quickly...
"A little bit of knowledge is a bad thing..."?
Tuesday, 13 May 2008
Florence, and interviews.
Well, that was a day.
It started in the usual way – people not being in the place they were supposed to, at the time they were supposed to be there. Lots of promises of people who can help in the coming days, but nothing immediate.
It was to the civil hospital, where a Florence Nightingale celebration was taking place! Anand and I snuck into the back – we were felicitated with flowers and asked to give a speech. At this we balked, and managed to get away with just flowers and photographs. We were, at this point ‘guests of honour’, and were placed front row, in the middle, with the eyes of 300 nurses piercing into the backs of our skills.
Photographs
Florence Nightingale, it turns out, is a bit loved round here. It was more than a bit amusing to see her picture draped in flower garlands, with haldi and coloured powders scattereda round like a Hindu deity. We left the hospital after a couple of hours – felt bad for leaving, but we had work to do!
We did three interviews – the first of which was not just with a woman, not even just her and her husband… but with a whole extended family sitting and feeding into conversation. Pretty rubbish really – how’m I supposed to ask about the mother-in-law’s influence when she’s sitting right there? Anyway, we carped on for a while about papayas being bad during pregnancy and hit the road. The second was much more interesting, although the baby in the background was a pain. The third was much better and she had lots more to say –including that pregnant women should eat before men – revolutionary.
It started in the usual way – people not being in the place they were supposed to, at the time they were supposed to be there. Lots of promises of people who can help in the coming days, but nothing immediate.
It was to the civil hospital, where a Florence Nightingale celebration was taking place! Anand and I snuck into the back – we were felicitated with flowers and asked to give a speech. At this we balked, and managed to get away with just flowers and photographs. We were, at this point ‘guests of honour’, and were placed front row, in the middle, with the eyes of 300 nurses piercing into the backs of our skills.
Photographs
Florence Nightingale, it turns out, is a bit loved round here. It was more than a bit amusing to see her picture draped in flower garlands, with haldi and coloured powders scattereda round like a Hindu deity. We left the hospital after a couple of hours – felt bad for leaving, but we had work to do!
We did three interviews – the first of which was not just with a woman, not even just her and her husband… but with a whole extended family sitting and feeding into conversation. Pretty rubbish really – how’m I supposed to ask about the mother-in-law’s influence when she’s sitting right there? Anyway, we carped on for a while about papayas being bad during pregnancy and hit the road. The second was much more interesting, although the baby in the background was a pain. The third was much better and she had lots more to say –including that pregnant women should eat before men – revolutionary.
The assistant, looking tough.
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