For three weeks we were posted in various departments throughout the hospital. This was great because we had the opportunity to go to departments that we were already really interested in and it also allowed us to go places that we didn't know much about. Throughout these weeks I have had the opportunity to learn more about what gets me excited in healthcare as well as the things that I would be okay never seeing again. My postings were as follows: gynecology, maternity, family medicine, surgery, oncology, pediatrics, orthopedics, and maternity again to conclude the three weeks. Since these three weeks were so busy with long days in the hospital, that had me coming back to my room ready to curl up on my bed with a book and relax, I didn't have a chance to write about my experiences and impressions of each place. So, I'm going to do it now.
Before coming to the family medicine department I had met Dr. Linge once and the other interns all spoke fondly of the time they spent in family medicine. After arriving in family medicine in the morning I sat in a room with the interns. When patients come in they are first seen by the interns and then the interns take the patients into Dr. Linge's office where they tell him what they have learned from the patients and tell him what they think the problem is. Then Dr. Linge gives them a full checkup and quizzes the interns about whatever he suspects to be wrong with the patient. This seems like a great way for the interns to learn because they are getting the opportunity to do everything on their owns and then having their work checked by Dr. Linge.
The first patient we saw that morning was a little boy who was in a lot of pain and complaining of have brown urine. After having him lie on the examination Dr. Linge discovered that he had a swollen spleen. Dr. Linge also pointed to a spot on the boys chest that looked like a freckle to me and told the interns and I that the boy was growing a third nipple. I am not entirely certain if he was serious (I am almost certain it was a freckle), but he quizzed the interns about the mammary line. In the end he sent the boy to the medicine department where he would get some test run to determine if he had malaria or something else.
The next patient was a woman who had come in complaining of painful urination. She has been married two months and the pain has been going on for about that long. The interns informed me that she is suffering from, what they call, the honeymoon sickness. Since she was a few days late for her menstrual cycle they had to be cautious with the medication they chose to give her because she may have conceived, but they have to wait a while before they can give her a urine pregnancy test to determine this. This prompted Dr. Linge to give me a lecture on the frequent pregnancy problem in India. He told me that a lot of the time families are not prepared for pregnancy and once the woman becomes pregnant they do not adjust their diets or take additional supplements to support their new guests. This is something that I have also learned in the rural health clinics and the mobile clinics as well.
Before spending the day in oncology I knew very little about what they did in this department. I spent a while sitting in the OPD and was surprised at the way they conducted the visits there. There were four interns and one physician for the whole department. All of the interns sat in one room around a large table and patients would come in this room to see them and get referred to other departments or receive prescriptions for medications they need. This wouldn't be so bad if there was a nurse who was regulating the flow of patients coming in so that each intern had one patient at a time. Instead all the patients pretty much just come in at the same time and it is almost like they are just trying to crowd each other out and push the way to the front so that they can have their chance with the doctors. At one time I counted 18 patients in the room. I am not sure how they kept the patients all straight in their heads when it was so busy and they were seeing so many people at once, but it seemed to work out for them.
After a while I spent some time with the radiation technicians. I learned that they have two radiation machines. One uses xray radiation and the other is a cobalt 60 machine, which uses UV radiation. The smallest area that the cobalt 60 machine can cover is 5cm by 5 cm whereas the newer x ray radiation machine is able to get as small as millimeters, which is great because you can avoid more of the healthy organs this way. I had the opportunity to watch them prep patients using both machines and they each require a little bit of a different process.
After this I went with one of the radiophysicists and learned all about the computer program they use to determine the exact angles and dimensions the machine needs to use to avoid major organs. With the program they have a virtual person on the screen, resembling each patient, and they adjust various things so that they have the highest proportion of the red area, the target tissue, and avoid as much of the other areas as possible. Before the program is set up for each patient a physician labels the diagram with the different organs and color codes them so that the radiophysists know what to target and what to avoid. In addition to this they also have a chart that shows how much radiation each organ can handle before its functions are compromised.
I spent one day in orthopedics and in this time I was able to talk to a few of the different interns and observe their outpatient department. While observing one of the interns dress a wound he explained to me how it occurred. The patient had a surgery a while back and recently began scratching the scar because it itched. This caused the scar to open up and become infected. The intern told me that he explained to the man that if he does not stop scratching it and it continues to be infected they will have to amputate the arm. After this he told me that the patients they see are not educated and they don't know what they should be doing so stuff like this happens all the time. When I asked him if the doctors ever explain the things they shouldn't do so that they can avoid things like this he responded in a way that was basically like saying "it is not the doctor's job to educate them." This was completely beyond anything that I could comprehend, but wasn't the first time I had seen this attitude from one of the interns. To me it seems like they have no concept of preventative medicine and they also act as if the patients they are seeing are so dumb that they cannot understand simple instructions. Just because they haven't gone to school as long as the doctors doesn't mean they won't understand not to scratch their scar if it itches because it will become infected.
After this I watched as the intern removed a suture from a guy's back. It seemed very painful so I asked about it. They are supposed to put local anesthesia on to numb the pain, but since they see so many patients it is both too costly and too time consuming so they just do without. They also don't tell them it is going to hurt and just hold them down, getting upset if they complain or move because of pain, which is a little weird to me.
While doing the dressings and removing the suture the intern was trying to help me understand some of the practices that occur in the larger public hospitals in the bigger cities. He told me that there are so many patients that the doctor is not concerned if a patient dies in front of them. The doctor will just move on to the next patient in the neighboring bed, they are just too busy to worry about it and "life is cheap in India.".
It has been really hard in these last three weeks to see some of the harsher practices in India when it comes to medicine, but it has also made me feel so grateful to have grown up in the US. You never truly appreciate things until you realize how different they can be. This is true for so many things that differ between the US and India and it has truly made me proud of my culture. At the same time, I have also been very impressed with how they have learned to be resourceful here with their healthcare practices. They are not as lucky as us to have access to all the things they need all the time (even basic things like electricity sometimes) and they are still able to make due and provide care to their patients.