Gudalur Adivasi Hospital, Tea Estates & Safari

By Cristina

After the hustle and bustle of Vellore's rickshaw-packed streets, Gudalur's lush jungle and fresh mountain air were a welcomed change of pace and scenery. The Gudalur Adivasi Hospital serves 20,000 tribal and local non-tribals and is run by a doctor-couple. Dr. Nandakumar (NK) Menon, a surgeon, and Dr. Shyla Devi, an OB, have trained local tribals as nurses, community health workers, and hospital staff. They are basically the Paul Farmers of India!

This is us walking from the guest house, just up the hill, down past the hospital, on the left in the picture, and walking into town for fresh fruit and snacks. The white truck is the mobile clinic which goes out to Area Centers in the community to treat patients ½ hour to 2 hours away.

On Monday, our second day in Gudalur, Dr. Shyla (center front) gave us the low-down on the hospital and explained why she and her husband chose to dedicate their lives to the tribal people. The couple always knew they would return to India from New York after saving up $100,000 from their medical practices. Now they laugh and say they were naive because that amount is meager compared to the funds they need to run a hospital and are now raising through donations and government funding for tribals. Their hospital has grown from a one-bed facility in 1986 to forty-bed hospital in 2011 complete with delivery room, operating room, outpatient rooms, lab (to run samples for diabetes, anemia, sickle cell, and TB), pharmacy, daycare, and classrooms upstairs to train the staff. From the onset, the couple's philosophy about the hospital was that is belonged to the tribal community-- the community would have power of all decisions about the hospital, while NK and Shyla act as advisers. Likewise, they realized they needed health workers from the community itself in order to gain the trust of the tribals and provide an effective health care system. It was interesting to realize that even though NK and Shyla were from India, they were viewed as outsiders by the tribals. The tribal community is actually comprised of four separate tribes each with their own identity, customs, and beliefs, though all four groups live in harmony with one another. Shyla said that in the tribals, they see the values that have been lost in the world, the values all religions promote- peace with fellow man and the environment, generosity, honesty, and kindness . Over the course of our visit, we found this to be true, and we saw that it was very easy to fall in love with the tribals and this jungle land of jackfruit and elephants.

The view of the mountain from the main street in Gudalur.

Play time! Perfecting our Bollywood moves for Saturday night’s gathering at NK and Shyla’s.

A view of the hospital from the first floor. The delivery room is the first right going through the door in the picture. Inpatient rooms are on the first and second floor on the left.

Tuesday- Seeing patients with Dr. NK and team.

Dr. NK (front right) and Dr. Abraham (back right) seeing outpatients. An anesthesiologist had visited on Saturday, which allowed NK and team to perform many surgeries like hernia repairs, trauma, and fistulas that required general anesthesia. Most patients were back today for post-op follow up.

Dr. Abraham (front center) discussed TB case studies with us. Anyone with cough lasting more than 3 months is suspected of having TB because the bacteria is so common in India—2 billion people are infected with TB bacillus, of which 10% become active cases. We also learned that TB can manifest almost anywhere- abdomen, spine, meningies (brain), pelvis, urinary tract.

Dr. Chandy made sure we had a balanced diet of work and play. On Tuesday we went to the Mudumalai Tiger Reserve in the Tamil Nadu National Forest, about ½ hour from the hospital. The Tiger Reserve spans for miles and we saw tons of animals just driving along the main road- elephants, bison, peacocks, mongoose, and wild boar. During the official safari tour we also saw white spotted dear (below) and some lucky members of the group even saw a leopard that Dr. Chandy pointed out! That was definitely the highlight of the drive, but unfortunately no one captured it on film.

This trip was approved by Martin Hoffman. "Two thumbs up!" 

On Wednesday, Siobhan, Patrick, Jon and I went with JiJi (one of the hospital’s social workers) to several villages to see the Area Centers and the “health animators” – what a cool title! One hours drive up and down windy hilly roads through tea estates brought us to our first Area Center, Murukampadi, where we met Ayyappan and Janu. There were three big rooms in the new looking cement building and a little kitten outside meowing away. One room was the clinic and pharmacy where we saw Janu helping a mom who’s son had sickle cell and was getting treatment to manage the disease including pain meds, vitamins, and an antibiotic for a URI. After the Area Center, we went to a village called Vattakolli (above) which we walked to through the tea estates from the main road. Jiji (in pink) showed us the health cards all children have that includes their growth chart and vaccines.

Walking to several villages through the Tea Estates, praying the leeches will leave us in peace.

Janu (the health animator) is weighing a young boy in the cloth. She then recorded the weight in the health chart which stays with the family. In this area, the main causes of weight loss or failure to thrive in children are sickle cell anemia, hookworm, and diarrhea. Children are given Albendazole every 6 months to kill worms if present. We actually bought some Albendazole before leaving India to “deworm”, as advised by Dr. Chandy!

A Kattunaikkan tribal woman.

An elephant had stomped through the village the day before, crushing plants and damaging some homes. Some villagers saw the giant, but no one was injured. The ground was packed mud, rock solid, and the elephant was still able to leave its mark. Fortunately, we didn’t meet the owner of the prints during our visit!

When we visited the homes, we were instantly offered a mat to sit down on and a glass of hot tea with fresh milk and sugar—in spite of earning only $1.50/day in the Tea Estates! I was completely humbled by their generosity. I was so touched that these people whom we had just met were willing to share with us even though they had very little. Imagine if everyone lived that way.

At the Area Center with Ayyappan, thanking him and saying farewell.

On Friday, we took jeeps out to the Tea Estate owned by the tribals. Needless to say, it was a muddy and bumpy ride!

These 200 acres are owned by the tribal collective.

It felt like we were in a cloud forest!

A set of clippers with a collecting bin on the top for pruning or picking the new tea leaves off the top.

Mind the leaches. (No joke! Check out a previous blog entry about creepy crawlies of India.)

At noon, all the workers weighed their collections and picked through to make sure no bad leaves made it in. Workers must pick 25kg in order to earn their $1.50 per day.

On Saturday, we drove to a tea factory to see what happens to the tea leaves after they leave the tea estates. Unfortunately, we couldn’t take pictures inside. There was one huge warehouse-sized room for drying the leaves, then they were sent via conveyer belt through four grinders until the leaves became finely ground. Next, the grounds were fermented with water for 90 minutes to create black tea. We learned that green tea is made from the same leaves as black tea. The only difference is that green tea leaves they are not fermented, and therefore, not oxidized, so it keeps its greener color and leafy taste.

On Saturday evening we were invited to the home of Dr. Shyla and NK for dinner. We toured the gardens, mushroom colony, chicken coops, and cricket fields before going inside for food.

Shyla gave us saree tying lessons—it’s not as easy as it looks!

The guys looking good in their mundus.

Freshly tied sarees. Thanks Shyla!

Talented men in the kitchen—we were very excited for dinner!

Pre-dance.

Bollywood dancing in India, we couldn’t resist.

Dawn and Jon were naturals.

What a lovely evening!