4th clinic
The fourth clinic day was at the same site as the 3rd
because we had so many patients that day, and the village was bigger than most
of the others. I was in pediatrics again
this day. One of our more interesting
child cases was an 8 year old boy who had lower leg pain for the last 2 years. He said it hurts the most at a scar he showed
us, and hurt the most with cold water and with running. The biggest concern was that he could have
osteomyelitis (bone infection) resulting from the dog bite. However, it was also possible that it was
leftover nerve pain from damage caused by the bite.
This day at the clinic was a little less busy since we’d
been there the previous day. While we
were standing around waiting to go back to camp, we were talking with a few
teenage girls through our interpreter Shaellie.
We asked them if they felt we were more ‘masculine’ based on our dress
(pants) and our career choice. However,
they said that they thought it was pretty great. They didn’t feel that we were masculine, just
different then what they experience in their culture. They said they were also very happy with
their lifestyle and the ‘norms’ associated with it. This interaction was interesting because of
the pretty extreme restrictions for women in these cultures. However, they seemed very open minded in
understanding our culture and situation as well. My cynical side was also in the back of my
mind, wondering if these girls had really experienced the restrictiveness and
oftentimes disrespect that comes with being a woman in India. Hopefully they will never experience it, but
it’s fairly common.
The evening of the fourth day, we held a ‘road-side’ clinic
back at our campsite. Since a lot of the
people living where we were staying work all day, they were unable to make it
to the day-time clinics. So around 4:30,
we set up a few tables across from our campsite and saw patients, with goats
walking around amongst us and on top of the roofs of the village. The most memorable and thought provoking
woman from this clinic was a 22 year old woman who came in with her 3 children
ages 5, 3, and 1. Each child was there
with a pretty severe scabies rash, molluscum contagiosum (a skin virus that
usually clears on its own), worms, and malnourishment. The youngest child also displayed strabismus,
a condition where the eyes are not aligned together. It seemed the child could see with both eyes,
as he would sometimes watch you with one eye, and sometimes switch to the other
eye. Besides treating for parasites
(which can sometimes cause this) we could only refer her to another more
specialized physician. We gave the rest
of the children vitamins in hopes of helping with malnourishment (the 5 year
old child weighed only 22lbs). As the
mother finished up with her children, she also had a few concerns of her
own. She said she hadn’t had her period
in 4 months, and she thought she might be pregnant. She had gone to the doctor after having her
youngest child a year ago, and was given oral contraceptives to take for 5
months. The physician hadn’t told her
that she would need to get a refill to continue taking after she ran out of
those, and so she ended up pregnant again.
She wasn’t very happy about the pregnancy, as she already had 3 children
and she was so young. She mentioned that
both she and her husband had been open and considering receiving surgery to
prevent having further children, but they didn’t know where they could go to
have it done. This was the most
depressing part of it for me because she was educated and had an open enough
relationship with her husband that they had tried to make the right choices for
their family, but because of a lack of resources were in this position of
having another child they were unprepared to take care of. These are the realities of living in a place
like Himachal Pradesh.
The fifth clinic day was relatively uneventful. It was really slow, but we had a sciatic pain
and a carpal tunnel patient. These were
interesting for me since we had learned the physical exam skills to diagnose
these kinds of issues, but I had never been able to see them on a real patient. Luckily, we were able to provide a splint for
the carpal tunnel patient, and some physical therapy for both of them to
improve their symptoms. These are the
types of problems that arise from such hard manual labor though, and I expect
many people live day to day with these types of pain.
On our sixth clinic day, we set up another roadside clinic. I was at the pharmacy this day, so I didn’t
get to see any patients. However, at the
end of the day I heard about another really sad and complicated case. A man and woman had come in together, for
each of their own problems. The man went
the adult medicine tent and explained that he and his wife were having trouble
getting pregnant. He said they had had a
child 8 years ago and he had died of a heart defect. They had taken him to a hospital when they
realized something was wrong, and the surgery would have cost them 10,000INR
(Indian Rupees), equivalent to $200.00.
They were unable to afford the surgery, so they took their son home to
die. They’d been trying to conceive for
the past 8 years without success. He
also mentioned that he had some burning with urination, and some other symptoms
that indicated a sexually transmitted infection. We later found out that he was married to the
woman who had gone to the gynecological tent for complaints of infertility as
well. She told them that her and her
husband had had 2 children, one girl, and one boy, and the boy had died of a
heart defect. Her husband was upset with
her for ‘her’ inability to get pregnant and produce a son. He was threatening to remarry. She begged the doctors to tell her husband
that it was his own fault they could not conceive, as they had been to many
doctors before who had determined it was a problem with him that meant they
could not conceive. Her physical exam
was normal. The delicacy of this social
situation meant that the doctors treated the man for sexually transmitted
infections, and explained that they didn’t have the necessary testing to
determine the cause of the infertility. This
was another example of how women are restricted disrespected, and the
difference in social norms and expectations.
The 7th clinic day took place inside the
hospital. We saw a young woman this day
who had just been married 11 months earlier, and was 6 weeks pregnant, but
feeling a lot of pelvic pain. After
determining that she had Pelvic Inflammatory Disease (which can sometimes be
caused by STI’s), we decided to treat her with an intramuscular shot of
ceftriaxone (which is quite painful), and oral azithromycin. We also asked her if she could have her
husband come in later on for treatment, as these kinds of things can be passed
back and forth and may put the baby at risk.
We were uncertain about whether or not they would actually return, due
to the delicate dynamics of husband-wife interactions in such cases. However, later that evening after dinner, she
arrived with her husband. He asked why
he needed to be treated too even though he wasn’t having any problems. We tried to explain without placing blame
that infections can cuase these problems, and can be passed back and forth
between husband and wife, and it is for the safety of the baby that he is also
treated. Fortunately this was an
acceptable explanation for him, and he willingly accepted the painful
shot. The interaction between the young
husband and wife was sort of refreshing given the other things we’d seen to
make us more cynical of this kind of situation.
The 7th day there was also a 17 year old girl
named Amshita who came into clinic with her father who was presenting with
diabetes (which is fairly uncommon for the group of people we had been
seeing). She spoke surprisingly good
English, and it turned out that she was studying pre-medicine in Chandigarh and
was home on break. She was interested in
staying and helping us with interpretation for the rest of the day and she was
very helpful. She also took us on a tour to see the local Buddhist monastery
and the rest of the town.
Another example of the difficulty we encountered treating
people in this situation was a story told by one of the students that
evening. She said that a patient had
come in complaining of foot pain and swelling.
However, in the middle of his interview his aunt came in and pulled up
his shirt to show the physician the man’s back, which had a large open
ulceration that looked infected. The
bone was just about visible, and they said he had received a skin graft from
the local hospital, but that it hadn’t taken very well and he was still having
problems. After sending him home with
antibiotics and some advice to keep pressure off his ulcer, and to return to
the hospital for another graft, Katherine saw him walking up the pathway on our
way to visit the village. He was
carrying a large basket of rocks on his back, and it was pressing directly
against the ulcer. It was incredibly
distressing to her, and is another example of the difference in priorities one
has living in such circumstances. It was
not an option for him to take time off to rest and heal his problem. The priorities seem to be more day to day,
such as dealing with the pain, and making money, rather than having the luxury
to use foresight and expenses to retry the skin graft, and allowing the proper
healing time.
The eighth clinic day had many of the same encounters. There was a very cute puppy however that
everyone wanted to play with. Our
infectious disease attending was very clear that we should NOT touch the dog,
because the rabies treatments were only in Delhi, and it would be a real bummer
to get airlifted out on one of the last days.
After the clinic days were over, we began our long journey
back over the Rohtang pass to Manali, then driving to Bilaspur. The final day in India we drove 5 hours from
Bilaspur to take a flight from Chandigarh to Delhi. We waited in the airport for another 5 hours
because our flight was delayed. Once I
reached Delhi, I had to pick up my bags and re-check in to my flight from Delhi
to Newark. I waited a few more hours in
the Delhi airport (thankfully it was very comfortable and provided all amenities
needed) before getting on a 15 hour direct flight back to the US. Gina picked me up at the airport at 4:30AM
(although my internal clock was WAY off).
I went with her back to NYC and
hung out for a few hours before driving back to Massachusetts. All in all, a very successful trip.
If anyone has any specific questions, please post them and I
will try to answer them as best I can!
Sorry the rest of this blog ended up being so late. Thanks.
No comments:
Post a Comment