Dermatology and moms and babies

There is not much more to report about Goa, as everyone can see it was a fantastic trip, and it was sad to leave. Katherine and I have had a couple days on dermatology, and it has turned out to be a wealth of information and interesting stuff. One of the most striking cases and that we have is a patient on the wards who has pemphigus vulgaris. This poor man looks like he should be in a burn unit- he has tons of open wounds, blisters, and healing crusts all over his body. He cannot even have a lit blanket over him because it is so painful. His eyelids are involved... It is just terrible to see. We have seen a number of patients with this conditions here, something I have never seen at home. I did read (in a brief moment of trying to be studious) that the prevlence of the disease is 1 in 1,000,000 to 60 in 1,000,000, depending on the ethnicity. So I am assuming that people of southeast Asian descent might be more likely to get this disease. Nevertheless, it is very impressive to see. Another thing we have noticed is that the psoriasis patients here, at least those who are admitted, have a horrible disseminated psoriasis that covers every inch of their skin, rather than the plaques we are used to seeing. I haven't done a derm rotation at home, but this type of psoriasis looks pretty bad. And of course, a couple patients with leprosy, which is certainly something we don't see at home. On our last day of community medicine last week, I learned some interesting things about maternal/fetal care here in India. I was with a doctor who was performing prenatal checks on women at the rural health center. One fun fact I learned: you can hear the fetal heart beat with your stethoscope at 24 weeks of pregnancy!!! Amazing... Us Americans with our dopplers checking for the heartbeat, when all along we could just use the stethoscope. Though, I am sure that many American who men would not want to wait until 24 weeks to hear that sound. Other interesting pieces of information: - prenatal labs and testing are very similar to home, except that every pregnant woman gets a tetanus shot during the second trimester, as well as getting de-wormed. Since worms are so common in people here, they do it to all pregnant women. Granted my knowledge of pharmacology needs a significant amount of brushing up, but I think all the de worming medications are category C for pregnancy (ie- not particularly safe). Though I suppose risk benefit ratios come into play here... Still sounds scary! - gender identification of a fetus is ILLEGAL. This law came about in about 1992, but wasn't really enforced until about 6 years later, and doctors and ultrasound technologists were sent to prison by the dozens for revealing the sex of the child to the family. Male children are much preferred here, and people might do unfortunate things with information about the gender of their child. Femal fetocide is still a problem here, but it is getting better because of that law. We actually saw some posters about it in Delhi. - abortion is legal and accessible to anyone who wants it. The law is written in such a way that includes women who are pregnant as a result of rape/incest/sexual violence, but also includes a clause that permits abortion in the case of "contraception failure". Since it is quite difficult to determine if contraception was in fact being used, women can have the procedure without having to jump through many hoops. It is legal up to 24 weeks here. Contraception is actually quite easy to come by as well- oral contraceptive pills are available over the counter at any pharmacy. Dr. Avitha was surprised to hear that you need a prescription for it in the US. Then, when I answered her question about how many children are born out of wedlock in the US with "maybe 30% or more?" (for which I got some raised eyebrows and a shake of the head), we decided that you probably needs prescription in the US so that doctors can monitor for STDs. I think she's right, but I also think it has a little to do with fear of litigation... Another fun fact: India has the highest rate of teenage pregnancy in the world.... But they are all married. - I had noticed that most women here do not wear rings on their fourth finger to signify that they are married. I finally learned what kind of signs to look for. 1. Toe rings. Married women will wear rings on their second toes. 2. Nose piercing used to be a sign as well, but now almost all women pierce their noses so it's not a useful took. 3. Gold necklace with black beading. 4. A red mark at the top center of their hairline. I think this explains why so many women have been looking at our feet as we walked by them. We couldnt figure it out for the longest time, but I think they are looking to see if this large group of white young girls is married. One mystery solved :-) Phew! Long post, full of medical stuff. Not a whole lot else to report on, though. We all do find ourselves needing a break from time to time from Indian food, so we have found a Chinese and Italian place to satisfy those needs. I think we are all looking forward to a nice, crisp salad when we get home, though, where we don't have to worry about what the vegetables were washed in. -Sasha