The day that we arrived in La Vaquita, we met with Elena (the auxiliar) and she showed us the casa de salud (the clinic). We saw just a few materials (a couple of beds, some scales, and peoples' records). Elena told us about the problems that La Vaquita has with doctor attendance (months will go by without them ever coming for a consulta). They are supposed to come twice a month (once for vaccinating the children, and once for the consulta,when they meet with people who have chronic conditions or more short-term problems). When the doctors don't come, people get discouraged and stop tending to show up at all.
This is a map of La Vaquita that was in the clinic that I liked. I think that it has all the families that live in the town.
One thing I liked was that the health team at one point took a sort of census of everyone in La Vaquita. They ask every family (I wasn't clear if they went house to house or just asked those who came to the clinic) a lot of information and write it on these pretty detailed forms. They ask how many people there are in the family, how many have married, how many children, how many younger or older people have died in the past and why, how many times they eat certain types of foods, like eggs and milk, what the roof/walls/floors of the house are made of, any diseases they've had in the past year or so and what they were, if the children went to school, where the water comes from (good or bad source), the electricity source. We saw a copy of the census form (which was really detailed). I wished that we could see the results (it would help in getting a sense of the overall health of the community), but the forms are kept in the main office of the health team, not in La Vaquita.
The census form. Unfortunately you can't read anything from this picture, but it's really detailed.
Ophelia showed us how little medicine the clinic has now. The last time they received medicine from the government was in January. Now she is missing medicines for a lot of basic things, mainly for small children. From what Ophelia told us, the most common diseases include diarrheal disease, cervical cancer, diabetes, high blood pressure. Kids under 5 get sick much more than adults (which I'm guessing must be true everywhere). They have medical records in the clinic for the kids. There are also forms detailing vaccinations (from several years ago). It seems like the vaccinations go fairly well (because they make it a priority), although I think sometimes vaccinations are missed. They do vaccinations during several times of the year.The doctors are supposed to come again on August 24th, so hopefully we should see some of them. Elena mentioned that the doctors might not show, but that if we wanted to speak with them, she could send them a message asking them to come and saying that we were here.
The whole 'checking out of the system' thing is really common in rural india too, when the ANM doesn't show up to run the clinics. That's why people end up going to more traditional doctors/witch doctors - i don't know if they have those there? And then when the nurse/doctor does show up, there's no one at the clinic, so they feel underutilized and are less likely to show up the next time and the cycle perpetuates itself. So a big challenge is to fix the healthcare system AND make people utilize/believe in it again. Any ideas on that front?
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