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.

We shall overcome

I think this was an very interesting day for everyone. i am writing this independently of the others, so if we cover the same stuff, I apologize.

Today, our second day at Sivananda, we visited the DOTS program, the workshops, and the children’s HIV orphanage. I have to say that it’s amazing what they are able to train the patients to do to become productive citizens. I do think that Americans are definitely the wimps when it comes to learning marketable skills. They’re making their own metal furnishings, including all the hospital beds, bicycle rickshaws, all the cloth bandages, sheets and towels they use, school uniforms for their children, candles…and that’s just the ones who can’t realistically get work outside the home.

The children’s HIV orphanage was amazing. They currently have about 30 children, and are expanding to take 20 more. Some of them are true orphans–one or both parents died, leaving the on the streets begging, scavenging, even looking after each other. Others are orphaned by social stigma. One girl and her grandmother were kicked out by their family when they found out the reason for the girl’s recurrent illnesses: she was HIV positive. The 75 year old grandmother realized she could not care for both herself and the granddaughter, and dropped her off at Sivananda.

Almost all the children there came in severely malnourished and failure to thrive. Most had opportunistic infections: diarrheal illness, recurrent or persistent infections. Everyone there seemed to respond to HAART. Some of the most important things they did for these children were to provide them with clean, safe drinking water and healthy food. Treating infections and getting them on antiretroviral therapy also helped, but meds don’t help if you keep getting infected.

They are all bright, and happy to see us. I gave them the shiny Ticonderoga pencils that I brought along, and they in turn made us cards welcoming us, and showed us their sketchbooks of art.

I asked the doctor how many orphanages there were in Hyderabad. She could only come up with 5 in the state. Hyderabad is a city of at least 10 million.

What I was thinking about the whole car ride home (in monsoon rains, mind you) was how much work needs to be done, and it’s not really fancy research, or complicated interventions:

–Clean, hygenic drinking water

–adequate sewage systems

–access to health care

–fighting the social stigma of HIV, even among health care providers. (It’s kind of interesting, leprosy, the old stigmatized disease, is now becoming rare, and they’re closing down leprosy blocks at Sivananda. They’re expanding to serve HIV patients, the new stigamatizing disease)

–fighting malnutrition

Back in middle school, I attended week long youth church retreats looking for some inspiration. We had talked about people having “mountaintop” experiences where one has a moment of clarity. Today was the mountaintop experience for the trip so far. Now I just have to figure out what to do with it.

I marvelled at how much good Sivananda has been able to do with the children. They all seem healthy, eager to learn, and most importantly just be kids. I know a lot of their stories are just going to run together in my mind as time goes on. I am amazed at their fortitude and resilience. Whether or not she knows what she was singing, what brought tears to my eyes was when one of the girls in the orphanage wanted to sing us a song. We listened attentively as she sang “We Shall Overcome.”