Oh yea, the medicine…

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.

Monica Speicher, Leslie Banks liked this post

The People of India

This gallery contains 15 photos.

Here are some shots of people in India.  Notice the color/fabric schemes of the women, and the multiple riders on the motorcycles.  It’s amazing.  I always told my Julie that you could take the whole family on the motorcycle.  She never believed me.

The town celebration

We are in the town of Thenkarai, Madhurai, which is a ways from Madurai, India, but we commute there every day.

The day we got to town, there was a fantastic celebration for the rededication of one of the temples in town. This only happens every twelve years.  They washed, and cleansed the temple, sang songs, had readings from the holy books of the Hindu.  There was a loudspeaker and a sound system that broadcast the proceedings all over town.  When we got into town it was already in full swing and may have been going on for a couple days.  The people were active and preparing for It all over town.

When we got settled in, we went into town and saw many great and wonderful site(to be posted soon), and when we returned home, the celebration was still going on.  When it became dark, we went outside and saw them pulling a large statue by 2 dozen men, and a line of women with pots on their heads following.  It made procession all around town.  While we followed it, the kids surrounded us and wanted their picture taken, as well as some of the adults.

After the statue was carefully placed in the temple, there was a stage program that was arranged with a troup from the local town of Madurai.  There were several musicians playing local music with a couple opening acts.

The first was a man dressed up in a very shiny outfit.  He seemed to tell jokes and be funny.  The people kept a straight face, except for a few instances when he did a funny impression.  He also sang and played along with the music.

The next act was a woman who danced and sang and told jokes.  Dr. V explained the first guy was a comic, essentially, and this woman seemed in a similar vein, but she danced a lot more.

The music group had a few songs of their own to open and in between.  We left about 11 pm.  The celebration continued to about 4 am.  The main act was the story of the gods that was acted out by the troupe.  We never got to see it because of our tiredness and we had to work tomorrow.

Here are some scenes  from our night. (Click to enlarge)

 

My first international incident….


So we went out to see the attraction of a statue being placed in a dedicated temple. The people were pulling it on a large wagon, with lights, and a procession of women with potted plants on their head with beautiful flowers and designs. Well, as we approached, everyone was watching us, and then they came….hordes of them out of no where…children coming from every place. Some of them were trying out their English, asking us our names and our parent’s names. They were even trying out swear words and phrases they’d picked up on TV. Some tried to trick us into using bad words on them. They were pretty funny.
There were a couple girls who were following us as well. Most of the horde was boys. Once they saw me taking pictures, they asked me over and over to take their picture and show it to them. Some adults would also come up and gently asked if they could have their picture taken.

It was truly an international “incident” as it was the first up close an personal look I had of the Tamuli people, other than walking around them.
It was fun.

Jennifer Klun liked this post

On my way…

plane Wing

And that is the semingly small plane for the puddle hoppin plane I boarde to start me trip.  I’m heading from pittsburgh to washington DC, there to meet up with my group to head first to Germany..too bad my sister won’t be able to see me…and then to Chenai(Madras) India for day 1.

I kissed Julie and the boys goodbye, walked Gracie to her bus with the family this morning…she was sad…and now I’m off.   I’ve never flown over and ocean before.  Never left the continent.  I already mis my family.

The plain is particularly loud…prop planes, go figure.

Blog ya later.
David

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Boy do I have a fat face..