Around the hospital

Today started off with a new breakfast treat: upma- a semolina dish and some sapota (a fruit.) Ale and I were off to work a little late today. We got in a rickshaw, and within 1 minute it puttered out. To be honest, we have been on plenty of rickshaws that sometimes putter out, and every rickshaw turns off whenever we are stopped (which is often due to traffic.) But this one kept puttering. And then the driver would jump in the back with us and jostle with the petroleum tank. In the midst of the puttering, our driver consulted us about his sore throat. Since he did not speak much English, and we do not speak any Kannada or Hindi it was not our best patient visit. 2 almost doctors from the states in India does not at all equal one real doctor. We recommended nothing since we decided it was viral based on a very through history and physical. With the caveat: seek medical care in 7 days if this has not improved. America had taught us to cya (cover your ass.) We somehow got to work, albeit late due to our rickshaw. We had to walk the last block since the rickshaw might have met its last ride.

I went to clinic again this morning. Clinic is fun for me, because I usually get what is going on by reading the chart and the prescriptions and what is being ordered (all upside down while the doctor is seeing the patient and writing everything). There is much less patient physician communication, so it is much easier to follow. And since it is usually me and a 2 doctors (1 consultant, 1 intern or resident) the me:doctor ratio is much lower than rounds, so I can ask lots of questions if I don't get what is going on.

I also got a chance to see the Thacker's maid's grandchildren today. Her daughter, who is 21, was pregnant with twins and went into St. John's on Thursday of last week because of preterm labor. She was at about 34 weeks on 1-26 when she delivered the two babies- a boy and a girl. The boy was only 1.5 kg and the girl about 2 kg. Since only the parents had been in to see the babies, Mrs. Thacker and the maid wanted me to go see them and keep them updated. Keep in mind, there isn't too much communication between doctors and patients, so the maid and her daughter knew very little. Had this been two weeks ago (guess what- today is our two week anniversary to arriving in India!), I would have been like "umm you want me to go into the NICU where I don't work in India?" But by now, I was quite comfortable flashing my name badge and getting in anywhere. Operating rooms, patient rooms, NICU. You name it, I'm in.

So I found my way to the NICU and asked around for the "Smith" twins (I'm trying to keep some patient privacy.) I asked one of the pediatricians if I could see the "Smith" twins and he of course showed me where to wash up. I scrubbed extra extra well because I knew I'd probably be having the little 34week boogers thrown in my arms. One of the sisters showed me where "Smith" boy was. I walked barefoot into the NICU and then washed my hands another time and got to see the little fella. True love. He was so tiny but so adorable. He was breathing fine on his own, had a feeding tube, and was under lights because he was a little jaundiced. It was a little odd that he was laying on plastic and not on any blankets, but I decided getting his poopy diaper changed was more important at this moment. He had on an adorable little eye mask to protect his eyes and they use these adorable cloth diapers that make me want to just wear them myself. He was so sweet. After a few minutes, I then asked to see "Smith" girl. She had a little more meat on her bones and was in the less critical NICU. Also under light in her eye mask, she was a little sunbathing queen. She was also quite adorable and I enjoyed holding her tiny little hands (rewashed of course) and rubbing her little baby belly. She was luckily on some blankets, but again Sister had to change her dirty diaper. Apparently for 8000 rupees/night, frequent diaper changes are not included.

Which brings me to my next point, these babies were staying in the NICU for 8000/night each. How long will they stay? The family had no idea, so I asked the nurses and physicians. No one was really sure. I asked if the girl would be released first since she was healthier than the boy but "oh she will go with her brother." The maid, their grandmother, makes no more than $50 per month. 8000 rupees is $160. The mother also is a maid and goodness knows what her husband makes. So many hospital bills. And this was a result of an infertility drug. And I'm sure the parents were not counseled on the risks of infertility meds and the risk of multiples and preterm labor. Oy. I guess when it comes down to it, the babies are absolutely precious. So what more can you ask for?

So after loving on the babies, I walked out with "Smith" girl to go see her mother. Just kidding. This NICU was quite the contrast to the US where every baby has an alarm bracelet on.

Some things about clinic:
- the lights turn off several times randomly throughout the day and no one thinks twice
- the women get on and off the examination bed and the sheet is never changed. ObGyn entails pelvic exams by the way.
- patients admitted to the hospital who need to see another speciality, make their way down to the outpatient clinic (OPD), instead of in the US where the physician goes to see them in their hospital room.
- we saw a patient today, 19 yo who was married 9 mo ago. She was complaining of burning and pain for 6 months and she had been to two other hospitals. Her exam was obviously very painful and the doctor just says "relax, relax." It's almost like it Is their right to examine the patient. And the patients just suck it up and still thank everyone after. It's a very different interaction than the US.
-Language barrier. I don't speak Hindi (the language of some of Northern india) or Kannada (the language of Karnataka, the state we are in), but most of the physicians and nurses speak English. Most of the patients, though, only speak their native language. So I definitely feel a disconnect with the patients. There are so many times I just want to put a hand on a patients shoulder, but since none of the doctors do this and I can't say any words of comfort, I feel lost. I appreciate that I can show affection to patients in the states.
- I was looking at some of the info sheets of the patients we were seeing, and written in for income was between 5000-10,000 rupees/month. Some of the charges: 30-40 rupees for each doctor visit, 350 rupees for a pelvic ultrasound. These seem so cheap, yet comparing it to the incomes, how can these people afford to live, let alone bring babies into this world?
-An incident from Thursday during a vaginal delivery: As the mom was pushing, all the sudden amniotic fluid went flying all over the place. It would have been semi-fine, except for the fact that no one wears eye protection or face masks or hats. I avoided getting close to either of the doctors doing the delivery the rest of the day.

In other news, Ale and I visited fabindia again today (pic 1) We had another delicious dinner of roti and pabbad, a potato/cabbage dish, a yogurt curry, and pickles (see those blue containers in the second picture.) It was followed with a trip with Mr.Thacker and Vishal for Jalibe (a dessert) made on a street in old Bangalore (last 3 pictures.)