Correction & CHAD

I must make two corrections to my last post - first, I suggested that the reason Toyin and Charlotte didn't have a wonderful hot shower while we were in Pondicherry was that their shower wasn't working. It turns out that they actually just didn't try it because "it looked a bit rusty". Second, I forgot to mention that the legendary Shankar also revealed (under direct questioning) that Toyin doesn't count as gora - rather, she's kala, which I believe is Tamil for black. Logical though this is, it means we've had to drop the moniker "team gora", so we've replaced it with "team egg puff", in honour of one of the more curious-sounding CMC snacks.

CHAD (Community Health And Development) is the community arm of CMC, and it's a very interesting model. Although it's technically part of the main hospital, it's on a different site and runs along very different lines - they have their own outpatient clinics (which are even busier than the ones in the main hospital), their own wards, their own labour room and so on, and they only refer patients on to CMC proper if they don't feel they can handle them. From that point of view it's like a secondary referral centre in the UK (or a district general hospital), but it also does the primary care work which is done back home by GPs. This involves looking after about 120,000 people in the various villages around Vellore.

They've done this in a very interesting way - they essentially assimilated the traditional birth attendants, who were already part of the community, and paid them retainers to be part of the community work done by CHAD. Straight off the bat that gave them a lot of local knowledge and direct access to these communities. They then send nurses out to the villages every week or so to check up on any people who are pregnant or have illnesses (TB, HIV, etc), and to keep track of what's going on, and send doctors out every month to run clinics. They then refer anyone needing a higher level of care on to CHAD back in Vellore, and the really tricky ones get referred on from there to CMC.

At a practical level, what this means is that they know just about every person in every village "personally" through the birth attendants, and they know how to find people when they need to and vice-versa. It means they have an enormous amount of trust and goodwill built up in that community. On top of that, they got a visiting guy from NASA to satellite-map the entire area for them - and have all those people mapped to where they live on the map. They then plot the incidence of diseases and so on on this map - the example they gave was that if they had a number of cases of diarrhoea in a village, they could go down to the level of detail that would tell them if there was a drain linking the houses affected, and act accordingly.

Bloody impressive, basically, and something which the NHS would probably kill to be able to replicate in any number of South-East London council estates.

My own trip out to the villages was in the back of a van; we did the rounds of the expectant mothers, bereaved, and ill in the morning, and were fed a lot of dangerously brown-looking peanuts (the main crop round here) which tasted a little as I imagine wet wood to. We also visited some of the creches they run for kids whose parents are working the whole time - the teachers had the classes singing for us, and Toyin drew a blue sheep-like thing for one of them which totally baffled the children even when she began saying "Baaaa!" hopefully. The creches are entirely free and aim to ensure literacy among the local population, social interaction, and above all nutrition - they weigh them and so on - and are yet another impressive aspect of the program. In the afternoon we went to one of the rural clinics, which were insanely busy, and took turns examining pregnant women - should have that clinical skill nailed, anyway.

This is all contributing to my general opinion that actually, given the resources they have to work with and the problems they're up against, healthcare is probably better here than in the UK. On which depressing-or-happy note (depending on how you look at it), I'm off to pack for the beach and look up the Tamil for "lobster thermidor for me, please".