International Health Elective

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Christian Medical College (CMC) History. Started in 1900 by an American woman, Ms. Ida ScudderCreated out of her desire to help women and children in need. Wanted to provide care to the underserved in India.Wanted a place to provide education for future health care providers. . Center of CMC Ho

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International Health Elective

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1. International Health Elective Kavitha Dileepan Vellore, India 2007

2. Christian Medical College (CMC) History Started in 1900 by an American woman, Ms. Ida Scudder Created out of her desire to help women and children in need. Wanted to provide care to the underserved in India. Wanted a place to provide education for future health care providers.

3. Christian Medical College Today A large tertiary referral center for patients from all over India and parts of Asia Home of school of medicine, college of nursing, college of allied health, etc. Has now expanded to a 1700 bed hospital 2,000 outpatients per day 1,000 inpatients 43 operations 22 clinics 16 births.

4. Health Care in India <1% of population has private health insurance Nearly all patients must pay for health care costs “out of pocket” There are Government hospitals that provide “free health care” but the quality of care is very poor.

5. “We discharged two patients because they didn’t pay.” Physicians must report the patient’s income on the medical chart, and often assess the patient’s ability to pay. The family must purchase and bring prescriptions when the patient is admitted. Bills are sent to the patient every week during an inpatient stay. If the family is unable to pay, the physician will negotiate a more affordable sum.

6. Neonatology Level I, II, and III nursery Does not accept babies <27 weeks gestational age or weight < 1000 grams Routine newborn screening: TSH Few babies are in incubators or continuous EKG monitoring

7. Clinical Case- Myelomeningocoele Infant born as “precious baby” Diagnosed with myelomeningocoele on third trimester U/S At birth, exam showed that meningeal sac had ruptured. Baby was born with paraplegia and increased rectal tone. Prognosis was poor and surgery did not want to operate. Family’s decision on intervention would determine the level of bonding the team would encourage Ultimately, family decided against surgery. Mother never initiated feeds and baby was discharged on artificial feeds.

8. General Pediatrics TB is extremely common. Use WHO classification for TB symptoms, but use Indian Academy of Pediatrics recommendations for treatment. A pt. with fever and rash- suspect dengue fever or rickettsial infection Few well child visits- therefore limited anticipatory guidance Growth charts based on Indian standards (97%ile=50%ile on Harvard curve

9. Developmental Pediatrics Patients come from all over India to be evaluated by Dr. Mathew, one of the few developmental pediatrics experts in the country Inpatients admitted largely for assessment and some treatment (ie. Anticonvulsants) Primarily focus on appropriately assessing and helping patients to achieve developmental milestones.

10. Community Health and Development (CHAD) Covers an area of 69 villages or 135,000 people Health care team includes: PTCHW (Part time health care worker) Health aide Community health nurse Community medicine doctor

11. CHAD Nurse visits to each village twice a month. Doctor visits once a month. The health aide collects data on every death and birth. Each villager has his or her own registry number. Monitor epidemiological data in villages by GPS

12. Vellore In Tamil Nadu, approximately 2 hours south of Chennai Major businesses in Vellore- CMC and Vellore Institute of Technology Sightseeing: Vellore fort and Gandhi Road for shopping

13. Pondicherry Approximately 3-4 hours from Vellore A former French colony Located on the beach Can get good “European” food

14. Kochi Southwest part of India Beautiful beaches and backwaters Sightseeing: Chinese fishing boats, Fort Kochi, Ayurvedic massage, shopping in Ernakulam

15. Things to Know to Travel in India Almost 1 billion people live in India- implications on personal space Organized public sanitation is not developed everywhere. People are very welcoming to foreigners, but foreigners may get charged substantially more for things .

16. Traveling on Indian streets can seem like a “near death” experience. Animals are frequently encountered in roads, sidewalks, etc. Always remove your shoes when you enter someone’s house. Often, you do this in stores too.

17. Indian standard time= nothing starts on time Many Indians (including myself) will respond with the “head nod” Food in India is very spicy. If you eat at someone’s house, expect to eat twice as much as you wanted to.

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