Sorry there has not been a post for a week now. We are experiencing difficulty with our internet connection. This posting is intended to get you caught up on Saturday through Monday, Tuesday through Thursday in the works.
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WEEKEND SURGERY
Each weekend, specialty surgeons from cities such as Puna and Mumbai travel to the hospital to perform surgery on specialty cases. The specialties that visit are pediatric and adult orthopedists, spine specialist, neuro surgeons etc. Some of these specialists will come each weekend, others every other weekend or once a month. This weekend we had a pediatric orthopedist and a spine specialist. Between the 4 of us we took part in the following cases: spine stabilization, hernia repair w/ circumcision, a lumbar spinal fusion w/ discectomy, 2 modified radical mastectomies, 1 of a series of 5 surgeries for clubfoot repair, and a c-section.
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Flip Flops and Socks
It is customary and respectful to remove your shoes before entering schools, homes and temples in India. Ok, no problem. But when it comes to the OR? Yes, that’s right. When entering the OR or an ICU it is also customary to remove your shoes before entering and once in the doors to take a communal pair of flip flops from the box to wear while in the ICU or OR. There are 2 reasons for this: 1) Respect, 2) Cleanliness, so as not to track the outside dirt in. These are entirely understandable. BUT, when there are not enough flip flops, then you just go barefoot! That’s right! Barefoot in the OR! I have not yet been brave enough to go barefoot in communal flip flops or in the OR. So I have adopted the Jeff Bell method of socks with flip flops! And the one time there were not enough flip flops in the OR, I observed the case in my stocking feet. This is just one of the customs that takes some time getting used to.
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HANDS ON
We have been spent some time in radiology with Dr. (Sir) Patil over the last few days. On Sunday he allowed Beth to do a thoracentesis (draining fluid out of the space between the chest wall and lung that accumulated due to an infectious process) and later he allowed me to do a paracentesis (draining fluid from the abdominal cavity which accumulated due to chronic pancreatitis).
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MEDICAL DETAILS – Skip if not interested
The thoracentesis was on the woman I spoke of earlier with that presented with Ludwig’s Angina (neck infection) at 34 weeks gestation. Last I spoke of her she had the abscess in her neck drained and 2 teeth extracted. The day following the tooth extraction, the fetal heart monitor began to show decelerations, so it was decided that the best thing to do was induce delivery. Turns out the induction did not work and they had to take her for c-section. Now for c-section they give the patient a spinal block so they can perform the surgery w/o putting the mother under general anesthesia. Well, as luck would have it for this poor patient, the spinal block did not work and anesthesia was necessary. The surgery went well and she delivered a healthy baby boy. Now post-pardum it was discovered that she has a Right luculated pleural effusion (multiple pockets of infection in the lining between her chest wall and lung) which have caused her right middle and lower lungs to completely collapse. The thoracentesis revealed purulent fluid which was sent off for pathology and results are still pending. Today she is doing better. Her CXR (chest xray) show improvement, she has increase breath sounds, she is more alert and her counts are improving.
Another patient we have been following with massive abdominal ascites due to pancreatitis with pancreatic pseudocysts, came down to radiology with need of a paracentesis (draining fluid from the abdomen) for diagnostic reasons. This time Dr. Patil let ME do the paracentesis. So with some local anesthetic and a Z-line approach I aspirated 20cc of dark, bloody appearing fluid from his abdomen. Dr. Patil said this was a classical appearance for pancreatitis. He now has a drain in place to relieve the pressure of the fluid that is collecting in his abdomen causing pain and distention. The only treatment here is to remove the tail of his pancreas where the pseudocysts have formed, along with his spleen. For now he has a drain placed that will offer some relief of symptoms until the surgery can be done later in the week.
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YOUNG BOY
We have seen some amazing things already in our short time being here, but for the first time I had to kind of choke back some tears. A 12 y/o boy, appears to be8 y/o, was brought to the hospital last night, referred by another hospital, with chronic renal failure diagnosed at age 9. The short of the story is that the cause for his renal failure is unknown and it has now progressed to causing respiratory distress. He needs dialysis, but there is no pediatric dialysis here and the family cannot afford to continue traveling to Mumbai. Even still, dialysis is not a permanent solution. He needs a transplant, which seems to be unheard of here. So ultimately there is nothing that can be done for him, and he was essentially sent home to die. I understand it is just the reality of things here, but it still breaks your heart. He was SO cute too!
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NECESSITIES
We have learned since being here that the nurses use gloves very sparingly around here as a way to reduce cost. They know that any cost to the hospital is ultimately a cost to the patient, and as it stands most patients cannot afford the treatment they receive. Things are more so based on 'pay what you can'. In the last 2 days Beth and I have witnessed on 3 occasions where the gloves are being washed, hung to dry and re-used!! So when we get back, or even while we are still here, Beth and I are going to contact a glove manufacturing company in the US and see if we can arrange for a regular donation of some sort. Honestly there are a lot of things that they could use here, but we figured gloves and maybe a replenishment of their hand sanitizer supply would be simple and could go a long way.
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TO THE 1ST YEAR PA STUDENTS
We have a lot of suggestions for you if any plan to take this trip next year. We certainly are all glad we came, however, which we had known before our arrival. We have suggestions for what to read, how to pack, what books to bring etc.
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JUST OUTSIDE THE CAMPUS
Julie and Jeremy have gone running just outside the hospital campus a few times now. Sunday was the first time Beth went for a walk outside the campus to see the village near the hospital. For the most part the village homes are built using a natural porous rock that is broken from the ground in the form of bricks. The porous property of these bricks allows for air movement and keeps the homes a bit cooler. Almost always you will see some sort of veranda or cover porch because during the hot summer months it can be too hot to be in the house so they will spend their time on the veranda protected from the sun. It is also common to sleep out on the Veranda on hot nights.
The main crop grown where we are is rice. The rice is grown in paddies as a sustainable crop. Only a small portion will be sold to provide the family with some income. Rice is the staple, and sometimes only, food that a family will have, other than some junk food they make purchase from a neighbor running a small convenience store out of the front of their home. Now, we have two problems here. One, is that rice does not provide all the nutrition a person needs. This leads to malnourishment, which is especially a concern in children and pregnant women. We have seen some children that are 12 yrs old and appear to be maybe 7. In pregnant women this contributed to India’s low average birth weight of approximately 5 lb. Two, all the junk food and poor/ non-existent oral care is creating problems in both adults and children. Some children may already be missing large portions of their adult teeth due to them breaking off as a result of decay. There is a community projected headed by the hospital aimed at bringing awareness about oral health to the schools. I will talk more about this project later.
Just outside the hospital there stands set up where locals are selling candy, fruit, tobacco, juice drinks, coconuts, small packets of laundry soap, coffee packets etc. The current exchange rate is 50 Rupees to $1. At the stands we can gets bananas for 2 Rupees each, a green pepper for 3R, a piece of hard candy for 1R, single serve coffee packet for 1R, small package of cookies for 5R. We went to a local restaurant the other day where the 4 of us ate for 548 R ($11) and Jeremy eats a lot, so trust me when I say it was a lot of food!
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Upcoming
Please know that we are all doing well! We have recently had the opportunity to spend time in the community, go on a school dental visit, witness a meeting of town leaders, get a close up look of village life with a tour from an elder and today on our day off we were able to tour local tourist places. All of these I will talk about in future postings.
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I do have posts planned for food and more on village life. Any other Questions or Suggestions? I certain do not claim to be a great writer, so I will take whatever suggestions you may have. Thank you!
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