August 22nd: College of Nursing Community Health (CONCH) in Venkatapuram



Sarah, Andrea, Mrs. Shirley, Alison, and Rachael on
the roof of the CMC College of Nursing

Today we started off at the CMC College of Nursing and had a tour of the new facilities by Mrs. Shirley, one of the assistant deans. The building was consecrated last August and is very large and welcoming. There are several courtyards with open air hallways. The school has a mock ward for simulation, many classrooms and office spaces, a continuing nurse education classroom with videoconferencing, a nutrition lab, and many other educational spaces. During their nutrition classes, the students not only learn the science of nutrition, but also how to shop for and prepare various diets so they can teach patients and their families. The nurses demonstrate how to cook meals in the home (instead of just presenting information).

We then went with a group of students and staff to a village (Venkatapuram) for community health nursing. There are many CMC faculty/staff nurses that run community clinics and the students join them during their community rotation. Each week, three days are spent in the clinics and two in are spent conducting home health visits. There is also a pre-school and primary school education component.



Nurse drawing blood from patient's finger
by applying oral suction to a pipette

The yellow school bus takes the staff and students (along with some CMC hospital nurses) and drops them off at various rural clinics in the area. We went with a group and observed today. The clinic where we observed was a four room structure, about the size of a bedroom or living room in the US if not smaller. It also serves as the village library. The community nursing in India covers a broad scope. There is generalized nursing care with taking vital signs and providing education and medications, there is prenatal care, and school education (going to the schools in the community and providing education on health and hygiene). The care is also subsidized- the nurses know the communities really well and each person pays what s/he can afford. We were able to observe several visits in the clinic and two home visits.

Family members of the
village vice-president

We went to the village vice president's home and she served us coffee and tea. They were very gracious and we spoke about one of the sister-in-laws upcoming arranged marriage. The CMC RNs are mostly Christian and the village people are both Hindu and and Christian. This family was Hindu and had a separate temple room with a separate kitchen (food and flowers are offered to please the gods).

The governing body of each village is the leader in deciding what programs are offered in each village. The president/vice president help organize getting potable water, electricity and even building the village's Hindu temple. The president also helped bring in the CMC presence. India's government is also trying to improve the overall health of the nation, such as paying Rs 6,000 to the women for giving birth in the hospital. The government also helps subsidize medication – a lot of the medications given out today were given out in kind to those who could not afford it. There is also another program, Primary Health Care (PHC), that is government run, and if the CMC clinic does not have a particular medicine, then they refer the patient to PHC. For example, today a toddler was brought in with a terrible case of Otitis media – an ear infection –and the clinic did not have the drops to prescribe so the family was referred to PHC. It is great to see the autonomy of the nurses at the clinic. The patients come in with their individual medical records (like brochures of their past checkups) and the nurses update everything in a notebook and gives out any needed medications. For the rest of the morning, we observed more nursing visits.

Andrea, Alison, Rachael, and Sarah
in Hindu temple



Sarah with a bindi on her forehead

After lunch, we wandered over to the village's recently built temple (only a few feet away from the clinic). For the whole morning, the boys/young men and an old man had been looking into the open windows and smiling at us. One group member, Rachael, wanted to see the temple and suggested we go over. All of the temples are brightly colored. The youngest boy ran to get the keys and they opened each door for us and showed us the status of their gods and insisted that we pose for pictures. Even though we shared

very few words (such as hello in both English and Tamil) and the names of the gods (but with different pronunciations) it was a lot of fun and we felt very welcomed.



Alison interacting with the school children

In the afternoon, we went to a primary school where one of the CMC students gave a health lesson. During their community health clinical rotation, the nursing students have to present projects to the primary students, and it was so much fun to see both how the school education is conducted and the children. They loved the cameras- we would take pictures and then show it to them. We were able to have basic communication with the children – for example, asking them to smile with teeth showing and reciting the colors of the rainbow in English. We had so much fun – all of us love kids.

CMC nursing student teaching
primary school children

The nurses use large educational flipcards to teach about different health topics. Today's lesson was on parasites and prevention, as well as questioning the children on what they ate for lunch (follow-up from a previous lesson on nutrition). Most of the outreach relationship between CMC and the village schools seems to focus on health education/prevention and caring for the children when they are sick (different from what Alison has been learning from her US work/research where the school children are given physical examinations and there is followup at home). 



Thatched roof hut in village; not that
of client

We then went to a thatched-roof hut and visited a woman living with Parkinson's disease who is supported by her daughter. The daughter has three children and is separated from her husband and is the sole wage earner in the family. It was an interesting juxtaposition from the vice president's house. Overall, it seems like the village is being built-up. The elderly woman was able to get her medication and the standard ration of food from government programs. Additionally, she receives 1,000 rupees a month and additional rice from the government as she is an elderly widow.



Primary school students in
uniform waving goodbye

We also learned about the government's role in providing education. In Tamil Nadu, education is free, girls are encouraged to attend, and uniforms and bicycles are provided. There is also sometimes a free midday meal.
At the end of the day, we took the school bus back to the nursing school campus, tired but excited about our full day. We are so grateful to everyone who is taking the time and energy to help us learn about India, especially the CMC faculty, staff, and students and the local community members.