Week 1

October 1st, 2019 by Kimberly Hall

Hello! My name is Kimberly Hall and I am a Doctorate of Nursing Practice student specializing in Family Medicine at The University of Kansas. Back in 2013, I traveled to Vellore, India for an undergrad clinical rotation at Christian Medical College and fell in love with the country and its people. I jumped at the opportunity to return with a different focus. It is wonderful to be back in the land of constant honking and the “yes” “no” combo head nod that it took me forever to understand!

I am only able to do 15 clinical days, so week 1 I hit the ground running. Nurse Practitioners are not recognized as a part of the nursing profession in India, but work is in progress to open educational programs. The main push back is from physicians, I saw this in research prior to arrival and have had it confirmed in person. India practices in a more traditional hierarchical care model as opposed to the team based care we now see in the US. I had a great conversation with a medical student who came for a residency interview at CMC, he loved the idea of team based care but stated that is definitely not how things work in the current system.

I have done daily “word vomit” journals, as I call them, because I feel I am taking in a ton of information each day. The community health program here is huge. I am going to do my best to organize the highlights!

I am spending most of my time in a branch of CMC called the College of Nursing Community Health Department, or CONCH which is completely nurse run/managed. I was given a presentation all about CONCH, but I did not take notes, so here is what I remember which should be pretty close to the facts. Vellore is split like a grid into blocks and CONCH covers two of these blocks, which includes ~25 communities and over 60,000 people. They have both urban and rural communities and have a standing set of orders from which they are allowed to provide care. They mainly provide first aid, monitoring of chronic disease, screening for tropical diseases and provide appropriate referral (to CMC or government facilities) for community members. These are considered primary centers, secondary centers are essentially outpatient clinics and tertiary centers are hospitals. The primary centers hold different specialty clinics (chronic disease, eye, antenatal etc) throughout the month as well as being open for drop ins and doing home visits daily.

This week I visited two rural clinics in Kilminnel and Puttitakku and an urban clinic in Ramnayakapalayam. The nurses loved trying to get me to say that last one right! I settled on Ranaya-papaya 🙂 In each place I was given a tour of the community including the churches, temples, gathering area, preschool or Balwadi’s and primary schools. The children were adorable and so much fun to interact with. I learned about government nutritional support for children, and even got to taste biscuits made with the fortified mixture they use. This is given free to mothers, but they sometimes have trouble with the parents selling it instead of giving it to the children. The children are weighed weekly and health education is provided in group meetings for parents. Government education is free and if families have more money, they often send their children to private school as they are viewed as superior.

Home visits are a highlight for sure. The nurses say this is how they learn about the community and form strong bonds with families. They keep a book information on each community including the number of men, women, children, community leaders, resources, typical occupations etc. Everything is handwritten and I am very impressed with their systems. When we go into a home we often see at least two family members, as it is very common for multiple generations to live together. Generally we see hypertension, diabetes and antenatal or postnatal patients, but there are many other conditions as well. On Saturday we visited a home with a down’s syndrome patient because the nurse, who has a school age child, thought he would love to enter the drawing contest and brought him the papers. The family was thrilled to see her and we were able to check in on 4 other members of the family too.

Every family tried to feed and give me coffee/tea. I hear “you sit” constantly and honestly, my bum is sore from the bumpy bus rides/constant sitting! I do not want to be rude, though, so I at least sit and occasionally enjoy some food/drink. I am often sitting in the only chair and we do most visits on the floor. One visited homes was on a the start of the Tamil month (I believe) which is a special day in Hindu culture. One family gave me the honor of witnessing the ritual they do which includes getting special food and ringing a bell/praying as it is being carried to the house. Then, they pray over it and eat. She made us some sort of fried dough from scratch (also super cool to see) and we played with her 7 month and 2 year olds. I had 3 other families try to get me to join for the ceremony, lots of yummy snacks, got flowers put in my hair twice and got to see lots of children (no school). Needless to say….I think I got a lot more out of that day than our patients!

Finally, I was able to reunite with Naina, who helped us on my last visit to India and studied at KU. She and her family invited Michael (my husband) and I to a Harvest festival. We ate a traditional meal and got to watch the kids play many different games. It was a great time!