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.
Friday, September 10, 2010
Monday, August 30, 2010
Once in a Lifetime: Part 3
The Monthly Meeting
My very first weekend with PAASAM was an especially significant one considering that it coincided with the organization’s monthly meeting, essentially a three day retreat for HIV infected individuals and their families set at the idyllic Paasa Bhoomi residential care home. Located on the outskirts of Dindigul town, Paasa Bhoomi, affectionately nicknamed the “Farmhouse,” is a charming location featuring gooseberry orchards, a rustic cattle shed, and a veritable mini zoo complete with ducks, turkeys, dogs and rabbits. The actual two-story building is meant to eventually house a 20 bed residential care center for HIV infected individuals, but until this care center is up and running, Paasa Bhoomi functions as a monthly retreat center and summer children’s camp for PAASAM clients.
Day 1 of the retreat actually begins at the PAASAM office in downtown Dindigul. Guests from various villages surrounding Dindigul congregate at the office, located conveniently just behind the Dindigul Government Hospital where all HIV infected individuals in the Dindigul region must come for testing and treatment. They spend the greater part of the day availing of the health services provided at the office (all free of cost), including filling prescriptions they received from the hospital, collecting nutrition powder, a powerful concoction of various pulses and grains meant to supplement an inadequate diet, and receiving glucose IV lines and vitamin injections to boost stamina. Although the office is open six days a week and provides these services every day with the dedicated effort of the PAASAM staff and two amazing staff nurses, the day before the weekend retreat was the first time I have ever seen the office so crowded.
That Friday afternoon at the office was the first time when I realized the full extent of the horror of living with HIV/AIDS. Sure, I had spent the last 3 days with 7 women who were all HIV positive, but the PAASAM staff are the exception to the rule in comparison with the clients who utilize PAASAM’s services. Relatively healthy, I would never have been able to guess that any of the PAASAM staff was HIV positive, had I not been told, and apart from the occasional migraine, nausea, or general weakness, they all seemed generally able to lead an active lifestyle. This was definitely not the case for the clients who came to the office. Mere skin and bones, many of them were so weak from diarrhea that their eyes seemed to bug out from the very sockets of their gaunt faces. A few of them were fighting tuberculosis, a very common opportunistic infection for people living with HIV/AIDS, especially in India, the country with the world’s highest TB prevalence. Others were battling bacterial infections that caused unsightly and painful sores on their hands and feet, which made walking and eating extremely difficult.
Once all of the clients finished their errands at the PAASAM office, vehicles were waiting in the wings to transport them to Paasa Bhoomi and the main festivities of the weekend. Essentially, each PAASAM monthly meeting is an opportunity for psychological healing. The whole point of the weekend is to provide the people living with HIV/AIDS with a chance to escape the harsh daily realities of living with the infection, including but not limited to societal rejection, poverty, and the devastating physical effects of the disease. The monthly meeting is also an attempt to provide HIV infected individuals with a platform to find support from others who are undergoing the same challenges they themselves face.
Saturday morning, day 2 of the monthly meeting, started out with loud music, raucous laughter, and lots of popped balloons as 100+ HIV positive individuals inaugurated the events of the June monthly meeting with a balloon popping contest. An ice-breaker conceived by the meeting’s resource persons, a husband and wife tag team who are Siddha medicine practitioners, a branch of ayurvedic medicine that focuses on curing illnesses with natural herbs and other plant materials, the balloon popping contest soon transitioned into a fascinating thought exercise: does your life resemble that of a broken or a whole balloon?
In the small group discussion that I sat in on, the responses that I heard to this question ended up being a pleasant surprise. Although many of the group members recounted depressing stories of unexpectedly losing spouses to the HIV infection they didn’t even know they were carrying, encountering economic hardship due to the loss of the primary bread-winners of their families, and of the need to hide their HIV positive status from their employers, neighbors, and even their own family members, the overwhelming response that everyone came up with that day was that they felt like a whole balloon, thanks to the confidence which PAASAM had instilled in them to live their lives to their fullest extent. Everyone that I saw at that meeting seemed to possess this intense conviction not to indulge in self-pity. Many people expressed the sentiment that although it was unfortunate that they had contracted the virus, their only concern now was to live for their HIV negative children and to see them become successful, happy and included members of society. Similarly, even though many of the clients had experienced unspeakable hardships themselves, they all seemed to feel that the suffering of their neighbor was all the more heart-breaking. In this vein, they all possessed the selflessness to console their neighbor, while putting their own hardships into the background. Perhaps most shockingly considering the intense suffering they experience on a daily basis, each and everyone of the people I met that day expressed the desire to approach their lives with a sense of joy, gratitude, and the resolve to make the most out of the time they had left, a conviction most evident in the vocal, collective booing that accompanied one woman who got up to share her desire to end her life after learning of her HIV infection.
My very first weekend with PAASAM was an especially significant one considering that it coincided with the organization’s monthly meeting, essentially a three day retreat for HIV infected individuals and their families set at the idyllic Paasa Bhoomi residential care home. Located on the outskirts of Dindigul town, Paasa Bhoomi, affectionately nicknamed the “Farmhouse,” is a charming location featuring gooseberry orchards, a rustic cattle shed, and a veritable mini zoo complete with ducks, turkeys, dogs and rabbits. The actual two-story building is meant to eventually house a 20 bed residential care center for HIV infected individuals, but until this care center is up and running, Paasa Bhoomi functions as a monthly retreat center and summer children’s camp for PAASAM clients.
Day 1 of the retreat actually begins at the PAASAM office in downtown Dindigul. Guests from various villages surrounding Dindigul congregate at the office, located conveniently just behind the Dindigul Government Hospital where all HIV infected individuals in the Dindigul region must come for testing and treatment. They spend the greater part of the day availing of the health services provided at the office (all free of cost), including filling prescriptions they received from the hospital, collecting nutrition powder, a powerful concoction of various pulses and grains meant to supplement an inadequate diet, and receiving glucose IV lines and vitamin injections to boost stamina. Although the office is open six days a week and provides these services every day with the dedicated effort of the PAASAM staff and two amazing staff nurses, the day before the weekend retreat was the first time I have ever seen the office so crowded.
That Friday afternoon at the office was the first time when I realized the full extent of the horror of living with HIV/AIDS. Sure, I had spent the last 3 days with 7 women who were all HIV positive, but the PAASAM staff are the exception to the rule in comparison with the clients who utilize PAASAM’s services. Relatively healthy, I would never have been able to guess that any of the PAASAM staff was HIV positive, had I not been told, and apart from the occasional migraine, nausea, or general weakness, they all seemed generally able to lead an active lifestyle. This was definitely not the case for the clients who came to the office. Mere skin and bones, many of them were so weak from diarrhea that their eyes seemed to bug out from the very sockets of their gaunt faces. A few of them were fighting tuberculosis, a very common opportunistic infection for people living with HIV/AIDS, especially in India, the country with the world’s highest TB prevalence. Others were battling bacterial infections that caused unsightly and painful sores on their hands and feet, which made walking and eating extremely difficult.
Once all of the clients finished their errands at the PAASAM office, vehicles were waiting in the wings to transport them to Paasa Bhoomi and the main festivities of the weekend. Essentially, each PAASAM monthly meeting is an opportunity for psychological healing. The whole point of the weekend is to provide the people living with HIV/AIDS with a chance to escape the harsh daily realities of living with the infection, including but not limited to societal rejection, poverty, and the devastating physical effects of the disease. The monthly meeting is also an attempt to provide HIV infected individuals with a platform to find support from others who are undergoing the same challenges they themselves face.
Saturday morning, day 2 of the monthly meeting, started out with loud music, raucous laughter, and lots of popped balloons as 100+ HIV positive individuals inaugurated the events of the June monthly meeting with a balloon popping contest. An ice-breaker conceived by the meeting’s resource persons, a husband and wife tag team who are Siddha medicine practitioners, a branch of ayurvedic medicine that focuses on curing illnesses with natural herbs and other plant materials, the balloon popping contest soon transitioned into a fascinating thought exercise: does your life resemble that of a broken or a whole balloon?
In the small group discussion that I sat in on, the responses that I heard to this question ended up being a pleasant surprise. Although many of the group members recounted depressing stories of unexpectedly losing spouses to the HIV infection they didn’t even know they were carrying, encountering economic hardship due to the loss of the primary bread-winners of their families, and of the need to hide their HIV positive status from their employers, neighbors, and even their own family members, the overwhelming response that everyone came up with that day was that they felt like a whole balloon, thanks to the confidence which PAASAM had instilled in them to live their lives to their fullest extent. Everyone that I saw at that meeting seemed to possess this intense conviction not to indulge in self-pity. Many people expressed the sentiment that although it was unfortunate that they had contracted the virus, their only concern now was to live for their HIV negative children and to see them become successful, happy and included members of society. Similarly, even though many of the clients had experienced unspeakable hardships themselves, they all seemed to feel that the suffering of their neighbor was all the more heart-breaking. In this vein, they all possessed the selflessness to console their neighbor, while putting their own hardships into the background. Perhaps most shockingly considering the intense suffering they experience on a daily basis, each and everyone of the people I met that day expressed the desire to approach their lives with a sense of joy, gratitude, and the resolve to make the most out of the time they had left, a conviction most evident in the vocal, collective booing that accompanied one woman who got up to share her desire to end her life after learning of her HIV infection.
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