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.

Not Just Pondy?

I am now thinking that we may split time between Pondicherry and Hyderabad. The experience at Pondy will be direct patient experience with medicine, surgery, and OB/GYN. There will be interaction with med school faculty, residents (Postgraduates) and students. The major success of CIT1, in my mind, anyway, is the opportunity we had to see other aspects and venues of healthcare. I think that visiting the Sivananda Rehabilitation Home is a fantastic experience for anyone. The Fever Hospital is also an excellent education in the clinical manifestations of tropical diseases as well as a display of healthcare inequalities. Most of the patients there (without diarrhea) have vaccine- preventable illnesses. I am also thinking about other things available in Hyderabad that may not be as easy to come by in Pondy. Not to mention that as beautiful as Pondicherry sounds, Hyderabad is a more typical Indian city.