Sunday, September 8, 2013

Rural Family Practice

Doctors don’t realize what they are missing by not experiencing the challenge of rural Family practice! I was on rounds along with a young FM resident at Prem Jyoti yesterday. She was enthusiastic energetic and compassionate.  2 months into this rural hospital she was having a time which I am sure would be transformational for her.

One day rounds – Patients with - Obstructed labour with LSCS done, Pelvic Peritonitis – on conservative management, 8 year old kid with PSGN (Post streptococcal Glomerulo Nephritis) in severe failure and fluid over load, 50 year old alcoholic with Hepatic failure and ascites, 30 year old lady with severe dimorphic anaemia, amenorrhoea and failure, couple of neonates with sepsis, couple of other obstructed labours – forceps, vacuum, LSCS, Cerebral contusion and L1 compression fracture on conservative management, couple of patients with cerebral Malaria and a kala azar….where else but in a rural place like this one would get opportunity to care for such a variety of clinical situations….

Not only the variety – but to practice medicine in the context of “Family”.  We are used to “closed ward” rounds – clean the ward of relatives and go round and round! But here in the tribal community, where family is part of the care team, it is a different experience to do rounds along with the family members. You will Find Intensive care patients sitting along with rest of the family in the veranda and enjoying the community where healing  happens faster….The concept emerging is one of dedicated “non visiting times” for nurses to do proper care and all the rest of the time to be visiting time…!

And the pace of life – where life moves at a different pace – from understanding of their own age – how old – 30 to 50; how long illness 3 days to 3 months, waiting for treatment to start, as long as it takes, going home as soon as possible…time moves at a different pace, even when there is a crowd, the crowd waits as if time is waiting till we catch up….Mobiles work only at appointed times and anointed places….and so much time is gained….!

But recovery from illness – much faster – because of non polluted bacteria….!

And the economy of health care – a mandated understanding for health care providers. Which caste or tribe, how many cows, land owned or not, how far is home, how much they can pay, any earning member in the family….Questions which we are not taught to ask but are mandated to ask, if “healing” has to happen…and many of the answers, transformational for the care giver who comes from a different socio-economic bracket – if reflected with discernment…..

And cost of living – much less – Onions are still less than 20 Rs!

And where spiritual issues are an integral part of the everyday grind of life and health care. Unapologetic praying with the patient, sharing the pain, being part of the struggle the family is going through….And your soul does catch up much more faster….

Do you need a call to be in such a place – I do not think so. You need a call NOT to be in such a place! What do you need to continue in such a place? A community which grows together…..Will someone reading this make a plan to visit and experience this life….If I am given another life to study – I will do Family Medicine….!

 

Stations on the Road to Freedom

Dietrich Bonhoeffer(1906-1945) Discipline If you set out to seek freedom, then learn above all things to govern your soul and your sense...