As Dr. Speicher pointed out, I haven’t written about the medicine. So there are 3 of us here, 1 in surgery, 1 in neurology, and me in OB/Gyn. Unfortunately for me, there is a residency here, and I’m lower than the interns in scale, and since I don’t speak Tamil, I just get to watch. The most interaction I’ve done is help the Intern with his H&Ps. Which is fun, because the intern I was working with is a great guy(and the only guy) in the department at the moment. He’s doing his rotating intern year. His name is Mohamed, and he has taken really good care of me. He’ll translate things for me, and work with me directly, and explain what is going on. All the doctors speak English, but to varying degrees. The first day we showed up, the Department head just kept saying, we’re very busy, and when she tries to talk to me, her accent is VERY thick, and it’s hard to understand her. There is another woman, who is a director who is much more interactive, Dr. Padma, who will actually ask what we do for this or that. She is there’s go-to Doctor for Surgery and issues.
During the day, there is a consultant service going on, where the interns and lower residents to the History(and just the history) in the chart, and then hand it to a consultant who reviews it, and makes the Assessment and plan. I’ve had some opportunities to figure out what’s going on with a few patients, and follow up with watching their surgery or procedure. That was interesting. One lady came in with post-menopausal bleeding starting the day before, and I pretty much said cancer…and it was, large necrotic mass on her right ovary. They did a curettage to get the staging I guess? I thought they’d just take it out. They seem to do hysterectomies pretty freely(when indicated, since they don’t have novasure or things like that).
I’ve seen 2 c-sections and picked up a couple tricks I thought were interesting in the OR. They have a lot of pre eclampsia, near 10% prevalence. They also have a difficult time getting people to come in for prenatal visits, probably why they have a higher rate of pre eclampsia. The C-Sections I saw were both related to Pre-eclampsia. The goal the OB department has is to see the patient 3 times a trimester, they are lucky if they get 1 per trimester, and they live with that because of the social issues around it. Tamil Nadu is actually very good at lowering their mortality rate for both babies and mothers. One of the lowest in the country, but it took them about 30 years of advances in public health to do that.
The OB department has a about 6 attendings(I think), and a consultation room, with 2 desks and 10 chairs for patient interviews. No private rooms for interviewing patients. You all gather around the table and get the histories. Then the Pap smears/pelvic exams are behind a curtain in the same room. Next is a general ward, with 18 beds 1 foot apart and in 2 rows. This is the general ward where most things come to, deliveries, 2 days post op, normal care. Then in the back is 4 small cubicles which are more private, but at the end of the general ward.
Next is 3 private rooms, right off the hallway for paying clients with cash(rupees) and then a clean room for sterilization/fabrics, etc. Then a dressing/storage room for the men. Across from that is the Doctors room for the on call doctor and a lunch/meeting room. Then behind a set of doors is a small 6 bed, 1 room Post op room. Here is all the critical cases/post op care which is staffed by an attending and an upper year.
Next is the next set of double doors and then the 2 ORs with a wash room in between to scrub. Both are set up for surgery, but one has nicer equipment for laparoscopic and more technical anesthesia equipment.
Okay, what I am about to explain may seem unreal to the common American doctor, but it’s true. So, first off, you wear flip flops in the OR. I kid you not. Some of the attendings have a pair of crocks, but I only counted 2. Some of the Techs where nothing at all on their feet, walking in bear feet. Next, when they scrub, they wear a plastic apron and then a cloth covering over them—a large green apron that ties on. They assumed their hands are sterile when they scrub in and they use them to tie their wrists and then glove up. Usually double gloving. They usually have 4 docs scrubbed in, an attending, an upper year or 2 and an intern.
Unfortunately they are so busy that I haven’t been able to scrub, but that’s life. The anesthesia cart in one room has a picture of Jesus stuck right under the nitro valve. It was the first picture of Christ I’d seen on my trip here.
The anesthesiologists are pretty nice, there is a trainee and an attending. There is a scrub nurse who is handing things to the field from silver canisters with long sterile pronged grabbers. They keep counts like we do and they waste almost nothing. Laparoscopic surgeries are 5 times more expensive because of the cost of what is wasted, the sheaths, the equipment, etc. If you can afford it you can have it. Money plays into everything here. There is some charity care, but it’s not as easily obtained. Only about 20% of the population has any kind of insurance. There are some government issued cards that have a cash amount that they can use.
The OB suite is small, 2 normal beds and 2 birthing beds. They do NOT give epidurals. They don’t use any anesthesia unless you’re doing a C-Section. Most notably, I never heard a word or scream, or peep out of ANY of the women doing labor. I was amazed!
It’s amazing to see the differences in medical care. They don’t waste ANYTHING. They re-use sterile gloves by autoclaving and use them on the floor. In a normal surgery, like a hysterectomy, they use cloth, metal tools and nothing except old sutures, and blades get tossed. They are very efficient. It made me think a lot about what I use in medicine.