Familiar Faces, Food, and Chi

The couple's dinner on Sunday was a huge success.  The worship hall was decorated with heart-shaped balloons, streamers, hearts and flowers cut out of construction paper, and candles.  We had about 25 couples attend.  It was so much fun to see all the ladies dressed up in their beautiful saris.  We served a 3-course meal and the couples played some games, and at the end of the evening Katie and I announced the best-dressed winners.  After group photos, everyone joined hands and sang a song called "Bind Us Together, Lord."  It was great fun.

After spending every waking moment of my entire weekend on this party, though, I was exhausted.  So I asked if I could have Monday off, in part to catch up on some sleep and in part to try to get over this cold that's been nagging at me.  I already feel better today.

The campus has another American this week.  Nikki is a nurse just 2 years out of nursing school from Washington state, where she recently quit her job to come work in India for 6 months.  She's already been in India since November, and she's been traveling around from one EHA hospital to another and one community development project to another.  She'll just be at Herbertpur Christian Hospital for a week, but it's great to have her here.  Not only to have another "familiar face," (all Americans now seem to have familiar faces) but also because she's so knowledgeable since she's been here so long already.

The 3 of us - Katie, Nikki, and I - all walked up to Vikas Negar late this afternoon for some fruit shopping.  Oranges are a welcome treat to break up the monotony of the Mess food.  The Mess food isn't bad, it's just always the same.  There's always rice, there's always roti - India's version of tortillas - and there's always dal, which is like a thick soup composed mostly of beans or peas or lentils of some kind.  Every day, for both lunch and dinner.  The only thing that ever changes in the kind of dal they serve, but they only have about 3 or 4 different kinds in the rotation.  It's decent food, and I wouldn't mind having it one or twice a month, but every meal for 3 weeks is a bit much.  I shouldn't complain, since they're only charging me 60 rupees per day for food: about $1.50.

One thing I love and have not gotten tired of is the chi (tea).  They make it very sweet here, and you couldn't get a cup of black chi even if you wanted it because they mix cream, sugar, and honey into the entire pot.  It's excellent.  The hospital has a chi service that comes around twice a day - once in the mid-morning and once in mid-afternoon - so that all the doctors and staff can have their twice daily cup of chi.  No one ever misses chi no matter how busy it gets, even if it means having to drink it while seeing a patient.

I'm posted in the Casualty unit all this week.  I really like it.  The autonomy is so much fun.  Sometimes I'm the only one there resembling a doctor, so the nurses look to me to make decisions about the patients who roll in.  Fortunately, one of the 2 Casualty nurses is a seasoned veteran, so she has my back and makes sure I don't overlook anything obvious.

Just one more week left in the hospital.  Can't believe it's going by so fast.

Doctors-To-Be

Saturdays are just half days at the hospital, but even just a half day is plenty of time to run across something exciting.  We had 2 patients come into the Casualty unit with TB.  I've never seen chest x-rays look so dirty.  One patient has TB and has been smoking 3 packs a day for 20 years.  He's in bad shape.

One young patient came in referred from another outpatient center with severe headache, vomiting, and new-onset seizures.  He had gotten a CT at a stand-alone imaging center in town (we don't have CT machines here), and sure enough... Neurocysticercosis.  Unbelievable.  Neurocysticercosis is caused by a tapeworm found in bad pork, and it causes cysts in the brain which can be seen on a CT.  It's almost never seen in the States, but apparently it's quite common here.  This is one of those obscure diseases we learn about but never really expect to run into.  All the doctors here were so nonchalant about it since they see it all the time, but I was amazed.  Just another reason to avoid the meat here.

This week 2 pre-med girls from Delhi visited the hospital for an "exposure trip," I guess just to see what they were getting themselves into.  In India, medical students don't have to go to college; it's just straight from high school into med school, which is 5 years.  These 2 girls are both 19 and have finished with high school and are now taking a year off to study and prepare for med school's entrance exams.  They want to go to India's Christian Medical College and eventually serve the poor.  They're 19, but a very young 19, and knew so little about medicine (they had never heard of a C-section, for example).  They seemed quite overwhelmed and intimidated, so I tried my best to explain what was going on.  They called me "Dr. Angela."  When I asked what kind of doctors they wanted to be, one said, "My heart beats for psychiatry," so she became my favorite.  The two of them left today, but before they did they each gave me a note written on pages torn out from their journals thanking me for my help this week and wishing me blessings.  They each gave me a chocolate bar, too.  So sweet.  It warmed my heart.  It encourages me to see girls wanting to go into medicine here, where it is still very dominated by males, and it is especially encouraging to see an aspiring psychiatrist.  Please say a quick prayer for them for me.

I spent the entire afternoon getting decorations together for the couple's dinner tomorrow night, an there's still a lot to do tomorrow.  I think it'll be a success though.  If I don't get to post tomorrow it'll be because I'm busy with that, and the computer lab is closed on Mondays so it may be a couple of days before I can check in again.

Hope everyone is staying warm back home!

Pleural Marriages

Another full day.  This morning we saw 50 patients in 4 hours in the Ob/Gyn outpatient clinic.  I would do the exam on one patient while the doctor was talking to the next patient, then he would send her in to me for an exam, and bring the next one in.  Like a machine.  I will say I think I'm getting better at my prenatal exams with all this practice.  I was able to diagnose a breech today just by palpating.

This morning on rounds I was introduced to a patient who had just given birth and whose husband just died 2 months ago.  So sad.  In the tradition of the people that live in this area, though, she will marry her deceased husband's brother.  How very Biblical, right?  And if her deceased husband had more than one brother, as they often do since contraception is not commonly used, she will marry all of them.  This is a very common practice here.  One woman married to several different men, all brothers, who pass her back and forth and share her.  The result is a woman who is perpetually pregnant, and no one knows who the father is of any of her children.  It sounds dysfunctional, but I guess it works for them.  I think it's better than being a young widow.

On Sunday evening, the hospital church is putting on a dinner for all the married couples to celebrate Valentine's Day, and Katie and I were volunteered to help.  We just returned from town where we bought decorations, and we're going to spend this evening making the fellowship hall look festive.  We'll also help serve the dinner on Sunday, and Katie and I are to be the judges for the best-dressed competition.  The winning couple gets a nice dinner at a fancy restaurant in Dehradun.  Such fun!

So I'm off to do some decorating!

Busy

Today, the doctor I'm working with was covering both the Ob/Gyn service and the Casualty unit, so I spent the day running back and forth between prenatal exams, C-sections, and emergency evaluations.  Most of the day, though, was spent in Casualty, and I loved it.  There was cholecystitis, an upper respiratory tract infection, alcoholic cirrhosis, a femoral head fracture, a labial hematoma, metastatic cancer, seizures, a vertebral compression fracture, a DOA (dead on arrival)...  And a suicide attempt - ingestion of pesticide.  My mind was racing with questions I wanted to ask the patient for a full psychiatric evaluation, but not the time or the place.  He was kind of busy being decontaminated (since the toxic substance can remain on the clothes and skin).  He'll get a gastric lavage and some activated charcoal and then sent on his way.  Even if there were psychiatric services available here, the people here would never go for it.  It's a shame.  All he's learned is that he needs to take more pesticide next time.
The hospital is so short-staffed that I can function as a sort of baby doctor.  I can evaluate patients, write notes, order labs and radiological studies, and make recommendations.  I love the autonomy.  And it's so satisfying to feel that I'm actually being of some help.  The doctors here work 6 days a week, sometimes 7, and they're on call every 3 nights with no post-call day off.  They're perpetually exhausted.  It may be that my being here is just as much help to the doctors as it is the patients. 

As for me, I worked 12 busy hours today, and while that pales in comparison to the doctors' schedules, I'm still tired.  But it's so much fun.

Surgical Flip-Flops

I spent part of today working in "Casualty," which is what they call their ER, just doing some training and learning their system of doing things.  I hope to start working there more regularly next week.  I don't know of any statistics on this, but I just know the hospital's rate of infection must be sky high.  Everything here is dirty.  Gloves are not used for examining patients.  Sinks for hand-washing are scarce.  Not even any antibacterial gel anywhere.  It occurred to me today that I have probably been exposed to enough TB to turn my next PPD test positive. So that'll be fun to try to explain when I'm starting residency.

Another scary difference is that they operate in flip-flops.  As in, do surgery with toes completely exposed.  This is horrifying to me.  There are designated surgical flip-flops that everyone changes into when they change into scrubs to come into the OR.  The idea is that they don't want to get their own shoes dirty.  I don't know if the idea of shoe covers has never occurred to them, or if they can't afford to keep purchasing disposable shoe covers...  But we were taught NEVER to wear open-toed shoes in the hospital, much less in surgery.  What if someone drops a bloody scalpel?  What if the C-section is especially messy?  Yikes.  I was told in my orientation not to question how they do things here too much, because resources are very limited and they do the best they can with what they have.  I guess this is just one example.

Those who know me will not be surprised to learn I have made a canine friend.  There is a feral dog that lives on the hospital grounds.  The story goes, the dog was on death's door about a year ago, very sick, and the pastor of the hospital church took him in, cared for him, and nursed him back to health.  The dog has never forgotten it.  Each morning he comes into the waiting room of the hospital where we have morning devotional time and sits at the pastor's feet.  But somehow he knows he's not allowed in the hospital at any other time.  He will follow the pastor to church on Sundays and wait patiently outside until the service is over.  I can hear Ryan's voice telling me not to touch any stray dogs, so I won't, but I did take pictures.  His name is Foxy.

I hear another round of snow has hit Texas.  Can't say I miss it.  It's beautiful here.  Cold at night and in the mornings, but sunny and warm all afternoon.  I think I picked the perfect time of year to come to India.

I saw a quote today that said "A ship in the harbor is safe, but that is not what ships are built for."  I think I can safely say I am out at sea.

Mobile Clinic

A beautiful day in the Himalayan foothills!

Today I went to one of the hospital's "mobile clinics" located in a village several miles away.  A small group of us piled into a Jeep and drove for about 45 minutes along narrow, tight switchbacks up into the hills through beautiful forests filled with monkeys.  The clinic site is located in a small town on a dusty road, and the clinic itself is set up in a small courtyard behind one the shops.  There is a table and plastic chairs for consultation, and a bed made of wood and grasses for exams.  Common medications are stored in a locked shed and dispensed for free. 

One patient was an 8 year old girl with a swollen lymph node the size of a golf ball on the side of her neck.  Mumps.  I had never seen mumps before.  Not something we really have in the States, thanks to vaccines.  The girl  required no medications, as mumps is usually self-limiting.  She'll be fine in about a week.

There were several other patients that just couldn't be treated with the extremely limited facilities there.  One man came in complaining of chronic productive cough.  Here, chronic productive cough usually means TB, but we can't be sure without a sputum culture.  We gave him a referral card and urged him to come to the hospital, but it's doubtful that he will.  Herbertpur is so far away for him, and he just doesn't understand why it's so important.

On the way back to the hospital, we stopped by a home where a girl sells hand-made blankets.  She looked like she was in her late teens, early twenties, and she lives in small house with a thatched roof with her extended family.  Outside their home is a huge loom, which she demonstrated for us how to use.  She even makes her own thread and yarn out of old discarded fabrics.  As we were leaving she asked if I would stay.  What can I say, it must be the blonde hair.  Next time we go I'd like to buy something from her.

Tonight Katie and I walked to Vikas Nagar, a small town consisting basically of one long road lined with shops just a little up the road from the hospital.  One our way we ran into a wedding celebration.  We heard it before we could see it.  Drums beating, cheering, shouting, dancing in the streets.  The bride and groom were dressed in all kinds of beautiful adornments, and the getaway car was decorated with flowers.  The crowd saw Katie and me with our cameras in hand and begged us to take pictures.  We were happy to oblige. 
I've noticed many of the people here are delighted by having their picture taken.  One little girl, maybe 10 years old, came up to me and said in beautiful English, "Hello.  How are you?...Fine," then looked at my camera, grinning.  I snapped a photo of her and then showed her her picture on the camera, and she giggled and giggled.

So it looks like I'll be staying on the Ob/Gyn service throughout the rest of this week.  We'll see when I'll be able to rotate somewhere else.  Maybe next week.

Dehradun

This morning started off with a worship service that ended up lasting for 2 hours.  And Ryan says Baptists like to sing!  It was a nice service, though, half in English and Hindi.  The music was almost all in Hindi, but I still really enjoyed listening to it, especially with the accompaniment of the conga drums (I'm sure Indians have another name for them, but I don't know what it is).  We did sing one song in English, "What a Friend We Have in Jesus," and it brought me right back home.

Then Katie, the other American medical student, and I decided we'd take a trip into Dehradun, the closest large-ish city.  So we hopped on a bus for the hour-long trip.  The bus ride was fun, and it was one of those moments when I become acutely aware that I am in a very foreign foreign country.  The paint on the bus was lime-green and chipping everywhere, and some great Indian music was playing over the speakers.  I watched rural India pass by outside the window, and it seemed like these communities are just frozen in time, isolated from all modern advances.  Horses and donkeys are still used to pull carts stacked high with hay, sticks, and reeds, which will be sold to be used to make beds, furniture, and even homes.  And again, cows everywhere.

My favorite discovery of the day was on that bus ride on the way to Dehradun.  The first time I saw one I wasn't even sure I had seen correctly.  But then they were unmistakable: monkeys!  We passed through a wooded area and all along the side of the road were monkeys, walking, sitting, eating bits of food, sifting through trash, watching the bus go by.  There were even several babies walking behind their mothers.  I was completely blind-sided by this.  Cows, pigs, goats, dogs - all of these animals roaming the streets I was prepared for.  Monkeys were a happy surprise.

In Dehradun, we ambled through the markets and took in all that there was to see.  I learned quickly that you have to always be alert in Dehradun because something is constantly being thrust at you.  Cars and motorcycles come rolling by, aggressive merchants display their wares, and children tap your arm begging for money.  I caught quite a few stares from people; I think the blonde hair and very white skin must have been fascinating.  Children pointed, young people spoke what English they knew - "hello, ma'am!" - and one woman came right up to me, grinning, and poked my cheek with her finger.  I decided to find it all flattering.

When we got back to Herbertpur we stopped in the food market and picked up some fruit (only fruit that could be peeled, of course) and a couple of packages of cookies.  Indian people aren't as big on sweets as Americans are, and dessert is not really a concept here, so I'm very grateful to have cookies in my possession now.

It was a fun but tiring day, and I think I'll sleep well tonight.  Tomorrow I will probably start working in a different area of the hospital.  I'm excited to find out where that will be.