Sri Ramachandra, Thursday

I am electing to take some time to re-discuss a place I visited in Vellore. RUSHA, not to be confused with Russia, was a health care center supported and run by CMC, which catered primarily to the poor and villagers in rural India. They have an elaborate system, where they have divided villages into blocks, and have offices in each block, and each block trains members of each village to meet their specifications as a health care diplomat of sorts. This "diplomat" goes throughout the village and checks on people and helps to educate them in health care. This "representative" is usually a married woman with children, as they deemed that important for one reason or another. RUSHA is an acronym, which I cannot write here as I have forgotten it precisely, and the book I have it written in was checked in at the front desk, as this library (at Sri Ramachandra) is extremely strict and only allows us to bring in a pen and a few sheets of plain lined paper to take notes. So, RUSHA was about an hour and a half drive out of Vellore into the rural areas of India, and we saw their health facilities. They also have a school for young men, designed to train them in skills to do some kind of work, like fix cell phones or other things like that, which gives them an opportunity to find employment and thus an honorable income. They focus on education, and have programs meant to go directly to the community. It is the ideal model for this kind of care, and is cited globally as a success story for bringing care to rural populations.

We have mostly been around Sri Ramachandra, apart from going to dinner with the master students. Today I was supposed to go to OBGYN, and I did, but at the last minute we were invited to the beginning of a national conference on child abuse being held on campus, so I was only there for an hour and a half, and thus was not able to see a birth. :( Perhaps tomorrow afternoon it can be arranged to go back and try again. Tomorrow I am assigned to surgery, but it is again cut short as there are lectures and conferences cutting into clinical time. Perhaps we are more guests of honor here, or perhaps it is the Chennai or Sri Ramachandra way, but we seem to be involved in far more ceremonies and "pomp and circumstance" than we were at Vellore, which in some ways is nice, but is crippling my efforts to see health care. The OBGYN ward was in the free area, so there were considerably fewer luxuries than I have seen in the pay ward, though it is still much nicer than the general appearance of CMC. At CMC, everything was free with the exception of a small pay area that was nicer, and at Sri Ramachandra, everything is pay with the exception of this small free area, set up specifically as a unit for students to practice. So, these patients get free care as long as they are willing to give up all privacy and have anyone watching, and have students working on them who may not be the most experienced people. As one doctor said however, the worst part of Sri Ramachandra, or CMC for that matter (since they are both private hospitals) is far superior to the care and appearance of government hospitals, which also offer free care, but which is full of corruption, infection, hospital induced disease, bribery, and unskilled care anyway. Apparently, you have to bribe care takers for food, care, or basic items of comfort. I am still not sure where these private and government hospitals get all of their funding, but I think at CMC at least, the motto is to take from the rich to give to the poor, like Robin Hood, so those who can pay must (I think at reasonable rates) and if you can prove you can't pay, you are given free care easily. If you say you can't pay and can, they have ways to find out, so apparently people have a hard time cheating the system. They take such good care of their resources and are very careful with what they have, that I do believe that the fees of those who can pay are substantial to cover the fees of the poor without burdening anyone. This is a private hospital, so their practices do not necessarily indicate success if it became a nation wide phenomenon.

For the next couple of days, the students of Sri Ramachandra are putting on cultural dances and events, so last night was American dance. I went to about 10 minutes of it, at the end, in a large auditorium set up like an American style concert hall for hip hop etc. Apparently, famous movie stars and movie directors were making appearances throughout the night. Tonight is Indian music, and tomorrow, the main event, is a long night of traditional and modern Indian dance. It is quite an event for just a campus location. I believe, though, that these events are the reason we are at Sri Ramachandra now, as the chancellor invited us at this time specifically to attend.

This Saturday we are spending the morning playing with kids at SEED orphanage, and Saturday night having dinner at the house of one of the nurses who has been working with us a lot. On Sunday, we are having a fancy banquet with the Chancellor, who is the son of the founder, whose picture covered with garlands is all over the hospital, and which you can find on Sri Ramachandra's web page. The founder and his wife are buried in a big memorial/tomb on campus, which is pretty and well lit at night.

Well, I must get back to writing my paper! Sri Ramachandra is very different from Christian Medical College!

The set up of Chennai is quite striking, as it is much more western in many ways, but traditional in others so moder and poverty/tradition are side by side among the trash. The KFC (the first American restaurant I have seen, besides one McDonald's I saw yesterday) is right next to a small grass hut complex with goats grazing, trash and sewage running by, and the big main traffic filled street going front (which I walk along to get to the Internet cafe), so poverty and the west are side by side, almost without reconcilliation. In more downtown, which we got to see more when we were travelling to the clinic for leprosy yesterday, large sky lines are bordered by poor communities, and a nice western car dealer is smack in the middle of rubble. It is very different from Vellore, where everything was about the same in appearance, and significantly more traditional, though surrounded by trash.