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