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Published: February 23rd 2006
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Do they mean "no spitting"?
Read carefully - I think this hospital sign is trying to discourage spitting, but spiting is bad also. First things first...I have an Asian Studies degree. Besides experience gained visiting the doctor, being raised by a Nurse Practitioner, and watching my fair share of ER episodes, I have no formal medical training. I entered the Child Family Health International program as a Pre-Masters of Public Health student, but if there is anything I have learned, it is that not all things translate well.
The first day of rotations, immediately after meeting the cardiologist, a patient in a very crowded office is herded into a seat for Marti and I to inspect. Marti is a PA student I am paired with and thank goodness she is here! Marti listens to the patients heart and lungs and then it is my turn. I listen to the heart and lungs - not sure what I am listening for, I was more concerned that I was putting the stethescope in the right place! Next we are handed an EKG to interpret. The only thing I know about an EKG is that you are in big trouble if the line is straight!! That is how week one began...
So, as hairy as it sounds, things have been going very well. I feel fortunate that
Blythe with the Docs
Blythe with the Docs at one of the rotation sites. Marti and I were paired together for rotations, she is very knowleadgeable, explains a lot to me, and allows me to pester her with a zillion technical questions. I, in turn, share any cultural, religious, or historical info I have with her (don't laugh - there is quite a bit that pertains to medicine, etc, here).
We are both staying with the Mehta family - Mr. and Mrs. Mehta and their son, Varun. They are feeding us very well and Varun loves American rock music so we discuss bands, music, and have even seen his band play.
Getting to and from our rotations has been quite the experience - the Mehta's live in a residential area and we ride "vikrams", large autorickshaws acting as public buses (seating 6-9 depending on how crowded), to and from town. It is great to watch peoples reactions when they see us - there is a double take and then staring, giggling, pointing us out to friends, etc. More than a few people have almost driven their bikes/scooters/cars into our vikram because they are staring and not paying attention to where they are headed!
During the first week our rotations were with a cardiologist in a government hospital, and an OBGYN in a private clinic. We quickly learned that medicine and health care systems here are very, very different.
For example, the room the cardiologist sees patients in is about 12 x 20 feet. It contains one desk, a couple of chairs, and for the week we visit, 2 doctors, me, and Marti. Add to that anywhere from 25-35 people - patients, their family members, etc. As a patient is inspected by the doctor, everyone in the room is watching the proceedings. If he draws a picture to explain something to me and Marti, the whole room cranes their necks to see!
Us being there definately did not help the crowd situation. There were many, many times when someone would spot us, leave the room, and return with 5 or 6 more people to see the foreigners.
The amount of patients doctors see in a day here, especially at gov't hospitals, where people who can't afford health care go (and there are many - more than I can even begin to imagine), is astonishing. Patients are asked quickly for symptoms, blood pressure is taken, they are inspected, sent for more tests, or given prescriptions in under 5 minutes. This is purely because the ratio of people to doctors is so imbalanced. The doctors have very few resources in terms of tests, etc, and must rely on their clinical skills to pick up things that we find in lab work and testing in the states. They also have to take care of a huge range of problems - the two cardiologists were not only diagnosing cardiac problems, but also treating patients with chronic pulmonary diseases, TB, etc. The cardiologist we worked with was a great teacher - he asked us lots of questions and answered ours. By the end of the week, I had listened to heart murmers, learned how to pick out abnormalities on an EKG, and learned about some of Indias public health issues like high rates of rheumatic fever and cardiac consequences, among other things.
In the OBGYN office we were exposed to more of how culture effects medicine. As the OBGYN ran a private clinic, we were mostly seeing patients with more money who could afford more than the gov't hospitals, although poorer patients did come because they know the care will be superior. We saw many pregnant women and the subject of contraception and female infanticide were discussed. To give you an impression of what an issue female infanticide is here, there is a HUGE sign as you walk into the radiologists office saying "Disclosure of the sex of a fetus is illegal." A national law was passed in the 1980's making it illegal for an abortion to be preformed on the basis of sex. Unfortunately it is still a big problem. In general, my impression was that there is very little understanding of one's own body, fertility, etc.
So, I'll write more about our weekend trip to Rishikesh and Haridwar (lots of screeching monkeys and the Holy Ganges), and about the second week of rotations with an internal medicine doc and more emergency and cardiology (I witness a procedure that, while interesting, almost makes me faint!).
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