Notes from Another Sphere: Record-keeping

March 24^th 2016

The garbage dump outside the clinic is growing. This clinic is in a pretty poor part of town, in what doesn’t look like a slum, but for all practical purposes, is. Narrow roads (one main reason why I can’t call this area a slum- which slum has roads in it that you can drive a car or an ambulance on?) upon which the BBMP civil engineers, in their unfailing enthusiasm, have placed tall speed-breakers (and breakers of back, neck and every type of bone) every 5 meters, criss-cross the neighborhood. There are no trees; small garbage heaps make a colorful patch every few yards. Large garbage dumps mark the really important locations. The BBMP PHC has the most gigantic garbage dump that I have seen. 

This time, as I enter the clinic, one of the attenders tells me to enter my patient details and my plan of care in one of the registers. I’m quite excited- this would be a good way of keeping track of my patients. I peek into the earlier entries in the register. I see many different handwritings, corresponding to many different doctors. Most have scribbled the patient’s first name, followed by chief complaint and medications prescribed during the visit. I can do this, I think to myself.

I see patient after patient after patient. Sometimes, I have to stop them from launching into their story as soon as they sit down, while I scribble down my notes. I miss a lot of details in the hurried note-taking. At the end of the 2.5 hours, I count the number of notes I have jotted down: 19 mothers/ families with babies or children, and nearly all of them for low weight. My notes about interventions done nearly all read “counseled on diet and nutrition”. 

Most breastfeed their infants. But I think that the point where the greatest confusion occurs is during the introduction of solid foods. Lots of mothers give their kids biscuits and idlis. But they shun fresh fruits, mashed vegetables, even rice, or ragi, or wheat. Many refuse to add ghee to the child’s meals for fear that the kid will somehow fall sick. 

Writing this down, I wonder if what might be really useful is to make a few handouts to give mothers, lots of pictures explaining what to give a child and when. 

At the end of today, I feel really energized. Writing down notes on my patients really added an entire dimension to my experience here. 19 patients! Underweight kids! Suddenly I have a handle on this population, I’m beginning to understand them.