Once in a Lifetime: Part 4

A Visit to the Dindigul Headquarter Government Hospital


Another eye-opening experience for me this summer was the opportunity I had to visit the Dindigul Headquarter Government Hospital, home to the largest Integrated Counseling and Testing Center (ICTC) in the Dindigul region. The ICTC is an initiative sponsored by the Tamil Nadu State AIDS Control Society and is essentially a one stop shop for HIV/AIDS prevention and care. Staffed by counselors, doctors and nurses, lab technicians and outreach workers, the ICTC provides HIV testing, medical supervision, treatment and care for opportunistic infections and STDs, and the means to promote the behavioral change necessary to reduce vulnerability to HIV infection, including access to condoms. The ICTC is also the location where patients receive their bi-annual CD4 count tests and where they have access to anti-retroviral therapy (ART), sponsored free of cost by the government and reserved for those infected individuals with a CD4 count less than 200 or for those individuals in stage 4 of the progression of the disease.

From the very limited glimpse that I had of the inner workings of the ICTC I can come up with a few things that the organization does well and a few things where the ball has very obviously been dropped with regards to patient care. Worthy of commendation is the organization’s policy of effectively organizing patient care by stream-lining access to patient records. Every HIV infected individual is given a notebook detailing lab reports, symptoms, medications, and a relevant medical history which the patient must bring with them to every visit. In a way, this simple system efficiently by-passes shoddy hospital records, ensuring that the doctor has a complete medical history including lab reports, which often fall through the bureaucratic cracks, thereby facilitating the effective tracking of a patient’s progress.

On the other side of the spectrum, face to face patient care at the ICTC seems grossly lacking, chiefly due to the problem of overcrowding. The Dindigul ICTC services an HIV infected population of around 8,000 individuals, all with a medical staff of three doctors, only two of which are actually involved in patient care, while the third, a dermatologist, serves merely as an administrative figure-head. On the day that I visited the Dindigul ICTC, the eve of a major inspection by the National Aids Control Organization, the clinic was even more overwhelmed than usual due to the absence of one of the practicing physicians. The line of people waiting to be seen easily exceeded 30 individuals. Inside the doctor’s cabin there were no examination tables, stethoscopes or anything else one would associate with a conventional doctor’s office in the United States. Patients would simply file in one by one, hand their notebooks over for inspection by the doctor and recite their current symptoms. The doctor in turn would write out prescriptions for the stated symptoms, but there was absolutely no physical contact: no physical examination, no taking of vital signs, no listening to the patient with a stethoscope. On average, interaction with each patient lasted 2 minutes.

If one takes into account the huge volume of patients that are seen at the ICTC on a daily basis, the above patient interaction that I witnessed is not so shocking: simply put, the Dindigul ICTC is grossly understaffed. Although the problems of overcrowding and a lack of medical personnel may explain the shoddiness of patient care at the ICTC, these are feeble excuses for playing with the lives of countless patients. How many patients suffered from a serious underlying condition because the doctor did not have the time to conduct a simple physical exam and catch a problem which a patient couldn’t identify themselves as they reported their symptoms to their doctor? Add to this the travesty that HIV infected individuals can only seek medical care at centers like the ICTC. At private hospitals in the city, including the famous St. Joseph’s, where patient care is immeasurably better, wait times to be seen are less, and overcrowding and understaffing are not major issues, HIV/AIDS patients cannot receive treatment.