Today was our first exposure to patients. After meeting with Dr. U.K. Singh, the chair of microbiology to discuss our objectives, we took a brief tour of the microbiology labs and had a chat with one of the Assistant Professors of Microbiology. They have very few resources compared to the central micro lab at UH, but since they have to bill for all their services, as well as the media and the lab tech’s time, very few patients would be able to afford the services. Blood cultures are done the old way, innoculating them into media, and then visually examining them daily. No fancy Bac-tec machines named after the Jackson 5 here. Susceptibilities are all done by hand, and they don’t routinely run antigen tests since most people can’t afford them. They do have the ability to run ELISAs and Western Blots, but at 3000 rupees a pop (about US$70), it’s out of range for most Indians in the area.
Paras, Alicia, and I then met with the Chair of Pediatrics, who was kind enough to take us on a tour of the hospital. We saw the NICU, Respiratory ICU, and the Pediatric Wards, as well as the outpatient clinic. The NICU was far more advanced than I would have thought. They have monitors, electronic warmers, and modern ventilators. The last ventilator that I saw in South Africa was extremely archaic, and was only used in emergencies. These were state of the art touch screen vents. They do not, however, have ECMO, iNO, or any cardiac cath capabilities for babies. All the congenital heart kids go to Chennai by road–the same harrowing 3.5-4 hour experience we had. Because the families here lack the capability to care for any disable children and will often ignore them as if they were dead, they do not resuscitate below 28 weeks. As such, they have no incubators, and all their beds are open. Their main priorities in the NICU are controlling sepsis and hyperbilirubinemia. What astonishes me is that the microbiologic flora are completely different here than back home. They see almost no group B strept which is the bane of the Mac House moonlighter’s existence. They see more gram negative infections, and their initial choices for coverage are a second generation cephalosporin and amikacin.
We also talked to the chair about the vaccinations. They have most of the regular vaccinations for free, paid by the government. This includes the BCG, Hep B, oral polio, TDaP, and Hib. Others, like Pneumococcoal, Hep A, and rotavirus are paid out of pocket if the family wants them.
It was interesting talking the the attendings here. The big concerns are always cost to the patients and resource allocation. The common thread is that they would all love to have state of the art equipment, but if they can’t use it enough to justify the cost, and can’t bill patients for their use, what’s the point? Money still makes the world go around.
The quick visit to the post-natal wards was very different from Mac House. Every one was co-sleeping, and the earliest discharge day was DOL 3 for a vag delivery. For C-Sections, it’s 7 days. The chief of pediatrics told us that they have the same army of grandmothers that we have in Cleveland out there giving advice on what to do for their grandchildren. So they like to take the extra time to teach the mothers how to take care of their children.
The peds wards have about 30 to 40 beds split amongst general wards, the gastro ward, and the “PICU,” which is still awaiting equipment. So far nothing strange or exotic–pneumonia, febrile seizures, gastro, and breakthrough seizures.
The people here are quite sharp. The NICU attending we talked to was preparing to depart for fellowship training at Sick Kids in Toronto for Pediatric Nephrology. And everyone I talked to seemed to know the western “standard of care” that they would like to see practice, and then compare it to the reality that they know they can deliver and get paid for.
After lunch at “the dive” next to the canteen, which is very fast and efficient with good food, we got to see slides of malaria and microfilaria.
And now, we chill in front of the computers.
CaseIndiaTrips 2 