Hellooo Squatty Potties: Go-ahhh

As per Katherine’s post, Goa was a wonderful and much-appreciated break from the hectic city life in Bangalore. There isn’t too much to add to her account, as most of our time was spent on the beach and/or eating, but one other interesting experience was the Saturday Night Market slightly north of our beach. The Lonely Planet describes it as “well-organized” and “more relaxing” than the bigger Wednesday market. I can’t compare to the Wednesday market, but the night market was plenty busy, huge, and chaotic for my tastes. There were hundreds of stalls selling the usual tourist stuff as well as some things we hadn’t seen elsewhere, such as vintage Bollywood film posters and more contemporary Indian art. There were also many food stands and a stage with live music. It was quite the experience and we were all glad to have seen it. The vendors (and many of the patrons) are a blend of Indian and aging, mostly European hippie-types. Interestingly, there is apparently a large Russian influence in Goa, and many signs were in Russian. We even heard Indian vendors speaking Russian to customers, which was weird, particularly for Sasha!

This morning Abby and I made it to community medicine in time to get the van to the urban health center. This is located in a large slum near St. John’s. There is another student from BU on the rotation with us this week, and the three of us joined a faculty member from St. John’s at the clinic. Unfortunately, the clinic is apparently not very well known in the area, as we only saw two patients in the few hours we spent there – one of whom was the son of the cleaning lady, who she brought in because he’d had a fever that morning, and one for a medication refill. I was surprised that there weren’t more patients, given the clamoring throngs always present in the St. John’s outpatient department. Appointments at the urban clinic only cost 10 rupees, so you would think people would be eager for this service. Part of the problem may be lack of awareness; while the clinic had a sign posted above the door it was obscured, at least today, by someone’s laundry drying in the window above, and I don’t think there is much advertising of the services elsewere in the slum. The slum itself didn’t seem as bad as I had expected – streets wide enough to drive a car through in most areas, and not too much more trash than elsewhere in the city. The main difference was the rickety corrugated tin structures. The faculty member we were with, Dr. Brem(?), said the government is putting in cement apartment buildings on the edge of the slum to try to attract residents out of the more temporary structures so it can knock them down and put in more valuable real estate. He told us that about 20% of Bangalore’s population lives in slums, and that that is a low figure compared to other big cities in India and much of Asia.

The lack of patients was unfortunate, but it did give us the chance to ask lots of questions about health, health care, and health disparities in India that I’ve been unable to ask before due to the busy schedule on pediatrics. Dr. Brem’s research interests are in prenatal/perinatal care and tobacco, so we talked a lot about those, but also health care in general. Some figures and statistics I found interesting:

-The birth rate in southern Karnataka and Tamil Nadu is around 2.1. It has been decreasing steadily with improving infant and child mortality rates. In northern Karnataka, the birth rate is closer to 3 and further north in India it is even higher.

-In the last five years, there has been a drastic drop in the percentage of babies born at home, due to a new government incentive that gives people a financial incentive for delivering at a hospital.

-Most children in the slums do go to school, many even to private schools. Dr. Brem thinks many children are able move out of the slums when they get educated, but more people keep moving in from rural areas so the slum populations are not dropping.

-Tobacco use in India is a big problem, but smoking cigarettes is only a small percentage of this. The rest is divided more or less evenly into beedies (hand-rolled tobacco) and chewing tobacco. Unlike in the US, smoking is much more prevalent in men (around 15:1 ratio) while chewing tobacco is about equal in men and women, especially in rural areas.

-We also learned more about St. John’s. It falls between the government hospitals and the “corporate” hospitals in terms of cost to patients. A patient pays about 300 rupees per night to stay in a common ward, plus the costs of any lab tests, imaging, treatments, etc. that are needed. To get a semi-private or private room will be 1000 rupees and up. These fees cover all of St. John’s expenses; they do not receive any government assistance. The costs charged to patients are lower than a private hospital, and St. John’s compensates for this by paying its staff lower wages. Unfortunately, that often means good doctors leave for more lucrative positions. A government hospital theoretically provides most services for free, but a patient might have to pay bribes in order to have x-rays done, etc. Also, the care is not as good and a patient might wait for days to see a physician.

-Medical schools habitually sell seats to students. St. John’s has to fight with the government every year not to let them allocate any seats. Since it is a Catholic institution and considered a minority organization, it has some special privileges and has so far gotten away with not giving any seats to the government, however most medical schools do not have full control of their admissions process as the government gets to decide a certain number of the placements.

Anyway, that is a long post – here are some pictures from Goa to reward you if you are still reading!

Happy to have my first Tuborg since Denmark!