Vector Issue 10 - 2009

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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
Mental Health Crisis in China Words Ron Cheung Medical student University of Sydney // Image by Ringoc2 (sxc.hu) Mental health is a substantially underestimated problem in China. In a four province study, 63 000 people were screened in random urban and rural sites. A trained psychiatric nurse screened-out those at high risk of mental illness, or those with a pre-existing diagnosis of a severe mental illness. Those at moderate to low risk were administered a Chinese version of the Structured Clinical Interview for (DSM)-IV axis I disorders by a psychiatrist. Importantly, clinicians who spoke the local dialect and were familiar with local expressions and culture were selected, so they could adapt questions in order for patients to understand. Seventeen percent (17%) of the population had a form of mental illness (this is 173 million people!). Eleven percent (11%) of men had issues with alcohol abuse: an increasing problem that has thus far not received attention. Of those with mental illness, 25% were so severely disabled by it that they were unable to work. Among all those with mental illness, only 5% have ever seen any mental health professional. Unfortunately, China’s health care system is plagued by systematic issues. There are no mental health services in rural areas. There is a stigma towards mental illness and even though people realize they have it, they refuse to seek treatment. There is a lack of knowledge - 60% of people interviewed had never heard of the word depression, even though they had full blown symptoms. In China, GP’s do not offer mental health services, only large psychiatric wards in large hospitals do so. It is not seen as part of a GP’s duties to address mental health. Closing the gap in mental illness and services in China is challenging. The culture of medicine will need to be changed: barriers will need to be overcome, medical school curriculums redeveloped, effective reimbursement patterns in hospitals introduced, and the makeup of the health care workforce that includes a consideration of the mental health agenda. november 2009 vector11 www.ghn.amsa.org.au
Page 1 and 2: vector The Official Student Publica
Page 3 and 4: editor’s note “ Kruthika Naraya
Page 5 and 6: Heart disease and stroke threaten d
Page 7 and 8: Right: Influences on the energy equ
Page 9: Many of you may recognise the paint
Page 13 and 14: Stories from Cambodia Behind these
Page 15 and 16: global health network update Welcom
Page 17 and 18: Student Involvement Helping VSAP to
Page 19 and 20: This morning, with thanks to the Au

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