We've settled in nicely to Bangalore and, after our first day scavenger hunt for signatures, we have all been on various postings with St. John's. Sasha, Jill, and I elected to do community medicine for our first two weeks here.
Mysore Market- as always, sensory/photo-op overload
Maharaja's Palace, completed in the early 1900s, complete with electricity. There was one built before this that unfortunately burnt down.
Our first day was spent touring an urban government health center, followed by clinic at St. John's urban health center. We were impressed at the follow up and the efforts by the government health center workers with regards to vaccinations and TB medication administration. For children's vaccines, we were shown their cold storage system (they mean business about this, every health center we've been to stresses their vaccine cold storage), and their follow up system. For children that miss a vaccine, workers actually go to the child's home in an attempt to get them caught up. For TB, a patient receives a "kit," stored at the health center, containing their entire duration of treatment, categorized based whether it is new TB or if it is for TB that has been treated before. The patient comes to the center each week for a new supply, and random visits are made to the home to ensure the patient is taking their medications. Following our government health center tour, we opened clinic at the St. John's urban health center, located in one of the many Bangalore slums. This has been open only two years and they are hoping to become better established in the community. The photos above are of St. John's urban health center, and the slum in which it is located.
Our second day was spent at Mugalu rural health center, also a St. John's facility. This has been around since 1992 and is loaded with patients. We arrived during a diabetes education lecture- as it turns out, chronic disease is an extremely common problem here, with type II diabetes on the rise. While Sasha and Jill spent the day in the geriatric clinic, I spent the day with the medical interns in the general outpatient clinic. Its amazing the differences between the USA and India. Patients have much less privacy, and are expected to listen to the doctors before asking questions (Sasha even noticed a sign- listen first, ask later). The visits went extremely quickly, and ended with the intern cutting off a strip of pills from a blister pack, and documenting the visit with a few sentences in a clinic register. I also got to spend some time with the interns discussing the differences between med school in India vs. the USA. Unlike the USA, medical school begins at 18, and is 5 years long. Indian med students spend their 5th year as an intern (like our first year of residency), and then apply for post graduate medical education, similar to our residency. They were quite surprised at my age and that I would not be done with residency until I was 30.
Our third day was spent at a government primary health care center and ENT/vaccination clinic. Our post graduate explained to us the government hierarchy of health care centers in India: the smallest being a sub-center, followed by a community health care center, then primary health care center (with facilities for labor and delivery, and a couple of inpatient beds), a district hospital, and then a referral hospital. There are also many, many private hospitals which patients have the option of choosing as well. There is no health insurance, patients must pay for their health care up front. Even if a doctor is willing to provide treatment for free, patients still must pay for supplies, medications, etc.
This is where our experiences diverge. On Friday, Sasha and Jill went to what I hear was a very interesting psychiatric clinic. I spent my Friday sleeping most of the day, with diffuse myalgias (think flu-type body aches), chills, and a very very low grade fever. I awoke Saturday in decent enough shape to take a day trip out to Mysore with the gang. On returning home, things quickly worsened and I have been experiencing some pretty amazing abdominal pain and GI discomfort...1 dose of Azithromycin is in, 1.5L of water and counting has been drank (drunk? I never know which is right), and I am hoping hoping hoping that I'll be in better shape tomorrow. This makes 2 of us which have succumbed to awful, awful E. Coli nastiness. Another interesting fact: A side effect of Pepto Bismol, which I immediately brushed off as silly, is a black tongue. Lesson learned: side effects actually happen. For everyone's sake I will NOT be posting a photo of my black tongue, just know that I am probably more horrified than you.
Please enjoy a few photos from Mysore:
Sri Chamundi Temple, at the top of Chamundi HillMysore Market- as always, sensory/photo-op overload
Maharaja's Palace, completed in the early 1900s, complete with electricity. There was one built before this that unfortunately burnt down.
Please send healthy vibes in my direction,
KJ
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