On May 9th, 2018 My fellows and I had an opportunity to sit through a lecture with Dr. Praveen Kulkarni, an assistant professor for the department of community medicine at JSS Medical College for Mysore University, whom gave us an introduction to India’s healthcare system. Dr. Kulkarni expressed that it is a universal rule for anyone to have the same access to healthcare; that the community and country can afford and maintain at every stage of their development in the spirit of self-reliance and self-determination. Along with this system, the access to healthcare is one of India’s biggest and most debatable issues across the country. There are numerous of inequities within certain group of people that do not have the same distribution of this healthcare, creating disparities along the bigger picture. This disparity, along the private and public sector (government owned), ultimately is where the difference in the access to healthcare is based.

       The Public Health Research Institute of India (PHRI) is an evidenced based care institution that helps promote excellence in both basic and applied health research. Their focus is to help tackle these disparities by helping women in rural communities get proper screening and have proper treatment and prevention for one of the most common fatalities in Indian women, cervical cancer. There are 144 villages outside of Mysore and PHRI makes it a priority to visiting one of these villages, once every other month. That is, they drive out to these villages to attest to these women and allowing them to have a proper screening for Human Papillomavirus Virus, also known as HPV. On Monday, May 21st, my fellows and I had an opportunity to assist with the staff of PHRI and help these women attain proper screening on one of these mobile sites.

      Our day started out bright and early along with the staff as we headed on a bus to roughly an hour away from Mysore to a village called Sagarkatte. We passed a couple of rural homes and what seemed to be like huts before reaching a building that had two different rooms we were to use. Upon arrival, my Global health fellows and I quickly got to cleaning the campsite before unloading all the equipment from the van to the site. The campsite was organized to have

 four different sectors each serving a different purpose. The women that walked in first had to begin through group counseling, an opportunity for the women to speak along other women and have some guidance from our PHRI counselors as to what expect for the remaining of the day. The women were then passed to registration where we helped take their vitals such as height, weight, and blood pressure. In addition to their vitals, they were asked a series of questions regarding their past health checkups to see if they qualify for a proper HPV screening with the camp. Women whom were currently menstruating, or previously screened in less than three years with PHRI, were examples of not qualifying for a screening at that time. The third sector of the campsite is where I spent most of my time with these women. This part was dedicated to one on one counseling from our trained counselors by asking a series of more personal questions regarding their health and sexual history. With proper consent from these women, I was able to monitor the series of questions however, there was particular woman who was reluctant to share any information to the counselor when she saw I was observing the conversation.  After the counselor explained the purpose of us students observing, the counselor proceeded with questions regarding her being tested of certain infections. When the counselor reached the section on whether or not the woman has been tested for HIV, the women would not respond. After a second time of asking if she had been tested for the disease, she mentioned she didn’t know exactly what HIV.

                        In relation to observing the woman’s answer, unawareness to HIV is not an uncommon factor. A population-based study by Ranjan, Bhatnagar, Babu, & Detels (2017) took a sample of 850 wives between ages 15-49 from the area of Muzzaffarpur district in Bihar, India. The women were given a questionnaire regarding their awareness on HIV and their sexual behaviors with their husbands. After the survey, the participants were then tested for HIV with serum samples. The results showed that along the median age of 30 within this sample of 850 women, 0.6% of the women turned out to be HIV positive and 0.41% of this sample had never heard of HIV. The research interestingly enough showed that being literate and owning a television was significantly positive in terms of awareness regarding the disease. This was brought to light within the more personal side of the questionnaire that further looked into the socioeconomic status of the women. In relation to this research, part of the questions the counselor at PHRI asked, were questions regarding the woman’s socioeconomic status.

                  Moreover, after I observed the one on one counseling of the campsite I was able to sit and have a conversation with the ladies of the group counseling. One particular woman had expressed that she might potentially be pregnant however, she was there to be able to attain a pregnancy test. Making healthcare available to all women during pregnancy is critical for perinatal outcomes between mothers and babies globally. A systemic review done by Jolivet et al (2018) created a generic model of an antenatal group care, to gather a series interviews and surveys to a team of doctors, nurses, and midwives. The purpose of this model was to see if the professionals believed people of low and middle-class income would be accepting of this care in different communities. In relation to my experience, the women seeking out to this particular campsite to attain a pregnancy test, is an example of how people from the rural community can be accepting of care from the private sector.

                    Living and learning about the healthcare system in India, I happen to see that our healthcare system is similar in different ways.  Healthcare has been one of the most debatable issues our nation has faced and continues to face. With the issue that Americans pay more for healthcare than the rest of the world, we still seem to see unequal distribution of it across the nation.        

 

 

 

 

Ranjan A, Bhatnagar T, Babu GR, Detels R. Sexual behavior, HIV prevalence and awareness among wives of migrant workers: results from cross-sectional survey in rural North India. Indian J Community Med 2017;42:24-9 

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