November 14th, 2019 by Kimberly Hall

This was a week a variety! I was at a new place each day. One was the community center Melakuppam, which was having their morbidity clinic. This is a rural clinic and for comparison, we had 30 patients come to the clinic so ⅓-¼ of the amount we saw in the urban morbidity clinic. The nurses provided a lot of education and there is definitely accountability between community members (aka a couple tattled on each other for not taking meds etc :)). I don’t think I’ve mentioned, there are no rooms in the clinics, just one big room-they have a curtain to pull or clear the room for antenatal visits. So, everyone hears everyone’s business if they try. There is no electricity aka no fan at this location and no bathroom. Because there was no school that day due to a holiday, there was also no running water! We walked to a home that has a huge well to wash our hands before lunch. The communities value the clinics and any limitations are met with a solution by the community!

My husband got to come along for a day this week! We had a long bus ride, so he got to see several of the clinics I have been at as we dropped the nurses off for the day. It was great for him to get to see the community. We toured a government primary health center (Melvisharam). Greeda wanted me to be able to compare the centers and see a center outside of CMC. The nurses clearly knew each other and discussed some community members and their concerns. This facility provides free care to a mainly Muslim population. I could definitely see the differences in dress from what we typically see in clinic (although we see Christian, Hindu and Muslim patients….just mainly Hindu). They have a specific room for the distribution of meds and management of TB, the antenatal clinic line was out TWO doors, a small lab and pharmacy. It was an antenatal clinic day and similar to CMC different clinics are offered on certain days. We also got to meet with the president of the rotary club who was there to discuss remodeling of the buildings with a group. He works with both government and CMC clinics and they wanted a picture with us. I think everyone was in awe of Michael’s height.

I also went to CHAD or community health and development. Chad is physician run and has both inpatient and outpatient services, including an emergency room. Everything looked and ran very similar to RHUSA. We actually went out in a van that was set up for antenatal visits and med distribution. The van was awesome!! We had a table and chairs in the back and would see the morbidity patients out in the shade. The views of the beautiful hills and countryside were phenomenal. The van had four stops and patients knew where the van would come and were waiting for us. Patients are seen and then able to get their medications for minimal cost…once we saw them all, we moved to the next community!

LCECU or lost cost effective care unit was another clinic I visited, which offers both outpatient and inpatient services as well. It is also known as family urban medicine and serves to poorest of the poor in the community surrounding CMC. This branch started in the 80s and has a specific screening process. There is a social worker on site who interviews the family of each prospective patient to ensure they meet criteria for getting care at LCECU. I also learned that when a poll was taken several years back staff identified that they were not seeing nearly as many extremely poor patients which is the mission of the hospital. So, I’m 2016 they shifted their model to add “home visits” and are still learning and developing this. I put home visits in quotes because there still is a station vs actual home visits. But the stations are located in 5 slums, which are very crowded.

I visited on an antenatal clinic day, which looked different than the community clinics. Their visits are more comprehensive with a urine dipstick, blood work if necessary, ultrasound and a room for transvaginal exams. Each service has its own cost. I was able to observe each aspect of the antenatal visits-learning more about ultrasound was my favorite! I also observed rounds and learned about the inpatients on the labor unit. They also have a procedure room which was fun to observe. There were some painful looking wounds and the patients were very tough with very little complaining. In the afternoon I did outreach care home visits.

I spent my last morning with Binitha at Kilminnel. It seemed fitting to spend my last day with her and in the village where I spent most of my time. We went for home visits to patients with mental health disorders. Then, one of the community leaders walked us to the famous nearby Hindu temple which has a miraculous story and was massive. The lake was also being built and Binitha said that people are coming from near and far to see the temple. It was incredible. The community leader was thrilled to take me and show me a part of the community he is very proud of. I was able to meet many people along the way, as he stopped to talk with people. We got back and finished the geriatric club and did some BP checks before heading back to the college of nursing. It was very bittersweet for my time at CMC to come to an end, I am very thankful for all of that I have learned and have no doubt it will impact my practice as a Family NP!