Saturday, January 26, 2008
Stopping in the Middle East
Thursday, January 24, 2008
Goodbye Sweet India
I was asked to make a speech by someone from the tourism department regarding their International Dance Festival. The background is a rock carving from 400AD. Random weird stuff like this speech has happened frequently. I made a joke that they must have had good forsight in carving the wall just for this dance festival. Nobody laughed, there is quite a language barrier.
Wednesday, January 23, 2008
Leprosy
Staff bus at Karigiri.
Monday, January 21, 2008
Nurse Rounds
Men readying their boat to fish in the morning.
hello all -
I am going to postpone my leprosy blog once more because I need to do some more research since it will be part of my grade. So, instead I will share about our nursing rounds on Friday and our great trip to Mumallapurum.
The Jist:
I have started my last week at CMC, now rotating through the PM&R department. I will blog on that after I have been there for a few days. I leave on Saturday for Dubai, where I will stay until returning back to the states on Tuesday.
The Medical:
CMC has an outreach program called Community Health and Development (CHAD). Part of this program includes nursing rounds. A group of villages have a health aid, a group of groups of villages has a nurse, and then there is a head nurse who covers around 20,000 people and visits the villages as needed, hitting each village about once every two weeks. The purpose is to field any minor problems to prevent patients from having to go the the ER. They also keep records of deaths and births along with pregnancies. Many of the visits are for prenatal care. That is just a quick summary, but pretty much they check on people in their homes. Doctors rounds, as blogged about earlier, is really a mobile clinic and there are no home visits.
It was an eye-opening day and the nurse who was with us was very open to questions and ready to teach. Our first visit was to a home (see picture above) to investigate a recent death of a 65 yo man. The family and other members of the community gathered to recount what had happened and this quickly became an argument, forcing the daughter to leave the house as she disagreed with the details given by others. It was a tense encounter, though in another language I could sense that this was a difficult situation. This picture is one of my favorites because it tells a story. On the right sits the nurse, recording the details of the death and turning her eyes towards someone speaking about the circumstances. The middle lady is the wife of the man who died. For seven days after the death of the husband she is allowed to wear bridal clothes, expensive jewelry and other decorations - including the traditional necklace she is wearing which she acquired at her wedding. On the seventh day her family will remove these objects and she will no longer be allowed to dress in anything other than a plain sari. She will never again wear jewelry or a red mark on her forehead (called a bindi, signifying a married woman - but more recently young unmarried girls wear bindis as a fashion mark). Widows are considered bad luck. In the past, widows were known to throw themselves on the funeral pyre of their husband because life as an unmarried woman is harsh. That is less common, but the stigma still persists.
We also visited the home of the young boy who is pictured. He suffers from juvenile rheumatoid arthritis, quite a disabling and progressive condition. His father carries him everywhere. All who know him comment that he is one of the smartest children in the village. His older brother suffers from seizures and is mildly mentally retarded. This is quite a burden for a farming family and I wonder how they make it but they do. The love for their children is palpable. Just as we were about to drive away the mother approached the car in tears, asking for medication of some sort for a pain, but I had this feeling maybe she felt she could express to us safely that she was a bit overwhelmed herself. The nurses talked with her for a while and handed her some pills, likely vitamins or something.
We visited more villages and the nurses performed several prenatal exams. We examined one child for malnutrition. The nurse saw a patient who just two weeks prior was laying in the street unresponsive. She had a stroke and was left for dead by her family, but they took her to the hospital with the nurses encouragement and on this day at least she was walking and smiling as we encouraged her to take her medication.
I really enjoyed the change in scenery, being out in the rural areas reminded me of the place where I grew up. I had quite a chuckle when the other students were snapping multiple photos of the cows and goats. Smells were very familiar to me and I felt proud to have grown up around nature. I noticed a bag hanging from a tree (pictured above) and soon found out it is tradition to hang the cow's placenta in the tree to encourage cow fertility. Now, I don't remember seeing that as a child but whatever.
I like the system because it has layers of intimacy between the medical community and patients. Each village has an aid that seems to know the business of everyone in the area since that is her job. She was able to predict who would be home when based on their habits and whether or not they were seeing family for Pongal season. She is even able to coax out of them the truth of their medication compliance, since it is fairly common for them to not disclose noncompliance to their doctors.
CHAD was something I heard about during the presentation by the students from last year that made me want to come to CMC. My feelings were justified, it is a unique and privileged experience. People will invite you into their home and make a place for you to sit. It is like seeing patients up close and personal, on a real life level. I can't recall doing anything similar in the states which is a shame.
The Beach:
We had a great, restful weekend in Mumallapurum - a beach town south of Chennai. I was able to get a one hour massage for $12. A four course feast runs about $5. I am thankful to be in an area with such cheap prices, I have decided Europe is way too expensive and money can go a lot farther in places like India. For one meal I was teased by another student for ordering something "safe" - a vegetable coconut curry. I asked the waiter to bring me the hottest thing on the menu, and he brought me something called Devil's Chicken. I ate the whole thing and am still alive with no intestinal difficulty.
Thursday, January 17, 2008
Take a break
Wednesday, January 16, 2008
Happy Pongal!
Monday, January 14, 2008
Quiet possibly my strangest day yet
Saturday, January 12, 2008
People who serve God should have plush towels
The Jist:
My first week in India has come to an end. We visited the Vellore Fort and temple today and got in some good shopping and a great lunch at Hotel Darling. Tonight will be just time to relax before starting the rural health rotation on Monday. This blog does not have an easy way to move pictures around, so apologize for the random placement.
The Medical:
We saw an interesting case in the pediatric population. There was a young boy who had met all milestones until about six months of age when he was not crawling and still not standing by one year. Since then he walks, but unsteady with many falls and appears to be deteriorating. The white on his forehead is a common religous marker. He has a congenital myopathy that is degenerative, more tests are pending. His face is dysmorphic as well, notice his eyes seem widely spaced.
I took video of his eyes and gait, not the best quality but you can see it:
My Thoughts:
I sprayed DEET bug spray on my arms and neck to avoid malaria harboring mosquitos. Well, I also ate some pringles. The small amount of DEET must have touched my lips because they tingled and went numb. I guess it works.
There is a language barrier obviously, but even more than I appreciated. Each of the students has had the same experience that instead of responding "I don't know" to a question about location, sometimes they just point which means go away you are making me uncomfortable, but we take it to mean that is where the place is that we were asking about. It can be confusing.
I have decided that some cows are fat and some cows are skinny. Whoever feeds the cows must play favorites.
Some people here are very uncomfortable if you are standing up when you could be sitting. "Please sit, please sit", chairs will be summoned from all parts of the Earth in order to have you sit. Saying you are just wanting to stretch your legs and would rather stand is not really a good excuse.
A patient lunged towards my attending in what I thought was an aggressive move, but he was really just attempting to "wash his feet" by dusting his shoes, a sign of respect.
The towels on the CMC campus are quite worn and barely functional. If I had an extra grand lying around I might by new towels for everyone. People who serve God like this deserve plush towels to use after a long day of work.
Taking the young patients picture caused a stir in the pediatric ward. Nurses requested I take pictures of all the children.
Thursday, January 10, 2008
The adventure continues, plus luggage
The Medical:
Nurses wear pure white saris with plastic hats.
Wednesday, January 9, 2008
Grand Rounds
Good day today with grand rounds. My luggage is "on its way" and I bought my first sari.
The Medicine:
Today was grand rounds where the whole neurology team of about 12 residents and two attendings rounds on every patient (approximately 50). There is an astonishing variety of cases here. One girl presented with persistent headache of several months. It was diagnosed today as disseminated tuberculosis with chronic meningitis. TB is very common here and I think I will return home with a positive PPD test. There is no quarantining here. In the US you will find many patients on isolation for VRE or MRSA and definitely TB, but I don't think the facilities would accomodate that here. Many of the patients present not due to an acute event necessarily but because they have been finally brought to medical attention after dealing with something for years. We have a young boy on the service with a strange congenital myopathy yet to be biopsied, who walks with a leg descrepancy and pes cavus with hammer toe. This is his first time to see a doctor at age 10.
Final Thoughts:
We had a good Indian lunch today at China Town. Chicken masala with stuffed paneer - excellent.
Indian women are downright beautiful, their clothes are always colorful and many wear nose rings, earrings, necklaces, toerings, and bangle bracelets.
The nurses here dress in solid white saris with a plastic nurse hat.
"The Gift of Pain" by Dr. Paul Brand is a great book.
Tuesday, January 8, 2008
I made it
So I am here after 38 hours of flying and taxis, safe in the Christian Medical College Campus of Vellore, India. My luggage is taking it’s own vacation and I started my neurology rotation today. This blog is rambling secondary to fatigue, but I promise they will be more cohesive in the future...
The Meat:
I left San Antonio Friday afternoon full of excitement, anticipation and a margarita. Little did I know we would be stranded on the tarmac for over an hour, each 20 minutes brought a new announcement of further delay. My head was churning with the math – how long would we have to connect to our flight in Houston? Well, not long. Once we landed I ran one mile with a forty pound backpack plus my carryon bag. I guess those days at the gym were no help, I nearly hijacked a cart to get there on time. Waiting another day was in the balance, so I ran in my one inch mules as fast as I could. I was the last one on the plane.
The fifteen hour transatlantic was enjoyable after I caught my breath. I sat next to a nice couple (Rachel and Thomas) from Dallas returning to India to visit family. They were good conversation and offered helpful tips during our group bathroom breaks. Emirates airlines provides personal tvs with hundreds of games, movies, tv shows so the time passed though it was the most taxing flight I have taken. Once arriving in Dubai I realized we made a good decision to tack on a few days there on our way back. The airport was a masterpiece and the surroundings were so interesting I know it will be fun to return. We took a 3 hour flight to Chennai, India – the best one yet as I got a free upgrade to business class due to a seating error. We arrived in Chennai at 2am Sunday morning and waited an hour to find out our bags did not make the tight connection in Houston. After making our baggage claim and searching for a hotel, we decided the easiest thing to do was sleep in the lobby as it was already 5am and hotel advice was hard to find. We somehow waited around until 2pm, when we met up with others to get a taxi to Vellore.
Vellore was a welcome site, our final destination. The city itself is cramped, but the campus is full of gardens, chapels, and open spaced all within a secured area. Our room included some friends – er roaches – who we tried to battle with no avail. We are now in better housing tonight and thankful for that.
The Medicine:
I started my Neurology rotation today hoping to see interesting cases and sure enough there were more than I could have imagined. Tuberculosis meningitis, cavernous sinus thrombosis, transverse myelitis, suicide attempt by hanging, typhoid/malaria, and many more. These cases are so incredible and I will blog more this week as the rotation develops. I have found the attendings to be so helpful and patient as they have to translate nearly every conversation just for my benefit. The whole CMC place is special, it has a divine feel about it and I am privileged to be here.
Final Thoughts:
My new friends on the plane said it would be good to see India for India and refrain from making comparisons to the US. So, in that spirit, I will orient my blogs towards being an observer, not just a scorecard between India and what I know as normal.
My dad will not fit in an economy seat for a transatlantic flight - dad you may want to look into that.