Our days off in Pondicherry

As Brooke mentioned, we saw another case of organophosphate poisoning yesterday on rounds. Of course it had to be, because it seems they need to have a census of at least 2 OP poisonings in the ICU at all times.

Yesterday those of us who were in town and were feeling well enough came into Pondicherry to hang out, and either do work or explore the Indian quarter. Tim, Alicia and I wandered around to find the Grand Bazaar, a large more or less open-air market, although everyone tried to build as much of a roof over their stalls and aisles as possible. Think of this as the West Side Market, but on steroids. Row after row of vegetables piled up in baskets or on the ground, hundreds of bolts of fabric in every color imaginable, and a very fresh chicken. As in still breathing. This is the India I was expecting when I came.

Added to the list of things I wish I had brought: Tamiflu.

The three of us attended services at the Catholic cathedral in town last night. We were hoping the mass would be said in English or French. Instead it was in Tamil. About 20 minutes into what we thought was a homily, we decided we’d had enough and made a quick exit to pick up Brooke for a very leisurely dinner.

I use the term leisurely to mean slow service. But at least we finally got to have our dinner overlooking the beach and Promenade.

Gopal made his way back into town last night. I’m sure that will be the subject of another post shortly.

We’re all looking forward to the Indian food dinner that is being prepared for us at Coffee.com #2 tonight. I am sure we will not be disappointed.

Yes, we all can fit in one (1) auto-rickshaw.

It’s been really interesting seeing how medicine is done at the MGMC & RI, and we are especially grateful to Dr. Hanifah teaching us so much during rounds in the ICUs. Here’s a group picture of all of us on our last day, the man on the left is the PG, or resident, on service. Ladies, please note the mustache.

Today we saw another case of organophosphate poisoning, this time given via injection! It turns out they can get syringes very easily at the pharmacies without a prescription, which I guess shouldn’t be surprising to us since they can get all the azithromycin they want too, maybe sometimes they want to get it IV? Anyway, his arm didn’t look too good, we didn’t linger in the RICU today as it was stifling-hot in there, but I hope he was on some abx, because I don’t think he used medical injection-grade organophosphates. Per the admitting doctor it was another case of “love gone wrong.” It’s sad how many suicide attempts we’ve seen in our few days here.

As Brian mentioned we ran into two Americans, Matt and Chris from Dalit Solidarity, who seem to be doing a lot of the stuff we were talking about the other night. I don’t want to belabor the point, but I really am just so happy that we found someone doing what we all agreed was the most important, which is improving the basics, including providing PCP-like care! You know I love my ID peeps, but before we can have good efficacious HIV treatment we need these people to have the basics that allow them to take that medication and avoid other infections, and prevention! They even taught us a little Tamil, which is too bad we’re leaving soon!

And since you wanted to see some pictures of the ‘stashes, here is a cute group photo. Alas, the facial hair is still sparse in this picture, but I am confident in a few days they will really be very nice. In the background is the Auroville dome which you can’t really see on account of glare. Also maybe Brian’s camera had too many options for the man whose meditation we interrupted to have him take this photo. Perhaps when Dr. Yadavalli rejoins the group tonight or tomorrow we will get another group picture. Oh man, speaking of that… I better work on my presentation…

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.