I was assigned to ID this week, but it ended up becoming a conglomeration of everything I was trying to see before leaving India. On the first day back from Kerala, I showed up to the latter half of CMC's Hansen's disease clinic, which were run by Dermatologists. The first feature I noticed was the classic rash of leprosy: hypopigmented, ill-defined borders, eventually anesthetic. I had never seen leprosy before, so throughout my life, it felt like a mythical disease. That's why my first leprosy patients were so eye-opening, even if their disease were not advanced enough to manifest deformities. I plan to devote my next entry to leprosy, so I will save the details until them. For the next 3 days, I worked in the ID wards, where I saw multiple cases of MDR TB, and the Pediatric ID clinic. The Pediatric ID attending, Dr. Valsan, is one of those rare teachers who can carve an impressionable understanding of all the complexities in a medical condition, including those originating from gross inequity and social injustices. He always had an opinion to pick your brain. For instance, I remember when I asked him what he thought about Slumdog Millionaire, a success that was huge news in India at that time. His response was, "It is a good film that will, at most, stir the conscience." He told me about other documentaries in the past revealing social inequities in India, including an Academy-award winner called "Born into Brothels". The film told the story of children of sex traffic workers in Calcutta. A year or two later after its release, one of the film interpreters discovered that most of the children had already followed into their mothers' circumstances. He posed the question: What glorifies these expensive, time-consuming films? Change, or simply the idea of it?
I want to close this entry with a moment of enlightment I experienced on Thursday. As it turns out, Thursday morning was the deadline for our residency match lists. However, I woke up that morning to discover that an incident had occurred which lost my place in the match for residency. The entire morning, I felt like my stomach had turned over with the idea of scrambling or taking a year off, of flushing down the time and money I spent applying and interviewing. My eyes were blinded by these worries, but as the day progressed, I began to look around at the people walking in the streets earning $1 a day, at the women who will never have the choice of an education, at the beggars who were outcasted from society for one reason or another. I began to find perspective: I am definitely lucky-- in fact, I'm so lucky that it is difficult to imagine when I lose things. But look at the resilience, the happiness that people can still find when they have nothing. This comparison was once a concept to me, but I supposed I needed an experience that was very real, that challenged the way I percieve my life, to make me understand.
Wednesday, February 25, 2009
Monday, February 23, 2009
Kerala
We visited the southwestern state of Kerala, a state known for the beauty of its backwaters and its progressive culture. For instance, Kerala is thought to be one of the states that pushed women's roles in society (such as hiring the first women police officers). These acts are not insignificant in South India, where traditional ways of thinking, such as gender disparities, are still very much a part of life. Many of the more progressive Indians believe that, as a result of it's many breakthroughs, Kerala has one of India's highest literacy rates (90%, average life expectancy (73%), and household income. A seasoned Pediatrician I worked with who has practiced in multiple states in India (and also in the US) gave an example. He believes that much of Kerala's low infant mortality rate (1/3 of India's average) is attributed to the education of women--because more of Kerala's women are literate, they are also more educated about health and nutrition in prenatal care and parenting.
Much like many of our experiences in India, our journey to Kerala was a perfect example of losing our usual sense of control over our lives. In a sense, we travelled for 13 hours to another corner of India which we knew almost nothing about. Our journey started with an exhausting first day in Cochin. You see, during our time in India, I gradually acquired a stubborness in bargaining and an "excessive caution" of being cheated or taken advantage of. This became problematic in the tourist-saturated Cochin. If a rickshaw didn't offer a desired price (even if we are carrying all of our luggage, or are exhausted with achy feet).......we will walk the entire distance. Needless to say, we could barely stand at the end of the day.
Thus our second day began with a lazy morning sitting on a boat that gave us a glimpse of Kerala's beautiful backwaters and village life. It struck me how on an island just adjacent to the city, a completely different lifestyle could exist...where women fetched their daily water from a reservoir in the ground (which can often run low), harvested their own cooking oil and vinegar from coconuts, and wove fishing nets for the men who spent all day on the water. We also saw a rich diversity of plants that had uses from medicines to insecticides to henna ink. The last part of our journey in Kerala was spent in the cliff-side beaches of Varkala, where this chapter of our time in India closed beautifully. Much like we watched the sun rise from the East in the Bay of Bengal only a week ago, Varkala showed us the sun sinking into the West, into a layer of mist hovering over the Arabian sea.
Much like many of our experiences in India, our journey to Kerala was a perfect example of losing our usual sense of control over our lives. In a sense, we travelled for 13 hours to another corner of India which we knew almost nothing about. Our journey started with an exhausting first day in Cochin. You see, during our time in India, I gradually acquired a stubborness in bargaining and an "excessive caution" of being cheated or taken advantage of. This became problematic in the tourist-saturated Cochin. If a rickshaw didn't offer a desired price (even if we are carrying all of our luggage, or are exhausted with achy feet).......we will walk the entire distance. Needless to say, we could barely stand at the end of the day.
Thus our second day began with a lazy morning sitting on a boat that gave us a glimpse of Kerala's beautiful backwaters and village life. It struck me how on an island just adjacent to the city, a completely different lifestyle could exist...where women fetched their daily water from a reservoir in the ground (which can often run low), harvested their own cooking oil and vinegar from coconuts, and wove fishing nets for the men who spent all day on the water. We also saw a rich diversity of plants that had uses from medicines to insecticides to henna ink. The last part of our journey in Kerala was spent in the cliff-side beaches of Varkala, where this chapter of our time in India closed beautifully. Much like we watched the sun rise from the East in the Bay of Bengal only a week ago, Varkala showed us the sun sinking into the West, into a layer of mist hovering over the Arabian sea.
Thursday, February 19, 2009
Healthcare on Wheels
What an extraordinary day on the doctor-run mobile clinics. I rode along in the mobile which set up care for around 200 patients in five different villages: Allivarum, Kannadipalayam, Pappanthopu, Dharmavaram, and finally, Veppampet. All of these villages are part of CMC's peripheral clinic territory called Kaniyambadi, which covers an entire 46 km radius. Kaniyambadi has been drastically impacted by CMC's presence for over 40 years. For instance, infant mortality, a health statistic known to be strongly correlated with socioeconomic status, is almost 0%, compared with India's average rate of 55%.
Today I caught a glimpse of why this model of health care delivery is so potent. In each of the villages, we set up 2 stations: a desk for chronic morbidities outside and the antenatal care station inside our van, next to the pharmacy. Patients knew to come the same time every month bringing their own health records, and were reminded to keep their appointments by their health aide worker. From the moment we set foot into a village, patients would rapidly appear until they engulfed our table.
One of the most fascinating aspects of today were the few untouched glimpses into the daily village life from which our patients emerged. I was able visit the rice and sugar cane fields where I watched farmers covered with wrinkles from age and sunlight nudging their cows along as they plowed the land. I watched as young children napped on the tiny cement floor of the village preschool, surrounded by swarms of flies brought in from the hot weather. I saw a nomadic family of stone-cutters, who were part of a casteless and outcasted group called the "untouchables" thought to have descended from criminals. The father, thin and gray haired, sat expressionless in front of their cloth tent, their daughter stared at me curiously while she held a stray puppy, and the mother squatted to balance a hot pot on her feet. I watched women walking to their homes as they balanced buckets of water on their or gigantic bales of hay on their back. I listened as a newlywed woman, who did not appear older than 16, explaining the family charms on her gold marriage necklace.
Separated from a schedule and carried only by the drift of the day, I also discovered many simple pleasures such as walking into a grove of beautiful trees and identifying mangos on the verge of ripening (two major Hindu dieties were married under a mango tree, so it is often thought of as a symbol of love). I also greatly enjoyed playing with the children, and watching their improvised singing and dancing performances. Afterwards, they would crowd excitedly around my camcorder to watch themselves in replay. I sat under a plantation of coconut trees and admired how their abundance once provided the idea for iv hydration at CMC when sterile water was scarce. Imagine that--walking into a cutting edge hospital in India to find all the patients hooked up to coconuts. Apparently this provided the idea for the oral rehydration formula. I think it takes moments like these, when our minds are stolen from the whirlwind, to help us truly appreciate our surroundings and the gifts that they give us.
But the beauty of the day could not conceal many realities, many of which were explained to me by Sharon, the community physician who worked in the antenatal care station. For instance, I began to learn more gender disparities. When a newlywed woman gave birth to a girl, the family would mourn rather than throw the usual elaborate celebration for newborn boys. Girls are often thought of as liabilities, as they must be supported until their families somehow scrounge the money for their marriage dowries. We saw many women who claimed to be 18 or older, but were really 14 or 15, as their families attempted to marry them off as soon as possible. Unfortunately, women with any health problems, even with a condition like rheumatic heart disease, are seen as being defective and near impossible to marry off...unless somehow their family can offer a dowry that is unheard of.
After marriage, any inability to concieve, or even to concieve a male, is blamed on the woman who will often suffer consequences--beatings by her husband and his family, and in some cases "bride burning" (is what it sounds like) which can lead to her death. If she attempts to divorce her husband, or if she is somehow widowed, she is denegraded to the level of a prostitute and outcasted from society. Males, on the other hand, can remarry without difficulty. The government makes regulations, but in the end, they truly have little power over these cultural norms that have been ingrained over hundreds of years. It is like trying talk over a stadium full of chattering people who do not care to listen.
There is only so much that CMC's mobile clinics can do for their community's health and wellbeing--which is tremendous, don't misunderstand. But some things are not easily changed--gender roles, cultural chauvinism, care for the elderly and handicapped. I feel that much of my journey in India is an attempt to enrich my understanding and appreciation for different ways of life. However, there are some ideas which are difficult for me to understand outside the context of a natural pursuit for class power and wealth. Is it because I value or percieve freedom and happiness differently? Either way, I believe that greed and chauvinism, which exists anywhere in the world, provide the inequities that lead to maldistribution of education, clean water, and nutrition--staples of health and well-being.
Today I caught a glimpse of why this model of health care delivery is so potent. In each of the villages, we set up 2 stations: a desk for chronic morbidities outside and the antenatal care station inside our van, next to the pharmacy. Patients knew to come the same time every month bringing their own health records, and were reminded to keep their appointments by their health aide worker. From the moment we set foot into a village, patients would rapidly appear until they engulfed our table.
One of the most fascinating aspects of today were the few untouched glimpses into the daily village life from which our patients emerged. I was able visit the rice and sugar cane fields where I watched farmers covered with wrinkles from age and sunlight nudging their cows along as they plowed the land. I watched as young children napped on the tiny cement floor of the village preschool, surrounded by swarms of flies brought in from the hot weather. I saw a nomadic family of stone-cutters, who were part of a casteless and outcasted group called the "untouchables" thought to have descended from criminals. The father, thin and gray haired, sat expressionless in front of their cloth tent, their daughter stared at me curiously while she held a stray puppy, and the mother squatted to balance a hot pot on her feet. I watched women walking to their homes as they balanced buckets of water on their or gigantic bales of hay on their back. I listened as a newlywed woman, who did not appear older than 16, explaining the family charms on her gold marriage necklace.
Separated from a schedule and carried only by the drift of the day, I also discovered many simple pleasures such as walking into a grove of beautiful trees and identifying mangos on the verge of ripening (two major Hindu dieties were married under a mango tree, so it is often thought of as a symbol of love). I also greatly enjoyed playing with the children, and watching their improvised singing and dancing performances. Afterwards, they would crowd excitedly around my camcorder to watch themselves in replay. I sat under a plantation of coconut trees and admired how their abundance once provided the idea for iv hydration at CMC when sterile water was scarce. Imagine that--walking into a cutting edge hospital in India to find all the patients hooked up to coconuts. Apparently this provided the idea for the oral rehydration formula. I think it takes moments like these, when our minds are stolen from the whirlwind, to help us truly appreciate our surroundings and the gifts that they give us.
But the beauty of the day could not conceal many realities, many of which were explained to me by Sharon, the community physician who worked in the antenatal care station. For instance, I began to learn more gender disparities. When a newlywed woman gave birth to a girl, the family would mourn rather than throw the usual elaborate celebration for newborn boys. Girls are often thought of as liabilities, as they must be supported until their families somehow scrounge the money for their marriage dowries. We saw many women who claimed to be 18 or older, but were really 14 or 15, as their families attempted to marry them off as soon as possible. Unfortunately, women with any health problems, even with a condition like rheumatic heart disease, are seen as being defective and near impossible to marry off...unless somehow their family can offer a dowry that is unheard of.
After marriage, any inability to concieve, or even to concieve a male, is blamed on the woman who will often suffer consequences--beatings by her husband and his family, and in some cases "bride burning" (is what it sounds like) which can lead to her death. If she attempts to divorce her husband, or if she is somehow widowed, she is denegraded to the level of a prostitute and outcasted from society. Males, on the other hand, can remarry without difficulty. The government makes regulations, but in the end, they truly have little power over these cultural norms that have been ingrained over hundreds of years. It is like trying talk over a stadium full of chattering people who do not care to listen.
There is only so much that CMC's mobile clinics can do for their community's health and wellbeing--which is tremendous, don't misunderstand. But some things are not easily changed--gender roles, cultural chauvinism, care for the elderly and handicapped. I feel that much of my journey in India is an attempt to enrich my understanding and appreciation for different ways of life. However, there are some ideas which are difficult for me to understand outside the context of a natural pursuit for class power and wealth. Is it because I value or percieve freedom and happiness differently? Either way, I believe that greed and chauvinism, which exists anywhere in the world, provide the inequities that lead to maldistribution of education, clean water, and nutrition--staples of health and well-being.
Tuesday, February 17, 2009
Into the Village
Today was day one of our one-week Community Health rotation. We spent the morning on home visits at a local village. The home visits are a component of CHAD's (Community Health and Development Program) "peripheral clinic", meaning health care delivery outside of CHAD's central hospital and clinic location. The visits are delivered by a group of nurses and community workers. The basic group consists of a health aide, (residents of the community who each serve as the eyes and ears of around 2,000 patients), the public health nurse (who the aide reports to and who leads the visits), and the PCHW (public community health worker). Most of the cases are antenatal and post natal visits, care for pre-school age children, and health maintenance for chronic diseases. The homes are usually built by the families themselves, usually from concrete and dried palm leaves. Whether we stepped into a small, dark hut or a spacious building with rich wooden doors, we were always welcomed with warm hospitality and often left with candies and flowers in our hair.
Although the language barrier limited our understanding of the patient's medical conditions (we would often listen onward to the conversaion in Tamil over the mooing of the cows), I could understand that in each visit, extensive health education took place. For instance, during the antenatal visits, the public health nurse would display illustrations of eating greens (as multivitamins and folic acid are not given to all pregnant women), activity, and eating sufficiently (according to a public health student, many pregnant women in India do not eat enough in fear of having an oversized baby).
Witnessing how Indian families lived was an insightful experience. I realized that each household would hold multiple generations. I was told that after marriage, which in India (esp in the South) is almost always pre-arranged, the couple would often live with the husband's parents. Thus, I saw great-grandmothers who are in their 80's holding the newborns of their grandchildren. In addition, the villages are segregated by castes and therefore standards of living vary drastically from one to the other. The caste system, which predominantly makes socioeconomic divisions, has existed for thousands of years from the time that people were divided into 4 major roles: Priests (top caste), Soldiers/warriors (2nd caste), Merchants (3rd caste), and labourers (bottom caste). There is also a casteless group called the Untouchables, which includes a nomadic group of people who are social outcasts thought to have originated from a group of criminals. It is a wonder how these disparities have held strong for so many centuries As I continue to spend time here, I begin to see more and more how its influence resonates through India's economy, education, and healthcare.
Although the language barrier limited our understanding of the patient's medical conditions (we would often listen onward to the conversaion in Tamil over the mooing of the cows), I could understand that in each visit, extensive health education took place. For instance, during the antenatal visits, the public health nurse would display illustrations of eating greens (as multivitamins and folic acid are not given to all pregnant women), activity, and eating sufficiently (according to a public health student, many pregnant women in India do not eat enough in fear of having an oversized baby).
Witnessing how Indian families lived was an insightful experience. I realized that each household would hold multiple generations. I was told that after marriage, which in India (esp in the South) is almost always pre-arranged, the couple would often live with the husband's parents. Thus, I saw great-grandmothers who are in their 80's holding the newborns of their grandchildren. In addition, the villages are segregated by castes and therefore standards of living vary drastically from one to the other. The caste system, which predominantly makes socioeconomic divisions, has existed for thousands of years from the time that people were divided into 4 major roles: Priests (top caste), Soldiers/warriors (2nd caste), Merchants (3rd caste), and labourers (bottom caste). There is also a casteless group called the Untouchables, which includes a nomadic group of people who are social outcasts thought to have originated from a group of criminals. It is a wonder how these disparities have held strong for so many centuries As I continue to spend time here, I begin to see more and more how its influence resonates through India's economy, education, and healthcare.
Sunday, February 15, 2009
Mahabalipuram Excursion
Sunrise on the beach, ancient rock carvings, magnificent temples, beautiful artwork, seafood...and wobbly bikes. This was our weekend in Mahabaliparum, a world heritage site known as an ancient capital and seaport of the Pallava kings of the 7th century. Here, we can meet visitors from all over the world and all over India.
Our excursion began with a train ride to Chennai, where we jumped onto a moving train and packed ourselves into a crowded car. For the next 2 and a half hours, we stood in a narrow walkway (as there was no room to sit on the ground) balancing our bags on our feet, trying not to fall over from the pushing, and trying to ignore the intermittent whiff of various foul odors. Fortunately, at times, we were able inch close to the train to some scenery and breeze. Arriving in a state of exhaustion, we spent the night in Chennai where we would hunt down my luggage at the airport! It is so nice to finally be with luggage...although it really wasn't that difficult without, thanks to great travel buddies.
We then took a bus to Mahabaliparum (it sounds like one giant syllable when the natives say it). By the way, we have yet to take a taxi or private car...we decided to do everything Indian style and use the public transportation system. The scenery in Mahabalipuram lacks the rush, traffic, and crowds that we've gotten somewhat used to. Instead of nonstop honking, we hear the shopowners who are sitting outside the shops calling "hello!" at each foreigner that passed, and displaying their best items. Once the foreigner was attracted into the shops that held the eye candies of scarves, jewelry, intricate sculptures, they rarely left empty handed.
After around 5 hours of sleep, we arose to catch the sun rising over the Bay of Bengal. We arrived at the beach at 615, thinking that we had missed the sunrise, only to discover a faint red circle hovering through a thick layer of ocean mist. It was the sun...so subtle and mysterious! We ended up taking pictures of the beautiful scene with several curious families of Indian tourists from Calcutta...without cameras of their own, they chattered excitedly as we snapped pictures and showed it to them.
The rest of our excursion was spent biking from one attraction to another--from the Butter Ball, a giant round rock that looked like a cocoa puff balanced mysteriously on a hillside, to the Five Rathas, a site of intricate rock temples and figures, to the beautiful seaside shore temple dedicated to the Hindu diety Vishnu. The day ended as we balanced a watermelon on our bikes and painstakingly pedaled it to our hotel. We carried this watermelon on our journey all the way back to Vellore, and preserved it on our move to the CMC college dormitory. Want to know how to transform an ordinary watermelon into one that is unsurpassed in taste? Buy it in Mahalabalipuram, carry it for 300 miles and for 2 days, only to discover there is a watermelon stand next to your new dorm in Vellore.
Our excursion began with a train ride to Chennai, where we jumped onto a moving train and packed ourselves into a crowded car. For the next 2 and a half hours, we stood in a narrow walkway (as there was no room to sit on the ground) balancing our bags on our feet, trying not to fall over from the pushing, and trying to ignore the intermittent whiff of various foul odors. Fortunately, at times, we were able inch close to the train to some scenery and breeze. Arriving in a state of exhaustion, we spent the night in Chennai where we would hunt down my luggage at the airport! It is so nice to finally be with luggage...although it really wasn't that difficult without, thanks to great travel buddies.
We then took a bus to Mahabaliparum (it sounds like one giant syllable when the natives say it). By the way, we have yet to take a taxi or private car...we decided to do everything Indian style and use the public transportation system. The scenery in Mahabalipuram lacks the rush, traffic, and crowds that we've gotten somewhat used to. Instead of nonstop honking, we hear the shopowners who are sitting outside the shops calling "hello!" at each foreigner that passed, and displaying their best items. Once the foreigner was attracted into the shops that held the eye candies of scarves, jewelry, intricate sculptures, they rarely left empty handed.
After around 5 hours of sleep, we arose to catch the sun rising over the Bay of Bengal. We arrived at the beach at 615, thinking that we had missed the sunrise, only to discover a faint red circle hovering through a thick layer of ocean mist. It was the sun...so subtle and mysterious! We ended up taking pictures of the beautiful scene with several curious families of Indian tourists from Calcutta...without cameras of their own, they chattered excitedly as we snapped pictures and showed it to them.
The rest of our excursion was spent biking from one attraction to another--from the Butter Ball, a giant round rock that looked like a cocoa puff balanced mysteriously on a hillside, to the Five Rathas, a site of intricate rock temples and figures, to the beautiful seaside shore temple dedicated to the Hindu diety Vishnu. The day ended as we balanced a watermelon on our bikes and painstakingly pedaled it to our hotel. We carried this watermelon on our journey all the way back to Vellore, and preserved it on our move to the CMC college dormitory. Want to know how to transform an ordinary watermelon into one that is unsurpassed in taste? Buy it in Mahalabalipuram, carry it for 300 miles and for 2 days, only to discover there is a watermelon stand next to your new dorm in Vellore.
Thursday, February 12, 2009
Whew!
All of today was in Gen Peds clinic, where we saw around 36 patients (in addition to overseeing the interns' patients). Among many mild URI's, we had numerous memorable cases from neurocystercercosis to leprosy to CHARGE syndrome to Takayau's arteritis to Typhoid. The general approach for many cases is to diagnose through response to treatment rather than an expensive work up, because, in the end, this often the most cost-effective method.
I was also amazed by many families that traveled from West Bengal (including the rural areas) just for a few minutes of Dr. Rose's time. This area is in North East India, and for specialized care, families had the choice of traveling to Dehli or Vellore which are both thousands of kilometers away. Dr Rose would thus switch from English to Tamil to Hindi, for those from West Bengal. As the day went on and the folders kept stacking, the physical exams no longer took place on the exam table, the interviews became rushed, the interns would fly in and out, and the scene became a whirlwind. Even only as an observer, my brain became exhausted. But I realized that despite waiting for hours, the families never complained. Instead, they seemed thankful for every minute they spent with Dr. Winsley Rose, even if they were few.
I was also amazed by many families that traveled from West Bengal (including the rural areas) just for a few minutes of Dr. Rose's time. This area is in North East India, and for specialized care, families had the choice of traveling to Dehli or Vellore which are both thousands of kilometers away. Dr Rose would thus switch from English to Tamil to Hindi, for those from West Bengal. As the day went on and the folders kept stacking, the physical exams no longer took place on the exam table, the interviews became rushed, the interns would fly in and out, and the scene became a whirlwind. Even only as an observer, my brain became exhausted. But I realized that despite waiting for hours, the families never complained. Instead, they seemed thankful for every minute they spent with Dr. Winsley Rose, even if they were few.
Tuesday, February 10, 2009
The First Few Steps
DAY 1-- COWS AND RICKSHAWS:
Thanks for visiting my blog! I'm finally here after a year of anticipation! When I first stepped out of the Chennai airport at 5am (minus my check-in bag which is hopefully still pending arrival), I first noticed the crowds of people, the humidity, and how the smell of spices and sweet fruit mixed with the smell of cow dung. After meeting up with Janet and Karina across town, we crammed with our luggage into an auto rickshaw to travel to the bus station, where we would catch the bus to Vellore. This rickshaw ride gave me my glimpse of India--I got a taste of the beautiful and rich colors which dressed the women, cows and roosters grazing in the streets, traffic jams of buses so packed that people would dangle from the entrance with one arm or stick their torso out of the windows, abandoned buildings, dust, chaos, traffic.... the countryside was never a true green and untouched area that I had imagined, and was instead littered by building or structures which seemed to a have never been finished. Yet, the surroundings carry an unexplainable charm.
Getting around has also been an adventure, as most people outside the hospitals speak limited to no English. There is also the difference in gestures. I remember when I explained to a woman working on the airport staff that my luggage had not arrived, she rotated her head as if to disagree. I didn't know this is their way of nodding! And it remains bizarre when to find myself in a conversation when I'm nodding while the other person is simultaneously shaking it from side to side. Getting around has also been a physical adventure as we dogde the congestion of buses, motorcycles, and auto rickshaws who threaten pedestrians in the streets, and the ditches, sun-bathing cows, or dawdling donkeys in the sidewalks.
DAY 2--FIRST DAY ON PEDIATRICS
While our first days have been spent soaking in the culture and environment as we journeyed to and within Vellore, journey takes place within the hospital walls. All three of us are taking Pediatrics, and was assigned to the unit specializing in Infectious Diseases, Oncology, and Endocrinology. The day started out with a chaplain who gave talk about removing judgment while treating patients with diseases often carrying stigmatism (HIV, leprosy). The wards filled in the rest of the mornings.. The ward was a large walkway branching into areas of 6 beds with bright green sheets, between which a traffic of nurses in white caps and gowns would float. The patients are a mixture tiny infants to young teenagers, almost always with their concerned parents at bedside. I observed as Dr. Rose and two residents cases of Dengue Hemorrhagic Fever and Shock, Nesidioblastosis (causing congenital hyperinsulism), a possible Tay Sach's in a child with splenomegaly, seizures, and developmental delay, Common Variable Immundeficiency, and Tyrosinemia. This is just the morning.
The afternoon are clinics are spent behind rooms closed off by curtains, through which anxious waiting parents would peek and tug. My first day was spent in my first pediatric oncology experience, seeing cases of Ewing's sarcoma, ALL, medulloblastomas, advanced retinoblastomas. Patients came from all over India and from many different countries. Although Indian citizens receive round 40% healthcare expense coverage from the Indian government, the hospital is entirely self-pay. As I tried to imagine the monumental expenses of chemotherapy and surgeries for the majority of families struggling to feed themselves, I understood why 75% of families must turn to charitable grants for which CMC will help them apply. Within this disheartening context, I watched as children wearing masks and hairless scalps came in only with their warm smiles, shy stares, and eager greetings.
DAY 3-- PEDI ID!
My second afternoon was an amazing experience in the Pediatrics ID clinic, where we followed many young children who contracted HIV vertically. One of them was a quiet 8-year-old girl who had HIV encephalopathy. She had consistently slow developmental milestones, but I noticed something else: her mother attempted to set her down on legs which were fixed and crossed like scissors. As we examined her, we saw that she had spasticity, clonus, and brisk reflexes bilateral lower extremities. Did she fail drug therapy? We also had an interesting case in a 18 month old originally treated for TB, but only began to improve rapidly after...prednisolone? Turns out that he had Pulmonary Hemosideridosis.
In both clinics, the discussion of results, management, all took place before the family. Here, it would seem unthinkable to walk into a patient room and spend only 5 minutes at the bedside, with the remainder spent before a computer screen. The patient is always present before our eyes and ears, at the center of our attention.
Tonight, we also had a rooftop dinner with several other International students, including some 4th year medical students from Singapore who are also staying at our hotel. Glancing at the other international students, I realize that wearing local clothes may make us blend in even less. Maybe we have not mastered the fashion. Nevertheless, when I walk into a crowded waiting room where all faces turn to watch me, I can't help feeling that I've walked into a spotlight for interrogation of who I am and why I am here. Why am I here? Because, right now, there's no where else I'd rather be!
Thanks for visiting my blog! I'm finally here after a year of anticipation! When I first stepped out of the Chennai airport at 5am (minus my check-in bag which is hopefully still pending arrival), I first noticed the crowds of people, the humidity, and how the smell of spices and sweet fruit mixed with the smell of cow dung. After meeting up with Janet and Karina across town, we crammed with our luggage into an auto rickshaw to travel to the bus station, where we would catch the bus to Vellore. This rickshaw ride gave me my glimpse of India--I got a taste of the beautiful and rich colors which dressed the women, cows and roosters grazing in the streets, traffic jams of buses so packed that people would dangle from the entrance with one arm or stick their torso out of the windows, abandoned buildings, dust, chaos, traffic.... the countryside was never a true green and untouched area that I had imagined, and was instead littered by building or structures which seemed to a have never been finished. Yet, the surroundings carry an unexplainable charm.
Getting around has also been an adventure, as most people outside the hospitals speak limited to no English. There is also the difference in gestures. I remember when I explained to a woman working on the airport staff that my luggage had not arrived, she rotated her head as if to disagree. I didn't know this is their way of nodding! And it remains bizarre when to find myself in a conversation when I'm nodding while the other person is simultaneously shaking it from side to side. Getting around has also been a physical adventure as we dogde the congestion of buses, motorcycles, and auto rickshaws who threaten pedestrians in the streets, and the ditches, sun-bathing cows, or dawdling donkeys in the sidewalks.
DAY 2--FIRST DAY ON PEDIATRICS
While our first days have been spent soaking in the culture and environment as we journeyed to and within Vellore, journey takes place within the hospital walls. All three of us are taking Pediatrics, and was assigned to the unit specializing in Infectious Diseases, Oncology, and Endocrinology. The day started out with a chaplain who gave talk about removing judgment while treating patients with diseases often carrying stigmatism (HIV, leprosy). The wards filled in the rest of the mornings.. The ward was a large walkway branching into areas of 6 beds with bright green sheets, between which a traffic of nurses in white caps and gowns would float. The patients are a mixture tiny infants to young teenagers, almost always with their concerned parents at bedside. I observed as Dr. Rose and two residents cases of Dengue Hemorrhagic Fever and Shock, Nesidioblastosis (causing congenital hyperinsulism), a possible Tay Sach's in a child with splenomegaly, seizures, and developmental delay, Common Variable Immundeficiency, and Tyrosinemia. This is just the morning.
The afternoon are clinics are spent behind rooms closed off by curtains, through which anxious waiting parents would peek and tug. My first day was spent in my first pediatric oncology experience, seeing cases of Ewing's sarcoma, ALL, medulloblastomas, advanced retinoblastomas. Patients came from all over India and from many different countries. Although Indian citizens receive round 40% healthcare expense coverage from the Indian government, the hospital is entirely self-pay. As I tried to imagine the monumental expenses of chemotherapy and surgeries for the majority of families struggling to feed themselves, I understood why 75% of families must turn to charitable grants for which CMC will help them apply. Within this disheartening context, I watched as children wearing masks and hairless scalps came in only with their warm smiles, shy stares, and eager greetings.
DAY 3-- PEDI ID!
My second afternoon was an amazing experience in the Pediatrics ID clinic, where we followed many young children who contracted HIV vertically. One of them was a quiet 8-year-old girl who had HIV encephalopathy. She had consistently slow developmental milestones, but I noticed something else: her mother attempted to set her down on legs which were fixed and crossed like scissors. As we examined her, we saw that she had spasticity, clonus, and brisk reflexes bilateral lower extremities. Did she fail drug therapy? We also had an interesting case in a 18 month old originally treated for TB, but only began to improve rapidly after...prednisolone? Turns out that he had Pulmonary Hemosideridosis.
In both clinics, the discussion of results, management, all took place before the family. Here, it would seem unthinkable to walk into a patient room and spend only 5 minutes at the bedside, with the remainder spent before a computer screen. The patient is always present before our eyes and ears, at the center of our attention.
Tonight, we also had a rooftop dinner with several other International students, including some 4th year medical students from Singapore who are also staying at our hotel. Glancing at the other international students, I realize that wearing local clothes may make us blend in even less. Maybe we have not mastered the fashion. Nevertheless, when I walk into a crowded waiting room where all faces turn to watch me, I can't help feeling that I've walked into a spotlight for interrogation of who I am and why I am here. Why am I here? Because, right now, there's no where else I'd rather be!
Subscribe to:
Posts (Atom)