Saturday
We went to the Golden Temple today. So beautiful. Everyone there was also very helpful. I think they saw that we looked out of place and came to escort us to the ticket counter. Joel even bought a pativaisty (had to since you're not allowed to wear shorts). It looks like a towel that has been wrapped around the waist. We ended up buying the ticket that allowed us to bypass the insane line which was awesome because even just waiting the 30 minutes was hard. So hot, so sweaty, so loud. The people in line were very talkative and loved to stike up conversations. We talked to this one family that basically told us about the hot spot temples that we should visit before leaving Vellore.
Sunday
We took a mini tour of a town about an hour outside of Vellore called Kancipuram. Saw three temples devoted to Vishnu, Shiva, and I don't remember the third. So beautiful. Kanchipuram is also known for its silk sarees so we went shopping. I ended up buying a saree for my mom (HAPPY MOTHER'S DAY, MOM!) and a scarf for myself. Silk. So baller.
Monday
Today, I had to face the cold woman that turned me away last thursday. When I got to the hospital I went straight to the OB/GYN department. The secretary escorted me to the surgery floor. I was told to go to the ladies dressing room where the nurse handed me a pair of "scrubs". Mismatched, oversized, and linen. the pants were more capri like and the shirt felt like a smock. Did I forget to mention that the shirt had a giant blood stain on it? I got to wear my flip flops into the O.R. I did get a pair of booties to put over them though. I was also handed a face mask and a surgical hair net. Once I got all dolled up, I was told to go to operation theatre 3. The cold doctor was standing gaurd waiting for me. She told me I was going to observe a laproscopic hysterectomy. AWESOME. This was the first surgery I had ever seen. Lessons learned:
1. From the point that I arrived to the hospital to entering the O.R, not once was I told to wash my hands
2. The only people wearing gloves in the room were the surgeons. The nurses and I.T personnel did not have gloves on but were touching all the surgical instruments.
3. 99.9% of everything used in the O.R is reusable
4. Everyone wears flip flops
5. At one point, the surgery was paused so that various insturments could be assembled
6. People were texting and talking on their cell phones in the O.R
7. None of the lights hand plastic film on them. The surgeon kept adjusting the lights and by the end, the lights were covered in bloody handprints
8. People kept walking in and out of the O.R
9. I now know what burning flesh smells like
Even though I was assigned to the laproscopic hysterectomy, the operating rooms are set up so that 2 glass walls are the dividing feature between adjacent O.Rs. Because of this, I was also able to see 2 C-sections that resulted in the birth of 3 babies (twins + 1). My time in the O.R has confirmed several things for me.
1. I do not want to be a surgeon
2. I do not want to be an OB/GYN
3. I will never get surgery in India
Tuesday
We went to CHAD clinic today. It's a rural clinic that caters to a lower socioeconomic population and functions as a secondary hospital (while CMC is a tertiary hospital). When we got there the social worker gave us a history of CHAD and how they have 2 key functions. The clinic (OPD) and the mobile clinic. The mobile clinic takes doctors, nurses, social workers, and elective students out to the rural villages and tribal areas and provides preventative medicine and conducts research studies. It was unfortunate that there wasn't enough space in the van for us to go out with them that day. Instead, we spent the morning in OPD. The first doctor I was with was training in community health (which apparently is different than family medicine). The second doctor I was with was phenomenal. She kept switching between the regular patients and the high risk anti-natal patients. Prior to the patient walking into the "office", she would give me a brief medical history and chief complaint. She would quiz me about various lifestyle disease and was very open to questiosn from me.
1. Genetic diseases are probably concentrated in the tribal populations
2. 9 out of 10 patients were diabetic
3. Education for diabetics is provided but everyone is too poor to change their diet/lifestyle (sounds familiar, doesn't it?)
4. A 10 year old boy who had rheumatic fever 5 years prior, currently on penicillin prophylaxis, was seen for residual heart problems
5. Woman in 50s diagnosed with epilepsy came in because she forgot her medication plan. Doctor was impressed that I noticed the patients hyperflexed IP joints. I also mentioned that it could be due to a injury to the ulnar nerve (since she seemed to have almost a claw hand).
6. A teenager with Cushing's Syndrome
The most surprising case was about a mid 20's woman who was 30 weeks pregnant and left diagnosed with intrauterine death. She also has been diagnosed with anti-phospholipid syndrome which predisposes her to abortions. G3P1. She has been pregnant 3 times but only given birth once. The first child was still born. The second child was a succesful normal delivery. Now, the third child died at 30 weeks. She was being admitted for further investigation. I found it odd that she seemed okay. I didn't observe any emotional distress, tears, or anything that would indicate departure from a normal disposition. After the patient left, I asked her why the patient seemed emotionally stable in light of such a tragic event. The doctor told me that she wasn't sure when the fetal heart beat disappeared and because this young woman had already been through a similar tragic event with the first pregnancy and nearly lost the second one, she learned to become emotionally detached.
My time at CHAD further confirmed how much I adore family practice and that it encompasses everything I'm looking for in a lifestyle and practice of a physician.
Wednesday
Today, we spent time at Karagiri, a leprosy village. This was an unbelievable experience. We recieved a tour which included the various labs (micro, patho, and basic testing). Next, we were taken to the animal lab where the attendant explained to us how they were testing different drugs and their effects on leprosy. Mice were the chosen animal model since testing on humans is unethical and the only other host is armadillos which cannot survive in the indian weather, even in air conditioned rooms! After that we went to OPD and sat in on a few patient encounters. The doctor did a wonderful job of explaining what Leprosy is, diagnosis, prognosis, and maintaenance. We saw patients who had been treated and years removed from the disease and a patient who was currently undergoing treatment. After this, we went to the rehab center which is more of a lifestyle rehand instead of physical rehab. Everyone is taught how to earn a living and regain self-esteem. (Leprosy was and still has a social stigma associated with it.) Joel and I bought beautiful bags that had been hand made by some of the patients. After this we were shown a video that told us the history of the the village. Lastly, we were taken to Shantigaram. This is a place for people whose families refuse to take them in. Many of the residents there were 70+ in age.
1. CBA mice were the animal models (cross bred albinos)
2. 3 drugs are used in the treatment of Leprosy
3. Pauci or multi (2 categories of Leprosy)
4. Leprosy=Hansen's Disease
5. Loss of temperature sensation is the first sign of leprosy
6. 28 day drug packs for one year is the standard treatment. If replase, treatment is extended for 2 years
7. Hypopigmented patches, enlarged peripheral nerves, and loss of sensation are the 3 keys features
8. Psorasis is a side effect of one of the medications
9. Leprosy is thought to be transmitted by droplet just like TB (actual mode is not known)
10. Incubation period can be from months to years
11. Second generation drugs are avaliable if resistance to first line defense drugs is formed.
The plan for the rest of the week is to go to the Low Cost Effective Care Unit (LCECU) on Thursday and Friday. This clinic is similar to CHAD except it caters to the urban population instead of rural. We are also planning on going to the Vellore Fort tomorrow.
It's been raining the past few days which is good because the nights seem to be cooler but the following day is more humid. Also, I seem to be the only one that keeps getting bit by bugs. I know how 3 annoyingly large bug bites.
We went to the Golden Temple today. So beautiful. Everyone there was also very helpful. I think they saw that we looked out of place and came to escort us to the ticket counter. Joel even bought a pativaisty (had to since you're not allowed to wear shorts). It looks like a towel that has been wrapped around the waist. We ended up buying the ticket that allowed us to bypass the insane line which was awesome because even just waiting the 30 minutes was hard. So hot, so sweaty, so loud. The people in line were very talkative and loved to stike up conversations. We talked to this one family that basically told us about the hot spot temples that we should visit before leaving Vellore.
Sunday
We took a mini tour of a town about an hour outside of Vellore called Kancipuram. Saw three temples devoted to Vishnu, Shiva, and I don't remember the third. So beautiful. Kanchipuram is also known for its silk sarees so we went shopping. I ended up buying a saree for my mom (HAPPY MOTHER'S DAY, MOM!) and a scarf for myself. Silk. So baller.
Monday
Today, I had to face the cold woman that turned me away last thursday. When I got to the hospital I went straight to the OB/GYN department. The secretary escorted me to the surgery floor. I was told to go to the ladies dressing room where the nurse handed me a pair of "scrubs". Mismatched, oversized, and linen. the pants were more capri like and the shirt felt like a smock. Did I forget to mention that the shirt had a giant blood stain on it? I got to wear my flip flops into the O.R. I did get a pair of booties to put over them though. I was also handed a face mask and a surgical hair net. Once I got all dolled up, I was told to go to operation theatre 3. The cold doctor was standing gaurd waiting for me. She told me I was going to observe a laproscopic hysterectomy. AWESOME. This was the first surgery I had ever seen. Lessons learned:
1. From the point that I arrived to the hospital to entering the O.R, not once was I told to wash my hands
2. The only people wearing gloves in the room were the surgeons. The nurses and I.T personnel did not have gloves on but were touching all the surgical instruments.
3. 99.9% of everything used in the O.R is reusable
4. Everyone wears flip flops
5. At one point, the surgery was paused so that various insturments could be assembled
6. People were texting and talking on their cell phones in the O.R
7. None of the lights hand plastic film on them. The surgeon kept adjusting the lights and by the end, the lights were covered in bloody handprints
8. People kept walking in and out of the O.R
9. I now know what burning flesh smells like
Even though I was assigned to the laproscopic hysterectomy, the operating rooms are set up so that 2 glass walls are the dividing feature between adjacent O.Rs. Because of this, I was also able to see 2 C-sections that resulted in the birth of 3 babies (twins + 1). My time in the O.R has confirmed several things for me.
1. I do not want to be a surgeon
2. I do not want to be an OB/GYN
3. I will never get surgery in India
Tuesday
We went to CHAD clinic today. It's a rural clinic that caters to a lower socioeconomic population and functions as a secondary hospital (while CMC is a tertiary hospital). When we got there the social worker gave us a history of CHAD and how they have 2 key functions. The clinic (OPD) and the mobile clinic. The mobile clinic takes doctors, nurses, social workers, and elective students out to the rural villages and tribal areas and provides preventative medicine and conducts research studies. It was unfortunate that there wasn't enough space in the van for us to go out with them that day. Instead, we spent the morning in OPD. The first doctor I was with was training in community health (which apparently is different than family medicine). The second doctor I was with was phenomenal. She kept switching between the regular patients and the high risk anti-natal patients. Prior to the patient walking into the "office", she would give me a brief medical history and chief complaint. She would quiz me about various lifestyle disease and was very open to questiosn from me.
1. Genetic diseases are probably concentrated in the tribal populations
2. 9 out of 10 patients were diabetic
3. Education for diabetics is provided but everyone is too poor to change their diet/lifestyle (sounds familiar, doesn't it?)
4. A 10 year old boy who had rheumatic fever 5 years prior, currently on penicillin prophylaxis, was seen for residual heart problems
5. Woman in 50s diagnosed with epilepsy came in because she forgot her medication plan. Doctor was impressed that I noticed the patients hyperflexed IP joints. I also mentioned that it could be due to a injury to the ulnar nerve (since she seemed to have almost a claw hand).
6. A teenager with Cushing's Syndrome
The most surprising case was about a mid 20's woman who was 30 weeks pregnant and left diagnosed with intrauterine death. She also has been diagnosed with anti-phospholipid syndrome which predisposes her to abortions. G3P1. She has been pregnant 3 times but only given birth once. The first child was still born. The second child was a succesful normal delivery. Now, the third child died at 30 weeks. She was being admitted for further investigation. I found it odd that she seemed okay. I didn't observe any emotional distress, tears, or anything that would indicate departure from a normal disposition. After the patient left, I asked her why the patient seemed emotionally stable in light of such a tragic event. The doctor told me that she wasn't sure when the fetal heart beat disappeared and because this young woman had already been through a similar tragic event with the first pregnancy and nearly lost the second one, she learned to become emotionally detached.
My time at CHAD further confirmed how much I adore family practice and that it encompasses everything I'm looking for in a lifestyle and practice of a physician.
Wednesday
Today, we spent time at Karagiri, a leprosy village. This was an unbelievable experience. We recieved a tour which included the various labs (micro, patho, and basic testing). Next, we were taken to the animal lab where the attendant explained to us how they were testing different drugs and their effects on leprosy. Mice were the chosen animal model since testing on humans is unethical and the only other host is armadillos which cannot survive in the indian weather, even in air conditioned rooms! After that we went to OPD and sat in on a few patient encounters. The doctor did a wonderful job of explaining what Leprosy is, diagnosis, prognosis, and maintaenance. We saw patients who had been treated and years removed from the disease and a patient who was currently undergoing treatment. After this, we went to the rehab center which is more of a lifestyle rehand instead of physical rehab. Everyone is taught how to earn a living and regain self-esteem. (Leprosy was and still has a social stigma associated with it.) Joel and I bought beautiful bags that had been hand made by some of the patients. After this we were shown a video that told us the history of the the village. Lastly, we were taken to Shantigaram. This is a place for people whose families refuse to take them in. Many of the residents there were 70+ in age.
1. CBA mice were the animal models (cross bred albinos)
2. 3 drugs are used in the treatment of Leprosy
3. Pauci or multi (2 categories of Leprosy)
4. Leprosy=Hansen's Disease
5. Loss of temperature sensation is the first sign of leprosy
6. 28 day drug packs for one year is the standard treatment. If replase, treatment is extended for 2 years
7. Hypopigmented patches, enlarged peripheral nerves, and loss of sensation are the 3 keys features
8. Psorasis is a side effect of one of the medications
9. Leprosy is thought to be transmitted by droplet just like TB (actual mode is not known)
10. Incubation period can be from months to years
11. Second generation drugs are avaliable if resistance to first line defense drugs is formed.
The plan for the rest of the week is to go to the Low Cost Effective Care Unit (LCECU) on Thursday and Friday. This clinic is similar to CHAD except it caters to the urban population instead of rural. We are also planning on going to the Vellore Fort tomorrow.
It's been raining the past few days which is good because the nights seem to be cooler but the following day is more humid. Also, I seem to be the only one that keeps getting bit by bugs. I know how 3 annoyingly large bug bites.
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