For tribal people, here in Tamil Nadu, all doctor checks at the primary health care center and hospital stays are free. But not all people can go there, some are too ill, some live in remote villages and the travel to a primary Healthcare center is far away, the roads are sometimes bad… Some tribal people simply not trust the modern doctors and prefer their own care. But things are changing…
Today, we went with a mobile clinic team to three tribal villages (a 30, 40 km away from Coimbatore) – to learn and to see how they manage the visits. Here, in this area some years ago a doctor came to work in a tribal hospital and managed to attract 24 doctors more by motivating old study friends and a large doctors community to join hím at least for three years. When I met him yesterday, I got a concrete idea how leadership, creative and innovative approaches can empower change…this man has improved a lot the services and proudly he tells about all his colleagues. They managed even to get a mobile dialysis bus, just a 2 days ago. Even Indian doctors very often prefer working in cities instead of staying in remote areas. However, the primary Healthcare center and the hospital cannot cover the whole population. The need of medical support for tribal people was enormous and it is still today: ca. 500 patients per day come to the hospital for a visit, 50 patient are recovered as in- patients. The doctors normally work
The mobile clinic
The mobile clinic has been introduced only a few years ago – due to money issues that had to be solved first, but also and mostly due to the lack of doctors. The doctors here work for 6 days per week. Some of them are willing to work their free day for the mobile clinic, a service that helps the tribals where they live, directly onsite.
When we arrive in the first village a huge number of women is waiting for us in front of a community hall. Soon the doctors and the nurse arrange a table; more or less twenty chairs are in the room. Weight, blood pressure, temperature and a tongue check are the basic steps every women, every child and man has to run through after being registered. The visit takes about 5 minutes each. Some of the patients are malnourished, some have high pressure, infected cuts and wounds, children are brought to be checked, as well. The mobile service is very well accepted and the women wait with patience to be called, one by one. In the meantime they talk to each other, children play at the ground, and young mothers show me proudly their children. The visited patients get all a paper, the prescription for the next two weeks. They go outside where a pharmacist sitting in the back of a jeep in middle of paper card boxes take care of them and give them the needed medicine. In two weeks, when the medicine finishes the village people will call and someone will bring them the ration for the remaining two weeks, unless the mobile clinic will come back.
All is very simple, but very efficient. 36 patients are checked, also some very old women and later also some men. When I ask what will happen if a person is seriously ill, the tell me: “We can organize also an ambulance and bring them directly to the hospital.” Pregnant women are checked also during their pregnancy time, therefore it is important that also a woman doctor comes with the mobile clinic. But at the moment in this village there are no pregnant women. Unfortunately, there is no real help for mentally ill people, just a few pills. So, an old lady – probably accompanied by her son – obviously is very ill, she cries. After a short visit her son takes her back home. I understand that care that goes beyond pills can be covered by the families only – a real problem for the caretakers, esp. if the family is small and they need to work all to survive. There are no homes, no rehabilitation centers, no assistants…
In the second village there are also around 20 patients waiting, this time the visit takes place in front of a house. There is no community hall, just a roof where the people can sit in the shadow. “It is important that I always have the stethoscope around my collar,” says the doctor with a smile. “Otherwise they would think I am not a good doctor…” and then he re-starts a new series of visits together with the nurse and the second doctor (btw: she is his wife). Here the atmosphere around is depressing, people have no work. Normally they work in the bricking factories aside that at the moment have been closed for one month. No work, no money. Many people, women and men, young boys just sit in their houses watching TV or staying on the small stone banks in front of their houses. Goats stay with them. But there is no real “life”.
Nearly four hours have passed with the first two visits when we reach the 3rd village, the last one for today. The women are excited when we arrive. While the medical staff is busy again with the visit preparation, one woman shows us a flyer. On 1st of December a huge village function will take place – because of a new temple that they have constructed in their village all together during the last months. Proudly, they ask me to follow them and show me the holy building. Their eyes are twinkling, an old woman starts to dance and clap the hands talking to me. The only thing I understand is that she wants me to come on 1st December and to stay with them. When we go back, the medical visit has started: a simple, but efficient visit, some prescription and the “jeep” medicine given by the pharmacist with the paperboard containers.
I think of our ambulatories, the modern ones with TV programs, the silence in the waiting rooms where people rarely talk to each other and if so, just in a hushed tone, the disturbed patients who feel they wait too long (and others came later, but are already called for the visit) , the reception desk and the registration machines, the mass of different health insurances and the problems these machines sometimes cause, the assistant that call patients one by one and takes them into an empty “private” room, the doctor entering, the standard visit, the labs in specialized rooms and extra machines, the computerized prescription activities, the good technology, well organised processes – without doubt.
But … but then a thought just crosses my head: if I were a doctor, probably I would prefer to work here – in these villages with these people and a basic equipment.