Update

We have been having issues with the internet the last few days. Will have an update on the last few days for you today! And Kristin... We have spend time in the villages the last 2 days so I can answer some of your questions.
Thanks :)

Saturday Morning

Hope this posting finds everyone well digested and shopped out! 

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Preventative care and health screening are not regularly practiced in India, especially in the rural areas such as Dervan. There are many misconceptions and rumors about the hospital and healthcare are rampant in the rural areas. Some of these rumors include that the hospital is performing experiments on patients, or that the doctors are taking pictures of the patients, selling them to magazines and becoming rich. At Walawalker they have a community outreach programs that go out into the villages to educate patients on the importance of healthcare and mission of the hospital. The programs focus especially on expectant mothers, malnourished children, pediatric vaccinations and cancer screenings. We will have the opportunity at some point to take part in one or more of these outreach clinics. 

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The outreach mobile cancer screenings target the 3 most prevalent cancers in India, and most of which present at advanced stages. The top three are #1) Oral cancer - high rate of long time chewing tobacco users in both men and women so oral screenings is a main focus of the outreach clinic. #2) Breast cancer – Today we did a pre-op assessment on a 65y/o woman for a modified radical mastectomy scheduled for tomorrow. She presents with a right breast tumor the size and density of a hockey puck. #3) Cervical Cancer – Pap smears and biopsies are commonly performed, anything more invasive and the patients are referred to the hospital.

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Earlier this week we were able to observe a CT scan on a 34 y/o male with such invasive oral cancer that the mass was CLEARLY visible to the naked eye and now only allows him to open his mouth about 4cm. The CT scan showed that the tumor had invaded his lower mandible (jaw) and he will require chemo therapy to shrink the tumor before undergoing surgery to remove tumor along with the muscle and part of his jaw. The surgeon will then take a portion of the pectoral (chest) muscle and use it to create a new ‘flap’ of muscle in the jaw. Once recovered the patient will still be missing his lower right jaw, but will be able to chew with the other side. In general, it is just far too impressive to see such extensive health conditions in such young individuals. 

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Beth and I spent a good portion of yesterday in OB/GYN where we saw a 26 y/o female, 32 wk gestation, whose chief complaint was anterior neck swelling and inability to swallow. Around here patients do not come to the hospital until even minor conditions become life threatening. This patient was diagnosed with Ludwig Angina, an infection in the floor of the mouth that spreads to the submental, sublingual and/or submandibular spaces (spaces below the tongue and in the neck). This condition can be life threatening as the infection/abscess grows to compress the airway. The initial cause of her infection was poor oral hygiene and dental decay. The abscess was treated with an incision and drainage, along with antibiotic treatment and extraction of the 2 infected teeth. It was important to get the infection under control because it could potentially lead to early labor.

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Later on, Beth and I experienced a vaginal birth. Now, I have not yet completed my OB/GYN rotation at home so this was a first for me, however, I cannot imagine that this is what I will experience in the US. The room was small, VERY warm (hot) and little to no ventilation. Then to top it off a woman who we believe is the equivalent of a CNA hops up on the table with the patient and ARGRESSIVELY compresses down on the patient’s abdomen to help push the baby out!

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It is currently the harvest season here, so the hospital is not very busy since it is more important for the people to work in the fields and provide for their families than to attend to any medical needs. Therefore, the hospital is a bit slow at this time of year, so we typically split into pair in the morning and go to different specialties, and in the afternoon the 4 of us will meet back up again and follow up on patients in the intensive care units.

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Today there are specialty surgeons coming from Mumbai. A neurosurgeon surgeon today that will perform a spine stabilization and I believe there will be orthopedists here tomorrow. This morning I will be taking part in the modified radical mastectomy on the woman I examined yesterday with the hockey puck sized right breast mass. Beth, Julie and Jeremy will be taking part in either the other mastectomy or the spine stabilization surgery.

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Our day off is Wednesday, and we plan to travel to a nearby city, so after that we will hopefully have something non-medical to blog about. I promise that I attempted to post some pictures, but our internet connection is not allowing me to. So I will continue to try.

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I am also a VERY wordy writer, but some of the things here are difficult to explain. If I am boring you with my ‘wordiness’ please leave me some feedback.

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Off to breakfast now!  ~Becky

Happy Thanksgiving!

Hope everyone had a wonderful Thanksgiving celebration! Unfortunately no turkey, stuffing, mashed potatoes or pumpkin pie here L But we all made sure to have a little Thanksgiving dinner before we left, so I believe we will survive! A short message for today, since we are due down for breakfast shortly.

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Being here for just a short time has made us all a little more thankful for everything we have… for the homes we live in, our education, family and friends, both those in our lives now and who have been a part of our lives in the past.
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I know I promised to post some pictures last night, but due to poor internet connection I was having some troubles loading the pictures. I will try again tonight.
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Wishing you all a Happy Thanksgiving and safe travels!

Becky

Merry Christmas!!

Too soon?! Not for us!! At approximately 6am today our luggage arrived shrink wrapped and zip tied!! Certainly a beautiful site on day 4 of our trip. The only injuries suffered were a rip on Jeremy's luggage and Beth's shampoo decided to leak onto her pediatrics book. Certainly nothing a few sutures and a good debridement can't fix!
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Yesterday we spent most of our day following a particular patient or two in the MICU or Recovery rooms. This included reading their charts to determine past medical history, current medication or treatments they are receiving, reason they are here etc. Then we performed our own physical exam and with translation help of the nurses, asked additional questions. For some of us following the patient meant going along to CT with them or in Jeremy's even heading into the OR for an emergency appendectomy on a 15 y/o girl.
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We are certainly finding many challenges along the way while working in the hospital, but the one that hit us the hardest yesterday was the medications. For example: Ramistar (ACEI), Betaloc (metoprolol), Pan (PPI), etc. We have found though that if we ask the nurses what a particular medication is for that we can figure it out. If not, then we ask one of the doctors. Here the female Dr are referred to as 'Madam' and the nurses are 'sister'.
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Today I believe is our day to spend time in radiology and orthopedics. We will split ourselves between the two. The wards are not terribly busy right now and 4 of us just makes things a little crowded. This afternoon we are giving a presentation to the nursing students on Universal Precautions, Hand Hygiene and an explanation on what a PA is and what a PA can do.
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I apologize for not having an pictures posted yet. I will put Beth in charge of making me do that tonight!
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Hope everyone at home is doing well and staying warm!
Becky

Day 1 with Hospital orientation

Namaste!

Well we survived the flight and the more importantly the car ride from the airport to the hospital! You think Chicagoans are crazy drivers? Yesterday was primarily spent traveling since we had a 7hr car ride from the airport to our village. We arrived at the hospital nearly 32 hrs ago, however, our baggage still remains in Turkey! They continually tell us it will arrive tomorrow, tomorrow... so tomorrow we will see! 

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The accommodations are simple but certainly serve our needs well. Our 'apartments' consist of 2 twin beds with a small nightstand, two chairs with end table, a bathroom with shower and an additional sink in the room. Outside of our apt door is an open common balcony that spans the length of the 3rd floor, with ceiling fans and a small table for us to gather at in the evening. 

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Today was much different than yesterday. The pace did a 180 degree turn. We woke up at around 6:30 (because of the jet lag) and ate breakfast.

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We are provided 3 meals a day, with every meal as wonderful as the last. Our lunch and dinner consist of rice, a hot vegetable dish, a side vegetable salad (i.e. finely chopped beets with cabbage, chopped cucumber with cilantro, onion with tomato), a curry 'soup' and of course chapiti (tortilla like bread).

Being here, we are trying our best to fit in with the people. They speak mostly Marathi (Maratee) so we have been trying to pick up a few words each day. We were given a list today with a few common phrases translated from English to Marthi. This morning’s interaction with the cook at breakfast went something like this:

Jeremy: "What is this dish called?"

Mori: "Ukma"

Jeremy: "Ok, and what is this one?"

Mori: "Ah... omelet"

The rest of us: laughing

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After breakfast we met with the hospital medical director, Dr. Patil, an extremely kind, helpful and patient woman. She introduced us to Dr. Rishikash, who is the head of the public health department, and he showed us around for the rest of the day. The pace of the hospital is much different than a traditional US hospital - much slower. We took all day to walk around the hospital and the rest of the campus.

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The hospital consists of a "casualty room" which is a one room emergency department, a MICU made up of 10 beds, a SICU of about 10 beds, male and female medical wards, a pediatric ward, NICU, maternity ward, 3 operating theatres (ORs), and some outpatient clinics including dental. We will get to spend some time in each department. In addition we will have the opportunity to take part in travel clinics that go out to surrounding villages on a daily basis to run screening for breast, cervical and oral cancers.

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A little history of the hospital: It was founded by Mr. Walawalker (hence the B.K.L. Walawalker name). The story goes that he was first off a relatively poor businessman who was called upon by his guru to drop what he was doing and become a carpenter. He complied, and eventually found great wealth in the construction business. Due to the successful guidance of his guru, Mr. Walawalker felt the need to pay him back. Thus he started this hospital. The B.K.L. in the name stand for the gurus that guided him. Mr. Walawalker gave all of his money to this hospital which is the primary fincancial support. He is no longer alive today, but his son is and still continues to support the hospital.

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The campus includes the main hospital, a cancer research center, housing for the hospital staff, a nursing college, a primary, secondary and junior college for the children, a small restaurant and very small convenient store. Future plans include building a palliative care housing unit for cancer patients. They are also at the beginning stages of building an enormous sports complex which will include an olympic sized track, cricket field, swimming pool and much more. The plans include building this complex in order to teach the children at a young age to become professional sports players.

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Our day also included a tour of the schools and college. We will be spending time there as well interacting with the students. They are utilizing us not only as students, but to help them learn as well. (pressure’s on!) We are scheduled to do about 2 presentations a week to either a panel of doctors, nurses, or students. Topics we may talk about include: basic hand hygiene, hospital acquired infections, What a PA is, etc. As we have been running through our game-plans for those, we have been finding it extremely difficult to figure out how to present what we know about these topics, because they are in need of technical and cost effective (aka. no cost) solutions. It is easy for us to say “wash your hands before and after every encounter” and “wear gloves with every patient” but these are not so simple to implement here. Sinks are actually a rarity around the hospital. You can also forget about hand sanitizer or sanitizing wipes to clean equipment. It requires a whole new way of thinking and approach to these issues.

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We were also asked to present to Dr. Rishikash a list of objectives that we would like to accomplish while we are here. We made a list including surgeries and procedures we are able to do and would like more practice in. It is a good thing we communicated this as they were quite surprised to find that we could actually perform procedures and such. (As some of you know, this was one of our fears coming over here since we are the first PA students they will have ever had). They told us that we will really have to be proactive and hands-on to be able to accomplish this. The nurses and doctors aren't used to the students who come here being able to do all that much, so we may have to essentially prove ourselves with basis procedures and work our way up..

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We had most of the afternoon off, which was a good thing as the jet lag still seems to creep up on us. So we got a nap in and check up on the “status” of our luggage. We hope to have a few pictures posted soon.

Count Down!

As we approach the one week count down the excitement is building! Our flight departs the evening of Saturday November 19th, and I'll be honest, as the weather here gets colder... I'm getting a bit more excited to take flight :)
Beth, Julie, Jeremy and I will be doing our best to post updates and pictures throughout our travels, though our internet connection may not be consistent. Please leave posts for us as well! We want to hear from all of you back home and know how everyone is enjoying the holidays! We will miss you all!
Becky