2 Week Review: Clinical

Samuha and India have been absolutely incredible so far. We arrived to Samuha on January 6th, and I can’t believe that 13 days have gone by. It feels as though we arrived yesterday. But, looking back at the amount of life changing experiences we’ve had and the amazing friends we’ve made, it seems as though we have been here for years.

Prabhaker, Josina and Madison EIC

Josina, Prabhaker, and Madison in the Early Intervention Centre

Everyday is packed with clients and cases that a physiotherapist in Canada likely wouldn’t see over an entire career! Many of the clients we see are suffering with severe and complex disabilities. This places extreme pressure on families who then require one of the family members to stay home to care for the individual who has a disability. Often times it is the mother who stays home, which takes away from the family’s income. Other times it is a sibling who stays home, missing out on education.

Some of the clients we have seen with CBR workers to date include:

– Many, Many children with Cerebral Palsy (I would estimate that 80% of the children we see have been diagnosed with CP). For those of you who don’t know, CP is a blanket term for any insult to the brain in children up to 3 years of life.

Now the question is why!? Why are there so many children with CP in rural, southern Karnataka? Well, according to Hampanna, the high prevalence of CP is due to unqualified doctors who are administering oxytocin to speed up delivery. In addition to this is the high number of home deliveries and large distances to hospitals

– Children with CP aged 8-10 who have never seen a health care professional!

This has been a sad but educational experience. Often these children have developed severe contractures, have very poor trunk and head control, and are often left to lay on the hard floor. This is mainly due to a lack of awareness of normal child development as well as available treatment centres and options for families.

This has been very educational as we can see first hand how important early intervention truly is. During our evening meetings, the students often say that they now have a better understanding of the value of physiotherapy.

– Post Polio syndrome

Although India has been declared polio free, the effects are still visible in a few patients.

– Bowing of limbs due to malnutrition

– Osteogenesis Imperfecta

– Pressure sores on spinal cord injury clients, children with spina bifida, etc.

– A client who had a “spinal cord stroke” that is likely a Guillian Barre or another neurological disorder.

– Strokes (40 year old, 24 year old)

– Bone Tuberculosis

– Spinal Cord Injuries resulting from falls at work

In one instance a client was working for the government on the electrical lines, was electrocuted and fell 20-30 feet.

– Non union of tibia

– Muscular Dystrophy

– Parkinson’s Disease

– Living Conditions and school situations

Home visit

The clients that we have had the opportunity to see with the CBR workers are the lucky ones that are being treated by the incredible staff at Samuha. You really start to think about how many people are not receiving the treatment they need. For instance, the Spinal Cord Injury Rehabilitation Centre (SRC) at Samuha is the only one in the state of Karnataka! The SRC can now accommodate 15 clients. The total population of Karnataka is 64 million!! That’s almost twice the population of Canada!

Another barrier to treatment that families encounter is that the Indian Health Care System is quite complex. I am in no way an expert on the health care system. But, after many talks with Hampanna physicians, surgeons, and families I have a bit of an understanding of the system and some of the opinions for and against.

Briefly, the Indian health care system included public and private hospitals. There is no universal health care in India. Consultations and medical procedures are paid for by the patient. It is recommended that individuals and families have private health insurance.

Many people in rural India are not aware of the insurance and coverage available to them. For instance, farmers are eligible to pay into a health insurance policy where they pay a relatively small sum per family member to receive medical services. But, most of the farmers around Koppal and Samuha are not aware of these programs.

Similar programs exist for children with a disability. But, again families are not aware and do not know where to seek care.

Part of Samuha’s role is to increase awareness of funding schemes and helping families and clients navigate the health care system. Another very important and needed service!

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  One thought on “2 Week Review: Clinical

  1. Jacquie Lester and Barry Lester
    January 20, 2015 at 7:01 am

    Great to read your blog Phil. The impact on the individual patients you are helping is apparent, but as you indicate any improved health has a societal value as well that should be accounted for: enabling a a mother to work and earn a living to support the family, enabling a sibling to attend school to gain an education.
    Wonderful to follow you and your team,
    Barry

    • January 20, 2015 at 2:24 pm

      Thanks Barry! You are certainly correct! I will be sure to emphasize the societal value with the students as well as the CBR workers who are attending our training days!

      It is amazing to see the emphasis on family and community here in India. Above all else, family members take it upon themselves to care for each other. Even if that means a lower income or less education.

      We are very fortunate to be involved at Samuha where they have many other programs apart from rehabilitation that help families with funding, and navigating the health care and insurance systems in India.

      I’m also very happy that our main role here is sharing knowledge with the CBR workers. Hopefully I will be back in the future to collaborate more on policy, community development, and health care.

      Phil

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