ID fellows, start making your differential

Today, our last day of CIT2 sanctioned events in India, we went to the fever hospital.  Compared to other government hospitals we have seen where occupancy is literally at 200%, it was a quite peaceful experience.  We got to see diptheria, with a small pseudomembranous plaque, tetanus, malaria, lots of gastro, and a few undifferentiated fevers.

Let’s hear it for vaccines.

The past few days I seem to have acquired an upper respiratory infection.   Is it Bocavirus?  It’s gotten to the point that I’ve started a steroid burst just to make me feel good enough to make it home.  By my calculations, my last dose will be taken in the Frankfurt airport.

So when I get back home and develop a fever 13.5 days after returning, there’ll be a great differential.  With my chronic asthmatic cough and known exposure, could it be TB?  How about Dengue or malaria?  But wait!  I took a course of steroids–could it be related to relative immunosuppression?  How about Avian flu?  I did walk (quickly) by chickens being housed alive in the Pondicherry Market.  What if I have a little bit of a sore throat, and something that looks plaquish…diptheria?

Once again,  reaffirming that I don’t want to become an interesting patient.

This weekend, Goa.  Then a long series of flights home.

Triage Talent

As Brian mentioned, we went to Sivananda again last night and spent some time with the kids.  It was so nice to see them again, they are truly inspiring.  Their stories we heard last week made me want to lose my faith in humanity.  How could such innocent children who were given such a difficult fate be rejected by their own families and society in general.  But then I see the compassionate care and support they receive at Sivananda and it renews my hope again.  Despite all they’ve been through they really seem like happy, well-adjusted and optimistic kids.  They were so excited about the festivities last night.  I felt very fortunate to have the chance to witness and even take part in their ritual and learn more of the culture.

Brian, Paras and I went to the Niloufer Women’s and Children Hospital again today.  As Paras and Brian mentioned earlier, the number of patients they care for at the hospital is overwhelming and I’ve also been shocked by the acuity of patients.  They see 200-300 patients per day in the casualty ward (ER) and average 5-10 deaths.  Paras and I rounded in the resuscitation ward of the ER around 11am today and they had already had 7 deaths since 8am.  One of the interns told me that bronchopneumonia and congenital heart disease account for a fair percentage of the deaths they see.  The acuity was dramatically presented to us when we first walked into the resuscitation ward on Tuesday in the midst of a full code on our left with a severely dehydrated, unresponsive child on our right.  Sounds like a routine day here.  They are a tertiary referral center, so many acutely ill patients are transferred from smaller hospitals,  but interestingly the only pediatric subspecialty they have is pediatric surgery.  They actually transfer all of their patients with congenital heart disease to a specialized heart hospital, yet the patients present to Niloufer when acutely ill.  An important part of our intern year is learning how to differentiate “sick” from “not sick.”  I imagine here they master their triage skills early on in training out of necessity as their ability to pick out the critically ill patients definitely makes the difference between life and death on an hourly basis.  It has been a very interesting experience to see the government-run side of medicine here in India.  I think Brian and Paras have both mentioned it already, however I have to reiterate how impressed I’ve been with their clinical skills and ability to provide care under the conditions in which they practice.

Bungee Parenting

Today is a national holiday.  It’s Ganesh Chaturthi, so we had the day off from the government hospitals here in Hyderabad.

To pass the time, four of us went back to Sivananda to see the kids and see their pooja, the religious ceremony honoring Ganesh.  I was very happy to see the kids again, today they were dressed in their fresh,  sparkling new (literally) clothes.  They were of course acting like kids-running, playing, and being generally rambunctious.  They recognized us as soon as we walked up, which was touching.  They all said “Happy Ganesh” to us, and one of the girls gave us ledu that she’d gotten.

Then we waited.  Ganesh was apparently running late.  About 45 minutes after his proposed arrival, the sound of drums could be heard coming down the path.  There was a plaster Ganesh being wheeled down the pathway with his exuberant entourage of all ages.

They wheeled him up to the place where he would reside for the next 9 or 10 days, and then there was trouble.  Apparently they didn’t realize that Ganesh would be hard to fit into his new home.  After about 30 minutes of manipulating him, he finally made it to his temporary abode, and then the pooja began.

It was a whirl of adorning, praising, burning incense, throwing rice.  Oh yes, and taking pictures.  I think I will have a stack of photos to send back to Sivananda once I get home.

To an outsider, it was all an incredible spectacle, the likes of which we rarely see at home.   The kids were excited as if they were American kids on Christmas morning.

We had to say our goodbyes fairly early to catch a cab back home.  I’m very glad we got to see the kids again, and I’m again amazed that in spite of the battles that they have to fight–the ones they had no say in fighting in the first place–that they can still be kids.  I feel a little sad and guilty that we’re essentially bungee parents, or even worse, bungee tourists.  It’s one of the regrets I’ve had about this trip, that we haven’t had the time to build the relationships with the kids, and others we’ve come across.

I guess that a whole other trip.

We go now to our CIT2 News correspondent…

On Saturday we did some shopping, and Sunday we did some touring! We checked out Golconda Fort, which is a really fantastic structure dating from the 1500-1600s, it’s huge and impressive, and the original city in this area! We milled around, listened to our hired english-speaking guide (without whom we would not have been able to appreciate many of the historical nuances) and had an awesome time. There are places you can hear noises amplified from other areas of the fort and some very detailed carving remains on some of the walls. The entire structure sits on natural large stone foundations, walls are nailed in with stone nails, and apparently there’s a secret passage to Charminar, but it wasn’t open to public access. The temple at the top is also amazing, including many large stones balanced on top of each other and the usual Hindu brilliant use of color.

When we were nearing the end of our Golconda adventure, enjoying some ice cream (CIT2 has eaten a lot of ice cream) I was approached by i-news and asked for an interview. I’m not sure who they thought I was, but I consented and it was kind of hilarious. They just wanted to know about my experience in Hyderabad and Golconda. Paras and Tim decided to dance in the background which was really a sight to see, then they got yelled at by the Indian TV crew! Hah! So why me? Some speculation suggests there may have been headlines to the effect of “Pasty American Giant Attacks Golconda!” but we couldn’t find it on TV or the net, so we may never know.

Lastly we went to Charminar which is a monument built to commemorate Hyderabad becoming the capital of Muhammad Quli Qutb Shah in the late 1500s. It’s an amazing four-sided structure that we were able to climb up in and get a great view of the markets and city. Since we’d just been in those markets it was even more impressive how packed they were. What did we get, you’d like to know? Well, in the words of one CIT2 Member “pretty, pretty bangles”. Hint: These were neither Alicia’s nor my words. Paras really busted out the Hindi and got us some good deals in the negotiation process which we really appreciated.

Itching

Yes, I know that I am of South Indian extraction, but man, is this mustache killing me.