This will be my final entry until I get back to the states. I am having some difficulty articulating exactly how this experience has affected me. Once I have had some time to digest what has taken place, I will add more pictures and a better "final thoughts" section.
Having said that, this has been a fantastic experience. I am grateful for the opportunity to come to India and observe medicine with limited resources, interact with a culture 180 degrees different from ours, and to develop a new definition of "poor."
CMC is both a magical and scary place. Magical in a sense that they deliver amazing health care to a population that otherwise would never be able to see a doctor. People's lives are changed every day here. Physicians at CMC are amazingly resourceful and cunning with what they have. Their mission, "not to be ministered unto but to minister" is definitely lived out and not just a statement on some plaque. When it is not possible for a patient to get to the hospital, the CMC goes out to the villages and gives their best. It is the way medicine should be at its heart...outreach to a people who are in need....
It is scary in a sense that their resources are in their constant thoughts. Supplies are limited, and physicians do their best not to use them up. Coming from a world where physicians simply know what they want to do, then do it without even thinking, "wait, how much more of that do we have?" I am awestruck at the limitations, and their abilities to work within it. Their task of combating social issues from hygiene to such a population that cannot understand simple hygiene--or even have access to hygienic methods--to cultural and religious practices that lead to the detriment of health and mind seems an impossible task, and yet they take on the fight with an other-worldly grace to change their world.
India's people are beautiful in simplicity and heart. I have seen gratefulness extended toward myself and the physicians beyond anything I have ever received elsewhere. They are deeply devoted to hard work and family, sacrificing often for their families' sakes. I have seen poor on an entirely new level, and their great need, in physical, mental, and spiritual, has only redoubled my heart for mission field.
" You are a chosen generation, a royal priesthood, a holy nation, His own special people, that you may proclaim the praises of Him who called you out of darkness into His marvelous light."
--I Peter 2:9
"So many people here need the Lord. We must hurry. The End is soon!"
--A. Collin, Chaplain, CMC
Thursday, January 25, 2007
MICU
Well everyone, the rotation is over. Unfortunately, I no longer have access to a computer that can download my images, so my pictures will be posted when I get back home on Feb. 10th. This will be my entry on the MICU.
My last week was in the medical intensive care unit (MICU). Since I like the ICU, I'm a little biased, but this rotation is tied with the village rounds as my favorite part of my time here. The cases are incredible, the situations sad, and the impact on people's lives are on a grand scale. The incredible part was the cases and the physicians that work there. From Dengue Fever, DIC (diseminated intravascular coagulation), to attempted suicide by organophosphate poisoning (drinking pesticides) they have things we only read about in the U.S. The physicians are light-hearted, but extremely caring.
Of course, 3rd world medicine has its depressing moments as well. Everyone is self-pay, so many who cannot afford ICU level care don't get it. I found out this is why patients are on vasopressors and ventilators on the wards. I also found out that the ventilators on the wards don't have any pressure support (sorry for the medical terminology for the laymen reading) so weaning is difficult. Monitoring is also intermittent, so no arterial lines, CVP monitors, and such are on the ward. On a few occasions patients requiring ICU level care were transferred out of the ICU because they cannot afford it. Physicians are also upset about it, but in order for the hospital to stay afloat, it must operate in such conditions.
I would also like to comment about the attempted suicides. This is a large problem in India, with organophosphate poisoning ranking the top choice to end one's life. The critical care attending mentioned they saw in their ICU last year 217 attempted suicides...a whopping 18 attempts per month. The most common reason is failure to cope with life's circumstances, and usually those circumstances are extreme poverty, debt, or loss of health. One of our attempted suicides fit such a case: a 19 year-old male who lived on the streets as a beggar. With no apparent family, no home, he tried to end his life. The other was a sort of odd profile: a 58 year-old woman who became upset that their daughter or granddaughter (I couldn't sort out which) refused to marry a man the family had arranged because she was in love with another man. Apparently, she did not feel she could live with with this dishonor. Making matters even more complicated is that there is no form of home health in India, so once patients are discharged from the hospital, they are no longer in the system. Within this framework, the physician must attempt to help the patient cope with their life. It is a tedious and often discouraging job, but the physicians at CMC tirelessly hold the hand of their patient and do their best to show that someone in a seemingly hopeless world cares for their souls.
My last week was in the medical intensive care unit (MICU). Since I like the ICU, I'm a little biased, but this rotation is tied with the village rounds as my favorite part of my time here. The cases are incredible, the situations sad, and the impact on people's lives are on a grand scale. The incredible part was the cases and the physicians that work there. From Dengue Fever, DIC (diseminated intravascular coagulation), to attempted suicide by organophosphate poisoning (drinking pesticides) they have things we only read about in the U.S. The physicians are light-hearted, but extremely caring.
Of course, 3rd world medicine has its depressing moments as well. Everyone is self-pay, so many who cannot afford ICU level care don't get it. I found out this is why patients are on vasopressors and ventilators on the wards. I also found out that the ventilators on the wards don't have any pressure support (sorry for the medical terminology for the laymen reading) so weaning is difficult. Monitoring is also intermittent, so no arterial lines, CVP monitors, and such are on the ward. On a few occasions patients requiring ICU level care were transferred out of the ICU because they cannot afford it. Physicians are also upset about it, but in order for the hospital to stay afloat, it must operate in such conditions.
I would also like to comment about the attempted suicides. This is a large problem in India, with organophosphate poisoning ranking the top choice to end one's life. The critical care attending mentioned they saw in their ICU last year 217 attempted suicides...a whopping 18 attempts per month. The most common reason is failure to cope with life's circumstances, and usually those circumstances are extreme poverty, debt, or loss of health. One of our attempted suicides fit such a case: a 19 year-old male who lived on the streets as a beggar. With no apparent family, no home, he tried to end his life. The other was a sort of odd profile: a 58 year-old woman who became upset that their daughter or granddaughter (I couldn't sort out which) refused to marry a man the family had arranged because she was in love with another man. Apparently, she did not feel she could live with with this dishonor. Making matters even more complicated is that there is no form of home health in India, so once patients are discharged from the hospital, they are no longer in the system. Within this framework, the physician must attempt to help the patient cope with their life. It is a tedious and often discouraging job, but the physicians at CMC tirelessly hold the hand of their patient and do their best to show that someone in a seemingly hopeless world cares for their souls.
Friday, January 19, 2007
Village rounds, directed by CHAD (Community Health Dept.). Typical home within one of the villages in Vellore. Since these people cannot afford healthcare, CMC brings healthcare to them. We all climbed into a jeep and went out into the village. The main focus is antenatal care for pregnant women, however, chronic illnesses are managed within the village as well. Their medical records of the village is phenomenal, so any healthcare worker can simply arrive at the village and have easy access to anyone's health records. The amount the people pay is determined by their income, and the rest is subsidized. This particular family shown can afford only 10 rupees per month (approx. 25 cents per month). With 25 cents, this childs mother, pregnant, will receive prenatal screening, care, vitamins, delivery of the baby, and 6 months post-partum care. Personally, the care is excellent, almost at level with the prenatal care in the states.
Tuesday, January 16, 2007
Typical outpatient clinic room. Here, two patients are seen at once by two different physicians. There is no privacy between patients; however, no one seems to notice. Other patients will sometimes join in on the history and physical exam of another if they feel they have been waiting too long. No one seems to mind. Physicians are also constantly being interrupted by clerks and housestaff. Again, it is all taken in stride. In the US, our physicians would be really flustered by all the intrusions, I think.
Thursday, January 11, 2007
General Medicine Wards, CMC
I'm not sure if I can fully articulate this place. As you walk in, the first thing to notice is every bed is full. It is simply an open room with rows of beds filled with sick people. I'm not exactly sure, but criteria for admission is pretty high tolerance with respect to our U.S. hospitals. We also visited the ER where I got the impression that patients who can be treated a few days or less simply stay down there, receive treatment, then leave. The ER is more like a ward. The Gen Med ward is more like our equivalent to an ICU or intermediate bed. Everyone is terribly ill. On the ward, some patients are even on ventilators and vasopressors because the MICU simply cannot contain that many patients requiring this level of care.
Physicians scramble and do their best to keep up with a too demanding pace in a hospital with limited resources. Despite their best efforts, as we walked by, we noticed a patient who's O2 saturation was 70% for well over 30 minutes before anyone could get to him. That isn't to say people are just standing around. Almost all the patients in the ward need immediate intervention. Due to the ward being so busy and chaotic, there was no teaching done. I was disappointed by this since I was really hoping to be exposed to different pathology than the US, however, I nonetheless appreciated the opportunity to view the ward.
Physicians scramble and do their best to keep up with a too demanding pace in a hospital with limited resources. Despite their best efforts, as we walked by, we noticed a patient who's O2 saturation was 70% for well over 30 minutes before anyone could get to him. That isn't to say people are just standing around. Almost all the patients in the ward need immediate intervention. Due to the ward being so busy and chaotic, there was no teaching done. I was disappointed by this since I was really hoping to be exposed to different pathology than the US, however, I nonetheless appreciated the opportunity to view the ward.
Wednesday, January 10, 2007
Stephen-Johnson Syndrome
Story time
Guys, this experience is a taxing one for the body and soul. When we first arrived, we got to our hotel only to discover they were completely booked! You cannot imagine the sudden fear you get walking down a horribly busy street with your luggage in tow, walking past truly the poorest of the poor. Knowing your one luggage bag contains more riches than they will see in their lifetime is heartbreaking and surreal. Hotels here do not look like hotels at all, so we could not find one walking. Eventually, we arrived at the hospital exhausted and at a loss for what to do. We dropped our luggage in a hallway and sat, homeless. It was a terrible feeling. I lowered my head and prayed for a place to stay.
Afterward, I walked up to a random person in the hallway and began to explain our situation. He introduced himself as Collin, shook my hand and said, "Give me half an hour. Sit." So we sat there in the hallway with no way to form a plan as to what to do. 27 minutes later, Collin returned. "Frank, come. Rest stay with luggage." As we walked, I asked what he did at the hospital. Miraculously, my random person was the hospital chaplain. He came out immediately saying he was a Christian, and so I will find best lodging for you and friends. Then he asked if I was a Christian. I told him he was actually an answer to my desparate prayer for a place to stay. He then explained to me in very broken English, "You should never worry. The Lord always provides. I am happy to serve you. Many staff here call me 'Angel.' I have knack for showing up and providing God's service, then disappearing."
I asked, "Disappearing? Why?"
He responded, "Much work to do, so many souls need Lord. Must keep moving to reach them all." We talked some more about his church services and times and invited me to them, which I was grateful for. We arrived at the hotel, and it was small, but extremely clean, a real surprise. Total cost: $7 per day. Sold! I went up the stairs to the room to make sure it was actually clean, and it was indeed very clean. I breathed a huge sigh of relief and ran downstairs to hug and thank this man, but he...well, disappeared. I scanned the mass of people outside, but couldn't spot him.
I smiled, eternally grateful. Not just for the room, but at meeting a man who was hurrying because he had a world to save. That first night in the hotel, I ended my prayer in a huge smile. Never before had I prayed a prayer of thanksgiving for having a roof over my head.
Afterward, I walked up to a random person in the hallway and began to explain our situation. He introduced himself as Collin, shook my hand and said, "Give me half an hour. Sit." So we sat there in the hallway with no way to form a plan as to what to do. 27 minutes later, Collin returned. "Frank, come. Rest stay with luggage." As we walked, I asked what he did at the hospital. Miraculously, my random person was the hospital chaplain. He came out immediately saying he was a Christian, and so I will find best lodging for you and friends. Then he asked if I was a Christian. I told him he was actually an answer to my desparate prayer for a place to stay. He then explained to me in very broken English, "You should never worry. The Lord always provides. I am happy to serve you. Many staff here call me 'Angel.' I have knack for showing up and providing God's service, then disappearing."
I asked, "Disappearing? Why?"
He responded, "Much work to do, so many souls need Lord. Must keep moving to reach them all." We talked some more about his church services and times and invited me to them, which I was grateful for. We arrived at the hotel, and it was small, but extremely clean, a real surprise. Total cost: $7 per day. Sold! I went up the stairs to the room to make sure it was actually clean, and it was indeed very clean. I breathed a huge sigh of relief and ran downstairs to hug and thank this man, but he...well, disappeared. I scanned the mass of people outside, but couldn't spot him.
I smiled, eternally grateful. Not just for the room, but at meeting a man who was hurrying because he had a world to save. That first night in the hotel, I ended my prayer in a huge smile. Never before had I prayed a prayer of thanksgiving for having a roof over my head.
Tuesday, January 9, 2007
Thursday, December 28, 2006
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