More clinic and weekend fun

Hello!

Friday was OPD day again for pediatrics unit two, so I spent most of my day in the busy clinic. This time the doctor I sat with also had a resident with her, and they both saw patients at the same time. There were also about 5 medical students intermittently coming and going to present other patients, so with all of those people along with the patients and parents there were often more than 10 people in the small exam room at a time. In spite of the crowding and general chaos, I did see some very interesting patients:

1. A girl with megaloblastic anemia from B12 deficiency (hemoglobin 3.9!). I learned, unsurprisingly, that both iron and B12 deficiency are very common in Indian children since most people are vegetarians. I also learned that hyperpigmentation can be a sign of B12 deficiency.

2. A boy with thalassemia, who has already had a splenectomy and requires biweekly blood transfusions. I learned to recognize thalassemic facies (frontal bossing and maxillary hypertrophy from extramedullary hematopoiesis).

3. A baby with hemihypertrophy and hemangiomas, likely due to Klippel-Trenaunay-Weber syndrome.

4. Two kids being treated from pulmonary TB and one recently treated for TB meningitis.

5. A baby referred from Tamil Nadu for further workup after a stroke.

6. Two brothers with severe growth delay being worked up for growth hormone deficiency or other hormonal problems.

A few kids come in just for vaccines, but otherwise there don’t seem to be any “well baby/child” visits – almost everyone we see is actually sick. It’s probably not ideal for children’s health, but it does make for a more interesting clinic than the typical American pediatric clinic! I’ve been very impressed with how well the doctors remember everything (anatomy, drug dosing, detailed pathophysiology, etc) without ever seeming to look anything up.

I won’t go into too much detail about our weekend excursions since Abby and Katherine have already done so, but here are a few pictures:

Nandi bull, Mysore (4th biggest nandi in India, we were told):

Devaraja market, Mysore:

This sign was hung on some bamboo by the bull. A man explained:

"It's because sometimes children pull on the bamboo and break it".

Oh... ok then.

Back to the wards tomorrow. I'm hoping I can go to "unit of hope" clinic (disabilities clinic) on Tuesday or Wednesday. Goa next weekend!

Namaskara! (Karnataka version of Namaste)

Libby