A little of this, a little of that

Happy Thursday to all! Its hard to believe that week 3 at St. John's is nearly complete, and that we only have one week left to go!

Sasha and I have really been enjoying our week in dermatology- and have been seeing many cases that we rarely see at home or never expected to see. For our medical friends, here are a few things which have stood out to us: (hopefully this is not an exact repeat of what Abby has posted)

-Measles in an adult: If this occurred in the USA, a patient would be placed in isolation in the hospital, and the media would be eating it up! Terror would ensue, and then who knows what would happen. Unfortunately, measles is just a really contagious virus without any treatment anyways, so the patient we saw in clinic was just told to go home and rest.

-Leprosy/Hansen's disease: like Abby has mentioned in her dermatology posts, it is something that is much more common here. One of the patients we saw had every complication imaginable, from corneal ulcers, to having braces on his hands due to muscle weakness, etc.

-Neurofibromatosis type 1: Sasha and I diagnosed this patient right when he walked into the room. We decided maybe it was worth remembering after all.

-Pemphigus Vulgaris: a really terrible blistering disease with a spectrum of severity. We have seen these patients in clinic as well as hospitalized. According to Dr. Madhurkada, our attending we have been with all week, most hospitals do not treat these patients due to complications of the disease (infection), which is why we have seen so many at St. John's.

This week in the hospital has also made us realize the harsh reality of finances and health care in India. Patients are required to pay for their services up front, and health insurance is not a common thing in the country. Patients who cannot afford medications will not receive them- for example, there was a severe pemphigus vulgaris patient who looked more like a burn victim with, blisters and open wounds from head to toe. (If he was at home, he'd be in a burn ICU with a PCA pump filled with morphine, as opposed to his current place on the general wards with only 4mg of morphine each day) His condition is declining and it seems as if he is developing an infection. The discussion today was not whether or not to switch to a stronger antibiotic, but rather whether or not the patient would be able to afford it. Its something that is hard to see, but this is how the system works.

Clinic is also quite different than at home. Rather than each patient having their own room, a patient comes to the doctor after their number is called. The doctor may be sitting in a room with another doctor running another clinic. There are no computers, and visits seem to take all of 5 minutes- Doctors can see around 30 patients in 4-5 hours. Patients generally do not ask questions, and the doctor/patient relationship here is certainly more authoritarian. According to Dr. Madhurkada, there is a movement towards more documentation, but he is concerned that he will become less efficient and not earn his salary. Despite these hyper-fast visits, he has taken time to describe each patient and important physical findings on them- its been a highly educational week!

While at lunch today, Sasha and I came up with a little list of foods we're missing:

-peanut butter

-salad

-bacon

-beef

-sushi

And a list of things we are excited to return to:

-A/C

-laundry machines

-crossing the street without fear of death

-the ability to eat whatever kind of food whenever we want- don't get me wrong, curry is delicious, but heavy...so its getting tough to do every day...

Oofta, that was long. Thanks for reading! Please enjoy a smattering of pictures from our Bangalore neighborhood.

Ok, this little guy was actually at one of the village clinics a week ago. Oh, how I wish I could actually play with him without fear of rabies...

Spit bin at the Bangalore botanical gardens. Because everyone needs a good spit from time to time.

Another day, another cow hangin out with the traffic. Turns out they know to go home to their owners (who the owners are, we have no idea) at night. Just behind him is our trusty ING bank, our dollar/rupee exchanger and ATM site of choice.

Namaste,

KJ