One of my main ambitions this time was to gain a better understanding of the areas I have been less aware of at RUHSA. I am very well acquainted with their social welfare programs which VRCT are involved in, but there is so much more going one here including other international collaborations. It is mind-boggling what a microcosm of a benign welfare state RUHSA is to the people and community of KV Kuppam block. They are a vocational college, Healthcare System, Social Services, Citizens Advice, University, Research Centre, Agricultural College, Community Support and much, much more all rolled into one. Just to illustrate the diversity of approach, the class I took today contained a wide variety of students: there were nurses, doctors, social workers, medical sociologists and health administrators all learning together. This fundamentally integrated approach to welfare delivery means that each person who comes into contact with RUHSA has a much broader perspective of what constitutes wellbeing. It would be amazing if universities in the UK had such a mixed syllabus approach for students instead of isolating everyone into their ivory tower subjects.
I was especially interested in learning of the other international collaborations for research projects. With the Bill & Melinda Gates foundation, RUHSA is a centre researching the aetiology of neonatal sepsis. They have recruited 1100 or so women, of which 750 have delivered and so far one baby instead of the expected 10% has developed sepsis.
In a long standing collaboration with University of Sydney, there has been a 7 year project looking at cervical screening of the local population. In rural India they are way away from the acceptance of having a 5 yearly smear and education about the need for women to be screened is slow work. You can just imagine the multitude of barriers in a country where no-one even kisses on screen in films, so to expect them to come freely and have an intrusive internal examination when they have no symptoms is a big ask, but even though the pilot project finished after 2y RUHSA has maintained the impetus, making it one of their core pieces of work to try & improve the health of the women in this block. The education about the causes of cervical screening is also fraught with problems because most of these village women have only slept with their husbands, but infidelity is a common occurrence and the women have little or no influence on the number & frequency of their husbands other partners. Husbands are welcome to attend the screening with their wives, but little or nothing is said to them about their role in the whole process. Cultural taboos make this difficult.
Aberdeen and RUHSA have started a new collaborative around nutrition in children for which they have opened a new nutrition centre, where they give cooking lessons to families in which there has been a child identified as being underweight. I did not have a chance to see the cooking lessons, but it would be lovely to see next time.
I also spent some time in the clinics. My god they are busy and apparently this is a lean time due to Pongal. It is like a noisy, bustling, exceptionally colourful conveyor belt. Forget about 10 minute appointments, no chance. People are even scattered all around the grounds as there are insufficient benches for everyone to sit on whilst waiting for the few moments with a harried Doctor squished into a short walled, open plan cubicle with an equally harried colleague an elbow poke away in the same space. There was not enough space for me to sit and observe, I had to lean over the partition from the entrance, whilst being bumped and squeezed past by the constant flow of patients, relatives, staff and children moving through the clinic like grains of rice sloshing around on a plate with too much rasam. The luxury of a spacious room to myself with a comfy lean-back chair - absolutely no possibility of leaning at all unless it is into the next cubicle to borrow a pencil - a large desk with computerised notes (yup the remaining spaces between people awash with thin Indian sheets of paper for various & all purposes) are but a few of the things I will be heartily thankful for on my return.