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.