Nursing and dentistry students launch into Palampur projects

COUNTRY: India, Palampur
PROGRAM: UniBreak
PROJECT: Nursing and Dentistry
WRITTEN BY: Palampur UniBreak Group November 2013

Namaste! In late November, four dental students from the Gold Coast and one nursing student from Adelaide embarked on a one month journey to Palampur in North India for an experience that would no doubt change our outlook on health in developing countries! We have Joel, Amy, Kent and Cherie (me) from Griffith University Dentistry and Gemma from Flinders University Nursing.

Day 1 – Exploring New Delhi
After 14 hours on planes, the five of us met in New Delhi where we began our trip. When I arrived in New Delhi at around midday, the culture shock immediately hit me on the highway. Within the first half an hour of travelling, we were seeing families of five balancing on small motorbikes and cars speeding past which missed us by centimetres! The lanes on the road pretty much meant nothing with cars just squishing up against each other in all directions.
My first impression of the capital city – chaos.

After arriving at our house in G.K. 1 in South Delhi, we quickly went out again to experience as much of the city as we could in half a day. We passed the India Gate which was a memorial to the 90,000 Indian Army soldiers lost in World War I. We then went on to visit Akshardham – the biggest Hindu temple in the world!
Our visit to Akshardham began with an intense car search by some Indian soldiers as we entered the car park. We then went through a series of metal detectors and had people frisking our bodies and checking our bags just to get a glimpse of the temple inside. (This was certainly one of the most ‘thorough’ body checks I’ve ever had in my life!) Before entering the temple we had our first true Indian meal with some traditional daal and roti bread – a first for some of the volunteers! The spiciness of Indian food is definitely something we’ll have to get used to during our month abroad. When we entered the main temple, it was definitely worth the wait. Every inch of the enormous temple had intricate carvings of Hindu gods and symbols on the pillars, walls and ceilings in white stone. You could definitely see how the temple took 300 million hours worth of work! An amazing first glimpse of India!

Our next visit was to the Lotus Temple, which was an amazing modern temple shaped like a lotus flower! After a short visit here we tackled the Delhi rush hour traffic back home to G.K. 1. We spent the last bit of our night in New Delhi exploring the suburb near our house and visiting some night markets were Amy and I got some amazing henna tattoos on our hands.

We finally got some sleep and got ready for a big car trip the next morning!


Day 2 – Roadtripping to the Himachal
After an early rise and a quick breakfast, we quickly got into our car for a 12 hour car ride up to North India! And nothing would have prepared us for the adventure ahead.
We tackled the early traffic jams of Delhi before hitting the highway. Here we started to experience the more rural vibe of India with horses, cows and dogs running freely around the cars. Lunch was a traditional Indian ‘thali’ – basically a selection of curries, yoghurt and dishes served with naan bread, rice and papadams. This absolute feast amounted to 160 rupee – under 3 Australian dollars!
For the next ten hours, we delved deeper and deeper into rural India and the highways turned to dirt and then into small, winding streets. After an exhausting final few hours, we finally reached our home for the next month with Bobby – our host dad for the month!
After crossing 3 whole states between New Delhi and Palampur, we’re all very glad that we wouldn’t be taking that sickening car ride anytime soon. It definitely took a toll on us.

Day 3 – Orientation Day
Today was our first dive into normal everyday life in Palampur!
We woke up to some amazing snow-capped Himalayan mountains at breakfast – a sight that we’d have to get used to seeing every day! After a short talk with our supervisor, we were off to the city to learn all the tips and tricks of public transport and shopping in these rural areas. A single bus trip would cost us a maximum of 20 rupees one way – which is roughly 30 cents!

The bus system is an enormous part of the lifestyle in these areas. It is the most common method of transport and pretty much reaches every village around Palampur. Busses come every 3 minutes to each stop which is a lovely change from Queensland’s unreliable public transport. The basic idea is – get on quickly (even if the bus is still moving), try to find a seat, if you can’t find a seat – hold on for dear life. Staying up right as the bus is speeding around corners and braking suddenly is definitely a challenge.
We began with a ‘short walk’ to Bobby’s dental clinic which is about 1.5 kilometres away uphill. This is probably a short walk for some of the local people, but I certainly discovered some muscles I didn’t know were there! We spent the afternoon with another guide to the Palampur town centre to get acquainted with the confusing bus system and see the markets. The bus station there was beautifully smoky and vibrant with hundreds of people yelling and shouting at each other between busses. Such a fun environment to be in! And of
course, there were the snowy Himalayas behind which were just breathtaking. Still can’t get enough of these mountains!

The stalls were bright and brilliant and full of random items ranging from three-piece suits to vegetables to tupperware! After a few hours of navigating the crowded streets and
lined by huge amounts of street stalls, we were told that the market wasn’t even on and that the real market throughout the rest of the week would be much more crowded – absolutely crazy! We’ll be sure to visit these markets many times.
We also spent our time in Palampur looking for toilet paper as our house had run out. After 2 hours of searching, our grand total came to 3 single rolls! It will be a challenging month.

Another exhausted day of the trip done with an even bigger day ahead! Time to start our placements!

Day 4 – Placements
DENTISTRY: The Public System
For our placements with 4 dental students, we had 2 students (Amy and I) going to the public hospital, 1 student (Kent) stationed at Bobby’s private clinic and 1 student (Joel) at another private clinic. We’d rotate around each of the clinics every few days to get a taste of what private and public dental care was like in India!
We were driven into the town of Saliana (about 45 minutes away from our home) which was surrounded by tea fields and arrived at our placement - a primary health centre which served around 15 of the surrounding villages. We also found out that the healthcare system was not too different from Australia with a primary, secondary and tertiary level of care. The place that we were stationed at was at a primary level where all patients could come and pay for very cheap treatment. This excluded those below the poverty line who received completely free treatment. The poverty line in India was at about 6000 to 10,000 RP a month, which ends up at a maximum of 150 Australian dollars.

The hospital was made up of a mix of random specialties. These included some general practitioners, dentists, nurses, pharmacists, dental hygienists, occupational therapists as well as another woman employed purely to bring everyone chai tea! The dentist that we were shadowing was the only one working in the building and would get about 30 patients throughout a short working day. After a slow morning due to the electricity being cut briefly, we finally got to see some procedures in the afternoon. Patients were walking in and out of the clinic within minutes and at times there were even multiple patients in the one room asking for help!

Within two hours in the afternoon, we witnessed countless root canal therapies, pericoronitis, periodontitis, some simple restorations and an intense scale and clean which sent flying chunks of subgingival calculus around the size of five-cent pieces! It was a really amazing yet confronting insight into the severity of cases that are encountered daily in India. The patients seemed to be more or less diagnosed on the spot within first sight. For example, one look at the tooth and the dentist would begin an extraction or root canal without any further investigations or radiographs. Treatment here is pretty much the complete opposite to our university clinics in Australia where there would be full medical histories, complete intraoral and extraoral examinations and countless radiographs before a diagnosis could be reached.

My first impression of the public hospital was – “oh my god”. There was no doubt that the facilities were quite primitive with pretty much a concrete building with painted Hindi words on the walls to distinguish between the different areas. The clinic itself was not so bad although they have a habit of drowning some of their instruments in a tub of disinfectant and using it again for the next procedure. Their main method of sterilization was a metal box with boiling water in it – a huge contrast to Australia’s strict autoclave system.

Interesting fact: Root canal therapies and simple restorations in the public Indian system costs 100 rupees – roughly $1.40 in Australia. Think about that next time you get a $60 composite restoration done!

Another confusing yet common thing encountered here in India was the ‘sideways bobble’ of the head that many Indians used in answering ‘yes/no’ questions. After hours of tireless researching and asking the locals, we found out that the sideways bobble does not only mean ‘no’, but it also means ‘yes’, ‘maybe’ or ‘I don’t know’. In other words – we have absolutely no clue what it means and probably will never understand!

NURSING:
It probably won’t come as a surprise to know that it was a bit of a shock walking into the Karan Hospital. Patients are seated to the left as you walk in with doors leading to various rooms which are described by large signs in English directly above the doors. Everything seemed to be quite basic. Dr Veena’s office is not big but it contains her desk, chairs on either side of the desk, chairs on the other side of the room for patients to sit on and wait as well as cabinets in which medications are kept and an examination table. It was a bit of a squeeze sometimes with patients, nurses and doctors in all at once. Meeting Dr Veena was great as she showed me around the hospital in between seeing patients and conversing with other staff members. The nurses, I believe, were worried because I am on my own and in a country where English is only the second language. Even so, everyone was very welcoming and helped me to feel comfortable even though communicating was difficult at times.

I was delighted to find that the first thing I would be witnessing was women in various stages of pregnancy come to the hospital for an ultrasound. The conditions of course are vastly different from those in Australia, while one woman was on the bed having the ultrasound done two or three other woman wait on chairs less than a metre away from the bed. Next door is the room for dressings which has an adjoining door to the ultrasound room and there is always a hustle and bustle of doctors and nursing moving through these doors. The staff were happy to say ‘good morning’ and how are you’ in English and it was funny to see their reactions when I tried some Hindi. It was also interesting to watch the interactions between the staff and the patients in the hospital.

The rest of the day was spent at our house playing with Bobby’s dog and playing some ‘backyard cricket’ with some of Bobby’s relatives. The cricket game was cut short when Joel had a near miss with one of the local dogs.

Day 5
Today was the second day of placements and it’s truly the first day where we would be catching the bus and making our way around the villages on our own.
The morning bus was truly traumatic. Traumatic but a lot of fun.

The bus was pretty much as full as it could get however we were pretty much squished into the rickety four-wheeler. After we somehow closed the door behind us the bus began to speed along the windy roads. With each sharp turn, all the metal on the bus started to creak and everyone inside fought to stay standing. I was waiting for bus to capsize down the mountain.

DENTISTRY- Public
After finally finding our way to Saliana, we began our second day of observation in the dental clinic. It was an amazing day with many extractions which eased our nausea from the morning bus ride.

NURSING
The second day at the Karan Hospital was just as busy as the first. A doctor was preparing a woman for surgery for an abscess on her scalp. I saw a large amount of her hair lying in a bucket underneath the bed and a nurse prepared a blade to finish by shaving the area that was going to be operated on. The conditions are something to get used to. There also were representatives for certain medications walking into Dr Veena’s office and discussing different brands with her and prices that they will sell them at.
The afternoon was spent shopping around Palampur town centre and getting the true ‘Indian market bazaar’ experience. We were stunned to see our first albino Indian and enjoyed letting Joel lead the way and getting us all lost. The girls went shoe shopping whilst the boys ran around town looking for a good cricket bat!