1. NURSING IN INDIA Abigail Greene University of Kansas School of Nursing Summer 2015

2. CITY: VELLORE STATE: TAMIL NADU COUNTRY: INDIA

3. BACKGROUND The city of Vellore resides in Southern Indian within the state of Tamil Nadu. Vellore is considered a more rural part of India with a population of around 4 million (Vellore (District), 2011). Vellore is home to one of the largest medical institutions in India; Christian Medical College (CMC). The high recommendations of CMC that I heard strengthened my previous interest in traveling to India for my nursing elective.

4. CHRISTIAN MEDICAL COLLEGE CMC functions the same way KU does by operating as a school and as a hospital. This institution was founded in 1900 by an American missionary named Ida S. Scudder (History of C.M.C., 2010). The hospital has grown to include a variety of community programs to treat patients who could not afford medical treatment alone. My rotations at CMC included time in the emergency department, pediatric department, labor and delivery department, neonatal department, along with many of the community programs.

5. COMMUNITY PROGRAMS Rural Unit for Health and Social Affairs (RUHSA) Self-Help Groups (SHG) Low-Cost Effective Care Unit (LCECU) Community Health and Development (CHAD) College of Nursing Community Health (CONCH) Door of a home in one of the villages we visited with CONCH

6. LOW COST EFFECTIVE CARE UNIT CASE We spent time following around a really amazing nurse named Bala in some of the villages. He would visit patients at their homes to check up on them or initially discuss the health concerns that they are experiencing. One of the people we got to visit was a man who was battling cancer. When he was first diagnosed, he did not have the financial resources to get proper treatment leading to a downward spiral of depression and alcoholism. Bala heard about him through one of the CMC trained workers in the village and worked with him to get him his treatment. Now the father and husband has been sober for 8 months, has completed many rounds of chemotherapy, and is preparing for surgery at CMC.

7. COLLEGE OF NURSING COMMUNITY HEALTH This is a nurse-run program that provides clinics and home visits in villages. Essentially, a bus with the nursing students and nursing faculty drives to villages in the morning and drops off certain nurses in each village. There are 21 villages with a clinic in each that provides care for a population of 65,000 people overall. Through these programs Vellore has seen decreased infant mortality, decreased malnutrition, and significantly increased immunization (60% to 99%). Clinic site for CONCH in one of the villages

8. Left-over decorations for the Harvest Festival in one of the villages (left). One of the homes we visited with CONCH and one of the nurses (right).

9. CULTURAL CASE The head of pediatric nursing at CMC told us about a boy who had developed measles and, per his grandmother’s request, was left in a temple for 21 days to heal. During these 21 days, he wasn’t given food. By the time of his admission, he had encephalitis and Stevens-Johnson syndrome. His skin was in such poor condition that the staff used banana leaves between him and the linen to prevent further irritation. Fortunately, the boy left healed without any mental impairments. Pediatric unit at LCECU

10. HEALTH CARE IN U.S. VS. INDIA Breastfeeding with HIV: in developing countries mothers are encouraged to breastfeed regardless of any HIV present. While there is still the risk of transmission, the families in India do not always have the resources to adequately supply an alternative to breast milk. Dengue fever prevalence: In India, the issue of Dengue fever has become an epidemic with 3-4 admissions per day at CMC. This disease is caused by a virus and is transmitted by mosquitoes, thus it worsens when there is heavy rain like in monsoon season. Primary prevention in lower socioeconomic populations: CMC does a fantastic job of meeting patients where they are at. The large focus on community health is something that the U.S. is working on improving but still has a long way to go.

11. HEALTH CARE IN THE U.S. VS. INDIA Home remedies: Some of the home remedies that are used in Indian villages include fenugreek for diabetes, ginger for colds, and many more plants along the road. Neem mixed in water is set outside the home if someone in the home has chickenpox. Some women will preserve the umbilical cord so that it can be eaten by a woman for fertility. Plant used for small lacerations in the village of Puttuthacku

12. HEALTH CARE IN THE U.S. VS. INDIA Diabetes: This chronic disease is becoming increasingly problematic in India. Unlike in the U.S., obesity is not a leading cause of diabetes in India. Research has shown the Indians are more predisposed to developing coronary artery disease thus leading to a development of complications of diabetes at a younger age. Malnutrition in childhood has also been shown to be a potential cause of metabolic abnormalities leading to diabetes in adulthood. There has also been a decrease in physical activity in recent years with little decrease in white rice and starchy foods leading to a similar pattern of diabetes as seen in the U.S. Furthermore, the resources needed to effectively manage diabetes is not as accessible to much of the diabetic population in India.

13. one of the classes during the diabetes group visits at LCECU One of the nurses at CONCH eating a typical lunch in southern India.

14. HEALTH CARE IN THE U.S. VS. INDIA Inclusion of family in patient care: It seems that in each of the clinical areas of CMC I went to there was a heavy family presence with each patient. In the mental health hospital it is required that a patient be admitted with a family member so that the family member can learn about caring for their loved one. In the triage at the ER, family members were the ones usually speaking to the nurses about the primary concern and medical history of the patient. In the hospital units, the families provided the services that nursing assistants provide in the U.S., like bathing, toileting, etc.

15. ACKNOWLEDGEMENTS I am so grateful to have had the opportunity to go on this adventure. I want to thank the international academic affairs office at the University of Kansas Medical Center for helping and preparing us for the duration of this trip. I would also like to give a big thanks to the Robinson Scholarship and everyone who is apart of it. I would like to specifically thank Dr. Mani who helped prepare our group so immensely and has been so welcoming to us before and after our time in India.

16. REFERENCES Vellore (District). (2011). Retrieved from http://www.citypopulation.de/php/india- tamilnadu.php?adm2id=3304 http://www.citypopulation.de/php/india- tamilnadu.php?adm2id=3304 THE HISTORY OF C.M.C. (2010). Retrieved from http://www.cmch- vellore.edu/misc/volunteer_guide_new/page1.htm