A shiny new bicycle

Rita looked very well when I saw her this morning. She was very pleased to see me, we hugged and kissed enthusiastically. It is so nice not to have to work out what my reception is going to be like and to negotiate my response accordingly. It’s very simple now. She is delighted to see me just as if she were a genuine friend, which she is. We had a half hour catch before the engineers arrived to discuss the details of the new outpatient block which has finally been approved by CMC who are also funding it. At one point, RUHSA applied to us to support this, but we felt that this was not the best use of our funds, because it should be core business for the organisation and would cost an enormous amount, meaning the small, small grass roots stuff would not get done. RUHSA has, due to personal politics, been quite isolated and forgotten for about 25 years and so the campus has been neglected, despite receiving about £25,000 annually from us for maintenance in the past. There has been no evidence really of this money being spent well in the previous, previous administration. One of the reasons I went out in the first place, was because VRCT (the English charitable trust I am now a trustee of) had stopped sending any money because no-one could or would say how it was being used and the new director, Dr John, my old contact from many, many years ago as a 19y old on my year off, had made a request with his proposal for a project to work with the vulnerable and they wanted me to see whether it was a sensible thing to fund. In the last 4y since I have been involved now, VRCT has been much more rigorous about what they send money for and overall campus maintenance is no longer considered to be our responsibility. It was important for RUHSA to start shouting about the work it does and get the recognition it deserves and the exciting thing is that this seems to be happening. Credit to Dr J, I think it started with him, but Rita has cranked things up by several gears. So Rita has not only obtained both approval and money from CMC, but the work is starting and scheduled to finish in 2012. The little hospital at RUHSA is going to be a proper DGH and be able to do much more without having to send people up to CMC by bus.

When I went in first to see her, there was another doctor in with her. She introduced him. He is a newly appointed Family Medicine doctor. This is the first time there has been such an appointment at RUHSA. His wife is also an FMD and they are bringing their whole family to live on the campus as soon as his wife’s current post finishes. Half was through the conversation, after he had gone, there was a knock on the door and another man was standing out side. She introduced me again. He was the newly appointed chaplain who, with his family, is coming to live at RUHSA. Two new young families with children is a turn around compared to the previous long standing depletion of RUHSA through retirement. Even since I have been here, at least 3 people have retired and not being replaced, but there are new physicians here and at least 2 permanent families, not to mention the now guaranteed flow of interns, nurses and students from TUFTS in Boston. RUHSA seems to be slowly but surely coming back to life again. Of course, the fact that two of the new appointments are primary care physicians, makes my little heart skip with joy.

A completely unrelated but very exciting thing to happen the very day of my arrival was an email I received from a Dr in Delhi, with whom I had been intermittently communicating when I had been doing my MSc. I can’t quite remember why I contacted him to start with, I think it was something to do with trying to find out more about primary health care in India and discuss the principles of the 2002 health policy document which was so interesting and did theoretically put primary health care at the forefront of the health service in India, but of course the reality is that is is considered very much a second best option, not a vocation so much as a cop out if you can’t make any of the specialty grades. Of course, that is complete rubbish. Primary care is an extraordinary discipline in its own right but this fact needs to be actively promoted in order to attract young medics to consider it as a career option. I can’t remember where I found his email address, on a paper or something I think, but anyway, we have been intermittent corresponding all that time and we both have the same views on the importance and value of primary care and when I arrived in India, there was an email he had sent in a timely fashion telling me that as the president of the newly set up Association of Family Practitioners in India he would like to ask me to join as an honorary member. My God. How thrilling is that? Whole new vistas are opening; new contacts, new ideas and new futures.

As far as the projects which VRCT has been involved in there has been progress. There are now three EWC (eldery welfare centres) with another one due to open soon. I think the model is working well now and seems to be easily transferrable to other regions. They all depend on willing slf help groups who run the centres, feeding and providing exercises and company for very disadvantaged elderly. This not only provides a meal for people who would otherwise not get one, but also creates some employment for village women. It is an attractive model too, for overseas donators, because 2 of the EWCs are funded by people other than VRCT so there is growth beyond our involvement. Apparently, there has been some stasis on the development of the vegetable garden, which may be because it is easier to take than contribute and being passive is quite easy. However, this was a request made by some of the women at the centre and some of the stalling is due to an inefficient RUHSA community officer. Mathew says that they have finally started digging and Rita told me before I asked that since they asked for it, they will do it. Typically, there are often obstacles in starting something but once it gets going it is easier to maintain. The monkey net is up, but the pipes, although they are there, are not connected, neither to each other nor to the mains supply, but that too is in hand. Usually, there is a fury of activity whilst I’m here, so that may all take place in the next few days.

On Monday I am gong to see a couple of the centres and I look forward to seeing how things have moved on. There are new people at Keelalathur, although of course I shall miss not seeing Sukkupattu’s smile any more. The goat fund is generating money now with the sale of first kids which is great. In Kovasampet, there was a little controversy as some of the goats went “missing presumed consumed”, but they have repaid the money as they could not give RUHSA a kid. On Tuesday, I am going to see the expanded mental health clinic which now has started seeing children with intellectual difficulties in addition to adults with mental health conditions in anticipation of the newly appointed OT who will start in 2w or so. Wednesday I may try to see the kindergarten set up by Sally, for they have also started an elderly welfare centre and on Thursday I will go to Kovasmapet, so I will be busy. I am also going t try and see the woman who started her own school for children with intellectual disability after her son developed global developmental impairment following meningitis.

Meanwhile, I have a shiny new bicycle. It is too thrilling. Last time I was here I gave some money to buy three bicycles or so for any international visitors or interns, because it is so far from anywhere it is difficult to get around only on foot. Truthfully, I had totally forgotten I had done this until I arrived and asked for a bike and there was this glorious apparition in silver and green with a basket and a bell. They told me they have kept it specially for me and my bum is the first one to be on it. It is an exgtraordinary thing in India, that despite the overage height of the population, especially in Tamil Nadu being orders of magnitude smaller than me, the bicycles are enormous, I can barely touch the floor when I am sitting on the seat, but apparently this is standard size. I am wobbling all over the shop when I first start so although the bike looks glorious, its rider does not. God knows how the locals manage to do it and not look as idiotic as me, but I went for a ride today and like most bikes here, the only way you can cycle is incredibly upright like the queen. It’s a very regal experience and I’m glad to say that my new bike lives up to the image, so hopefully that will detract from the less than regal rider.