India Trip: CHAD (Community Health and Development

FROM 1/19/08:

As I have said before, CHAD is awesome. In other words, CHAD inspires awe. And this is why...

Modern medicine has produced a lot of pretty fantastic things. Unfortunately almost all of them require all the trappings and resources of a modern medical system and infrastructure. For rural or developing countries it is often only the urbanized or well to do who benefit much from all that current medical technology can provide. In order to combat this a great many programs, plans, and, as they say in India, "schemes" have been developed, and CHAD is one of them. Through a whole host of lesser programs and schemes CHAD has succeeded in providing medical care and social and economic development in many of the surrounding villages of Vellore that would otherwise miss out on the resources CMC has to offer. But all my pretty praises of CHAD are trifle if I do not tell you what it does so let's get to that. CHAD offers:

Daily doctor visits to surrounding villages. A well equipped and well staffed medical bus goes to four villages daily providing prenatal care, managing chronic disease, monitoring child development, providing medications and injections, and generally curing what ails ya.

Additionally, a daily nurse visits take place to other surrounding villages. Though smaller and without much of the equipment and medicines of the doctor mobile, the nurses spread out through the villages checking on patients in their homes and maintaining continuity of care.

A micro loan program, successful and popularized throughout the world, has been developed to help poor entrepreneurs start small business.

An array of STD ISD phone booths have been set up giving handicap people access to jobs

A whole series if lesser, lesser programs and schemes provide job training

Truly it should be called CDAH, as there seems to be more development than health, but I do not imagine "kuh-dah" has the same appeal. If you want a more extensive and descriptive list of what they offer, though, check it out here.

I spent my last week there and, though I was unable to attend the nursing rounds as scheduled due to over scheduling (which itself was likely due to the fact that Indians do not seem to like writing things down), I was able to venture out on doctors' rounds on Thursday. The fact that we have only the limited status of "observer" for our trip combined with no interpreters meant there was painfully little we ourselves could do, but simply seeing how it all worked and flowed was an enjoyable experience. In each of the four villages we pulled up, set up, and in short time usually had 30 - 40 patients coming to receive care. Most of it all done outside in some shady area of town where the people mingled and talked and waited to be seen. The physician in charge attempted to enforce the concept of lines as patients had previously complained about sitting for long periods of time only to have others be seen before them, but as elsewhere the lines generally degraded into people shoving their health records into the intern's face who was either too indifferent or intimidated to protest otherwise. Nevertheless most people seemed patient and content. Perhaps it was simply the fact that we were practicing medicine outside -- something I have always fantasized would somehow be possible in the US -- but even though I did not do much anything but observe and help set up I felt a tinge of excitement that I have only infrequently felt otherwise in my medical education to date. Though I do not necessarily have the data or statistics to back it up, I felt CHAD was making a difference in these peoples lives and in a significant manner. I have often felt that the world maybe needs a little more health and development and a little less free markets, democracy, or many of the other trappings of Westernization, and I feel even more so now.

Clinically speaking the pathology was not terribly diverse. Generally speaking most patients either had rheumatic fever (a consequence of strep infections gone bad) or seizure disorder (which was almost always treated with phenobarbital for better or worse). There was also of course some diabetes and hypertension and the like, and some COPD in old men, but by and large: rheumatic fever and seizure disorder. Why? Who the heck knows. I'll spare you all my boring likely inaccurate hypotheses. Completely changing the subject we did also have one elderly gentleman with Parkinson's. It was actually kind of weird seeing such a familiar almost Western seeming disease in a small, random village in India. All the disease aside, we concluded our day playing catch with some boys and a cricket ball.

Anyways, I am in an extremely hot Internet cafe taking a break from the outdoor clamor of Mammalapuram so I'll leave things at that. In closing, let me just say that CHAD is awesome.