Friday, January 18, 2008

the leprosy hospital

I spent the day at a Leprosy Hospital yesterday, and it was truly an amazing, unforgettable experience. I decided not to write about it immediately, as I think I needed to digest it a little before doing so.

Short med side note- Leprosy is caused by a bacteria, but most people exposed to the bacteria do NOT get ill, only @ %10 or less of the population is genetically pre-disposed to actually coming down with leprosy if exposed, and true exposure is rare, even for those with close relatives with the disease- and its cureable- if caught early all is good, if caught later the nerve damage is irreversible, ( so if your hands and feet are totally numb- they will stay that way, but usually meds stop the disease from progressing)- an example of the worst form of the disease- if you have ever seen Kingdom of Heaven with Orlando Bloom, the young king who wears the mask has sever e leprosy- thus the appearance of his face, and the story of how the previous kings adviosr saw that the boy could not feel a bad cut on his arm, and thus informed him that his son had leprosy

Some History- there is still one hospital/home in the US for people with Leprosy- "Leper Colony" is an extremely offensive and very politically incorrect term I learned- in the US in Carville Louisiana, where, even into the 1950's, patients arrived from all over the US IN CHAINS, like prisoners, even though their only crime was suffering from leprosy

Families traditionally disown children/siblings/husbands with the disease, so the leprosy hosptals had a sort of multiple use as a place to get treated with meds, have any corrective surgeries which may help the patient function at a better quality of life, learn ways to prevent further damage to their numb limbs, and then, a home for them to live in and a community safe from prejudice

Even though the main medical center here in is the middle of a nice size city- the hospital for leprosy is a 45 min bus ride into the country, as no one would allow a leprosy hospital near their homes in the 1950s when it was built. THe buses which take people to and from the compound read "Leprosy is a Cureable disease" on the back. There is an interesting connection between Leprosy and advanced Diabetes- no they are not related at all, but research for one can benefit both, as the mechanism is totally different, but the end stages of both diseases have patients unable to feel their extremities, which leads to injuries, blisters, ulcers, infection, and evenatully amputation, whether at the hands of doctors or (I'll stop there as some of you really dont want to know what can happen to hands and feet with leprosy)

The scholarship we all got from our school to come here is named after Dr. Paul Brand, an orthopedic surgeon who basically changed the way leprosy was viewed, proved there were many methods to help and even cure the disease, and gave his entire career, both in India and Louisiana, to bringing people with leprosy back into society as functioning human beings, instead of the "untouchables" they had been throughout history.
example of surgery
a person cannot move or feel their thumb on one hand, so cannot grip anything/work/eat/etc., so the patient is told to practice moving his ring finger up and down, for a few weeks, to strengthen the tendon and muscle, then, the patient has surgery, which detaches the tendon of the ring finger (but NOT from its nerve supply), and attach it to the thumb, after a few weeks in a cast, the patient is told to move his ring finger like he had been, but when he does (his mind tells his finger to move), the thumb moves in its stead, as it is now connected to that tendon's original nerves, but has a whole new location! So the patient can now grip things!!!

Physical therapy and Occupational therapy really become the major factors in the quality of life of a person with leprosy,
example of this-
since fingers get contracted into "claw hands" with no extension, special excercies and braces help stretch out fingers if caught early enough
always wear gloves or use a special cup holder when handling hot coffee or tea- its served HOT here- to prevent injury/blister/infection/finger loss
if fingers are already lost, they are fitted with special straps for their palms for using forks, toothbrushes, etc.
each patient can have very special shoes made, they are really prosthesis of varying degrees, depending on how much of the limb is lost-I have pictures of this I'll send

There is so much more I could say- but I'll wait until I have some pictures- and I'll include a warning for the really graphic ones for those of you who really can't stomach that sort of thing

Monday, January 14, 2008

Culture Clash, World News, Ob experiences

A big part of the Indian "experience" is had just outside the hospital complex gates, on the main shopping/bazarr area called Ghandi Street. I am loving the fact that I can go buy 4 amazing Indian outfits (all for a good cause- none of the clothes I brought for work actually cover my ankles, as they should) for a grand total of $5, but after reading in the Indian newspaper about "Eve Teasing", we have all agreed to 1. not shop alone, and 2. leave Ghandi street before dusk.

Even though the street is chock full of people, including families with babies, until well into the night, it is traditionally "innappropriate" for a female to be "alone" in public- I thought that was ridiculous, as there are 100s of women walking all over all day long- but I realized they are always in groups of 2 or 3, even as they walk to school. "Eve Teasing" is basically a male/group of males who harrass young women who seem "alone". Well, today, with 2 of us, in broad daylight, and at the hour that the street is teeming with hospital staff as well, we were simply running by a store to pick up a shirt we had tailored (you have to ask a tailor to attach sleeves to your shirts, even though all shirts have sleeves here, you dont attach them until the shirt is bought?)

It was only 5pm, not even close to dark, but I stopped in a shoe store on the way to the tailor, but did not buy anything as they did not have my size (all of these "stores" are simply open booths on the street). As we continued down the street, I noticed one of the shoe salesman followed us to another shop, and then another, another, then another which was actually an air conditioned inside store, then to the tailor shop (the tailors are these 2 very old, sweet english speaking men who we love) which is up an open flight of stairs on the street- I chose not to point this out to Kristen at first, because I thought she would freak out- and we were very much in public, surrounded by people of all kinds, and he was keeping his distance- sort of,

we went to a nearby store where we knew the man (having bought several shirts from him) and asked if he would tell the man to leave us alone, but when he looked up, the man walked off, but then reappeared. Then we headed to the infamous "4 full Indian outfits for 200 rupee" place I had found, the source of all of my ankle covering coolness, where not only do I know the men who work there (as I must be their best customer this week), but they were having a street sale so women of all ages were throwing elbows and yells- on our way in I decided I had to tell Kristen, at which time she totally freaked out, and started getting all belligerent saying "what, what!!! I'll beat him up!!! If he so much as touches me I'll hit him so hard he wont know what happened!!!!"

UUhhh, that was why I hadn't told her in the first place. So when I realized she was 1. dead serious, and 2. obviously considering going out there to do it, I knew I had to do something before the strongest little 90 lb American track star firecracker ran into the street to punch out this creep of an Indian dude- and thus get us subsequently acosted by an angry mob- so right then I just looked right at him, and he looked stunned, as I had pretended not to notice him until now- and screamed bloody murder for him to go away- so he got the message, but most people on the street could not discern my particular yell from all of the rummage-sale crazed ladies all around me!!! ( thankfully, women of all cultures go bazerk over a good sale)

The only other thing about Ghandi street that is hard to adjust to, is the beggars. Old women, old men, missing limbs, kids without functional legs scooting around on hands, anything you can imagine, is there. Beggars are so sad, but you immediately get used to simply ignoring them, as the locals do, because the locals frown greatly upon giving money to beggars because it perpetuates the practice, and makes parents keep kids (especially female) out of school in order to make money- speaking of girls, we had a pre- eclampsia patient lose a baby today, (long medical explaination, baby had no chance here in India so not quite as sad as it sounds, quite), and when the indian dr saw it was a "female baby", she sadly said "At least to these people losing a girl is much less of a heartache than if it had been a boy"- I find it so hard to rembember that so many cultures still consider females as lowly creatures, but somehow, knowing that was their culture, I still took some solice in the fact that this girl could see something positive, even if it was that, as she had carried the child for 25 weeks before falling ill.

As for whats going on in the rest of the world, Indian people are so much better at keeping up with and discussing current events and world politics than the average american, in my experience. I have been reading the paper everyday here- and their coverage of US and world politics is very interesting- its fun to see what makes the news here- cricket cricket cricket, Bhutto, cricket, Calcutta bazarr burned to ground, cricket cricket, Chinese soldiers keep incurring into India at the border, more cricket, Obama, Hillary (Sir Edmund Hillary that is, RIP), cricket, Hillary Clinton, cricket, crooked cricket umpires, multiple attempts on lives of Sri Lankan and Malaysian high officials (the Sri Lankan rebels are "Tamil Tigers"- I am living in Tamilnadu- Indian state of Tamils, with Sri Lanka a few miles off coast), cricket, Bush, Australian Open tennis, the evil evil Australian cricket team, AND the new Governor of Lousisiana being an Indian American guy!!!

honestly, I left out about 20 "crickets" and a lot of slurrs against Australians, if I were really trying to give an accurate appropriation of newpaper space, but Im sure you got the idea!!!

My next blog I will try to focus more on some amazing medial experiences, today I actually saw several things I had only read about, really things I guess you hope to ONLY read about, since we also saw a uterine rupture which happened at home, so overall it was a very sad obstetrics day, and I'd rather not go into detail about that, but as you read this be thankfull that most of you have quick access to emergency medical care, and even here in Vellore, where the medical care is on par with the US, only 25% of pregnant women deliver at the hospital, and often only come AFTER there is a complication, after seeing what I have seen today, I will seriously have to consider what I will say to future patients who want to birth at home or at a non-hosptial "birthing center". I can tell them about today, but I will never be able to do it the justice it deserves.

Saturday, January 12, 2008

First to get sick

Well, I am officially the first student to get sick. Thankfully it wasn't too bad, only in that it could have been much worse!! I am to blame, as I shared food with my new intern friends twice, and both times it was purchased at the hospital canteen, and than sat around for 45 min while we continued to deliver babies and such. I had some antibiotics already, but my mew pharmacist friend thinks I may have Giardia, so I'll probably head to town for some flagyl.

I am much better today, as I proved by shopping a lot in town. I managed to spend a few thousand rupees, which trust me, is not easy to do. I actually had an excuse, as I brought scrubs to wear to work, since I would be doing OB Gyn and Surgery, but I did not read the instructions that said we have to wear Indian professional clothes to the hospital. That means no sleeveless, and no ankles showing, which has been a problem for me, as I brought really loose skirts and pants, but they are all a bit shorter than my ankles. The interns joke that they can always find me because my "little white feet" show from under the curtains dividing the beds. Which is a bit ironic, because my whole life my family joked about my "little indian feet" as my feet are somehow always significantly tanner than the rest of my body. Yes, we do wear sandals in the labor room, and yes, it leads to some gross close encounters with all kinds of unseemly things.

We headed to town today to check out the 500 yr old fort, which is made with huge stones easily equivalent to the size of stones of the pyramids, I have no idea where they mined them from, or how they got them to where they are. There is a huge, river-sized moat around the fort, as well as a very ornate Hindu temple, easily 10 stories high, with intricate designs all the way to the top. You can see the whole town and all of the mountains around it when you climb to the top of the fortress wall.

I am looking forward to getting back into the medical learning mode, as I missed a day and a half from being ill. I really think I will learn more in 3 weeks here than I ever could in 3 months at a regular US hospital! I can't wait to see what I learn next!

Tuesday, January 8, 2008

First Days in Vellore

The CMC medical school campus is like a jungle oasis in the middle of a crazy rickshaw-filled city, so living here is very nice. Our accommidations are different, I learned we are lucky to have "squat" toilets, as opposed to hole in the ground, but there is a bucket and pitcher whose use I have not yet identified. I have learned you can shower with the equivalent of a faucet which is barely turned on, just beyond dripping.

Our room is on the fourth floor, so our view is pure tropical jungle plants, and our noises include supposedly "aggressive" monkeys, and the 4am music playing from the temple across the street. Apparently it is a holiday month, and that is part of how they celebrate. Good thing medical school taught me the beauty of ear plugs. I initially began using them as a way to keep myself from chatting too much with my studying neighbors at Starbucks, but this new use tops that, except for the fact that I overslept this morning, which meant 1. I missed breakfast and coffee, and 2. I had to sprint to the bus- which was actually a great bonding experience, as 4 Indian students were sprinting right along side me!

I worked in the Labor and Delivery ward all day today, which was definitely a learning experience! I saw 2 forceps deliveries, one resultant facial palsy (which thankfully resolved rather quickly, according to the neonatologist), a woman with severe hirsutism, to the point that she was truly a bearded lady, but after 9 yrs of infertility she had finally conceived. I learned that not all suture comes pre-attached to the needle, and that no one seems to mind when the doctor calls for cat gut. Just about every basic medical supply can be used for multiple purposes (ie. gloves are tourniquets), and the basic paperwork/lab tests/delivery notes are pretty much the same everywhere.

The biggest difference was the total lack of pain medications, epidurals, or spinals. All births are "natural", and the level of screaming does not seem that different than our typical labor and delivery sounds, except all 20 women are in one long room, a true "ward", separated only by the occasional cloth curtain. I realized all interns have similar experiences, sometimes praised, often scolded, always crazy busy, with no time to eat or drink, much less sit down. I actually went out and bought new shoes after work today because I only sat down once all day, and I was wearing flat sandals. Yes, I did say sandals, everyone wears open toed shoes, regardless of water breaking and other wonders of childbirth, and no, they don't have shoe covers.

I am sure I will continue to learn about similarities and differences between medicine here and at home, and I look forward to all the amazing learning experiences ahead of me!

Travel to India

The flight to India was a good primer for the trip. We befriended our neighbor for the 13 hr flight, who was an Indian living in LA, so he gave us some good tips. I watched a movie or two on my personal screen, but then found a Berlitz language program was an option, so I worked on learning a little Tamil (language spoken in Vellore), and Hindi. That was rather hard to concentrate on by hour 6, so then I practiced some Italian and Portuguese as those were more familiar to me. Somewhere in there I managed to fall so dead asleep that Kristen, my classmate, was worried she would not be able to get me off the plane- I have realized neck pillows are the key to sleeping on planes. They prevent me from leaning on and/or drooling on, my neighbors.

Our arrival in Delhi was interesting, as we deboarded off the back door, as it was closer to our seats, onto the tarmac, and then boarded a bus to the terminal. I realize US-style boarding indoors is nice when there is inclement weather, but it would be nice to be able to board/deplane from both ends- sure would save time!

Right as we entered the terminal, we noticed it was extremely hazy inside- almost like there was a fire somewhere- but it did not smell and no one was running for their lives. Supposedly this was due to construction, but when we went outside, there was still quite a thick haze. When we boarded another plane to Chennai, the pilot said there was a visibility of 2 km! Other planes on the runway were even hazy. As a person with pretty bad asthma, this was a bit disconcerting.

On our flight to Chennai (which I discovered is pronounced CHEN-ay), we met another nice man who worked at a nice department store in the city, who spent a good hour going over our Lonely Planet India book and giving us advice on what to do, where to stay, and where to shop!! Everyone we meet here is amazingly friendly and so helpful, I have never experienced anything like it in my travels.

Finally, we arrived in Chennai, there was no haze to be seen, only lush green palm trees and blue sky, as well as a nice 80 degree temp- where we met up with the rest of our classmates- and we headed out to Vellore, 2 hours away by van.