CaseIndiaTrips 4

Layers of Learning in Global Health

Big city meets country

Posted by amandamelissagomes on 30 September, 2010

Our drive out to “rural India” looked, to some extent, like driving from Toronto to Ottawa or through southern Illinois. There were fields, there were livestock and bright blue skies. The differences: palm trees, monkeys and road blocks secondary to goats. I think our driver (I am being very liberal with the title) got more than he bargained for with this trip. The reason for our trek? To see HMRI (Health Management and Research Institute) mobile provide primary care to villagers in a reliable fashion. Sixty kilometers outside of Hyderabad we met two large vans at the corner of some store across from some lamp post at the correct time by sheer luck. We followed the trucks in our Toyota van (also known as our home away from home) into the village. Once we arrived, the HMRI team of nurses, paramedics, and some logistics members (note: no actual physician was present) quickly and efficiently started setting up the clinic at the local town hall. While this was going on we milled about checking out the roaming chickens and roaming children and I worried about where in god’s name we would find a bathroom. My ears perked up when I heard the familiar chime of windows booting up which they had attached to a web cam to take pictures of the patients when they check in with their health cards. From here they get weighed (babies too!), have their BP checked, can get some labs checked and then on to the pharmacy where they can get free medicines (FYI: phenytoin was one of the drugs they had available). Of the labs they had available I was most intrigued (and concerned) about the haemometer used to check hemoglobin. This method involves mouth pipetting blood (thus my concern) from a capillary stick. Within 20 minutes there was a hemoglobin value with only the use of hydrochloric acid and distilled water and haemometer (no batteries or assembly required); I was impressed.

Later on we ventured out to the town school (they had a bathroom!) just down the road and created quite a stir just as any visitor would at a primary school. There were giggles, waves and let’s face it, a lot of stares…we may not be the best looking but we are quite the spectacle in Hyderabad let alone a small village. While the school was pretty nice it was hard to imagine learning without desks, with outdoor bathrooms, and an open fire in the school court yard. There were however, textbooks, notebooks and school uniforms, and I surprisingly even saw one little girl pull a cellphone out of the pocket of her pinafore.

I think I started the day with a bit of a negative prejudice about the whole set up. I mean isn’t a clinic without a physician a bit misleading? This of course prompted some serious consultation with team CIT4b; some of the smartest (and most opinionated) people I know. There definitely is not comprehensive care being provided by the mobile clinic, there aren’t vaccinations, it is not possible to start new meds or adjust existing meds. There are free labs, free drugs, reliable follow up and care right at their door step despite their remote location. These people are receiving support from their government in their home town; they don’t have to bear the burden of traveling to a city. I assume that this has to help with compliance. Maybe the PD nurses could get on board with HMRI mobile and patients wouldn’t have to travel 800 km to NIMS for their monthly visits? I wasn’t sure at the outset but seeing the setup in action and after some discussion with some smart cookies I’m convinced this government program is helping fill some large holes in India’s health care delivery.


4 Responses to “Big city meets country”

  1. Keith said

    whats a pinafore?

  2. amandamelissagomes said


    Girl wearing a white pinafore over her dress (about 1910).A pinafore (colloquially pinny in British English) is a sleeveless garment worn as an apron.

    Pinafores may be worn by girls as a decorative garment and by both girls and women as a protective apron. A related term is pinafore dress, which is British English for what in American English is known as a jumper dress, i.e. a sleeveless dress intended to be worn over a top or blouse.

  3. Puja said

    was there more ‘same same but different’ exchange on this topic? (rhetorical question I guess)

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