On our way back from the clinic the first day, we decided to
walk. Hem (our leader/organizer) told us
to walk down the road and then take a right down by the fields, but not to walk
through fields. Needless to say we got a
bit lost, and Shaellie our interpreter had to ask some locals for
directions. They took us down a little
path through a village and some fields.
It was pretty silly to see 30 or so Westerners wandering around amongst
these fields. We crossed a rickety
bridge while a bunch of locals watched us with interest. On our way back up to the campsite we passed
quite a large group of goats and sheep.
On the second clinic day, we were supposed to set up in the
bottom floor of a school house. However,
they were unable to do so because of some kind of event going on, so instead
the woman across the street offered to let us use her partially built
house. This day I was assigned to be in
one of the adult rooms. We saw a lot of
people with non-specific abdominal pain.
After ruling things out like GERD or diarrheal diseases, we de-wormed a
lot of people. This was also the first
day that I got to look at some good eardrums. It seems that a lot of people in
this region get recurrent ear infections and then lose their hearing over time. Many adult ear drums showed significant
scarring and previous trauma.
Unfortunately, at that point there is nothing we could do unless there
was evidence of current infection. One
of the most memorable patients from this day was an 85 year old man who had
signs of Parkinsons Disease. He had a
visible pill-rolling tremor in both hands, as well as shuffling when he
walked. He also had a pretty stooped
posture, limited facial expression, and shuffling when he walked. One of his main complaints was his inability
to swallow, and therefore continual drooling.
We had to explain to this man and his son that the process of aging and
the disease was irreversible, and just to continue helping him try to
cope. Most of the saddest cases were
ones like this, where people came to seek medical attention, but it was too
late, and the resources too poor to help them much, or at all. Another woman we saw this day came in for
some debridement of a previous frostbite injury that had not regenerated
healthy living tissue. They were able to
do some of it there, but it required more extensive work and we needed to refer
her to a hospital.
By the third day, we were becoming very familiar with the
clinic process. I was placed in one of
the pediatric tents, and we were given enough freedom to do the full interview
and physical exam before consulting the doctor.
We were then asked to give a “SOAP” patient presentation (Subjective,
Objective, Assessment, Plan). The doctor
would then consider what we had determined, ask a few more questions, do more
physical exam, and then use it as a teaching moment if we weren’t correct. This style quickly got us comfortable asking
questions of our preceptors, but also taking the reigns and doing the majority
of the patient interaction ourselves.
My favorite
patient from this day was an older woman of about 65 who came in complaining of
shortness of breath and joint pain. She
was my favorite mostly because she was really pleasant and nice. She was so grateful for our attention to her
problems. She had about 8 piercings with
rings in each ear, so heavy that they were weighing her ears down. She also had some home-done tattoos on her
hands and I showed her my ‘Om Mani Padme Hum’ tattoo which she liked. The Tibetan prayer I have tattooed on my foot
was very prevalent in this region, and I saw more than a few people with the
same thing, or only the ‘Om’ tattooed on them.
She also had a cleft lip and palate.
She allowed me to look in her mouth, and I could see the hole into her
nasal cavity. She said she never had any
problems with it. I was wondering about
how it might affect her marriagability, but she said she had kids, and
grandkids, so her winning personality (or dowry…) must have made up for any
stigma associated with the defect. The
other memorable patient we had that day was a boy of about 14. He came in for abdominal pain, but I noticed
that one of his eyes was smaller than the other. On inspection, we realized he had no pupil in
that eye, it was all iris. He said he’d
been born that way and never been able to see out of that eye. Both of his eyes moved together so it seemed
like the ocular control nerves were all intact.
I’m not sure how something like that could happen, but I assume it’s a
congenital defect. There was another boy
we’d seen who had a multitude of warts on his hands and enlarged lymph
nodes. He was there for eye pain and
difficulty seeing up close. Our
infectious disease doctor sent him to the hospital to follow up because it
makes a pretty good case for HIV infection.
After the 2nd clinic, we had a little time to sit
down and reflect on the patients we had seen.
Although I was in one of the pediatrics tent, we heard a bit about what
went on in the gynecological tent that day.
A woman had come in complaining of pelvic pain. On exam, and given the history, it was
determined she had an STD that was contracted from her husband after he had
‘been away’ and clearly cheating on her.
She told our female interpreter that he came back wanting her to do all
kinds of things she was uncomfortable with, and she was too scared to
disrespect him by asking him to wear a condom so she was forced to get this
infection. After we treated her and sent
her home with medication for her husband, she called a bunch of her friends who
all came with the same story. It was
pretty depressing that these women are in such a situation where their health
is at risk, and they’re unable to stand up for themselves. And I don’t really believe it’s a ‘cultural
difference’ because none of the women were really OK with it. It’s just a shauvanistic belief that it’s an
acceptable thing to do, and that’s only half the population. So I’m not willing to call that a ‘cultural
nuance’.
Another woman had come to the clinic on the second day, and
had what Abraham Verghese terms “the head and the heart disease”. It basically a physiological manisfestation
of depression, where a person’s head, heart, and many other things may actually
feel pain due to their extreme situation and their ineffective coping
mechanisms. It reminded me of the woman
who Dr. Kamat had seen at his office in Lonavla (during my previous program),
except this woman did not have access to such a physician. She said she had tried to attend our clinic
the previous day, but had missed it. So
between then and the 2nd clinic she walked for 8 hours between the
clinics. She was unable to catch a ride,
so she walked to whole way. She sat and
talked with our interpreter for a while, about general life things. Her husband, parents, and siblings had all
passed away, and her children had abandoned her. She had no where to sleep that night, so she
was planning to sleep in the shed by the school. It was pretty sad to hear about the
interaction, and it brought our interpreter to tears to recount the story.
The next day we took for travelling to our second
campsite. We woke up bright and early to
leave because although it was only supposed to be a 3 hour drive, they had
taken 7 hours the previous year because they got stuck in a river. The roads in these mountains are just barely
cut out of the mountain side. There is
just barely room for one car to pass another, and definitely not while both
cars are moving. About halfway to our
next campsite we went through the river they had talked about. It was about a foot deep and just pouring
down over the rocks and all down the road before continuing over the edge and
down into the valley where it joined up with the larger river. Once we got to our new campsite we saw that
it was much more open and flat. There
was a heli-pad that is used in the winter to fly in supplies to the
villages. However, since it wasn’t in
use, the drivers and the girls from the UK decided that we should play a game
of cricket. So they taught us the rules
and we all had a practice hit before we began playing a game. It’s pretty complicated, but it was fun.
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