On Monday we were posted back at the Babhaleshwar rural clinic to complete our three day rotation. Our new posting started on Tuesday and we were able to join the mobile clinic team for the next three days. Right now PMT (Pravara Medical Trust) is in the middle of an HIV/AIDS screening project for the migrant working population. The mobile clinic reaches these migrants workers in rural areas that would otherwise not seek out healthcare. Migrant workers in India are often from out of state some traveling even farther from places such as Nepal to find work, often to send money back to their families. These migrant workers range from construction workers, hotel workers, sugar cane farmers, factory workers and more. Currently the rate of HIV/AIDS in the migrant working population is 5-6% which is much lower then the rate before the implementation of the mobile clinics services to this population. HIV/AIDS in this area is spread primarily through sexually contact, recreational drug use has been a problem in other areas but not in this target area. Therefore the goal is to not only screen for HIV/AIDS but also educate the migrant workers on safe sex practices.
The Mobile Clinic
On Tuesday we left for our first day in the mobile clinic along with three nurses and Dr. Patil. Along the way we made a few stops picking up a lab technician and the medical intern that would be joining in the screening efforts. Our first day was spent screening construction workers in a near by village. Each individual had their blood drawn which would later be screened for HIV/AIDS. They were then able to bring forth any other health concerns to the doctor on site. We saw many minor complaints such as general pain and common colds. Check-ups and referrals are free however medicine comes at small a price, what the mobile clinic charges is very cheap compared to anywhere else the patients would go. The simple medication prescribed that was able to be given at the mobile clinic cost around 10-20 rupees (15-30 cents). For anything more serious including testing positive for HIV/AIDS the patents would be referred to PMT for medication and counseling. One aspect to the mobile clinic that I was so impressed by was the educational counseling that was provided to these migrant workers on site after the screening. One health educator would sit down with the group of workers and give a seminar on safe sexual health practices. They even had a model of a penis with condoms to visualize, as the health educator demonstrated proper use and disposal of a condom as well as different ways to promote the prevention of STDs or STIs. As simple as this may sound many of these people are uneducated and being counseled in this way can be all the difference between contracting a life threading illness such as HIV or not. It was very eye opening to watch the registration of the patients and seeing their education being listed as no education at all. The first day the highest level of education I saw was fifth grade. When I asked Dr. Patil what their children’s future looked like he explained to us that the government has expanded schooling to even the rural villages so that every child is getting an education, improving the next generation to succeed and have opportunities that would otherwise not be possible.
The nurses (they call nurses sisters)
Taking blood samples for the HIV/AIDS screening
Filling minor prescriptions
Education/Counseling on safe sexual practices (proper condom use ect.)
On Wednesday we drove the mobile clinic out to three different hotels which are found everywhere on the side of the road. These hotels are actually just roadside restaurants, with small housing in the back which the migrant workers live in. At the last hotel we visited we met a man who had already tested positive for HIV however had not been taking his medication for 7 or 8 months. When he was asked why he had stopped taking his medication he said because he had run out of medicine and did not have the time to go to the hospital and get more, because he had to work. After some counseling from the staff the man agreed to travel to PMT the following day in order to get his medication.
Second day at the mobile clinic with Dr. Patil and the nurses
Thursday we did very similar things as Tuesday and Wednesday, taking blood samples and providing simple check-ups to those who had minor issues. Thursday the migrant workers we screened were factory workers at two different paper mills. At these camps there were a lot of women as opposed to the other two “camps” we visited which were entirely male. These women, many elderly work so hard in the hot sun, for many hours. However many of them left with a giant smile, thankful for the services the clinic provided. One of the last women to be screened gave me the biggest smile and extended her hand to mine, although the thought to not shake this women’s hand did cross my mind, I reached out for her and held her hand with both of mine. As she said what I am assuming was thank you in their local language, I said you’re welcome in english. Although there was a major language barrier, it was a special moment for me.
Stamping the patient forms with the word “camp” to mark that these patients were from migrant working camps
On Friday we were able to observe one of the Center for Social Medicines current projects, the School Health, Hygiene and Environment Program also known as the SHAPE program. Here we were greeted by sweet kids and smiling faces. The shape program aims to reach the children in rural areas implementing health promotion in the schools with different health models. There were two students from the nursing college, two from the dental and one from the physiotherapy department to teach the children simple health straggles such as hand washing, oral hygiene and different exercises to improve spine development. The SHAPE program is being implemented in nine selected remote & tribal villages.
Nursing students presenting on health and hygiene
Children learning physiotherapy activities