TRAINING REPORT SUMMER 2003 - Olivier Groulx and
Joanne Aube-Maurice

General Objective: Our main goal was to be involved in the strategies of intervention of an international NGO promoting a global approach within the community, in the cultural context of rural India. In order to reach this objective, we have been involved in various activities:

Baldev medical and community center

Medical consultations: We improved our clinical judgement as well as our clinical skills by assessing patients with Dr. Saikat. We were exposed to the effects of financial and cultural limits on medical practice and on patients' health. The specialist camp was also interesting opportunity to see patients with numerous diseases that are unusual for us. Although the language barrier limited our possibilities of interacting with patients, our experience at Baldev was a rich immersion in to the clinical world.

Geriatric survey: Even if it was a brief experience, the two weeks we spent screening patients in different villages were very relevant for our formation. Effectively, we improved our self-confidence concerning our physical contact with patients as well as our personal findings. It was also a wonderful incursion into the culture of rural India.

Self-help groups: Attending the women's meetings led us to understand better the concept of empowering the status of this neglected (though crucial) group of the society in order to increase the whole community welfare. We were impressed by their enthusiasm and their good will and would have enjoyed more contacts with them.

Adolescent group: We gave two sessions on first aid and played games with this group. The idea of having informative and interactive sessions with teenagers once every two weeks seemed very interesting to us. We believed that it is a good way to interest them to various subjects, to increase their self-esteem and that it could encourage a proactive behavior in their future life. However, according to us, reaching such objectives would require a strong motivation from the organizers (and more time) to plan more frequent sessions(weekly) with attractive, structured and interactive activities in order to reach the teenager's expectations.

Shanti Bhavan

Children check-up and medical screening: These activities gave us an experience of pediatric follow up as well as precious contacts with
Shanti Bhavan's children.

Informative and interactive sessions:

- Growth and change (5th and 6th grades, teachers and staff): The two sessions we gave, the first regarding physical changes and the second emotional changes consisted in an open interesting exchange with children about sexuality. They were very open minded and enthusiastic, which helped us achieve our delicate task.

- AIDS (Two groups: teachers - staff): We referred to our previous experience in AIDS prevention to inform Shanti Bhavan's teachers and staff about this worldwide concern. As we gave two separate sessions, we found easier to communicate with the teachers group because of language matters.

We sincerely hope that these sessions will be helpful to Shanti Bhavan's teacher and staff to instruct the children about these crucial topics in future.

- Quebec (2nd to 6th grades and teachers): This cultural presentation on many aspects of life in Quebec was an occasion for the children to learn about a new culture, and or us to share our reality with them.

Personal research
- Health care system: In order to get familiar with the Indian system, we visited many different health care institutions, including a primary health unit, many primary health centers, a governmental hospital (Victoria), a teaching institution (St-Johns) and a private specialized hospital (Hosmat). Moreover we had a brief but interesting contact with the Indian traditional medicine. We also found a lot of information about the healthcare system in the Park textbook.

- Epidemiology: Some readings in the Park textbook and in other medical textbooks as well as discussions with various health actors helped us to have a better ideal of the most prevalent diseases in India.

All these activities were interesting opportunities to reach our numerous objectives. We are very grateful to all the people who accepted to give their precious time to involve us into the different projects and who believed in our contribution. These two months with The George Foundation have been a great human experience that will surely follow us in our future career.


Among all the objectives of our training with The George Foundation, one was to get involved in the EDPS2000 evaluation. Our goals were basically to learn how to lead a survey meant to evaluate the accuracy of a system like EDPS2000, and to understand how this system could be used in order to implement health care in rural areas.

We really enjoyed the way we were integrated into the supervision, the collect of information, and the group discussions. We had good relationships with the social workers, the medical students, the supervisors and the coordinators. The chats we had with different health system actors were very relevant for our future career.

These two weeks of survey led us to some interesting findings about the way the study was run and about the further use of EDPS2000 in India.

1. Running the study

- Leading a study in a developing country requires a lot of supervision to ensure that people collecting information are aware that rigor in their work is crucial for the validity of the survey. In order to avoid mistakes, we insisted a lot on filling the forms properly and completely.

- Most of the problems we met concerned the information we collect:

- for the first two weeks, the interviews with the providers were based on English forms and translated by the students in Tamil, which could lead to translation interpretations by the interviewers; the situation was corrected by the end of the second week.
- some patients were not respected in their refusal to answer the questionnaire, neither were the refuses taken in account which may under or overestimate the patient's satisfaction.
- the presence of a medical student in the provider's office sometimes interfered with the activities conducted by the provider, which could also introduce a bias.
- The randomization of patients going through EDPS was started only after first day

2. Ulterior use of EDPS2000

- In the context of a public PHC in India, EDPS2000 seems to slow down the doctor's work.

- The patient's satisfaction seems to be increased with EDPS. However, it is probably related to the additional attention they get rather than to the supposedly implemented care they receive.

- Some doctors complain of the EDPS operator's lack of training.
- The health providers recognized four major utilities in the system:
- keeping the patient's records
- keeping children immunization and mother health information
- epidemiological surveillance for public use
- patient's health education given by the EDPS reports

- The use of the system in private medical centers could look more adequate regarding the amount of time the doctor spends with the patient, but we are not convince it will help the doctor in assessing the patient. Nevertheless, it could help to keep records of the anterior visits and to give health recommendations to the patient.

- The use of EDPS in assessing patients and giving probable diagnosis seem to be more relevant in sub-centers in the absence of a doctor, where a well trained paramedical worker (eg.VHN) can operate the system. For this use, the diagnosis efficiently should be implemented in order to recognize the level of emergency of the cases. It would then reduce the flow of patients going to the PHCs while giving appropriate care to the
sub-centers' patients. However the use of EDPS in the health care system will require the training of new paramedical staff to avoid additional work for the field workers.

- Moreover, the EDPS records should not be added to the already existing records, but rather replace them to avoid multiplication of administration work.

Although we do not know what will be exact use of EDPS2000 in the future, we think it has a very good potential in implementing health care in rural India. We hope that you will find our observations relevant and we are grateful that you gave us the opportunity of joining your team in this study. We will appreciate to receive any further results concerning the study.

Olivier Groulx and Joanne Aube-Maurice,

July 18th 2003

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