Bit about the hospital ..

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Mosquito bites 3
Sickness 0
Diarrhoea 0

So after each morning in the palace that I'm staying in -
6.30am morning newspapers
6.45am telephone- what do you want for breakfast (even though the answer is always the same...'something different, and something indian'😉
7.00am breakfast
7.15am telephone- your cab is outside

(all the while the doorbell for the flat is loud enough to be heard in a palace, and this is all before I've had a cuppa tea!)

7.30am car drive to the hospital.
I am really grateful that I am living like a queen and i have my own car and driver, but not so grateful that he waits inside casualty to pick me up to take me back to the palace. No wonder the doctors in casualty are telling the local people that I am a specialist. I know they're trying to keep me safe, but this is like caging a wild animal, lol I feel like Jasmin out of Disney's Aladdin, trying to escape. Plus no one has actually said about the cost of all of this, as I'm sure they think I'm proper rich, but I reckon this is gonna be well expensive and eat into my money for sightseeing.

8.00am Start shift.
Casualty is basically made up of a small room, probably the size of a bigger cubicle in our A&E with 2 desks for the doctors to sit and basically triage the patients, a larger room with 8 beds (smaller than one of our bays in a ward in hospital), and at the end a minor treatment room, again the size of a cubicle, (of which the door is always closed and looks a bit like something out of Saw at the minute as I haven't seen the door open yet). The first room where the doctors sit, there are chairs for the doctors, and stools for the patients (if they're lucky) to come in and sit and tell the doctor whats there problem, and then the doc says either nope, out to outpatients (which is their system of our GPs in the corridor, where they get a number and have to wait to be seen- no appointments), or they say yep, serious enough, go through to the beds, or if they are really ill/injured the porters wheel them in on stainless steel trolleys or wheelchairs. O and patients have to take their shoes off at the door, professionals leave theirs on.

(Obviously this is all observation as I don't speak Mallayalam, but the time frame that the doctors use to talk with the patients don't leave much to the imagination).

So 8 beds, 100 patients easy every day, from all over, because this is a government hospital (free), plus its the first one to be accredited in India. The patients are seen by the doctors, who use a pad (like you get in restaurants by waiters to write down peoples orders), who write down their name, age, sex, problem, other known medical problems, and medications. Literally a few words for each. Then write them in a large book so they have a number, so that in the future they can prove they were here and were treated for whatever reason.

Every patient who has chest pain or abdomen pain (high enough) gets an ECG. And surprisingly every patient that has been given one that I have seen so far, has had signs on the ECG. ST elevation, T inversion, (all in different leads) complete heart block, right bundle branch block, left bundle branch block....I am learning ECGs so much faster than in the UK because each one I see has signs on it.

Every patient that has had a minor injury/laceration, gets injections of paracetamol, tetnus, antibiotics and ranitidine (to cover the stomach they say), which appears to be a cocktail that is given regularly.

Every patient that has been involved in a RTA (road traffic accident) and have a headache, gets a head CT. This is down the corridor, and the doc writes them a slip to say what they need, they go and have it done, come back with the film and ask the doc what they think.

This is the system for every investigation needed (apart from ECG which is done in the casualty), and if your half dying, you still have to do this yourself, but your relatives/bystanders hep you. This is regular in India. Your relatives care for you in the hospital, and bystanders that have witnessed what happened and brought you in, actually stay with you, help you to get the investigation you need, take you there and bring you back, if you need a medicine that the casualty doesn't stock (because its not emergency medicine), then they will go and get it and pay for it for you and bring it back. -----Can you imagine bystanders doing this in england? No. Your lucky if you get an ambulance rang for you, or helped up off the floor if you fall over (yes happened to me, in London, and no one helped, instead decided getting over me to get the tube was more important).

So some gruesome stories then?
A man was brought in by his family, attempted suicide by hanging. And along with a psych consult, he got a police one too, as suicide is illegal in India.

A girl got bitten by a snake. So she had brought the snake in to show the doctors. Luckily it was only a rat snake, not poisonous- they thought. So warned her to come back if she felt systemically ill.

Various people every day involved in RTA with intracranial bleeds-obviously so as they were disorientated, wandering about (no brace/head collar/sometimes not even a bed), with there heads pouring with blood, +/- heamatamesis (vomiting blood). And it isn't until you actually see a blown pupil in that setting that you think, my God. And then are told they'll have to wait for a ambulance to take them to another centre as they do not have neurosurgery facilities there, the nearest being Kottayam, 2hours away by road. And then you realise that the chances of these surviving is pretty low. But the patients are brought into the minor treatment room (Saw room) and deep wounds on the head are sutured, no aneasthetic, and you have to hold a patient's arm down from him grabbing the instruments and hold scissors in the other to cut the suture for the doc.

A girl brought in in a whirlwind on a trolley wrapped up in a plastic shower curtain. Head to toe burns. All her beautiful brown skin was like soot on the trolley, the floor, on the doctors, on me. Leaving red blisters everywhere. >95% burns. I followed her to the burns unit, the sound of which sounds impressive, but is yet agin another 8 bed room, only everyone has to take their shoes off and its got air conditioning. The mother grabs me and starts hyperventilating, crying. I bring her in, tell her to take off her shoes and put gloves on (only because everyone else is). She doesn't understand english but she knows what I'm saying, and does it. We go into the smaller room she's been taken into (with glass windows to see in, like she's a wild animal to view. We help get her off the shower curtain, help place her catheter and IV (in her foot) carefully so it doesn't bother her, while the nurses put cream on her. I ask what the chances of her surviving, 40-20-10%? The doc just shakes her head. The smell is overwhelming, burning flesh. She was 16.

I'm on my way back to casualty when the smell causes me to throw up. The doctors ask me back in casualty how bad the burns were, and I ask how was it done. They say the family's outdoor fire, and she caught the fuel they use to pour on the fire. They said they have to inform the police on all cases of burns because this could possibly be attempted murder or suicide, both of which are illegal. And I say, is this common, fires as suicides or murders, and they say, yes of course. And look at me like I've asked the most stupid question since I've been there.

What can I say? These are to name a few. The pace is so fast, dotting from one patient to the next and then back....a feel of abdomen, a listen to a chest, a feel of a pulse, a blood pressure, a quick nervous system exam (raise you leg, and that one, then your arms), pupillary responses.... no thinking time. So you just carry on. And not realise no ones washed their hands and the sheets aren't changed/washed between patients. As this would be ridiculous, doing it every few seconds.

The system isn't like ours. I don't think it would work there. The patients don't have to wait, they are seen immediately, and investigations (CT/XR) are done as soon as you get yourself there and back. The knowledge and medicine is faultless. But I can't help thinking the time restrains and lack of thorough history will lead to things getting missed. But if they do, who will care? Or who will put two and two together and consider a medical law suit? Certainly not the patients, few of who are literate, or who can speak english (which everything is written in), or who have the money to carry out such suits.

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Comments

[deleted_205281]

brings back memories
Very funny and touching account Alice. Brought back memories from 17 years ago - God - it feels like such a long time, but apparently nothing much has changed and Casualties are the same everywhere in India. I remember a Saw like room as well in my A & E in Madras. Once I attended a debridement and amputation of an arm from a drunk jaywalker who went under a bus. I knew instantly I didnt want to be surgeon. I swear I still remember the knife grating against the bone and grit in the muddy bloodied arm. My secretary read your blog as well (hope you dont mind) and she was amazed as well. Shouldn't you be asking about the cost of your royal life and legion servants - before it is too late? Dishwashing is not particularly attractive in India. And don't come back unless you can tick off at least half the cultural things on that list I gave you - you will never be forgiven if you spent all your saturdays and sundays in the hospital. Have you ben to the beach? river boats? dance programmes? eaten fried fish with the local booze (in safe company of course)? And I am very jealous of you learning so quickly on the ECG - I still havent managed to get my head around it. Have fun and keep us posted. SS