Hosptial Time

---

So I’m finally getting around to what I actually came to India for. The hospital. I’d booked myself a flight from Mumbai to Calicut in Kerela, the closet airport to the fairly remote town where I would be staying for the next month or so. My friends in Mumbai had finished their placement and left for Goa the day before, so I was out of luck with the free accommodation and had to fend for myself. This was harder than it sounds. Mumbai is hella expensive. I exhausted the Lonely Planet and resorted to Google, phoned round a lot of different places then had a strop and decided if I couldn’t find a dorm room for less than 1000 rupees (I normally pay 150-300 for a private room with an ensutie) I was just going to go sleep in the airport. The last place I tried before officially giving up quoted 1000 on the phone, which was reduced to 800 when I arrived and sweet talked the manager. I was the only person in a brand new, very modern, absolutely immaculate 10 bed dorm somewhat incongruously located in a fairly posh hotel. Very strange. Nowhere near the tourist bits of town but only 20 minutes from the airport so would recommend if you need somewhere to crash before or after a flight - Singhs Hotel International.

I bought a copy of Indian Cosmo to read on the plane. I never read girlie mags but I thought it might be good for a laugh. It was. For one thing, all the Indian girls pictured are so pale they’re essentially white (as opposed to English Cosmo, where most girls are so tanned they’re essentially orange). Since Indian Cosmo is aimed at fairly Westernised city dwellers there were a lot of similarities, but a few striking differences, for example the problem pages. Here are some actual examples -

English Cosmo: My boyfriend watches football too much, what shall I do?

Indian Cosmo: My boyfriend has asked me to marry him but he has AIDS and I am scared it will be too painful to watch him die, what should I do?

Arrival was easy because the hospital had very helpfully dispatched someone to the airport to pick me up. I mentioned that Calicut was the nearest airport but ‘near’ may be a somewhat misleading description. Its four hours drive. The distance isn’t that great but when you get up into the hills progress becomes slow. I remember seeing a road sign that read “Hairpin Bend - 1 of 9”, and realising that this may take some time.

Gudalur is an average Indian town. ASHWINI is not an average Indian hospital, but I will come to that later. It’s on the border between Tamil Nadu and Kerela, 45,000 people, 1000m elevation, in the Nigilris hills. The surrounding area is made up of jungle, tea plantations and nature reserves. Uninspiring though the town itself is, the setting is truly beautiful and I was so happy to be up in the hills and out of cities after time spent in Delhi, Jaisalmer, Jodhpur and Mumbai. I know it was definitely the right decision to do my placement somewhere rural.

I’m living with two other medical students… Hannah (the poshest person in the world, can play six musical instruments and has danced for the queen) and Stella (supposedly ‘mature’ student but I'm not convinced), both from Kings in London, though they hadn’t met before they came here. When I arrived I had no idea how many other students there would be, if any. THANKFULLY we get on really well, which given how much time we’re spending together really makes all the difference.

Our apartment is amazing. Based on past experience, I was expecting something shit. The other times I have lived/studied abroad, accommodation has been shall we say... a little more basic. Teaching in China and research in Cambodia were squat toilet, leaky roof, plank-of-wood-for-bed type scenarios. Here we have our own kitchen, two bedrooms and a separate living area. It’s really rather nice. I have lived in worse places back home. Unfortunately there is no hot water (which is only an issue because it can get quite chilly here), and we also lack access to a washing machine, so much of our time is spent hand washing our clothes and trying to find ingenious ways to dry them. The first week it rained every day and clothes took three days to dry, at which point they were so smelly they needed washing over again.

As an added bonus the apartment comes with a resident stray dog, Mange (so named by Stella), who is currently in disgrace because he ate my poncho. Mange is completely inert, he doesn’t interact with us or acknowledge our presence at all, he just enjoys sitting outside the apartment or on the stairs in our way, occasionally pulling clothes off the washing line, chewing them and making a bed from their shredded remains.

All our meals are included, provided by an energetic cook lady named Mala who delights in trying to induce us to eat vast qualities of everything. She rushes in and out during meals bearing dishes of dahl or rice, nodding encouragingly and exclaiming, “yes… you eat!”… “wait… bring more!”. I ate four and a half coconut stuffed pancakes one morning. She just kept bringing them! It was like that HSBC advert where the guy has to single-handedly consume a 12 foot eel. Luckily the food is amazing, though curry for breakfast is getting old pretty quickly.

The hospital is a scenic but incredibly muddy 15 minute walk away through the fields. Some days, if it hasn’t been raining, the path is ok. Other days it is like Glasto 2007, but with leeches. It is merely a matter of time before one of us slips and falls into some foul looking swamp-puddle, possibly never to be seen again. We invariably arrive covered in mud and are forced to start the day by washing our feet and legs in the tank of water outside the hospital while all the (inexplicably clean) patients in the waiting room stare at us. You CAN take a longer route via the road… but we don’t because we are almost always running late for our 8:30am start. Getting a good nights sleep here is challenging because the Mosque and the Hindu temple stage some kind of daily battle of the bands style contest to see who can play the loudest music, earliest in the morning. So far I’d say the Hindu temple wakes me more often but the astonishing tunelessness of Gudalur’s Imam makes the mosque borderline more annoying. Even if you somehow sleep through the religious fervor, the dogs will get you. They start barking and howling without fail just after 5am (though I don’t blame them, they are probably just shouting at the temples… SHUT UP! DON’T YOU KNOW IT’S 5AM!?).

On day one we were given a talk about the ASHWINI organisation by Dr Shyla. I could go on about this in great detail but fear not, I shall refrain. This post is already too long. For now I’ll just cover the basics. It’s a tiny charity hospital. There are only four doctors working here. Dr NK and Dr Shyla, husband and wife duo, other lady doctor whose name escapes me, and Dr D, a junior doctor who is here doing his year of rural service post med school. There are 40 beds. Outpatient clinics often see more than 100 patients in a day. The hospital works with underserved tribal populations who don’t access mainstream healthcare. The Adivasi people. They live in villages of various degrees of isolation and don’t integrate well with the rest of Indian society. Their health is extremely poor in comparison to average for the state and the country. The Indian government has an unfortunate tendency to unceremoniously boot them off their land, which they don’t technically own the rights to, though they are the only people indigenous to this area.

Why do they need their own hospital? They won't go to the government hospitals. They don't know the system or how to get help when they need it. They don't trust government institutions because they have been so badly treated. One tribe, the Paniya, were forced to work as slaves for the British right up until Independence. Shyla said they still haven’t lost this mentality and that when she first came here they would stop and turn away if you passed them in the street, wouldn't even look at you.

I get this everywhere I go in the world. “We did WHAT? Oh my god I’m so sorry.”

After a tour of the hospital and talk from Dr Shlya we were taken to meet Dr NK, the other half of the husband-wife combo and our main supervisor. He was in the middle of an operation but no one seemed to think this should present a problem. We had been instructed to go in and introduce ourselves but we hesitated at the door to the operating theatre. In England we would be unceremoniously murdered on the spot for daring to enter an OT wearing anything other than scrubs, but there were clearly people in there wandering around in saris. We took off our muddy flip-flops but lacked anything to replace them with, so we were ushered in barefoot. Dr NK was in the middle of a hand operation, a machete accident tendon repair. The patient was awake and apparently unconcerned. Instead of an anesthetist, there was a yellowed medical textbook resting open on a description of a brachial nerve block. On the floor was a bucket in which powdery discarded surgical gloves floated like weird jellyfish in a sea of disinfectant, waiting to be re-sterilised and reused. Dr NK says you can use them three times before they start to fall apart.

We quickly learned that medicine here it a whole different… kettle of fish (why do people say that and what does it mean?).

Our conversations with NK tend to go a little like this…

NK - What would you do?

Jenny - I'd order a CT...

NK - Oh would you, decadent extravagant westerner? Ha! Ah hahahaha!

Jenny - X-ray?

NK - No. We don’t have one. Go and diagnose the patient using only your stethoscope.

Jenny - My stethoscope? But I thought that was just for wearing around my neck to make sure people know I'm not a nurse?

NK - I despair of you.

There IS an x-ray shop in town (I think you just walk in, pay your money and irradiate the bodypart of your choice), though there is no radiologist in the whole of this district. If the docs think someone needs imaging they send them off to the nearest purveyor of scans (CT is in Calicut four hours away) then have them bring back the pictures and have a bash at interpreting things themselves.

One day someone here forgot to include a patient’s CT images when referring them on to a larger hospital. I had to put the images on the light box and PHOTOGRAPH them with my camera so NK could email them to the somewhat irate doctor at Big Hospital.

I very much hope no one made any important clinical decisions on the basis of my pictures.

I also hope he sent the right files and didn’t accidentally attach my snapshots of that cute baby elephant I saw by the side of the road.

---

Photos

Doctoring
Totally posed... I had to find a baby that was asleep so it wouldn't cry when I came near it and make me look bad.

Ward 2
(The other ward has actual beds)

Coconut pancakes
4-and-a-half is too many.

Mange the Dog
Eater of ponchos.

Re-using sterile surgical gloves
They also cut urine dipsticks vertically into three.

Comments

[mum]

Humble
This makes me so grateful for the NHS and the people who work in it - we take so much for granted. Its also a reminder about aspects of our past we would rather forget.

[Sapta]

Heyy
Hello...I accidently ended up at your blog.This was the first entry of yours that i read...Rushing to others!!!!! Great work..Please keep writing.Even though its my country that you are writting abou,i am reading so many things that i dint know all this time..