Peektures!

I know you want pictures of mustaches (and ladies, let me tell you, they are something to marvel at!) But no one has their camera connector here at coffee dot com today. We will definitely get you some mustaches to look at in the future, certainly, so be patient and enjoy what I have below:

This is a cute picture of us on the back of the bus, on our first bus ride out of MGMCRI & RI, notice how empty it is. This was a misleading view of bus rides as all subsequent rides have involved mild panic attacks from claustrophobia. You might note my sweet adventuring hat that also serves to keep the 12 degrees latitude Indian sun off my pasty Irish flesh. Cute, huh?

Ah, home sweet home! You may note the partially constructed dorm that we are currently living in. They are working hard to complete it, though, and do something involving hammers from approximately 5am – 10pm every day. The insides are nicer and we very much appreciate the air-conditioners.

The previously referred to cow, Betsy. As you can see, Tim is trying to get a closer look and she is giving him a very wary stare.

India is great, but….

We have all been having a fabulous time here in India learning the culture, meeting new people and experiencing tropical medicine, however I just want to take a moment and mention a few things that I truly miss from home. 

1) Coffee.  While it is readily available and very creamy and sweet, the coffee is served in dixie cup portions with only a fraction of the caffeine I require.  I am struggling without my usual 20oz to go cup of coffee in the morning.  I never thought I’d say it, but I miss Starbucks.  Thankfully, we’ve found Coffee.com however a 30min (and usually very crowded) bus ride to town and back in the morning is just not feasible. 

2) Toilets with toilet paper.  While I’m impressed that Indian women can finagle the hole in the ground style toilets, I much prefer ones with (clean) seats.  I haven’t quite figured out how they use the sprayer in place of TP without getting drenched and am fairly certain I’m not going to even try it.  I am just going to continue carrying my travel pack of Kleenex at all times. 

3) Traffic laws.  I never thought I would miss the threat of speeding tickets but the traffic here could use a little control.  I took me several days to not feel as if I was going to die every time I was in an auto of any type.  Now I’ve learned to relax and go with it.  We often get very close to the other cars, bikes, rickshaws, cows etc on the road but so far have only hit one (right Gopal?). 

That’s about it; otherwise I’m quite content here in India.  On the medical side of things, we’ve been having some very interesting experiences.  As you’ve heard, we’ve been working (actually more observing) at MGMC&RI this past week.  It’s been difficult to see pts that really could benefit from certain diagnostic tests or therapies but have been unable to receive them due to the family’s inability to pay upfront.  I have to remind myself that this is a private hospital and that care is available at the government hospitals.  We have not been overly impressed with the state of things here at MGMC&RI and from what I hear, it far surpasses the conditions of the government facilities.  I am very interested to experience the government side of medicine in India. 

Throughout the week, we’ve had a lot of conversations about lack of handwashing, contact precautions here in the hospital and how improvement in these areas is needed desperately.  In a society that for the most part does not have clean drinking water or proper sewage systems, I’m not really sure were the emphasis on improvements should lie.  It’s interesting how difficult it is to institute such simple things as handwashing and proper hygiene when they are just not part of the culture.  As the old saying goes, old habits die hard.  Change is just difficult to achieve.  As Gopal mentioned, even in our society where we are very aware of the importance of handwashing, there is far from 100% compliance.

Community Health and Other Things that Frustrate Me

As Brain (the Indian spelling of Brian) alluded to in his post yesterday, we visited the Department of Community Health on Wednesday. It was an interesting session. The assistant professor who took us through the department’s museum (basically a room with a bunch of models of different diseases, sanitation systems, water filtration systems, etc.) was willing to answer our questions, of which I had many. It seems in India, community health is an integral part of the medical school curriculum. They learn about how to treat the drinking water, how and where to dig latrines, entomology & the use of insecticides to kill vectors of disease, in addition to things like diet and cancer prevention. Needless to say, these subjects not usually covered in the U.S. medical school curriculum, but in the developing world they are integral. It is much cheaper to treat the source of the problem than the complications.

Over dinner that included one suspect pina colada and a round of cognac, we discussed the challenges of public health in the developing world.  I am no Infectious Disease specialist, so while discussing the intricacies of HIV treatment are interesting to me, I feel more drawn to the issues of preventative medicine (must be the internist in me).  I brought up the example of some Sub-Saharan African countries who are spending most of their health care budgets (with many of the dollars coming from the American and European NGOs)  on the treatment of HIV.  Not to belittle the problem of HIV, but these same countries that are spending millions treat HIV lack the basic infrastructure (ie clean water, sewage systems, schools to educate the masses on public health issues) needed to live a healthy life.  In India, the challenge challenge of changing public health is very complex and would require changing cultural habits (ie defecation on the street, not washing your hand in the hospitals, drinking nasty water, penning your animals) and huge monetary investments in basic infrastructure (ie underground sewage systems, water treatment plants, schools, developing a health care system that includes primary care). In some senses, it would be easier to just open a clinic and treat HIV, TB, diarrhea, and malaria, than to try to treat the underlying problems.  And that is what frustrates me about Community Health in the developing world.

Other things that frustrate me:

1.) We went to a lecture for 4th year medical students yesterday. The professor PIMP’ed me relentlessly while Paras, Brian, and Alicia sat quietly. Makes me wish I had a 3rd year to PIMP.

2.) Cost of CT head in India: 1000  rupees (~$30) ; CT Head in US: ~$1000.  Cost of Plavix in India ~10 rupees/day; in the US, ~$4/day.  I may fill my suitcase with Plavix and sell it on the black markets of Cleveland.

3.) Losing access to your UHHS e-mail account while in India. Can we outsource the UH computer help desk to India, so it would be a local call for me here? If anyone needs to reach me, send e-mail to tfernan295@yahoo.com.

4.) The Internet dying in the middle of writing long blogs and losing what you have just written.

Another one bites the dust

Brooke is feeling better.

Paras is not.  Overnight, Montezuma’s revenge caught up with him.  Or should I say Shiva’s revenge.

We’re all experiencing varying levels of GI distress, from heartburn to traveller’s diarrhea.

Yesterday Tim was pimped by the Dr. Walsh of MGMCRI.  Pimped mercilessly as the rest of us watched.  I think he almost broke down in tears.  I’m kidding about the tears.

This occurred during one of the upper level medical school lectures, where it’s kind of like CPC format-stump the attending.  Although it was more of a teaching session where the attending (in this case the department head) went through the process of clinical analysis of a patient.  In this case it was a case of edema and ascites.  Clinically, I think he concluded that it was caused by one of the hepatitis viruses.  I don’t think there was even a discussion of laboratory investigations.

The poor man probably didn’t even speak English, and was sitting in this room for an hour and half, wondering why we were talking about him.

In the afternoon, we spent a few hours looking at microscope slides with Dr. Singh.  He pulled out various tropical parasites–malaria, leishmaniasis, filariasis and other worms–and even a slide showing Negri bodies of rabies.  It’s kind of cool because I remember pathology in medical school being quite boring–this is the liver…this is an abnormal liver….this is a kidney….this is MPGN….   It was fun to be able to see things under a microscope that we wouldn’t otherwise see in the US…and textbook plates just don’t do it justice.

They have malingerers in India as well.  However at 5000 rupees for an ICU admission day, and 1500 rupees each day afterwards, it’s kind of expensive to be a malingerer.  In the drama that is becoming our usual morning routine, a nursing student apparently went into convulsions.  She’s had evaluations done, including an EEG, at another private hospital which were all normal.  Our leading diagnosis now is pseudoseizures.

As for yesterday’s snake bite patient, they think that it was all hysteria induced.  They gave her a dose of antivenin, but decided to withold medications to see what would happen…and nothing did.  Whatever bit her was not likely poisonous.

Our excursion du jour for yesterday was to the Kailash Beach Resort, about 3 km down a side road from the Eye hospital up the main hospital.  Even though we weren’t supposed to, we snuck onto their beach and went for a nice long walk (please, no jokes about long walks on the beach).  It was very pretty, and it was sandy unlike the beach in the city.  If you walk far enough, you get to the public area where the fishing boats were pulled up onto land, and the fishermen were untangling their nets from the day’s work.

It was all very pretty, until I turned around and saw someone squatting bare-bottomed on the beach and realized these were not stray dog droppings that we saw along the way.

The resort itself has a beautiful pool, decent restaurant, and while very expensive by local standards, was quite reasonably priced.  We sat and drank a couple of beers while waiting for the restaurant to open, and in the meantime filled up on cashews, peanuts, and other Indian equivalents of beer nuts.  By the time the restaurant opened, we decided to just get “snack” sandwiches, which turned out to be triple decker sandqiches with cheese and fresh vegetables.   I picked the vegetables off, and hope that was good enough.  They even called an auto-rickshaw for us to take us home!

It was nice to finally have a nice walk where you didn’t feel the stifling heat.  The breeze off the ocean kept things nice and cool.

This morning on rounds, our last discussion was about methods of suicide attempts in India compared to the U.S.  What rolls into our medical wards and ICUs are things like Tylenol, anti-depressants, and prescription medication.  Here it tends to be more things in the community–pesticides, posionous berries that are used as decorations, etc.  Just imagining how many people attempt, but don’t make it to the hospital for care, or cannot afford care is just mind-boggling.  The population of Pondicherry is about 1 million–more than the City of Cleveland, but about half the population of the metro area.  And this little private hospital-one of dozens of private and government hospitals– that’s less than half full has at least 1 or 2 OP poisonings at a time.