Day 5 - Health Care In Rural India

Most of today's entry will be about what I have seen in the clinic of Dr. Neginhal. Health care is similar to that what I have seen in the US yet so different. My thoughts will probably not have a rythym or flow and for that I apologize.
No appointments are made. It is on a first come first serve basis. Appointments could be set, but that concept is not well understood here. Many of the patients are coming from a far off village where a bus is not frequent. They ALL have access to cell phones so appts could be made but never are. Because it is first come first serve, many people will wait from 2-4 hours to be seen by the doctor. Rohini Aunty is also a physician and sees mostly female patients. Subhash Uncle is a pediatrician and it is with him that I have been spending most of my time. About 1 in 5 of his patients will still be an adult. After all of that waiting, the patient is usually seen for about 5 minutes. Typically, no extra assessment is done. In the US each patients blood pressure will be taken and other vitals. Here, the patient enters the office and explains what is wrong. Some questions are asked by the doctor. The patient then sits on the table and takes off their shirt or raises it (with virtually every patient Dr. Neginhal will listen to the lung and palpate the stomach checking the liver and kidneys). If it is an infant, the parent will hold the babies arms down while the assisstant will hold the feet. All children will be weighed after the assessment.
Coming to the hospital is a family affair. It is not often that a parent will come with a child alone. They are usually accompanied by a parent, spouse, or friend.The diseases or health problems the people face here are very different from what I have seen in the US. While I have been here, patients have been seen with malaria, typhoid fever (several), dengue fever, dehydration, rickets (many cases), and the measels. Many patients have also been seen for similar cases such as repiratory infections, bronchitis, and allergy related illnesses. Most of the equipment is old. I would put most of it in a 1960s movie. It all works well. There are two floors of patients rooms. They are old and cramped. All of this is of course comparing them to the US. What I love is that what is here is more than sufficient. People receive excellent treatment here. I have not heard one complaint (granted I really can't understand a word they say).
All interaction is done in kannada with a seldom use of Hindi. Because of the language barrier I rely only on body language to understand what is going on. Surprisingly, I can usually understand a lot of the conversation. After each patient leaves, Dr. Neginhal will tell me the diagnosis along with the treatment. Based on gestures and facial expressions along with the exam that Dr. Neginhal performs I have been able correctly 'guess' diagnose several patients. I enjoy that challenge. Of course I usually have no idea what is going on until Uncle explains.
There is no medical records. When Dr. Neginhal sees a patient, he is usually starting from scratch. For that reason, he has created an efficient system to record visits. For those that are reliable, he asks them to keep each prescription and bring in all documents each time they come in. For others, he has them purchase a small and inexpensive notepad where he will write the prescription. They are more likely to keep safe the notebook than the loose papers and it works very well. I was interested in this process because for me in the US, I recently had problems with medical records. I needed to get some immunizations for my trip here to India and I didn't know which ones I had already received. Luckily, I have tried to keep track on my own. I feel that a solution to this problem is fairly easy by recording all medical records on an online database that each medical provider could access. The other option I see is to learn from Dr. Neginhal and create a portfolio for medical records that patients know needs to be taken with them when seeing the doctor. I know that there are records keep at each doctors office but it is not an easy process to transfer those records or access them in my experience.

On average, it seems that about 6 salesman are seen each day. They don't actually sell any products but they represent the various drug companies trying to influence the doctor to prescribe their product. Dr. Subhash and Rohini only allow 1 minute for their presentation. It is very uncreative and in my opinion ineffective. They are trying to brand the doctor by showing them their product name as much as possible. There is no genuine interaction with the doctor, only a flipchart is reviewed as a hurried memorized dialogue is recited. Each drug rep will visit all of the doctors in an area each month. All presentations are the same. No real persuasion takes place.
Insurance virtually does not exist. All will pay out of pocket. If they cannot afford the treatment, they have access to the no-cost services at certain hospitals. The concept of insurance is very foreign to the people here. Health care is available to all here. It is relatively extremely inexpensive. Most walk out with a bill between $1 and $20.

I was able to speak with Rohini Aunty for some time today about several things. I learned how much the lower class makes here, amazing. The assisstants at the hospital along with the house workers make 350 rupees a week. The conversion corrently is $1 = 44rp. They are virtually making $1.50/day. They are satisfied with that and live happy lives. We also talked about Indian politics. The caste system still exists and is ironically enforced by the government. There are seats reserved for various minorities in government positions, in Universities, etc. Education is free for those that cannot afford it. For this reason, private schools flourish because of the quality of education received at public schools. Still, most people are content living the way they do. For this I don't blame them. I often envy the simpleness of life that many people here enjoy. Yes, they need to work for each meal. Even so, I feel they are more content with life than many wealthy people. The government takes very good care of the poor here. About 50% of the population is BPL (Below Poverty Level). They each receive a stipend each year and also receive food each month. I don't understand the finances involved in this but it has been enacted into law. As with many welfare programs, this has caused a drop in the manual labor workforce with people realizing that you make the same amount by not working. I have my opinions and on unemployment benefits but will not go into them here.