Written by Christina Kinnevey, MD, Fellow at Kaiser Permanente Napa-Solano Community Medicine & Global Health…
Written by Bhakti Patel, MD, PGY-3 at Kaiser Permanente Oakland OB/GYN Program while on Global Health rotation at Karvan Public Health Center in Kayavarohan, Gujarat, India from November-December 2016.
My Global Health Rotation was in India, specifically at an urgent care clinic in a rural town outside of the large city of Vadodara (Baroda) in the state of Gujarat, which is a few hours north of Bombay. The site is a government-run Primary/Public Health Center (PHC) which has two employed physicians, one as the chief Medical Officer (MO) who supervises the site and faculty, and one Ayurvedic doctor, as well as an onsite pharmacist, lab technician (who does on-site AFB and malaria culturing), medical assistants, and employed health care workers who draw blood work, give vaccinations, and travel to nearby villages to promote health care and prevention. I worked with both doctors but primarily Dr. Mewada, the MO at the site. But I did have the opportunity to learn some insight into Ayurvedic medicine and patient views on disease and illness particular to the culture of Gujarat. I also had the opportunity to improve my medical Gujarati, speaking to many local patients a day. Patients from the town walked into the clinic at any time and there were up to 30-40 patients per day! However, to be able to learn from each patient, I saw about 15-20 patients a day, which still kept the day busy. I saw everything from knee/back pain to chronic coughs, URI symptoms, fevers, minor farming accidents, requests for birth control, and more. Much of the care was similar to here but we did work up and refer patients with fevers or other concerning symptoms for both malaria and dengue testing, particularly the latter as there were dengue outbreaks while I was there. Dr. Mewada was particularly enthusiastic in teaching me about the different diagnostic criteria, workup, and treatment for different vector borne illnesses, including Tb, malaria, dengue, chikungunya, cholera, and more.
One of the biggest differences I noted from care here in the U.S. was that we often had to focus or limit the amount of care we could provide given we were a free clinic and had limited resources. This did include giving free medications to patients including Tylenol, cough medication, bronchodilator therapy, and more. However, a lot of workup or follow-up care that we would do here was often not available there, for example PFT testing for patients with likely COPD or asthma. But given the busy urgent care visits, there was limited time for primary care and preventative medicine, including smoking cessation and cancer screenings. A high percentage of patients that came to the clinic included active or former smokers, as tobacco crops are a very abundant source of income in that rural area and people unfortunately start smoking at a young age. However, the clinic did have a focus on preventing infectious and vector borne diseases which is particularly important in this part of India, especially rurally where people have less assess to clean water sources and less education and access to health care. We counseled many patients and people from the town on mosquito eradication and keeping water sources clean. Every case of dengue (and other vector borne infections) were reported to Dr. Mewada as the chief Medical Officer in that area, who would then supervise male and female health care workers who did field work by going into small neighboring towns near the outbreak to reinforce these preventative measures house by house to prevent further mosquito-borne diseases. I found this public health and outreach part of the rotation very rewarding as we were able to educate people and help them make small but practical changes to improve their health.
First patient I saw, presenting with shortness of breath and wheezing, likely COPD or asthma.