Vector Issue 10 - 2009

www.ghn.amsa.org.au
The Nageri Mission
Words Jennifer Prince, MS Gen Surgery trainee, CMCH Vellore
Having been in Christian
Medical College
(CMC), a tertiary
hospital throughout
my training, I entered with a
sinking feeling into the Church of
South India (CSI) hospital Nageri,
located on the Andhra Pradesh-
Tamilnadu border in South India.
This was a part of a rural
service obligation. In contrast to
CMC's state-of-the art facilities,
the Nageri hospital was a single
storied building with a minimum
of amenities.. The hospital was
located 100km from Chennai, the
capital city of the state of Tamilnadu
and 70km from Tirupati, one
of the large pilgrimage centres of
the neighbouring state of Andhra
Pradesh. It was a cultural potpourri
of the two states yet, development
came slowly to this region.
The hospital itself was conceived
by Dr Fanny Gibbens, a missionary
doctor, and begun in the front yard of
her house. She was in a land of strangers
with just the will to serve the sick.
I find it hard to imagine the depth of
commitment that step would have asked
of her. A new building sprung up as
the workload increased and in a few
years, the hospital reached the zenith of
its development, with long queues of
outpatients stretching into the night and
inpatients awaiting their turn for admission
on the floor between the cots.
But with Dr Gibbens' death the
hospital joined the ranks of Mission
Hospitals started by committed individuals
but struggling to remain open.
The reasons were many- lack of doctors,
paramedical staff, equipment and
a committed leadership. And here
I was, fresh from Internship, full of
hopes, and plans and apprehension.
There was a small medical staff
at the hospital, including the Medical
Superintendent, a Paediatrician, an
auxiliary nurse midwife in charge of
obstetrics and a senior from medical
school. We catered to a patient profile
that varied from those who could not
afford a 5 day course of Amoxycillin for
their children, to affluent businessmen
presenting for follow up between their
regular reviews in private city hospitals.
As the days passed into months, the
other doctors left Nageri and my senior
and I were left to care for the hospital.
As a primary evaluation centre,
the spectrum of cases was wide, from
respiratory infections and viruses to the
common emergencies of traffic accidents
and poisonings. Organophosphorous pesticides
were readily available to the farming
community of Nageri and were the
poison of choice for suicidal attempts.
As we did not have access to monitoring
equipment like an ECG monitor or
a pulse oximeter, or to a ventilator, the
patients were given a gastric lavage and
atropine. If there was any suggestion
of respiratory compromise, the patient
would be intubated and taken
“
by relatives
to the nearest city. What
can I say? It was far from
the ideal in my head;
some made it and some
did not. But occasionally,
we were rewarded
in the form of a patient
who returned for follow up after being
on a ventilator for almost a fortnight.
We did have a functional Operating
Theatre. However, in the absence of
an Anaesthetist, most of the surgeries
we performed were those that could be
done under spinal or local anaesthesia.
On some days, the city hospitals
would oblige us with the services of an
Anaesthetist for more complex cases.
As I mentioned earlier, we had a
section of patients who were from an
affluent background. They often presented
with chronic illnesses such as
Diabetes Mellitus, Hypertension and
Obesity. In fact, infected trophic ulcers
constituted one of the most common
as well as dreaded complications of
poorly controlled Diabetes Mellitus
resulting in amputations and numerous
visits for wound care. The patients were
provided advice on lifestyle modification
and were offered the services of
the visiting Physician and an Ophthalmologist
whenever possible.
My favourite part was the weekly
outreach clinic in a selected village
around the hospital, aided by a Non-
Government Organisation. There was
a social worker who supervised four
female workers, each of whom collected
the Health Statistics from areas
around the hospital. Regular Medical and
Ophthalmology camps were a unique
feature of this programme, as well as
health education and preventive medicine.
We worked towards understanding
their beliefs and perceptions on health as
well as addressing some superstitions.
Notable examples of these included
the avoidance of food or water during
diarrhoea or that a febrile illness with
rash was due to divine visitation. These
clinics provided the ideal perspective
of a patient's illness, allowing us to see
firsthand his or her usual environment,
lifestyle and beliefs. I will treasure the
friendships that I have with many of the
families through these interactions.
What did I learn from my experience?
That what mattered most was
that you did the best you could with
the situation rather than looking at the
What can I say? It was far
from the ideal in my head;
some made it and some did not.
”
flaws. I learnt not to take resources for
granted: indeed the hardest problems
were the lack of resources and expertise.
Gloves and sutures were hard to come
by and are to be used carefully. In the
absence of a senior doctor, I learnt to do
what I could in a given situation, often
performing surgical procedures with an
open book for my guide. It did add to
my self confidence and I learnt to rely
on myself in the absence of supervision.
It was also a lesson in administration.
I hope to go back to Nageri after
my General Surgery training. We have
a new administrative team, operations
are being scheduled on a regular basis
and things are indeed looking up. The
Nageri hospital was started with the
vision of service to the ailing. What
this requires is consistent work, vision
and money. Sometimes I question
if one person will be able to make a
difference. But the reality is that there
is often only one person and he/she is
the one who makes the difference.
10 vector november 2009