Here is part of a presentation that the students and I did at a Medical School in Koppal India. I started off by doing a little comparison of statistics between Canada and India.
So, here goes
You could fit 3 of India inside of Canada!
But, with an area 1/3 the size of Canada….
You would have to multiply Canada’s population by 37 to get the population of India!!!
India has the second largest population in the world today (Canada is at #37).
Forecasted Population Growth
And by 2050 India’s population is expected to surpass China’s to become the most populated country in the world
India has a population density of 386 people per square kilometre compared to Canada’s 4 people per square kilometre!!
How about life expectancy? What do you think?
88 years in Canada, 66 years in India
So, what are the leading causes of death?
All Cause Mortality
When I asked the medical students what they thought about the All Cause Mortality. (Meaning the total number of deaths relative to the population) they looked at the list above and said “That’s good! It means more money for us”!
Well, I guess that’s one way of looking at it. But, for me, it presents a huge opportunity for health care professionals in India and Canada… These conditions are preventable!! As a healthcare professional, especially one focused on exercise and prevention, these statistics get me excited! It means there is something we can do about it!
Let’s get people moving and eating healthier!!
What else can we do? Let’s help everyone have equal access to healthcare! This should be accomplished by policy and governance. But, in the meantime let’s work on Community Based Rehabilitation Programs for under-serviced areas in Canada and India
Two years ago, Samuha’s Spinal Rehabilitation Centre (SRC) was opened a short distance away from the Early Intervention Centre campus. It is the only rehabilitation centre of it’s kind in the entire state of Karnataka. It is currently equipped to support 6 residential Spinal Cord Injured (SCI) clients for 3 month stays each. Samuha is in the process of expanding the centre to have the capacity to host 16 SCI patients at a time. The SRC is unique in its ability to host clients long term and provide effective rehabilitation throughout their stay.
Following a spinal cord injury in India, most people will spend some time in the hospital, where they may or may not receive physiotherapy treatment. Once they are discharged from the hospital, they return home, sometimes to villages hundreds of kilometers from the nearest hospital. Depending on their financial situation and mobility level, they may or may not be able to transport themselves to see a doctor for follow-up visits. Unfortunately this means that many of them end up spending much of their time lying in bed, without any mobility aids such as wheelchairs to get around in. When asked about this, the head Community Based Rehabilitation (CBR) worker at the SRC, Ayallappa, expressed concern that these patients spend most of their time sleeping and depressed in bed. What often happens when SCI clients are not well educated on their condition and do not receive the support the need, is that they end up spending too much time in certain positions and develop pressure sores. Without the proper attention, these pressure sores will worsen and likely become infected, leading to a very poor outcome.
When clients are admitted to the SRC for their 3-month stay, they are provided with a rural wheelchair (3 wheeler chair for rough terrain), a bed and 3 square meals a day. They are also able to use all the facilities on site, which include, a rehabilitation gym, accessible bathrooms, accessible laundry facilities, gardens and a learning hall. They are cared for by staff on site and are rehabilitated in the gym by CBR workers during the day. Many of them come to the SRC with pressure sores and the staff diligently clean and dress them to allow them to heal. They also often have to learn to sit independently, transfer in and out of bed into their new wheelchair and complete all the strengthening and stretching exercises they are given by Ayallappa. Over the course of their stay they become independent in their mobility and develop really strong upper bodies!
A physician from Koppal has started volunteering his time to come to the SRC every 15 days to ensure the patients are medically stable and provide them with any medications or treatment they require. He has also started teaching the CBR workers how to properly care for the pressure sores and how to monitor for signs and symptoms that might require medical attention. He is also able to provide them with professional consultation on equipment they may benefit from.
Now that you know about all the wonderful things happening at the SRC, could you imagine if they were able to address some of the missing pieces? Firstly, if they had air or water mattresses to sleep on, their incidence of pressure sores would decrease (according to the physician) by 50%. Secondly, if they were able to provide waterproof and more durable cushions for the wheelchairs this would help with longevity of the cushion and also to decrease the incident of pressure sores. Thirdly, the supplier that they get the specialized rural wheelchairs from has stopped providing those wheelchairs. Samuha is now unsure how they will be able to purchase these chairs to provide to their clients. If you know of a good supplier, please contact Phil. Lastly, since it is the only centre of it’s kind in the state, they are not able to accommodate even close to the number of people that could benefit from a stay here. Samuha has been cautious about spreading the word about SRC, because they know the demand will be so high and they won’t have the resources to provide a high quality of care to all those who could benefit. It’s unfortunate to know that some people may be stuck inside because they haven’t received the care they need post discharge from hospital. They are currently in the process of expanding, but this will only add 10 beds. So many more would benefit from this amazing centre!
During the day, we have started running group exercise classes to keep everyone engaged and they have really enjoyed being able to play their own music through our mini portable speaker. The guys also love when we get a group volleyball game going outside and you can tell the social aspect of the SRC is extremely beneficial. When asked by a prospective patient’s wife whether or not her husband should become a resident, all of the current residents raved about their experience at the SRC and how much strength, mobility and independence they have gained. We all look forward to our days spent at the SRC because the atmosphere is calm, laid back and friendly. Samuha has definitely created a great atmosphere for recovery and we’re so grateful to play a role in it.
– Krysta, Josina, Sara, & Madison (UBC Physiotherapy Candidates)
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.
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
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!
From the instant we stepped off the train onto the Koppal platform, the group of Samuha staff made us feel welcome and respected. They loaded our bags into their Jeep and us four girls got our first glimpses of Koppal from the back of motorcycles driven by the staff. The town is bigger than we were expecting, with many shops lining the streets, cows meandering around and cars, motorcycles and buses blasting their horns. We pulled into the campus, just outside of town, and relished in the calm and safe atmosphere created by the staff. After eating our breakfast with only our right hand (the left hand is the toilet hand), we settled into our room for the 5 weeks. It’s a simple and spacious room with 4 mosquito net clad single beds and our own bathroom with a squat toilet. We are sleeping just upstairs from the Early Intervention Centre (EIC), the staff offices and the kitchen and mess hall where we eat all our meals.
During the day, the calm of the campus is disrupted by the arrival of many families bringing their children, sometimes as far as 300 km, to be seen at the EIC. We quickly learnt through observation of the Community Based Rehab (CBR) worker, Prabhaker, who works in the EIC, why so many families come to him. His years of experience show in his ability to apply his depth of knowledge to each case with ease, all the while explaining everything to the child’s parents. As he works, he asks us for feedback and suggestions, even though we feel we have much more to learn from him than he does from us. Throughout the mornings, we see children with Cerebral Palsy (CP), Spina Bifida, malnutrition, and more. Prabhaker breaks only when chai is brought around and even then, he only pauses for a minute. He will work tirelessly until every child at the EIC is seen, regardless of how long it will take. The entire dedicated staff work diligently to provide the best care possible to their clients.
During our first staff meeting, we planned the schedule for our first two weeks. Through all the discussion back and forth, we were able to synthesize one main piece of information, the staff all want to learn from us. This was a daunting fact for some of us, as not all of us have completed a pediatric placement. It felt strange and remarkable that before any of the staff had seen us work, they already respected and trusted us. As much as they want to gain from our presence, they also all want to ensure we have the best experience possible. From driving us around in the Jeep, to accommodating our allergies, to showing us how to do our laundry (it involves slamming and scrubbing our clothing on a rough cement block), they never hesitate to lend a helping hand. A perfect example of this is when they took us to the local festival. 400,000 people attended the festival from surrounding villages, all traveling in overstuffed cars, piled on tractors and crammed into buses. For some of these people, we were the first Caucasian people they had ever seen. We got a lot of attention. People tried their best English to talk to us, grabbed our hands, but mostly just stared. If we stopped, they stopped and surrounded us. The Samuha staff then surrounded us, like a protective barrier, to separate us from the crowds. They must have anticipated this, but that didn’t stop them from providing us with the unforgettable experience, even though it took away from their ability to enjoy the festival.
As the days progressed and we settled into our roles as the Canadian Physiotherapy Students we continued to be humbled by the unwavering hospitality of the staff. We were also exposed to many of the CBR workers in the field and, again, were impressed by their knowledge, skill and dedication. It is clear that we will learn a lot from the staff and will be exposed to many different and unique cases. We have already experienced so much and can’t wait to see what the next four weeks have in store for us.