February 2018 | Issue 34


Project Kerala expands to include hospital exposure

Byline Matthew Chia (Kerala).jpgByline Tan Xin En (Kerala).jpgMatthew Chia and Tan Xin En, Class of 2022

On 17 December 2017, we set out as part of a group of seven LKCMedicine students to Kochi, India, for our seven-day Overseas Community Involvement Project (OCIP) trip under Project Kerala. We were attached to the Amrita Institute of Medical Sciences' Nursing College, a tertiary healthcare centre in Kochi. Over the seven days spent with nursing students, we had many opportunities to observe similarities and differences between healthcare in Kerala and Singapore. And for the first time, our programme included a couple of days spent in a hospital at the end of the trip.

But the trip kicked off with a visit to Urban and Rural Health Centres. These are relatively similar to polyclinics in Singapore, providing primary care to approximately 5,000 residents in the region, albeit with less reliance on technology. The visit provided us with insights into how primary healthcare is delivered in India as well as how some of the public health campaigns, for instance, TB Free Kochi and Smoke Free Kochi, are executed. The campaigns aim to reduce the incidence of tuberculosis and smoking in this vibrant port city with a metropolitan population of more than two million people.

We subsequently accompanied the Year 4 nursing students on their community health field visits, which brought us out into the suburban areas of Kochi. The main source of income for the residents there is agriculture and fishing in a nearby river.

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A nursing student from Kerala conducts a glucose test on the patient

Each nursing student covered 10 houses, noting the residents' medical history and current health status. For this particular visit, the students also checked the residents' blood sugar levels. To save costs, the students had to approximate blood sugar levels from a urine sample of the patient by heating it with Benedict's solution in a test tube over a lit candle, which they had brought in their kit bags. This was time consuming, but the students were experienced and completed the task confidently. Careful to always wash their hands, they did their best to keep the equipment sterile despite the lack of proper facilities.

These field visits were particularly memorable as they showed us a completely different side of healthcare. In resource-rich Singapore, we had never before thought of using Benedict's solution to approximate blood sugar levels when a simple dipstick could do the job and more. This is just one example of how limited access to resources makes the delivery of healthcare that much harder. Furthermore, special considerations and additional equipment had to be used to ensure hygiene, such as access to clean water which we take for granted in Singapore.

Later that afternoon, the nursing students conducted a geriatric health screening for residents. Compared with the house visits, this was more comprehensive, including height and weight, eye checks, and blood glucose measurements (this time using a glucometer). Our team contributed by presenting a mime on the topic of Compliance to Medication. We included voiceovers in Malayalam, the local language spoken in Kerala, before each scene to help the residents better understand the main message of our mime.

During our visit, we also learnt about national health policies and India's healthcare delivery system, alternative medicine, and discussed the different paediatric and geriatric problems faced by Singapore and India. We also learnt from the doctors we met about the various aspects of healthcare that India is strong in, such as robotic surgery, and areas for improvement, such as treatment of burns.

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Patients wait patiently during the comprehensive health screening ​run by the nursing students 

Our week-long stay ended on a high​, with a hospital visit. This was the first time the Project Kerala team got to shadow the doctors there. This gave us a better understanding of the Indian healthcare system at a tertiary level and the different health issues. We spent a day each with the Dermatology and Haematology departments. Despite being preclinical students, we gained many insights following the team of doctors around on their ward rounds and sitting in during their outpatient clinics. The experience was definitely an eye-opener as we were able to observe patients with many different conditions, as well as how they are managed in the hospital. The doctors would also briefly explain the cases to us, ensuring that we understood what was happening, adding to our learning.

All in all, this trip was an amazing experience and we came away with new insights, knowledge and perspectives. The health issues and challenges faced by the general population and healthcare professionals in India are completely different from those in Singapore. It was extremely enriching to be able to experience these differences first hand, and it has enhanced our appreciation of community medicine. We hope to be able to continue with Project Kerala to allow more students to experience the starkly different healthcare situation in India.