The Eye-Opener

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To start off, KEM Medical students = awesome. So friendly, so smart, so hard-working. I am very impressed with what I have seen from them so far. I've also been able to become friends with the foreign medical students that are here. Khaled and Nasir Khan are originally from Afghanistan, but they go to medical school in China (and they speak Mandarin!). They are my suitemates, and we have spent a great deal of time together. They have been invaluable to me as patient translators, as their Hindi is so solid. I have also had the pleasure of meeting Katie Dickson & Sam from the UK, Genevieve Verrastro from the USA, and Ninad Apte from Germany.

During the last 2 days, I have had the pleasure of spending time with Dr. Nikhil Karnik in different clinical settings. His prowess in diagnostics, his easygoing personality, and his eloquence with English has made him my go-to guy for Internal Medicine. He is a phenomenally good teaching professor, and I must say that he seems to be giving me preferential treatment due to the fact that I do not speak Hindi. That's how much he wants me to benefit from this experience. Plus, he is generally interested in how American health care works, so he always makes it a point to ask me about how much this drug costs or that disease is managed back at home. He is a very enlightened soul, and I hope to spend a great deal of time with him on this rotation.

I have seen some very interesting cases in the MICU/wards with Dr. Karnik. Here is a quick breakdown of some of patient illnesses I came across.



1) Pregnant woman with Hepatitis E who is in fulminant liver failure, on a ventilator, and barely hanging onto her life.

2) 2 cases of post-infectious Guillan Barre Syndrome, something that is seen very rarely in the United States. They have presented in different ways, and one of the cases is someone who has had it for the 2nd time and is now severely and permanently debiliated.

3) Tetanus - very rarely seen in the United States due to vaccination in childhood. This guy had significantly increased muscle tone, but is doing well.

4) Empyema - young girl who has a raging pneumonia, and who has now developed bilateral foot drop and weakness in the intrinsic muscles of the hand. Also concerning for Guillan Barre Syndrome.

5) Organophosphate poisoning - pesticide ingestion is a common way to attempt suicide in India, especially amongst farmers who have fallen on hard times.

6) Rat poison suicide attempt - apparently, ingestion of this (not the kind related to Warfarin) will cause liver failure due to the high phosphate content.

7) Tuberculosis - my patient has had 2 previous active infections, and he returned to the ED with compaints of fever, chills, and weight loss. He has significant physical findings in his right lung fields, and his Chest X-ray demonstrates multiple cavitary lesions. And I was definitely exposed, as is every other physician, student, and health care worker here. Sunjay, welcome to a likely positive PPD.



Another great professor has been one in the emergency department, one we endearingly refer to as Dr. Yasmine. She is someone who definitely will "pimp you" in the ED, but not in a malignant way. She is very young, but she is so accomplished and intelligent that she has shot up the ranks in KEM academia. In fact, I am told she is one of the senior Internal Medicine clinicians now. The ED works a bit differently here than at home, as the doctors are located at their desk space, and the patients come to them to be evaluated. If warranted, they are then shuttled over to the "interns" desk, where an IV line can be placed. These MBBS students in their final year have absolutely no problem placing lines or even doing Arterial Blood Gas studies. High volume means a hell of a lot of time to practice and perfect their craft, so they do these procedures efficiently and effectively. I have been fortunate enough to have a crack at a few, but no success so far. Then, patients are given instructions to head to the pharmacy to purchase their medications (if they are able to) or they are placed in a bed if their condition is serious enough. Once must remember that many patients enter KEM's doors in the very late stages of their illness, so I have already witnessed many deaths in the ED, including children. Not a happy scene when something like that happens.



One major theme I come across often is the heavily reduced cost of many drugs used in India. Since it is a government hospital, I am sure they are able to have medicines subsidized, but KEM has also made great strides in the creation of their own products. For example, Dr. Karnick mentioned to me that KEM has been producing its own albumin (a vital protein produced by our liver) product that can be given intravenously. Albumin is a very expensive medicine, costing hundreds of dollars per vial at home. At KEM, they are able to provide a few days worth of albumin without cost for their patients, and then a discounted rate of 50%. Another interesting example is the procurement of Zosyn, which is a very heavy-duty antibiotic. At home, hospitals will charge hundreds of dollars per day for its use, whereas KEM is able to purchase the drug for its patients at a fraction of the cost. I have no clue how they are able to do this, but I will try to find out. Anyone have any ideas?



That's all for now. Dhanyavaad!

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Photos

Dr. Karnik on rounds, surrounded by medical students
Dr. Karnik on rounds, surrounded by medical students

Comments

[Junaid]

India features pretty prominently in the realm of producing cheaper, generic pharmaceuticals, so KEM is probably able to offer these drugs so much cheaper because of state-sponsored companies cranking out the generics en masse? That'd be my guess. Sweet blog bud! Glad you turned the elective into a Med-Peds elective :)