My second day in the hospital was spent with the medicine/infectious disease team on the wards. Actually, it started in the morning with journal club where the huge team of interns, residents (called registrars here), and junior and senior attendings (called consultants;..I'm still trying to figure out the logistics and hierarchy here). All the cases presented were mid-30s and mid-40s year old patients all of whom died, and it took me about 5 of these cases to realize it was actually morbidity and mortality rounds and not journal club, so fortunately contrary to what I thought for about an hour, not all young patients die here, whew!
The residents and attendings here are surprisingly intelligent (I'm awful to assume they wouldn't be, I know, but I thought their training wouldn't be as rigorous as in the US), and also practice somewhat evidence based medicine, although adjusted for this resource limited setting and different patient demographics. The M&M was similar to that in the states as were the rounds that followed. Everyone is really friendly, but the hierarchy is still very strict here--lots of "sir"'s going around and no one challenges the bigger guy.
Then we did rounds on the inpatients. The med 1/ ID team is so big that there are 3 separate sub-teams within it and I joined the one that rounds only on the female patients (which unfortunately means that I had twice the load of patients as the 2 teams who split up the male patients). It's odd that they're separate though since the majority of the residents and all the doctors are male anyway.
Rounding is fortunately done in English at the bedside, although with the low-pitched mumbling and heavy accent, I still can only glean about 40% of what is said (40% more than Tamil though). The computer in the ID ward wasn't working well (by the way, I was impressed they have a hybrid medical record system with labs and scanned documents electronically and just notes are handwritten--kind of like how it is at Tufts!) so we went to the isolation ward where they keep the patients with proven active tuberculosis (TB) to use the computer there.
Rounds were pretty interesting because damn these patients are sick, and even though they're so sick they're not in the ICU. We had a 19 year old female patient with chronic ITP (rare autoimmune disease) with malnutrition and anemia, who was SO malnourished that her THIGHS were the size of the cardboard part of a paper towel roll. She has big, beautiful eyes and a full face but the rest of her body is like a pile of sticks, it was so sad to see it made me tear up.
There was a patient with a heart murmur from rheumatic heart disease (preventable if antibiotics are given for strep throat) so loud that you could hear it before the stethoscope was placed on her chest and you could visibly see it shaking her body. There was a woman who had a blistering, pus-y skin manifestation of likely spotted fever so all the skin on her arms and legs was sloughing off (it was purpura fulminans, something I'd never seen before in the US).
After rounds, I didn't have much to do because as an observer I can't really work with patients. Silly international laws. So I went into town, struggling around people, rickshaws, goats, sewage, and street goods, to find some tunics and leggings to wear for work. I found a nice family-owned shop, had to take off my sandals to get inside, and asked the girl (who didn't speak English) which tops she recommended for me. I paid her father (husband?) up front and hoped for the best that the tailored outfits would actually be there for me the next day.
The residents and attendings here are surprisingly intelligent (I'm awful to assume they wouldn't be, I know, but I thought their training wouldn't be as rigorous as in the US), and also practice somewhat evidence based medicine, although adjusted for this resource limited setting and different patient demographics. The M&M was similar to that in the states as were the rounds that followed. Everyone is really friendly, but the hierarchy is still very strict here--lots of "sir"'s going around and no one challenges the bigger guy.
Then we did rounds on the inpatients. The med 1/ ID team is so big that there are 3 separate sub-teams within it and I joined the one that rounds only on the female patients (which unfortunately means that I had twice the load of patients as the 2 teams who split up the male patients). It's odd that they're separate though since the majority of the residents and all the doctors are male anyway.
Rounding is fortunately done in English at the bedside, although with the low-pitched mumbling and heavy accent, I still can only glean about 40% of what is said (40% more than Tamil though). The computer in the ID ward wasn't working well (by the way, I was impressed they have a hybrid medical record system with labs and scanned documents electronically and just notes are handwritten--kind of like how it is at Tufts!) so we went to the isolation ward where they keep the patients with proven active tuberculosis (TB) to use the computer there.
The funny thing about the isolation ward is that the nurses wear only regular masks (not effective against TB) and the doctors don't wear any. When asked about the n95 masks (that actually protect against TB transmission), the intern said you have to go out and buy your own if you want it, but they don't bother because they assume they are already infected -- something like 40% of the Indian population has TB infection, which is almost 1 in every 2 people, so she's probably right. Oh, and they also don't have negative pressure rooms like in the US to remove the TB droplets from the air, just open windows and ceiling fans --which I assume just spread the aerosolized droplets around? Oof.
(^nurses in white saris!)
(^ I tried to crop out her face to protect her privacy, but you can still see her arm)
There was a patient with a heart murmur from rheumatic heart disease (preventable if antibiotics are given for strep throat) so loud that you could hear it before the stethoscope was placed on her chest and you could visibly see it shaking her body. There was a woman who had a blistering, pus-y skin manifestation of likely spotted fever so all the skin on her arms and legs was sloughing off (it was purpura fulminans, something I'd never seen before in the US).
After rounds, I didn't have much to do because as an observer I can't really work with patients. Silly international laws. So I went into town, struggling around people, rickshaws, goats, sewage, and street goods, to find some tunics and leggings to wear for work. I found a nice family-owned shop, had to take off my sandals to get inside, and asked the girl (who didn't speak English) which tops she recommended for me. I paid her father (husband?) up front and hoped for the best that the tailored outfits would actually be there for me the next day.
That night we again went out to dinner as a group of 30 (there is a weekly dinner outing on Wednesdays), but this time it was at the fanciest hotel in town, also on a roof deck, and since it's weekly, it was handled much better. On the way there, most of us took the public bus and a local guy on the bus kept shouting "Darling" at us, which is the name of the hotel, I assume it's because every Wednesday at 7pm a bunch of white people get on the bus for that very same reason. We all tried to rush off the bus as it was driving away at our stop. Then crossing the street to the hotel at night was an adventure, but I protected myself by surrounding myself with other people.
The dinner was tasty, and a little pricey--mine cost 200 rupees or about $3.50 USD. For schezuan chicken noodles and a mango lassi (a yogurt based drink). Meals are typically 30-50 rupees or less than a dollar (exchange is ~60 rps: 1 USD). Southern Indian food has been quite tasty, but it's basically fried dough or fried rice or fried potatoes with chicken or egg and a variety of curry/spiced dipping sauces to be eaten with the right hand only (don't use the poop hand!) and no utensils. This is the deal for breakfast lunch and dinner, but fortunately I'm not sick of it yet!
No comments:
Post a Comment