Field Visit: Sholapuram, Vadakkur, and Andipatti

Pictures: Sugha Vazhvu Rural Micro Health Clinic at Andipatti; view from RMHC; peppers growing behind RMHC; inside the RMHC; inside the primary health clinic at Vadukkur; grass huts at Sholapuram; temple at Sholapuram

Today brought some helpful insights into some of the public health concerns facing rural India, as well as a chance to view some amazing scenery and meet interesting and friendly people. Our class group was divided into smaller subgroups which allowed us to visit multiple sites simultaneously and converse more easily with people. My group first visited Sholapuram, a very small and remote village about 40 minutes outside of Thanjavur. The village straddles a narrow, winding paved road, shaded by palm and Eucalyptus trees. To get there we passed by fields of rice paddies, small clusters of skinny trees and palms, numerous cows and water buffalo, and a few dried up dams. We passed through a couple of tiny villages as well, consisting of a few stores and tiny shops, people, free-roaming animals, and lines of bikes. Despite being so small, each village we passed was alive with activity.

There is no formal health facility in Sholapuram- the nearest primary health clinic (PHC, run by the government) is about 3km away- not too far. But we visited the village mostly to get a feel for how daily life is. We took a long stroll passed the primary and secondary school (combined into one), the one water tower that serves as the primary source for the village water, a fading temple, and an intersection which serves as the village bus stop. A truck sat nearby, selling betel leaves wrapped in palm-frond bundles- these are used to wrap areca nuts (referred to as betel nuts), and often tobacco, to be chewed for their stimulating effects.

We stopped to chat with some people running a small stand near the bus stop. We learned that most people in the area survived by performing agricultural work, primarily at rice paddies and growing groundnuts (peanuts), egglplant, lentils, and radishes. Even children begin helping with the work at the age of 10 or 11. Most people in the village grow food for themselves and sell whatever is leftover. There is one tiny grocery stall selling a few vegetables (brought in from Thanjavur) and packaged spices, a few cold drinks, snacks, tobacco and few household items. We spoke with a woman about when and why she would go to a clinic, and she said when she had a fever or other ailment. Preventative healthcare is still unfamiliar in these areas, and understandably given that there is not a clinic in the village itself, not to mention that even in more developed countries preventative care is a challenge. This is something we will consider when thinking about our recommendations for addressing cardiovascular health.

Next we went to the nearest primary health clinic (PHC), in Vadakkur. The clinic is a concrete building consisting of about 10 rooms, including a delivery room, and recovery room for after births and procedures, a procedure room, an injection room, a room for administering DOTS (directly observed treatment, short-course) for tuberculosis. As in many other developing countries, tuberculosis is a rampant problem and especially challenging to treat when medicines are either not administered or taken correctly, as it is easy to build resistance to them. DOTS helps to address this problem by having a nurse or physician present to witness patients taking their medication on a daily basis.

While at the clinic, one of our facilitators from ICTPH fainted, most likely from the heat- it was very unfortunate, although it did provide an opportunity for us to see the nurses in action. We discussed the services offered by the clinic which are diverse and free, but we also learned about the paper record-keeping system that does not account for patients having multiple visits- follow-up with patients is not common since no individual patient medical records are kept. This is one shortcoming that ICTPH is trying to address with their programs.

Our final stop was in Andipatti, a slightly larger village where the newest ICTPH rural micro-health center (RMHC) resides. The RMHC was a lovely facility overlooking a field of pepper and eggplant bushes, as well as numerous palms and mango trees. It was idyllic to say the least. Unfortunately we were unable to visit with the nurses working there, as there were patients there at the time, but it was nice to see the facility nonetheless. As we continue our field visits we will decide in our groups what village(s) we wish to focus our proposed interventions on.

I am trying to absorb as much information as possible, as there is so much to learn- about India's government, politics, public and private healthcare, cultures, history- it can be overwhelming, but so rewarding and interesting to be having this experience. I look forward to continuing this journey.