Into the Village

Today was day one of our one-week Community Health rotation. We spent the morning on home visits at a local village. The home visits are a component of CHAD's (Community Health and Development Program) "peripheral clinic", meaning health care delivery outside of CHAD's central hospital and clinic location. The visits are delivered by a group of nurses and community workers. The basic group consists of a health aide, (residents of the community who each serve as the eyes and ears of around 2,000 patients), the public health nurse (who the aide reports to and who leads the visits), and the PCHW (public community health worker). Most of the cases are antenatal and post natal visits, care for pre-school age children, and health maintenance for chronic diseases. The homes are usually built by the families themselves, usually from concrete and dried palm leaves. Whether we stepped into a small, dark hut or a spacious building with rich wooden doors, we were always welcomed with warm hospitality and often left with candies and flowers in our hair.

Although the language barrier limited our understanding of the patient's medical conditions (we would often listen onward to the conversaion in Tamil over the mooing of the cows), I could understand that in each visit, extensive health education took place. For instance, during the antenatal visits, the public health nurse would display illustrations of eating greens (as multivitamins and folic acid are not given to all pregnant women), activity, and eating sufficiently (according to a public health student, many pregnant women in India do not eat enough in fear of having an oversized baby).

Witnessing how Indian families lived was an insightful experience. I realized that each household would hold multiple generations. I was told that after marriage, which in India (esp in the South) is almost always pre-arranged, the couple would often live with the husband's parents. Thus, I saw great-grandmothers who are in their 80's holding the newborns of their grandchildren. In addition, the villages are segregated by castes and therefore standards of living vary drastically from one to the other. The caste system, which predominantly makes socioeconomic divisions, has existed for thousands of years from the time that people were divided into 4 major roles: Priests (top caste), Soldiers/warriors (2nd caste), Merchants (3rd caste), and labourers (bottom caste). There is also a casteless group called the Untouchables, which includes a nomadic group of people who are social outcasts thought to have originated from a group of criminals. It is a wonder how these disparities have held strong for so many centuries As I continue to spend time here, I begin to see more and more how its influence resonates through India's economy, education, and healthcare.