I realized today that this is my last blog post of the rotation. Crazy how fast it has flown by. We headed to the metro station to meet Sanjay in a jam packed rickshaw. It is safe to say we have gotten used to sitting on top of each other (well at least Lacey has gotten used to people sitting on her). We first went to Kashmere Gate to a HIV testing center located at the bus stop there. The center is called Suraksha Clinic (which means protection) and receives funding from NACO. You may remember from previous posts that this organization gives Anti-retroviral treatment free of cost. You might be asking yourself why it would be there but the set-up was strategically planned. The providers/counselors at the clinic noted that this area had a high rate of HIV infections and also reported that people were able to stop in during their travels to different states and receive some counseling as well as the HIV screening test. They are trying to gather the at risk population with their target intervention program.
Entrance to testing center.
The meeting with a patient starts with pre-test counseling which includes education on HIV and motivation for testing. The counselor stressed to us that it is not their job to force people to receive testing but rather explain the purpose and benefits of testing. If the patient then wishes to proceed they can have testing done at that clinic. All services are free and there is same day reporting. If their test is positive the person is contacted and they are told to go to 1 of 9 government hospitals for further testing (including ELISA and CD4 counts) and treatment which is free. There is mandatory reporting in India as in the US for HIV. Additionally, the patient is referred to TB clinic if their HIV screening is positive. Whether positive or negative there is some post-test counseling including next steps and prevention. Condoms are offered free at the clinic site. There is a 3 month call to follow up and check as well as advised retesting in case the patient was in the window period. They have 8-10 patients per day but can reach up to 20 patients.
Intake area where counseling occurs.
Test Strip.
We then headed over to DOTS clinic where TB testing is done. The organization is government in run and started in 1998. There is over 100,000 people covered by this clinic (not all are positive but have gotten tested due to various exposures). They have their own lab technician that collects sputum samples and looks for acid fast bodies under his microscope at the center. If positive there is free treatment followed by WHO guidelines. They treat both pulmonary and extra-pulmonary TB. The goal is to get everyone to complete 6 months of treatment, and the center goes to extreme measures to make sure this is completed so as not to create multi-drug resistant TB. The physician there says he has gone to people’s houses or common hangouts to find them and make sure they follow up for their treatment. He told us that after meeting every new patient he or someone at the center pays a visit to their home to evaluate and learn how they live day to day, to meet their family and friends, and make sure no one else in the community should get tested. He stresses to the patients that just because they feel better does not mean that they should stop taking their medication. If the patient completes the medication they receive 1000 rupees from the government (equivalent of about $16 in US). The site we visited had about 65 current patients. In terms of prevention we did learn that all newborns in India have mandatory TB vaccination.
TB clinic.
Lab area for acid fast staining.
Chart for lab tech.
After our rotation was finished we headed over to Akshardham (sorry picture were not allowed). It was beautiful and peaceful there. We weren’t able to spend a ton of time there but are hoping to head back during our last week of adventures. We headed back to the apartment again in a jam packed metro and rickshaw. One thing I will not miss is sitting on top of everyone. One thing I will miss is having fun and spontaneous adventures with my friends and laughing until my abs hurt.
Akshardham.
Lacey enjoying the rickshaw ride.
-Steph