February 1, 2010

Street Medicine

On Saturday I had the honor of going out with the CR ambulance to Kalighat, where the doctor and health workers managed to see over 20 street clients within only a couple of hours. I was impressed by their very high (80-90%) turnout rate of patients. Their outreach teams have identified street-dwelling areas (about 13-14 sites in Kolkata) and they walk around the streets to find which people require medical treatment, providing the patients with tokens and information about the location and time of the upcoming mobile clinic. Patients arrive at the ambulance, parked merely on the sidewalk nearby where the street dwellers reside, and are evaluated for disease and risk factors by the doctor, and children are given de-worming medications, vitamins, and often over-the-counter medications such as for fever and lice. All of the meds are kept in bottles in a large chest, out of which a pharmacist dispenses the pills, about 1-2 weeks worth. The pills are enclosed in a paper printed envelope that delineates the instructions about dosage and indications. While patients wait, the health educator gives a brief course with information about de-worming, diarrhea, ORS (oral rehydration solution), hygiene, and malaria. The population is generally mothers with children, who arrive there together. It is a highly efficient system. Patients are surprisingly compliant, even when their care requires them to visit a clinic or hospital, since CR does absolutely everything to ensure continuity of care—transportation, medications, and social services. It is such a well-run operation, and I even felt in the way as each member of the team played their precise roles. The team is led by Debu, the OSN equivalent of Mike Sallows, who carries the same dignity and pride about his work. I have the utmost respect for this man, who is basically running the street medicine program single-handedly. Nothing more or less needed to be done, and I have a hard time trying to think of improvements, especially those within my talents. I got up the nerve to do some portraits of the children as they waited, though they were funny subjects—always staring down at the drawing as I made it, which is apparent from their pictures. They were fascinated by my drawings and others wanted their own portraits done. I was disappointed not to have enough room to sit by the doctor; besides, all was in Bengali, and I could not really help or witness much medicine. Nevertheless, once I started sketching, I was able to break a barrier, evoke smiles, and communicate with these people in some small way. It was a fantastic feeling to get to speak to them in pencil, at least. I would like to do more of these portraits, but without interfering with the elaborate operations. I have to be honest, I felt more in the way than constructive, and it was a bit off-putting how cold the workers were at times. I am not sure if it is just a pride thing, or an Indian thing, or a personal thing, or a fear thing, but it has been a bit disturbing how often I have felt completely unnoticed or worse, unwanted in many clinical situations. I don't know why this is, or if it is my imagination. Either way, I wish it weren't true, I wish I had more to give, I wish I could be more a part of the absolutely incredible things going on before my eyes, which are run entirely by completely competent Indians in perhaps the most impressive organization I have ever seen.

1 comment:

  1. Dear Emma, This is great stuff. Don't feel in the way:at med school on the hospital wards and in operating theatre they'll cr*p on you Good-O. All part of the so-called learning process. And when you meet a kind-hearted Guru like Dr.Jim Withers you'll absorb all he has to teach (which is a lot, indeed!) with real appreciation.
    Yours, Jack.
    And when you've completed your psychiatry studies you'll understand that the more insecure your contacts are on the job, the more distant they are with you.