"Doctors Are Like Gods"

From Friday, 6/12/09:

We just finished up our first unit here in Community Health. It was a busy two weeks of study that gave us a fairly comprehensive introduction to the public health infrastructure in the state of Tamil Nadu (and a bit about the whole of India as well). We took site visits to see examples of each component of the multi-tiered system… From the larger government tertiary care facilities all the way down to the tiny, one-room rural sub-centers. Each day we saw a new setting where healthcare was being delivered, learning about the services offered, staffing structures, the populations served, and the challenges faced. I’ve never been so simultaneously impressed and depressed by an experience. On the one hand, this system is a triumph of public health planning… Villages are tended to by individual nurses, who filter patients to sub-centers, who refer patients to larger facilities, who triage patients and send them to the large tertiary care centers if need be… The idea being that patients should only go as far up the chain of care (and as far away from their homes) as needed, and the health of each smaller community is managed locally by its own members. Meanwhile, primary care is delivered on a large scale at low costs, and the burden (both in terms of patient load and disease severity) is reduced at the large, expensive facilities. And the best part of this whole step-wise (or maybe web-like) system is that it’s means-adjusted… i.e. the people who can afford expensive care pay the full price tag, and the people who can’t afford anything are cared for free of charge, with a sort of sliding scale for everyone in between. I’ve oversimplified a bit here for the sake of brevity, but that’s the gist of the public health scheme here in the state of Tamil Nadu. And, in my humble opinion, it’s a pretty solid design. (I left out the part where the government also supports the integration of what we call “alternative therapies” in the US into mainstream care in India. Awesome.)


On the other hand, there are things about the reality of this potential-laden system that are unbelievably depressing. Mainly, the sheer lack of man-power to keep the whole beautiful operation going… Time and again, we went to facilities with longstanding vacancies on the staffing list, often in key care-provider positions. This means that the actual quality of care is far short of the mark. And the facilities, though carefully built by government and Rotary Club funds, are by and large not places where most Americans would feel comfortable getting a band-aid, much less a blood draw. Also, the lines (or “queues”) are unbelievably long at every service station… people wait and wait and wait, often foregoing their day’s wages. Here’s a photo outside one of the primary health centers we visited.

Another striking image from one of the urban health centers was the labor and delivery department. This woman had just given birth earlier this morning, on a modest stretcher-looking table with a small U-shaped opening at the foot. This is her recovering with the newborn in the nursery.

I guess I will forego the full analysis of the flaws of the public health system here, since that is probably left to someone with a lot more time and knowledge than myself. My main point is that there is so much to learn from the design of this system and the principles behind it… but also so much to improve about the way it is executed.

Another part of our introduction to the healthcare system involved a visit to a combined preschool-primary school. The schools are linked to the government healthcare model because they provide nutritional supplementation for children within certain age ranges, and serve as the main site of health screenings. This was by far my favorite afternoon of the whole two weeks… the kids were so excited to have visitors. And visitors with flashy digital cameras, oh my! Here’s a few of my favorite pictures…



One of my native classmates was explaining to me the culture surrounding the medical profession in Indian. I had picked up on the widespread reverence toward anyone with a stethoscope around their neck (the distinguishing feature of Indian physicians). However, I hadn’t realized just how deep this attitude ran. When she saw me more or less melting over one patient’s child outside a hospital, my classmate asked if I wanted to hold her. I thought this was odd, since the kid was comfortably secured in her mother’s arms and she was not exactly offering. But my classmate shook her head, gestured toward the child, and the mother immediately thrust the baby into my arms, smiling. I was shocked (so was the baby). She went on to explain that people here want doctors (or, I guess, lowly med students masquerading as doctors) to touch their kids because doctors are seen as all-powerful and almost divine. They actually have a saying here in Tamil that translates to something along the lines of “Doctors are like gods.” Whoa.

This would turn out to be the first of a few times that parents have gleefully offered their child into my arms. I certainly don’t object, but it’s a strange thing...


Just in case you were concerned that it’s all work and no play over here, I wanted to tell you about this darling little place where the international students congregate each Wednesday night. It’s actually called the Darling Residency (sorry, couldn’t resist…). In India, I’m learning, hotels have restaurants within them, and the words ‘hotel’ and ‘restaurant’ are used somewhat interchangeably. This one has a lovely terrace restaurant on the top floor, and really delicious food. After dinner last week, we went down to the basement level where there’s a bar. I should note that bars here (and liquor stores, or booze in general) are few and far between… and frequented only by men. If being white didn’t make us stand out already, being the only chicks at the bar definitely seals the deal. [Side note: Indians make a lot of delicious consumable goods, but I don’t think their beer merits any accolades…]

The only ladies in the place...