The last couple days we have been going to the Urban Health Training Center and the Rural Health Training Center as part of our community medicine posting- we are finally getting to see patients all day every day (and no lectures) : )
Here are just a few of the cases we have seen to give you an idea of the patient population and the health problems they face. Note that most treatment given at these outreach centers is just symptomatic and not necessarily curative.
On Friday at the RHTC I was able to see two elderly women suffering from chikungunya (don’t feel bad if you have no idea what that is- I didn’t until I got here). Chikungunya is a virus which is spread by mosquitoes (similar to how malaria is spread)- the disease was first described in Africa and was very rare until recently. In 2005-2006 there was a widespread outbreak of chikungunya in southern India- after heavy rains and flooding (think standing water and mosquitoes). The virus is generally not fatal although some deaths have been attributed to it. Patients suffering from chikungunya generally present with fever, rash of the limbs and trunk, and arthritic symptoms in multiple joints- can be debilitating. The women I saw both had swollen joints and decreased mobility. The physicians said that the crippling joint pain is the most common and pronounced symptom. The fever generally subsides after a day or two while other symptoms, mainly the joint pain, can last up to weeks or even months (generally longer in older patients). There is no specific treatment for chikungunya- at the RHTC treatment is given for relief of the painful joints- anti inflammatory treatment. (The physicians said that in some clinics steroids are being given.)
A mother and her two sons came to the RHTC- all were patients. The mother had malaria and was given quinine tablets for treatment- she presented with fever and chills for days. Her 3 year old son had a terrible case of scabies and an upper respiratory tract infection. He was given antibiotics, skin cream for the scabies, and advised to take an antiseptic bathe. Her 13 year old son was unable to walk or sit in a chair without assistance. This was the first time he had been brought to the clinic- the mother wanted to know what was wrong and what could be done. After a very brief physical exam and patient history the physician suspected muscular dystrophy. The mother reported that her son developed normally until the age of 7- after which he just got worse. Aside from his physical disability his mental function is normal. He is the product of a consanguineous marriage. The family was referred to SDM hospital- orthopedic department for further care. However, the physician was skeptical as to whether or not they would actually take their son to the hospital (due to a lack of transportation, money, etc.).
Side note- in the past few days I have asked a few physicians about consanguineous marriages in India and why they appear to be so common. Here is what I was told… primarily people don’t understand the medical problems that can result in children that come from a consanguineous marriage (congenital abnormalities). They reported however that the number of consanguineous marriages has decreased to about 50% overall- definitely more common in the villages and rural areas than in urban settings (this is down from about 60-70% 10-15 years ago- the result of education about these congenital abnormalities). The reasons given for arranging a marriage between family members were as follows. Since most parents arrange the marriage and since children generally take care of their parents in old age- parents figure that if both members of the couple are family both have some personal stake in taking care of the parents in old age… thus, the parents are guaranteeing that they will be taken care of in the future. Also, if both members of the couple are individually related to the parents this makes certain that any inheritance will be kept within the family. When the parents die whoever (husband or wife) inherits their land, money, or other property is sure to be family.
Maybe the most disheartening case was one I saw at the UHTC. A 19 year old female came in complaining of loss of energy and fatigue. The patient was clearly anemic and malnourished. In taking the patient’s history this is what the physician found out… the woman had recently lost an infant and complained that her in-laws (whom she lives with- it is customary for the daughter-in-law to move in with her husband’s parents) were giving her a hard time about being an unfit mother. She reported that the family was not giving her any food- she said she had eaten dirt she was so hungry. She said her child died because the family was not giving her enough food to produce sufficient milk for the infant. She said her husband, who works in the field during the day, is not sympathetic and sides with his parents. The physician treated her with antidepressants, nutrition supplements, and advice on free feeding programs in the area.
Along with the above cases there was a woman who presented with fatigue and appeared anemic. After a blood test she was found to have a hemoglobin of 5 (should be around 14). There were countless children with skin infections (the result of poor hygiene)… most of them had scabies and due to scratching the skin had been broken, increasing the risk for secondary infections- which most had (presenting as skin boils averaging 1-2 cm in diameter). Oh and a family of 5 all suffering from gastroenteritis- mother, 7 year old son, 3 year old son, 2 year old daughter, and 7 month old daughter. The physician treated them with antibiotics, oral rehydration solution, and a stress on personal hygiene. And on a more positive note today a 98 year old woman came in to the RHTC, after walking 2 km from the neighboring village, to inquire about getting some new glasses. She had broken hers and wasn’t able to see very well with the old pair she had found at home. Aside from the glasses request she was healthy (and probably the cutest old lady I’ve seen- Eva and I took her picture) : )
Our days spent at the UHTC and RHTC have been an amazing opportunity to learn about medicine, about healthcare in India, about treating a patient population with limited resources, and most importantly about compassion. I feel fortunate to have been able to see and learn from patient cases that are not likely to appear at the University of Iowa Hospitals and Clinics.
Tuesday, July 10, 2007
Sunday, July 8, 2007
Just a few thoughts…
So… this post is just going to be lots of things about our summer here in India and a little bit about our posting in community medicine (more to come later).
I knew coming to India that most Indian marriages are arranged… however I was totally unaware of the process behind arranging a marriage. While times are changing and more and more young people in India are meeting their mates in their own way- opting for “love” marriages (especially in the large urban areas) – here in southern India the majority of marriages are still arranged. Eva’s aunt and uncle are currently helping their nephew interview prospective brides. This past week Auntie and Uncle, as well as, mother and father have traveled three separate days to cities around Dharward to interview girls and the girls’ families. We inquired about the process and this is what I have found out….
First the parents of the man consult a matchmaker to learn of possible brides. They then set up meetings with these girls and the girls’ families for a sort of interview process. There are generally multiple meetings before a decision is made. If the families agree that the couple is a good match they then consult a fortune teller. The fortune teller must check the horoscope of both parties and give the union an “all clear” before the couple can be married. In some cases dowries are still given in the form of money, gold, a car, etc. (of course all situations are a bit different… this is just what I have gathered thus far). If it is decided that the couple is a good match it is at this time that the future bride and groom are able to communicate- get to know each other (alone).
Eva’s uncle explained that not only must the woman and man be a good match (caste, horoscopes, height, beliefs, future plans, etc.) but the families must fit together. Generally, after the couple is married the wife will move in with the groom’s family (most homes here are multiple family dwellings). She will assume the household tasks given to her by her mother-in-law. I don’t know a lot of details about the actually marriage ceremony (it is supposed to be quite the production- generally between 1,000- 2,000 guests)… Eva and I have been invited to attend the wedding reception of one of the physicians from the hospital. The doctor is in forensic medicine and will be getting married this Sunday. It should be an interesting event- we will be wearing saris to the reception.
Now I mentioned above that part of a couple being a good match is being members of the same caste. The caste system is the basic social structure of Hindu society and although it is not as strong today as it once was… it is definitely still present. For example, here at the house there is a girl, about 12 years old, named Lakshmi who helps Auntie with the house work. She is actually the daughter of the family who farms the land owned by Eva’s family (if that makes sense). Lakshmi lives here at the house and attends school in Dharward (which is a better school than the one she would attend growing up on the farm)- she helps cook and clean in exchange for room and board you could say. Even though the family likes her very much, she is a member of a lower caste and thus eats off of different dishes than we do and sleeps on the floor near the stairwell (even though there are about 6 empty beds in the house). Our driver, who takes us to and from the college everyday, is also a member of a lower caste and thus takes his tea out of different cups than we do. It is all very strange to me.
I, being totally unfamiliar with the details of this system, did a little reading in Lonely Planet… here is what I found out. In Hindu society there are 4 castes and below these 4 main castes are the Untouchables or Dalits (menial laborers- sweepers or latrine cleaners). The castes, from top to bottom, are as follows- Brahmin (priets and teachers), Kshatriya (warriors), Vaishya (merchants), and Shudra (laborers). It is thought that if one lives a moral life it is more probable that one will be reborn into a higher caste with better circumstances. Again, in India today the caste system is definitely weakened and far less rigid… but its presence can still be felt.
Eva and I have been enjoying Indian television in the evenings… there are about 3 channels in English. The channels actually broadcast some descent shows… Seinfeld, Friends, Scrubs, Arrested Development and some alright movies. However, more fascinating than the shows are the commercials. It is interesting all that can be learned from a society’s advertisements. For example, there is a commercial (which airs repeatedly) for men’s face wash… and what makes this face wash special is that it whitens your skin. It is called Nivea White for Men (sp?). So…. while Americans are spending loads of money trying to achieve that sun kissed summer glow… Indians are spending money on face soap that will make their skin whiter. There are similar advertisements for women’s face wash. Whiter skin is desirable because it says something about your social status- if your face is light you must work indoors and make more money than the dark skinned man who works in the sun as a laborer.
Onto the next topic… Eva and I have noticed a difference in the maturity level of the second year medical students here at SDM and the second year medical students at the U of I. For instance, the other day we sat down the in a classroom in the Department of Pediatrics with the batch of second year students we were posted with. Eva and I sat in the middle of the second row. Instantly all of the students moved their chairs behind us and one another so that they would be in the back of the classroom, farthest from the professor. Come to find out the medical education system is a bit different here in India… making the age of the students a bit different. In the States, after completing 12th grade, one must earn a bachelors degree (4 years), then attend medical school (4 years), and then complete a residency program in a particular specialty (minimum 3 years)… after this you are a full fledged doctor. In India, after completing 10th grade, one must attend college-11th and 12th grade-(2 years), and then medical school to earn a bachelors degree in medicine (5.5 years including internship)… after this you can practice medicine. There is the option in India to do a postgraduate degree in order to become a specialist (three years). What this basically all means is that at age 23 (my age), I would be practicing medicine already in India, rather than having at least 6 more years to go in the States. At home we must attend 11 years of education (minimum) after 12th grade to become a doctor. Here in India it is just five and a half years after 12th grade. So our fellow 2nd year medical students at SDM are on average 18-19 years old… this would explain the boys punching each other in the arm while the girls are trying to interview a patient : )
We are nearing the end of our time here in Dharward and are in our last posting- community medicine. While it has been a bit of a struggle conveying to the department that we want to spend as much time seeing patients as possible (and as little time in lecture as possible- the Head of Department designed a two week lecture schedule for Eva and I specifically) the posting has been very interesting so far. The Medical Council of India requires that all medical schools in India provide an opportunity for their students to learn about community medicine by establishing and staffing an Urban Health Training Center (UHTC) and a Rural Health Training Center (RHTC). These centers are basically outreach clinics which provide extremely affordable healthcare to the citizens of the lowest socioeconomic class. Patients pay 10 Rupees a month (a quarter) for unlimited treatment at the UHTC and 5 Rupees a month at the RHTC. While the clinics are by no means all encompassing facilities… they do both have 2-3 exam rooms, a small lab (to do blood and urine tests), a pharmacy (all meds are free after the monthly fee has been paid), and immunization programs. If a patient requires further care and is unable to afford the services of SDM Hospital (it is a private facility) they are referred to the free government hospital in Hubli. Each center is staffed by about 15 people (5 doctors) and serves a population of about 30,000 people. The centers are open from 9 AM – 1 PM (6 days a week) during which on average between 80 and 120 patients are seen. The UHTC is located near the slums around Dharward. The RHTC is located in Wayadad, a village of about 3,200 people about 40 minutes drive from Dharward.
Our last day at SDM will be Thursday, July 12th. On Friday Eva and I will take the train to Bangalore. We will be spending the weekend with her uncle in Bangalore… and possibly taking a day trip to Mysore. On Monday, July 16th we will fly to Delhi for a North India Highlights tour (visiting Delhi, Varanasi, Agra, Jaipur, Jodhpur, and Udiapur). The tour will end in Mumbai on July 26th. We will then do some sightseeing in Mumbai (hopefully take in a Bollywood movie or two) before flying home the night of July 31st. I am not sure what the internet access will be like at our various destinations… and seeing as we are moving cities almost every other day… I can’t guarantee updates on my Blog… but I will try : )
I knew coming to India that most Indian marriages are arranged… however I was totally unaware of the process behind arranging a marriage. While times are changing and more and more young people in India are meeting their mates in their own way- opting for “love” marriages (especially in the large urban areas) – here in southern India the majority of marriages are still arranged. Eva’s aunt and uncle are currently helping their nephew interview prospective brides. This past week Auntie and Uncle, as well as, mother and father have traveled three separate days to cities around Dharward to interview girls and the girls’ families. We inquired about the process and this is what I have found out….
First the parents of the man consult a matchmaker to learn of possible brides. They then set up meetings with these girls and the girls’ families for a sort of interview process. There are generally multiple meetings before a decision is made. If the families agree that the couple is a good match they then consult a fortune teller. The fortune teller must check the horoscope of both parties and give the union an “all clear” before the couple can be married. In some cases dowries are still given in the form of money, gold, a car, etc. (of course all situations are a bit different… this is just what I have gathered thus far). If it is decided that the couple is a good match it is at this time that the future bride and groom are able to communicate- get to know each other (alone).
Eva’s uncle explained that not only must the woman and man be a good match (caste, horoscopes, height, beliefs, future plans, etc.) but the families must fit together. Generally, after the couple is married the wife will move in with the groom’s family (most homes here are multiple family dwellings). She will assume the household tasks given to her by her mother-in-law. I don’t know a lot of details about the actually marriage ceremony (it is supposed to be quite the production- generally between 1,000- 2,000 guests)… Eva and I have been invited to attend the wedding reception of one of the physicians from the hospital. The doctor is in forensic medicine and will be getting married this Sunday. It should be an interesting event- we will be wearing saris to the reception.
Now I mentioned above that part of a couple being a good match is being members of the same caste. The caste system is the basic social structure of Hindu society and although it is not as strong today as it once was… it is definitely still present. For example, here at the house there is a girl, about 12 years old, named Lakshmi who helps Auntie with the house work. She is actually the daughter of the family who farms the land owned by Eva’s family (if that makes sense). Lakshmi lives here at the house and attends school in Dharward (which is a better school than the one she would attend growing up on the farm)- she helps cook and clean in exchange for room and board you could say. Even though the family likes her very much, she is a member of a lower caste and thus eats off of different dishes than we do and sleeps on the floor near the stairwell (even though there are about 6 empty beds in the house). Our driver, who takes us to and from the college everyday, is also a member of a lower caste and thus takes his tea out of different cups than we do. It is all very strange to me.
I, being totally unfamiliar with the details of this system, did a little reading in Lonely Planet… here is what I found out. In Hindu society there are 4 castes and below these 4 main castes are the Untouchables or Dalits (menial laborers- sweepers or latrine cleaners). The castes, from top to bottom, are as follows- Brahmin (priets and teachers), Kshatriya (warriors), Vaishya (merchants), and Shudra (laborers). It is thought that if one lives a moral life it is more probable that one will be reborn into a higher caste with better circumstances. Again, in India today the caste system is definitely weakened and far less rigid… but its presence can still be felt.
Eva and I have been enjoying Indian television in the evenings… there are about 3 channels in English. The channels actually broadcast some descent shows… Seinfeld, Friends, Scrubs, Arrested Development and some alright movies. However, more fascinating than the shows are the commercials. It is interesting all that can be learned from a society’s advertisements. For example, there is a commercial (which airs repeatedly) for men’s face wash… and what makes this face wash special is that it whitens your skin. It is called Nivea White for Men (sp?). So…. while Americans are spending loads of money trying to achieve that sun kissed summer glow… Indians are spending money on face soap that will make their skin whiter. There are similar advertisements for women’s face wash. Whiter skin is desirable because it says something about your social status- if your face is light you must work indoors and make more money than the dark skinned man who works in the sun as a laborer.
Onto the next topic… Eva and I have noticed a difference in the maturity level of the second year medical students here at SDM and the second year medical students at the U of I. For instance, the other day we sat down the in a classroom in the Department of Pediatrics with the batch of second year students we were posted with. Eva and I sat in the middle of the second row. Instantly all of the students moved their chairs behind us and one another so that they would be in the back of the classroom, farthest from the professor. Come to find out the medical education system is a bit different here in India… making the age of the students a bit different. In the States, after completing 12th grade, one must earn a bachelors degree (4 years), then attend medical school (4 years), and then complete a residency program in a particular specialty (minimum 3 years)… after this you are a full fledged doctor. In India, after completing 10th grade, one must attend college-11th and 12th grade-(2 years), and then medical school to earn a bachelors degree in medicine (5.5 years including internship)… after this you can practice medicine. There is the option in India to do a postgraduate degree in order to become a specialist (three years). What this basically all means is that at age 23 (my age), I would be practicing medicine already in India, rather than having at least 6 more years to go in the States. At home we must attend 11 years of education (minimum) after 12th grade to become a doctor. Here in India it is just five and a half years after 12th grade. So our fellow 2nd year medical students at SDM are on average 18-19 years old… this would explain the boys punching each other in the arm while the girls are trying to interview a patient : )
We are nearing the end of our time here in Dharward and are in our last posting- community medicine. While it has been a bit of a struggle conveying to the department that we want to spend as much time seeing patients as possible (and as little time in lecture as possible- the Head of Department designed a two week lecture schedule for Eva and I specifically) the posting has been very interesting so far. The Medical Council of India requires that all medical schools in India provide an opportunity for their students to learn about community medicine by establishing and staffing an Urban Health Training Center (UHTC) and a Rural Health Training Center (RHTC). These centers are basically outreach clinics which provide extremely affordable healthcare to the citizens of the lowest socioeconomic class. Patients pay 10 Rupees a month (a quarter) for unlimited treatment at the UHTC and 5 Rupees a month at the RHTC. While the clinics are by no means all encompassing facilities… they do both have 2-3 exam rooms, a small lab (to do blood and urine tests), a pharmacy (all meds are free after the monthly fee has been paid), and immunization programs. If a patient requires further care and is unable to afford the services of SDM Hospital (it is a private facility) they are referred to the free government hospital in Hubli. Each center is staffed by about 15 people (5 doctors) and serves a population of about 30,000 people. The centers are open from 9 AM – 1 PM (6 days a week) during which on average between 80 and 120 patients are seen. The UHTC is located near the slums around Dharward. The RHTC is located in Wayadad, a village of about 3,200 people about 40 minutes drive from Dharward.
Our last day at SDM will be Thursday, July 12th. On Friday Eva and I will take the train to Bangalore. We will be spending the weekend with her uncle in Bangalore… and possibly taking a day trip to Mysore. On Monday, July 16th we will fly to Delhi for a North India Highlights tour (visiting Delhi, Varanasi, Agra, Jaipur, Jodhpur, and Udiapur). The tour will end in Mumbai on July 26th. We will then do some sightseeing in Mumbai (hopefully take in a Bollywood movie or two) before flying home the night of July 31st. I am not sure what the internet access will be like at our various destinations… and seeing as we are moving cities almost every other day… I can’t guarantee updates on my Blog… but I will try : )
Friday, June 29, 2007
An interesting day in pediatrics
Tuesday (June 26) was the last day of the SDM medical students’ posting in pediatrics. Eva and I were scheduled to be there until Friday (June 29). I was a bit apprehensive that once again the faculty would not have any idea what to do with us. However, Wednesday was a pleasant surprise. Not only did I get asked to be an English teacher (presumably because of my complexion) J but we saw some very interesting cases in the Pediatric Out Patient Department (OPD). (One of the patient’s father asked, in broken English, if I would tutor his daughter, who is in 6th standard, in English. I tried to explain that I was in India as a student and not a tutor but I’m not so sure he understood. The conversation ended with me saying, “I no teach English.”)
We saw our first foreigner in the hospital, a Canadian. A white woman in her early 20s brought a young girl (with fever and diarrhea) to the clinic. She is in India working with a NGO at a school about an hour outside of Dharward. It was an interesting office visit… the physician was questioning the young girl in Kannada- the local dialect (which she didn’t seem to understand totally) and then speaking to the Canadian woman in English (which she didn’t seem to understand as her first language was obviously French). The physician prescribed some antibiotics and explained oral re hydration therapy. The physician said later that most NGOs in the area are fairly good at handling diarrhea, dehydration, and parasites.
Shortly after a family came in with their two and a half month old daughter. She was born with spina bifida, a developmental birth defect involving the neural tube (specifically the spinal cord and vertebrae), which was operated on at birth in a hospital in northern India. They brought their daughter to the OPD to ensure that she was recovering properly. The physician had a difficult time assessing this as there were no medical records from the patient’s previous care facility. He later explained to us that continuity of care is hard to come by in India.
After performing a general neurological exam, the physician said that the child most likely suffered from a meningocele. A meningocele is the least common form of spina bifida. In this condition some of the vertebrae are split (do not develop properly in utero) and the meninges are damaged and pushed out through the opening. This appears as a sac or cyst on the infants back. The sac contains both the meninges and cerebrospinal fluid (CSF). Luckily the spinal cord and nerves are not involved in a meningocele and neurologic function is generally normal. (In other forms of spina bifida, when the spinal cord is involved, neurologic function is impaired from the point of malformation in the spinal cord and below.)
Side note- the physician also observed that the patient exhibited the sunset sign (her eyes looked like a sun setting) which results from increased CSF pressure due to an obstruction in the flow- most likely at the location of the operation. (It is exciting when the stuff we have spent hours learning about at the library presents in a patient- makes all the time seem worth it.)
Next we were able to examine a six month old boy who suffered from severe hydrocephalus. Hydrocephalus is a condition where an abnormal accumulation of cerebrospinal fluid (usually due to a blockage in the CSF circulation) causes increased pressure inside the skull leading to progressive enlargement of the head. Infants with hydrocephalus have large heads because the increase CSF pressure has caused the individual skull bones (which have not fused with each other yet) to bulge outward. This child, who at 6 months is expected to have a head circumference of 40 cm, had a head circumference of 55 cm, the circumference expected for an adolescent. This child also exhibited the sunset sign. Compression of the brain by the accumulating fluid (increased pressure) eventually causes convulsions and mental retardation in these patients. The cause of this patient’s hydrocephalus is most likely genetic as he is the product of a consanguineous marriage (his parents are first cousins). The physician informed us that the patient would be admitted for a full evaluation and seen by the neurosurgeon on Monday (which is the day of the week the neurosurgeon is at SDM Hospital).
The treatment for hydrocephalus is surgery. A shunt is placed from the brain to the body cavity (most commonly), where the excess CSF can be resorbed. The shunting of the excess fluid relieves the increased intracranial pressure. It is difficult to say what the prognosis for this patient will be as it is probable that a great deal of neurologic damage has already occurred. There are also a number of shunt complications which can occur (malfunction, failure, and infection). If for some reason a shunt fails, CSF will begin to accumulate again, increasing the intracranial pressure and a number of symptoms can develop (seizures). Shunt failure rate is relatively high- patients often have multiple shunt revisions throughout life.
The remainder of this week in pediatrics was fairly uneventful (wellness checks and immunizations). Next week we begin our two week community medicine posting which should be very interesting. As far as this weekend goes… we are planning on relaxing and finalizing our travel plans for a world wind tour of India at the end of July. We will be leaving Dharward in just two short weeks, traveling around India (Bangalore, Mysore, Delhi and surrounding area, and Mumbai), and then returning home on August 1st.
We saw our first foreigner in the hospital, a Canadian. A white woman in her early 20s brought a young girl (with fever and diarrhea) to the clinic. She is in India working with a NGO at a school about an hour outside of Dharward. It was an interesting office visit… the physician was questioning the young girl in Kannada- the local dialect (which she didn’t seem to understand totally) and then speaking to the Canadian woman in English (which she didn’t seem to understand as her first language was obviously French). The physician prescribed some antibiotics and explained oral re hydration therapy. The physician said later that most NGOs in the area are fairly good at handling diarrhea, dehydration, and parasites.
Shortly after a family came in with their two and a half month old daughter. She was born with spina bifida, a developmental birth defect involving the neural tube (specifically the spinal cord and vertebrae), which was operated on at birth in a hospital in northern India. They brought their daughter to the OPD to ensure that she was recovering properly. The physician had a difficult time assessing this as there were no medical records from the patient’s previous care facility. He later explained to us that continuity of care is hard to come by in India.
After performing a general neurological exam, the physician said that the child most likely suffered from a meningocele. A meningocele is the least common form of spina bifida. In this condition some of the vertebrae are split (do not develop properly in utero) and the meninges are damaged and pushed out through the opening. This appears as a sac or cyst on the infants back. The sac contains both the meninges and cerebrospinal fluid (CSF). Luckily the spinal cord and nerves are not involved in a meningocele and neurologic function is generally normal. (In other forms of spina bifida, when the spinal cord is involved, neurologic function is impaired from the point of malformation in the spinal cord and below.)
Side note- the physician also observed that the patient exhibited the sunset sign (her eyes looked like a sun setting) which results from increased CSF pressure due to an obstruction in the flow- most likely at the location of the operation. (It is exciting when the stuff we have spent hours learning about at the library presents in a patient- makes all the time seem worth it.)
Next we were able to examine a six month old boy who suffered from severe hydrocephalus. Hydrocephalus is a condition where an abnormal accumulation of cerebrospinal fluid (usually due to a blockage in the CSF circulation) causes increased pressure inside the skull leading to progressive enlargement of the head. Infants with hydrocephalus have large heads because the increase CSF pressure has caused the individual skull bones (which have not fused with each other yet) to bulge outward. This child, who at 6 months is expected to have a head circumference of 40 cm, had a head circumference of 55 cm, the circumference expected for an adolescent. This child also exhibited the sunset sign. Compression of the brain by the accumulating fluid (increased pressure) eventually causes convulsions and mental retardation in these patients. The cause of this patient’s hydrocephalus is most likely genetic as he is the product of a consanguineous marriage (his parents are first cousins). The physician informed us that the patient would be admitted for a full evaluation and seen by the neurosurgeon on Monday (which is the day of the week the neurosurgeon is at SDM Hospital).
The treatment for hydrocephalus is surgery. A shunt is placed from the brain to the body cavity (most commonly), where the excess CSF can be resorbed. The shunting of the excess fluid relieves the increased intracranial pressure. It is difficult to say what the prognosis for this patient will be as it is probable that a great deal of neurologic damage has already occurred. There are also a number of shunt complications which can occur (malfunction, failure, and infection). If for some reason a shunt fails, CSF will begin to accumulate again, increasing the intracranial pressure and a number of symptoms can develop (seizures). Shunt failure rate is relatively high- patients often have multiple shunt revisions throughout life.
The remainder of this week in pediatrics was fairly uneventful (wellness checks and immunizations). Next week we begin our two week community medicine posting which should be very interesting. As far as this weekend goes… we are planning on relaxing and finalizing our travel plans for a world wind tour of India at the end of July. We will be leaving Dharward in just two short weeks, traveling around India (Bangalore, Mysore, Delhi and surrounding area, and Mumbai), and then returning home on August 1st.
Monday, June 25, 2007
Hot Showers, Diet Cokes, and Monsoon!!
Eva and I left Dharward, just the two of us, on Thursday evening for a weekend of independence after a semi frustrating week. While the things we have seen in pediatrics have been very interesting (two cases of malaria, a case of cerebral palsy, and a few new born exams) we stand around a lot and waste time as the unit seems short staffed and unprepared for students. Aside from the hospital, life at home with the family has been a bit confining- both Eva and I are used to living more independently (everybody here is very concerned with our well being- over the top concerned). We headed out of town on an overnight train to Goa on Thursday the 21st around 11:30. Goa is the state neighboring Karnataka to the west and is well know for its beautiful beaches. The train ride wasn’t too bad, we were in a sleeper car and aside from being a little too close to the bathrooms I was able to sleep most of the way.
We arrived at our stop around 7 AM and unfortunately there was no car to pick us up- a bit of a mix up with the hotel. In general it isn’t super safe (for women) to just hop in a taxi here- so Eva and I had arranged for the hotel to pick us up. Well turns out the car went to a different train station, so after a few phone calls, we got in a pre-paid taxi and headed to our hotel, the Sunset Village Resort. Unfortunately, June isn’t exactly beach weather, what with it being monsoon season and all, but we were determined to make the best of our freedom/independence!! Eva and I checked into our hotel early, got some breakfast (cereal w/ cold milk, lots of fruit, and amazing coffee- most American breakfast I’ve had since arriving), and headed back to our room for a nap. Between the air-conditioned room and soft mattress Eva and I had about the most amazing naps ever.
We crawled out of bed in the afternoon and set off to explore Baga and its beaches. We wandered around but unfortunately most of the shops, restaurants, and hotels are closed for the off season and won’t open again until September. We saw a few foreigners and found an open book store. After purchasing some books (we have finished all the ones brought from home) we walked back to our hotel along the beach. The Arabian Sea looked extremely ruff (due to the season) and there were very few people swimming or even in beach attire. (It hadn’t really rained yet… so I was a bit confused about the monsoon business.)
After returning to the hotel, I took a long hot shower, first one since I left home. We only have cold water at the house- of course with how hot it has been the cold water usually feels pretty good. But the hot shower was truly amazing! Eva and I had dinner and drinks at one of the restaurants in our hotel. After which we sat by the pool for awhile… there were two gentlemen playing a mix of Indian and some pretty bad American music. It is so interesting which American songs people cover all over the world. It began raining while we were at dinner and didn’t really stop for the rest of our time in Goa. I have to say monsoon rain is pretty awesome… it just pours and pours and pours.
On Saturday it was still raining, so after another lovely breakfast, we decided to just relax in our air conditioning and comfy beds. I started one of the new books, napped a little, and worked out. Our hotel had a real gym… with weights and cardio machines :) I’m pretty sure the gym hasn’t ever really been used and I definitely got some strange looks while working out but it felt soo good (again I haven’t had a good workout since I left- gyms aren’t easy to come by here and running outside is sort of out of the question for several reasons). In the evening we took a cab to one of the few restaurants which remains open in the off season for some seafood. Dinner was wonderful. It wasn’t so much that the seafood was wonderful (good but not wonderful)… but more importantly there was Diet Coke (my first… and second… Diet Coke since May). Eva and I also ordered 3 desserts to share. YUM! When we got back to the hotel we enjoyed the poolside entertainment once again and then headed to bed.
I woke up early Sunday to work out and take one last long hot shower. After breakfast we checked out and headed to the train station. Despite the complete absence of ideal beach weather, I didn’t even get my swim suit out of my bag; our weekend at the beach was wonderful. Between the hot showers, the Diet Coke, and the gym… I felt spoiled. The train ride home was fairly uneventful. The scenery was beautiful- rolling mountains covered in jungle and fog and a few waterfalls. After about 7 hours we returned to Dharward around 10 PM. I will remember Goa fondly and will have to attempt to return during the high season- around Christmas time.
We arrived at our stop around 7 AM and unfortunately there was no car to pick us up- a bit of a mix up with the hotel. In general it isn’t super safe (for women) to just hop in a taxi here- so Eva and I had arranged for the hotel to pick us up. Well turns out the car went to a different train station, so after a few phone calls, we got in a pre-paid taxi and headed to our hotel, the Sunset Village Resort. Unfortunately, June isn’t exactly beach weather, what with it being monsoon season and all, but we were determined to make the best of our freedom/independence!! Eva and I checked into our hotel early, got some breakfast (cereal w/ cold milk, lots of fruit, and amazing coffee- most American breakfast I’ve had since arriving), and headed back to our room for a nap. Between the air-conditioned room and soft mattress Eva and I had about the most amazing naps ever.
We crawled out of bed in the afternoon and set off to explore Baga and its beaches. We wandered around but unfortunately most of the shops, restaurants, and hotels are closed for the off season and won’t open again until September. We saw a few foreigners and found an open book store. After purchasing some books (we have finished all the ones brought from home) we walked back to our hotel along the beach. The Arabian Sea looked extremely ruff (due to the season) and there were very few people swimming or even in beach attire. (It hadn’t really rained yet… so I was a bit confused about the monsoon business.)
After returning to the hotel, I took a long hot shower, first one since I left home. We only have cold water at the house- of course with how hot it has been the cold water usually feels pretty good. But the hot shower was truly amazing! Eva and I had dinner and drinks at one of the restaurants in our hotel. After which we sat by the pool for awhile… there were two gentlemen playing a mix of Indian and some pretty bad American music. It is so interesting which American songs people cover all over the world. It began raining while we were at dinner and didn’t really stop for the rest of our time in Goa. I have to say monsoon rain is pretty awesome… it just pours and pours and pours.
On Saturday it was still raining, so after another lovely breakfast, we decided to just relax in our air conditioning and comfy beds. I started one of the new books, napped a little, and worked out. Our hotel had a real gym… with weights and cardio machines :) I’m pretty sure the gym hasn’t ever really been used and I definitely got some strange looks while working out but it felt soo good (again I haven’t had a good workout since I left- gyms aren’t easy to come by here and running outside is sort of out of the question for several reasons). In the evening we took a cab to one of the few restaurants which remains open in the off season for some seafood. Dinner was wonderful. It wasn’t so much that the seafood was wonderful (good but not wonderful)… but more importantly there was Diet Coke (my first… and second… Diet Coke since May). Eva and I also ordered 3 desserts to share. YUM! When we got back to the hotel we enjoyed the poolside entertainment once again and then headed to bed.
I woke up early Sunday to work out and take one last long hot shower. After breakfast we checked out and headed to the train station. Despite the complete absence of ideal beach weather, I didn’t even get my swim suit out of my bag; our weekend at the beach was wonderful. Between the hot showers, the Diet Coke, and the gym… I felt spoiled. The train ride home was fairly uneventful. The scenery was beautiful- rolling mountains covered in jungle and fog and a few waterfalls. After about 7 hours we returned to Dharward around 10 PM. I will remember Goa fondly and will have to attempt to return during the high season- around Christmas time.
Thursday, June 14, 2007
Badami, Bijapur, and the beginning of Pediatrics
We left Dharward at 7:00 AM on Saturday and headed north. Two aunts, one uncle, Eva, and me (plus driver) jumped into the rented SUV and headed out of town. Roads here are definitely sub par so it was a very bumpy ride. Prior to leaving Eva and I read about both Badami and Bijapur in our Lonely Planet- India book to get an idea of what we would be seeing. (while both of Eva’s uncles speak English rather well there is still a significant language barrier at times- we figured it would be best to do a bit of research before departing) We spent both Saturday and Sunday wandering around Hindu temples and Muslim mausoleums. We toured a few gardens in honor of various Hindu Gods. I took lots of pictures which I will have to share at a later date as we still do not have broadband internet. The weather was particularly hot but we still had a very nice time.
We spent the night in a semi questionable hotel... lots of bugs, no shower, and holey mosquito nets. However, our room did have a window AC unit (first air conditioning since I have arrived) and Star Wars II and III (in English) on TV. Eva and I stayed up most of the night chatting. We were a bit apprehensive about falling asleep and being eaten alive by mosquitoes.
On our way back to Dharward we stopped by the home of another one of Eva’s aunts (remember there are 12 siblings in the family). Eva had not yet met this aunt. Upon arrival we were shuffled into the home, fed more than we cared to eat, and given saris which were locally made. In fact on the drive through town, en route to the home, we could look into the shops and see men making the fabric on large looms- lots of bright colors. The hospitality of Indian families continues to amaze me- stopping in (unannounced) is expected- schedules are rearranged, food is prepared, and invitations for staying the night are almost always made. In fact, if one was in the area and did not stop in it would be considered rude. Before leaving, Eva and I, with the help of the Aunts, put on our saris and took pictures with the family. Then it was back in the SUV for three more bumpy hours.
We began our pediatric posting this week- so far it has been pretty good. The children of India are definitely beautiful. We are the only two students in the unit right now. We will join the other students when they begin their time in pediatrics next week. Being the only students has both positives (we get more attention) and negatives (the staff doesn’t always know what to do with us).
On Monday, we observed a physician for about an hour in the out patient clinic- lots of wellness checks/assessment of development and immunizations. Most children here are small for their age due to malnutrition and suffer from anemia, again the result of diet. The majority of India’s population is vegetarian making it difficult to get adequate protein, iron, folic acid, and other vitamins. Dietary supplements are expensive and generally not a feasible solution. In fact a healthy birth weight of a full term infant by western standards is around 3 kg. The healthy birth weight of a full term infant by Indian standards is 2.5 kg. We then received a short lecture I would entitle, “An Introduction to Pediatrics and ‘whatever I feel like telling you.’” The physician was all over the place- I don’t think he had anticipated we would be a part of his day. Eva and I listened attentively and thanked him- but we were glad to leave when he dismissed us. He did share that the general inpatient ward costs around $1/day, while the more expensive private rooms cost around $6/day. Eva reassured me if I got sick we could splurge for a private room. : )
Tuesday, again we reported to the out patient clinic and observed the physician on duty. He informed us that an office visit at the clinic costs 10 Rupees (about a quarter). Immunizations which are covered by the government are free of charge and additional immunizations cost around 20 Rupees. I am not exactly sure which immunizations fall into which category but the examples he gave were: government funded= DPT and polio, independently funded= Hep. B, meningitis, chicken pox
Wednesday was definitely interesting. We reported to the operating room to observe a pediatric surgery. A 3 year old male was having a congenital hydrocele repaired. (I let you look up the details if you are interested) After leaving the OR we went to the pediatric ward to examine two patients- a 6 year old boy and his 3 year old sister. The children are the product of a consanguineous marriage and as a result suffer from severe developmental delays and a metabolic disorder. Both children looked about half their age because of their small size and had extremely distended bellies. Upon palpation it was clear that both children had an enlarged liver and spleen. The little girl also had fluid accumulation in her abdomen. The physician said that some tests were still being preformed (samples have to be sent to a lab in Bangalore) to determine the specifics of the disorder- most likely an autosomal recessive genetic disorder effecting the CNS as well as metabolism.
At the end of this week our clinical time is half over- two more weeks of pediatrics and two weeks of community medicine. My time here is going very quickly. This weekend we are off to Hampi for another site seeing trip with the family.
We spent the night in a semi questionable hotel... lots of bugs, no shower, and holey mosquito nets. However, our room did have a window AC unit (first air conditioning since I have arrived) and Star Wars II and III (in English) on TV. Eva and I stayed up most of the night chatting. We were a bit apprehensive about falling asleep and being eaten alive by mosquitoes.
On our way back to Dharward we stopped by the home of another one of Eva’s aunts (remember there are 12 siblings in the family). Eva had not yet met this aunt. Upon arrival we were shuffled into the home, fed more than we cared to eat, and given saris which were locally made. In fact on the drive through town, en route to the home, we could look into the shops and see men making the fabric on large looms- lots of bright colors. The hospitality of Indian families continues to amaze me- stopping in (unannounced) is expected- schedules are rearranged, food is prepared, and invitations for staying the night are almost always made. In fact, if one was in the area and did not stop in it would be considered rude. Before leaving, Eva and I, with the help of the Aunts, put on our saris and took pictures with the family. Then it was back in the SUV for three more bumpy hours.
We began our pediatric posting this week- so far it has been pretty good. The children of India are definitely beautiful. We are the only two students in the unit right now. We will join the other students when they begin their time in pediatrics next week. Being the only students has both positives (we get more attention) and negatives (the staff doesn’t always know what to do with us).
On Monday, we observed a physician for about an hour in the out patient clinic- lots of wellness checks/assessment of development and immunizations. Most children here are small for their age due to malnutrition and suffer from anemia, again the result of diet. The majority of India’s population is vegetarian making it difficult to get adequate protein, iron, folic acid, and other vitamins. Dietary supplements are expensive and generally not a feasible solution. In fact a healthy birth weight of a full term infant by western standards is around 3 kg. The healthy birth weight of a full term infant by Indian standards is 2.5 kg. We then received a short lecture I would entitle, “An Introduction to Pediatrics and ‘whatever I feel like telling you.’” The physician was all over the place- I don’t think he had anticipated we would be a part of his day. Eva and I listened attentively and thanked him- but we were glad to leave when he dismissed us. He did share that the general inpatient ward costs around $1/day, while the more expensive private rooms cost around $6/day. Eva reassured me if I got sick we could splurge for a private room. : )
Tuesday, again we reported to the out patient clinic and observed the physician on duty. He informed us that an office visit at the clinic costs 10 Rupees (about a quarter). Immunizations which are covered by the government are free of charge and additional immunizations cost around 20 Rupees. I am not exactly sure which immunizations fall into which category but the examples he gave were: government funded= DPT and polio, independently funded= Hep. B, meningitis, chicken pox
Wednesday was definitely interesting. We reported to the operating room to observe a pediatric surgery. A 3 year old male was having a congenital hydrocele repaired. (I let you look up the details if you are interested) After leaving the OR we went to the pediatric ward to examine two patients- a 6 year old boy and his 3 year old sister. The children are the product of a consanguineous marriage and as a result suffer from severe developmental delays and a metabolic disorder. Both children looked about half their age because of their small size and had extremely distended bellies. Upon palpation it was clear that both children had an enlarged liver and spleen. The little girl also had fluid accumulation in her abdomen. The physician said that some tests were still being preformed (samples have to be sent to a lab in Bangalore) to determine the specifics of the disorder- most likely an autosomal recessive genetic disorder effecting the CNS as well as metabolism.
At the end of this week our clinical time is half over- two more weeks of pediatrics and two weeks of community medicine. My time here is going very quickly. This weekend we are off to Hampi for another site seeing trip with the family.
Thursday, June 7, 2007
Last Couple Days in OB/GYN
Our time in the obstetrics and gynecology department will end Friday (June 8th). Next we will move onto pediatrics. The posting as a whole has been very interesting, with the last couple days being the best so far. I am still not sure if this is the specialty for me- but I can say I have enjoyed my time with the department. The physicians, staff, and other students have been extremely helpful and Eva and I are very appreciative. As in the States, OB/GYN is female dominated specialty. We have only encountered one male physician in the department.
On Tuesday, Eva and I reported to the OR (operating room) at 8:30 to observe a laparoscopy assisted vaginal hysterectomy. I wasn’t sure what to expect… but can say now that it was definitely one of the coolest things I have seen. The patient was a post menopausal woman who presented with intermittent vaginal bleeding. After examination and biopsy it was determined that she had a large uterine fibroid and potentially uterine cancer. The treatment selected for this patient was total hysterectomy (uterus, fallopian tubes, and ovaries- are all removed). The decision was made to do a laparoscopy assisted vaginal hysterectomy (the uterus is removed through the vagina after its internal attachments are cut) rather than an abdominal hysterectomy (the uterus is removed through an incision in the abdomen) because it is a less invasive procedure. Here is the play by play… (or at least what I understood)
- the patient was first put under general anesthesia
- 4 small incisions were made on the abdomen (a camera with light was inserted in the incision near the umbilicus and various instruments were inserted in the others- two lateral and one midline but inferior to the umbilicus)
- carbon dioxide was pumped into the abdomen to slightly inflate the abdomen (this gives more room to work and a better view)
- then with the use of a cauterizing tool and scissors (which were inserted into the two lateral incisions) the superior attachments of the uterus were severed
- a instrument which looks like a wand with a small corkscrew at the end (which was inserted into the inferior midline incision and screwed into the fundus of the uterus) was used to move the uterus from side to side stretching the attachments- this made it possibly to identify, cauterize, and cut them
- in a similar fashion both of the ovaries/ fallopian tubes were unattached from the inside (they remained held in clamps which were inserted in the lateral abdominal incisions until they could be removed through the vagina)
- the carbon dioxide was then let out of the abdomen and the physician proceeded to perform the vaginal hysterectomy- first the uterus was removed then the ovaries/ fallopian tubes
- after suturing was complete near the vagina the abdomen was inflated one more time
the physician used the camera with light to visualize the inside- check for bleeding and suction out remaining blood/clots - the instruments were removed from the abdomen and the 4 small incisions were sutured
The surgery took around 3 hours and was pretty amazing.
Today, June 7th, was an equally amazing day. We reported to our posting at 10 AM and it didn’t appear that the students we had been accompanying knew where we were supposed to be. Eva and I decided to check the labor ward as we still had not seen a vaginal delivery here (we saw a c-section last Saturday). The labor ward is two rooms, one for women in the latent phase of labor and one for women in the active phase of labor (again no private rooms- just large rooms with multiple beds). As soon as we walked in we heard some moaning/yelling from the active phase of labor room. Eva turned to me and said, “that sounds promising.” We have been trying to see a delivery all week long and have had no luck. Between 70-90 babies are delivered per month here and we just happen to miss all of them.
One of the physicians we have followed on a few occasions told us that one woman was in active labor (7 cm dilation) with her first child and would likely deliver shortly. Another woman was at 3 cm dilation but was failing to progress much. Child birth in India is very different than child birth in the US-
- epidurals are not used (in part because of a shortage of anesthesiologist and partly because children are considered a gift worth experiencing pain for)
- no family members/friends are allowed in the delivery room (it is just the patients and staff)
- normal delivery at a private hospital costs around 2000-3000 Rupees (40 Rupees= $1)
- c-section at a private hospital costs around 5000 Rupees
The woman delivered a healthy baby girl (with a bit of a cone head) after a lot of hard work, vacuum assistance, and an episiotomy. A pediatrician was present upon delivery to examine the infant. The delivery went well and the physicians did a wonderful job caring for the mother and fetus… but I still can’t help but think I hope I deliver my children in the US w/family in the room and maybe an epidural. :)
The physicians decided to take the other woman, who was failing to progress, to the OR for a c-section. They told us to go have lunch and meet in the OR in half an hour. Eva and I saw our second c-section… this one a little faster than the first as the baby was showing signs of distress. The woman had a healthy baby boy. Turned out to be a very exciting day!
This weekend we are headed to Badami and Bijapur, two cities close by, with Eva’s Uncle and Aunt. Both places are supposed to have some pretty amazing architecture- temples and mosques. (hopefully I can get some pictures and fingers crossed... we will get broadband internet at some point so I can post them) On Monday we will report to our pediatrics posting.
Saturday, June 2, 2007
Trip to Gokak
On Thursday (May 31st) Eva, Shiva, Uncle, and I traveled to Gokak. Gokak, where Shiva and his 11 siblings grew up, is a city about 60 miles from Dharward. However, being as India moves at a different pace than the States (the trip one direction takes about three hours) we left early in the morning and returned late in the evening. The roads were bumpy and busy with buses, cars, trucks, and wagons full of sugar cane/corn pulled by cows, motorcycles, scooters, bicycles, people, goats, sheep, and a few dogs. I was able to see a great deal of Indian countryside and a few small villages on the way. Transportation here is a bit crazy but we arrived to Gokak safely. After a cold drink (the car has no AC and India is hot) at the Gokak Resort (a story all its own) we visited a temple up in the mountains. The “mountains” remind me of the badlands of South Dakota rather than the mountains of Colorado or Alaska.
To get to the temple we had to climb many steps, Eva and I were a bit concerned about Shiva and Uncle. On the trek up we were accompanied by lots of monkeys :) Uncle brought some coconuts and various things for puja (prayer/offering). The monkeys being rather clever and accustomed to guests bringing food snuck up behind Shiva and actually ripped a bag of rice open. Before we knew it a whole gathering of monkeys were feasting on the steps. When we reached to top we explored the temple a bit, took in the view, looked at all the monkeys, and observed puja.
After the temple we continued to Adubathi- the village closest to the farm owned by Eva’s family. The road was dirt and washed out so we walked most of the way. Once in the village we again visited the temple so Uncle could make an offering. I’m not sure how many people live in Adubathi or how frequently they have visitors (especially white visitors) but we developed a small following of children on our way through town. The homes were modest, with cattle in what I would call the front porch, and little kids everywhere. In the river near the temple women were washing clothes on rocks and some little kids were swimming/bathing. I took some pictures of the children and showed them on my digital camera- they laughed.
We walked down another dirt road to the farm house Eva’s family built in 2000. Her family still owns the land but has hired a family to farm it. We sat with the family living there for a bit. It appeared to be a man and his wife, their son and his wife, and the son’s children. The farm was peaceful and a drastic contrast to the hot car and crowded streets we had come from. After a short visit and some pictures we returned to Gokak for lunch and a visit to the home Shiva grew up in. On the way we got stuck in a traffic jam = sitting in a hot car for 45 minutes with the sun beating down and lots of Indian men yelling in a language I don’t understand :) We then went through the market where vegetables, fruits, and all sorts of spices are sold by weight. The streets were lined with local farmers who had brought their goods to town in large bags and spread them out in the street- Thursday is bizarre day in Gokak.
The home was built in 1900 by the family and Shiva’s eldest brother’s wife lives there with her children and grandchildren. The house was about 4 rooms w/an attic where everyone slept. Shiva shared storied about growing up there with his 11 siblings. Shiva and all of his siblings were delivered at home- he showed us the room (just next to the kitchen). The crib, which was used for about 40 children, is still in the house- it is wooden and hangs by hooks and chains from the ceiling. Shiva said it was not uncommon for mother and daughter/ daughter-in-law to be delivering at the same time- I suppose if one woman has 12 children. We had tea with Eva’s cousin as her Aunt had left for a pilgrimage up north and not yet returned. Then it was back in the car for the journey home- we took a different route this time and thankfully it was a bit smoother.
To get to the temple we had to climb many steps, Eva and I were a bit concerned about Shiva and Uncle. On the trek up we were accompanied by lots of monkeys :) Uncle brought some coconuts and various things for puja (prayer/offering). The monkeys being rather clever and accustomed to guests bringing food snuck up behind Shiva and actually ripped a bag of rice open. Before we knew it a whole gathering of monkeys were feasting on the steps. When we reached to top we explored the temple a bit, took in the view, looked at all the monkeys, and observed puja.
After the temple we continued to Adubathi- the village closest to the farm owned by Eva’s family. The road was dirt and washed out so we walked most of the way. Once in the village we again visited the temple so Uncle could make an offering. I’m not sure how many people live in Adubathi or how frequently they have visitors (especially white visitors) but we developed a small following of children on our way through town. The homes were modest, with cattle in what I would call the front porch, and little kids everywhere. In the river near the temple women were washing clothes on rocks and some little kids were swimming/bathing. I took some pictures of the children and showed them on my digital camera- they laughed.
We walked down another dirt road to the farm house Eva’s family built in 2000. Her family still owns the land but has hired a family to farm it. We sat with the family living there for a bit. It appeared to be a man and his wife, their son and his wife, and the son’s children. The farm was peaceful and a drastic contrast to the hot car and crowded streets we had come from. After a short visit and some pictures we returned to Gokak for lunch and a visit to the home Shiva grew up in. On the way we got stuck in a traffic jam = sitting in a hot car for 45 minutes with the sun beating down and lots of Indian men yelling in a language I don’t understand :) We then went through the market where vegetables, fruits, and all sorts of spices are sold by weight. The streets were lined with local farmers who had brought their goods to town in large bags and spread them out in the street- Thursday is bizarre day in Gokak.
The home was built in 1900 by the family and Shiva’s eldest brother’s wife lives there with her children and grandchildren. The house was about 4 rooms w/an attic where everyone slept. Shiva shared storied about growing up there with his 11 siblings. Shiva and all of his siblings were delivered at home- he showed us the room (just next to the kitchen). The crib, which was used for about 40 children, is still in the house- it is wooden and hangs by hooks and chains from the ceiling. Shiva said it was not uncommon for mother and daughter/ daughter-in-law to be delivering at the same time- I suppose if one woman has 12 children. We had tea with Eva’s cousin as her Aunt had left for a pilgrimage up north and not yet returned. Then it was back in the car for the journey home- we took a different route this time and thankfully it was a bit smoother.
Friday, May 25, 2007
Our first week at the hospital is coming to an end. It has been an interesting week to say the least. Wednesday was our first day attending postings in OB/GYN. Postings are similar to clinical rotations and lasts from 10:00 AM -12:30 PM. Here in India 2nd year medical students receive and introduction to clinical rotations. The OB/GYN rotation is 9 days long, so Eva and I have joined a group of 5 other 2nd year students who study here at SDM for the time being. I'm not sure what we will be doing after they move onto their next posting as we are scheduled to be in OB/GYN till the 9th of June, I believe.
On our first day, Wednesday, we received an introduction of how to perform an obstetrics exam. A faculty member, with the assistance of a patient, demonstrated how to take a history and perform a physical/obstetrics exam. The teaching style/vocabulary used were very similar to medical school in the States (history of present illness, chief complaint, etc). The lesson was interesting and I felt like I learned a lot.
The second day, Thursday, was a little different. Upon arriving at 10 we were told it was OPD= out patient day. I figured that this meant going to the out patient clinic and shadowing a physician as he saw patients. However, I was mistaken. We proceeded downstairs to the out patient clinic to meet with Dr. Maht. He began by giving us a summary of the previous days lesson. Then he brought in a patient and basically said "go to it"... we were to take a history, do a physical exam, and give report when he returned. Seeing as Eva and I don't speak the language (all teaching is done in English but the majority of the patients only speak Kannada- the local dialect)... it seemed unlikely we could assist. The 5 medical students we are accompanying looked confused about how to begin. After much discussion amongst themselves, in front of the patient, they began. The history taking and exam were done in an unorganized incomplete fashion. All 5 of the students approached the patient at once, asking random questions, taking blood pressure, and palpating her abdomen. Eva and I observed both thinking how different things are in the States. Patients at home would definitely complain about this, however our patient seemed amused as the med students scrambled. Dr. Maht returned after about a half an hour and the students began to give report, which he quickly interrupted and corrected. He then proceeded to talk for about 45 minutes, instructing the proper way to perform a history and physical exam. Eva and I were both getting restless and were pleased when he dismissed us around 12:30. We then met up with the son of a family friend who attends medical school here for lunch. He is very nice and showed Eva and I where most of the students eat/socialize.
On the third day, Friday, we were to observe two vaginal hysterectomies in the operating room (OR). Eva and I came early so we could see the entire surgery. After a bit of confusion about where to be, we changed into scrubs, and walked into the OR. Shortly after arriving, while the anesthesiologist was giving a spinal, Eva began feeling faint and left the room. I was still doing alright and observed as Dr. Maht began the procedure. It wasn't a half hour when I also began to feel faint. Luckily some nice gentleman in the OR offered me his chair. I sat for a few minutes (cold sweats and shaky) and then felt sick... so proceeded to the bathroom. It appears that both Eva, her father - who got sick the night before, and I are adjusting the food/water here. After making 3 trips from the OR to the bathroom I decided to give up on seeing the rest of the surgery and just sat in the locker room feeling nauseous. So needless to say it wasn't the best day...
Today, Saturday, we came early for seminar. They have lecture every Saturday morning at 8:30 for staff and students. Today's lecture was on monoclonal antibodies... the majority of the information Eva and I had been exposed to in Imunology. After lecture we reported to posting which turned out to be another day in the OPD. This time was similar to last. We saw three women, all were over 7 months pregnant and three to four years younger than me. For two of the women it was their second child. Again, Eva and I didn't understand much of the interview/exam because of the language. All in all it was still an interesting day.
After returning home, the power went out three times.... really not a huge deal except no power = no fans = sitting and sweating :) We also had our first monsoon rain which really cooled things down and made sleeping wonderful. Monday we are supposed to report to the OR at 8:30 again... hopefully this time around will be a better experience.
On our first day, Wednesday, we received an introduction of how to perform an obstetrics exam. A faculty member, with the assistance of a patient, demonstrated how to take a history and perform a physical/obstetrics exam. The teaching style/vocabulary used were very similar to medical school in the States (history of present illness, chief complaint, etc). The lesson was interesting and I felt like I learned a lot.
The second day, Thursday, was a little different. Upon arriving at 10 we were told it was OPD= out patient day. I figured that this meant going to the out patient clinic and shadowing a physician as he saw patients. However, I was mistaken. We proceeded downstairs to the out patient clinic to meet with Dr. Maht. He began by giving us a summary of the previous days lesson. Then he brought in a patient and basically said "go to it"... we were to take a history, do a physical exam, and give report when he returned. Seeing as Eva and I don't speak the language (all teaching is done in English but the majority of the patients only speak Kannada- the local dialect)... it seemed unlikely we could assist. The 5 medical students we are accompanying looked confused about how to begin. After much discussion amongst themselves, in front of the patient, they began. The history taking and exam were done in an unorganized incomplete fashion. All 5 of the students approached the patient at once, asking random questions, taking blood pressure, and palpating her abdomen. Eva and I observed both thinking how different things are in the States. Patients at home would definitely complain about this, however our patient seemed amused as the med students scrambled. Dr. Maht returned after about a half an hour and the students began to give report, which he quickly interrupted and corrected. He then proceeded to talk for about 45 minutes, instructing the proper way to perform a history and physical exam. Eva and I were both getting restless and were pleased when he dismissed us around 12:30. We then met up with the son of a family friend who attends medical school here for lunch. He is very nice and showed Eva and I where most of the students eat/socialize.
On the third day, Friday, we were to observe two vaginal hysterectomies in the operating room (OR). Eva and I came early so we could see the entire surgery. After a bit of confusion about where to be, we changed into scrubs, and walked into the OR. Shortly after arriving, while the anesthesiologist was giving a spinal, Eva began feeling faint and left the room. I was still doing alright and observed as Dr. Maht began the procedure. It wasn't a half hour when I also began to feel faint. Luckily some nice gentleman in the OR offered me his chair. I sat for a few minutes (cold sweats and shaky) and then felt sick... so proceeded to the bathroom. It appears that both Eva, her father - who got sick the night before, and I are adjusting the food/water here. After making 3 trips from the OR to the bathroom I decided to give up on seeing the rest of the surgery and just sat in the locker room feeling nauseous. So needless to say it wasn't the best day...
Today, Saturday, we came early for seminar. They have lecture every Saturday morning at 8:30 for staff and students. Today's lecture was on monoclonal antibodies... the majority of the information Eva and I had been exposed to in Imunology. After lecture we reported to posting which turned out to be another day in the OPD. This time was similar to last. We saw three women, all were over 7 months pregnant and three to four years younger than me. For two of the women it was their second child. Again, Eva and I didn't understand much of the interview/exam because of the language. All in all it was still an interesting day.
After returning home, the power went out three times.... really not a huge deal except no power = no fans = sitting and sweating :) We also had our first monsoon rain which really cooled things down and made sleeping wonderful. Monday we are supposed to report to the OR at 8:30 again... hopefully this time around will be a better experience.
Tuesday, May 22, 2007
So... today we went to the hospital to meet with the Dean of the medical school, the head of the OB/GYN department, the head of the pediatrics department, and the principal of the public health program. After much conversation... I think... we have our summer figured out :) Eva and I will be spending 1/3 of our time in each department beginning with OB/GYN and ending with public health. We are to be at the hospital tomorrow at 10 AM to go on rounds (yes rounds are at 10, a little later than rounds in the States I would say). We toured both the obstetrics and pediatrics departments today. Our time with the public health program will be at rural clinics... so we will have to wait to see what those are like. The wards that we did see seem relatively nice. Like most hospitals I have seen in developing countries, the wards consist of large rooms with lots of beds. There are no private rooms. The staff seems very receptive to having us there and the patients maybe a bit hesitant. (I still have yet to see another white person) The hospital we are working in is affiliated with a medical school (similar to the set up at the University of Iowa) so there are medical students all over the wards. This makes me feel more at ease as the staff physicians are used to teaching students.
After leaving the hospital we spend the rest of the afternoon reading and napping. It has been very hot the last two days, which makes both Eva, her father, and I very sleepy. I have finished one book and started the second since arriving. It is so nice to read for pleasure. Eva and I discovered a new part of life in India today... cockroaches... large cockroaches. Eva's farther Shiva killed them for us. I'm not sure what we will do when he returns to the States. We may have to recruit her uncle's assistance. The sewers are open in India meaning that cockroaches can climb up drainage pipes from sinks/showers into the house. The bathrooms in the house have one common drain for both the sink and the tub... we put a screen over the one in ours today :) Hopefully this helps.
We went to market tonight to buy some fruit, cereal, and juice. Eva's aunt has been cooking non stop for us... we are hoping with these purchases she won't feel the need to cook us breakfast before going to the hospital each day. We plan to eat lunch at the medical school or a restaurant close by. Since arriving I have yet to feel hungry. Eva's family is always feeding us... and everything has been wonderful. My stomach has been doing okay... no major illness yet. The market is crazy. It is streets and streets of small "mom and pop" stores as well as street vendors. There are people, cars, motorcycles, bicycles, buses, and rickshaws (small three wheeled open air taxis) everywhere. Walking around is a sensory overload... the sights, sounds, and smells are all new. We also stopped by a book store. Eva is trying to learn Kanada, the local dialect, which is what the majority of her family members speak (in addition to English). I picked up some books on India festivals and the gods of the Hindu religion. We also got mats made so that Eva and I can do yoga/ pilates before going to the hospital.
I am very happy to be here and things are going well. The pace of life is very different from the US and I am still getting used to it (it took 1 hour to exchange money yesterday). Family is extremely important here so I feel very safe/comfortable living with Eva's family.
After leaving the hospital we spend the rest of the afternoon reading and napping. It has been very hot the last two days, which makes both Eva, her father, and I very sleepy. I have finished one book and started the second since arriving. It is so nice to read for pleasure. Eva and I discovered a new part of life in India today... cockroaches... large cockroaches. Eva's farther Shiva killed them for us. I'm not sure what we will do when he returns to the States. We may have to recruit her uncle's assistance. The sewers are open in India meaning that cockroaches can climb up drainage pipes from sinks/showers into the house. The bathrooms in the house have one common drain for both the sink and the tub... we put a screen over the one in ours today :) Hopefully this helps.
We went to market tonight to buy some fruit, cereal, and juice. Eva's aunt has been cooking non stop for us... we are hoping with these purchases she won't feel the need to cook us breakfast before going to the hospital each day. We plan to eat lunch at the medical school or a restaurant close by. Since arriving I have yet to feel hungry. Eva's family is always feeding us... and everything has been wonderful. My stomach has been doing okay... no major illness yet. The market is crazy. It is streets and streets of small "mom and pop" stores as well as street vendors. There are people, cars, motorcycles, bicycles, buses, and rickshaws (small three wheeled open air taxis) everywhere. Walking around is a sensory overload... the sights, sounds, and smells are all new. We also stopped by a book store. Eva is trying to learn Kanada, the local dialect, which is what the majority of her family members speak (in addition to English). I picked up some books on India festivals and the gods of the Hindu religion. We also got mats made so that Eva and I can do yoga/ pilates before going to the hospital.
I am very happy to be here and things are going well. The pace of life is very different from the US and I am still getting used to it (it took 1 hour to exchange money yesterday). Family is extremely important here so I feel very safe/comfortable living with Eva's family.
Friday, May 18, 2007
I have arrived :)
So I am finally in India. We arrived to Dharward after three flights and a night stay in Bombay. Eva's family, who I will be staying with for the summer is wonderful! The house is very large, Eva and I will be sharing a room and have our own bathroom. They have a Great Dane at the house named Sparky... he is kind of the watch dog I guess. Her family had a party to welcome us last night at her aunt's mango farm. There were about 30 family members there and tons of Indian food. I am currently trying to figure out the internet situation so this post will be short... but I just wanted to let everyone know that we are here and safe. Today, we went to the hospital we will be working at this summer. The facilities were surprisingly nice and I am looking forward to learning a lot :) It is a private hospital with around 700 beds. We will be working there for 2 months and then traveling around the country the remainder of the time. On a side note... since arriving in Dharward, I have yet to see another white person :) I get a lot of strange looks and a group of children at the hospital all waved at me today. I'm not sure how large Dharward is... I have asked a few people and the responses have varied from more than 10,000 to about 2 million. I will investigate this one further.
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