Day 17 - Ward Rounds and the Sisters

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Ward Rounds

I knew that this trip would present me with a number of opportunities to enjoy new experiences but what I hadn’t anticipated was being presented with the chance to spend time on the clinical side of the organisation.

Yesterday evening, after work, I accompanied Scot Warden, the Ophthalmic Surgeon from Boston, on his post-operative ward visits as he checked on his cataract patients from his morning operations. This gave me a chance to see the hospital wards properly. The simplicity of the arrangements here are a joy to behold. During a patient’s stay in hospital there are no notes kept on file for them at all - they are simply handed their notes and told to keep them with them at all times. A simple and effective way to keep processes streamlined, no staff are employed in filing and there are no delays in retrieving notes.

When Scot operates, he has to make a note himself of his patients name and hospital number, it is his responsibility then to track down the patient later that day for review. Tracking down the patient consists of advising one of the sisters the patient’s name. The Sister then proceeds to enter the wards, which may contain 50+ patients in each, and calls out the name. At this point you often get several people responding because many names are extremely common, the sister will then work out the right patient and bring them to Scot for review.

The process is basic, it does not rely on computers or even paperwork and it is quick. The Sisters always seem to find the patient within a couple of minutes.

Scot reviews the corrected eye and decides how it’s progressing and what treatment it requires. Again a simplistic process is implemented to track his decision. If the eye is healing well, the eye is protected by a Green eye patch, which indicates to the sisters that standard eye-drop treatment is called for. Other coloured eye-patches symbolise different regimes, for example Red means double dose of drops. There is a note of the medication on the patients files as well but this simple colour coding, which is used frequently around the hospital, means that you can walk into a ward of 50 patients and simply by looking round you can see what medication everyone is on.

Sisters

It is worth mentioning here the Aravind use of the title Sister. In the UK this denotes a senior rank among nursing. In Aravind, every young female employee in the nursing, catering or housekeeping roles is referred to as sister. Mary, who looks after us in the Guest House is a Sister, as is a trainee nurse, as is the most senior nurse. There are around 800 Sisters at Madurai and virtually all of them live in the Nurses Home. They refer to each other as their Sisters and almost function as a family unit, providing support and encouragement for one-another. All these girls, typically aged 16-24 are recruited from surrounding villages and only occasionally get to visit their families. The concept of the Sister unit is extremely important to them in helping them adjust to life away from their families. Typically around 24/25 they will leave Aravind and return to their villages to be married. Mary, for example, is currently 24 and expects to be told by her family that they are selecting her husband next year at which point she will leave Aravind.

The sisters are entrusted to the care of Aravind by their families. When they are recruited, a member of staff from the hospital will personally visit each girl’s family and swear an oath to them to keep their daughters safe. Both morally and physically. Dr Natchiar oversees the welfare of the Sisters and maintains an extremely tight level of control. Any transgression from the rules is dealt with swiftly by Madame, as she is known!

The girls are paid what we would consider an extremely low wage. For the first 2 years of training they receive only a few rupees a month, equivalent to 4 or 5 pounds. Once trained their wages go up to 3,000 rupees a month £40. Of this about £10 goes straight back to Aravind for food and housing. About £25 has to be put into a bank account by the girls and they can keep around £5. Madame Natchiar is notified by the bank Manager if any girl fails to deposit! The sisters are not really allowed out of the nurses home, socialising outside is not an option, mixing with boys is certainly not allowed and alcohol is taboo.

Mary, for example, at 24 has not once had an alcoholic drink. This stance is purely cultural not religious given that Mary is Christian. There will be no concept of boyfriends or dating either before she gets married.

After Scot had completed his rounds we headed back to the guest house for dinner. To my surprise, Scot then invited me to accompany him the next morning in the Operating Theatre. An opportunity that I would not have thought I would be presented with. I can’t wait!

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