Photo Shoot

Today I was asked to take photos of myself with some of the inpatients and have been told that it's ok to share them. So, after 4 weeks I have some photos of myself, in a hospital, doing hospital-type things.

When I asked whether he read my blog Ryan told me "Nah, you write too much, I only look at the pictures". After initially being shocked I thought that maybe he had a point and so here is a photo-only entry, apart from my previous 5 lines...

A  group of patients who were in the right place at the right time to be grabbed for a photo

A gentlemen in the post-op surgical ward

Pretending that I 'm the one doing the drug rounds

In the dressing room. As in, ulcer dressings, not pantomime costumes.

Actually taking a blood pressure - not pretending!

A "Let's find someone in a wheelchair, that'll make a good photo" picture - outside the wards

I hope there weren't too many words, and that you like my new kurta :)

Learning to Love Dermatology

Having received a few messages recently from people who have said that they're enjoying reading my blog (shout out for dedication has to go to my Grandma who sent me a card via airmail that took 10 days to reach me!) I realised that it's been over a week since my last post.

To reassure you that I'm still safe and sound I thought I'd post an update about hospital life again.

Generic photo of the hospital entrance, taken after sunset, hence no blue sky

I spent most of the last week in the doctor's outpatient department with one of the dermatology doctors, Dr Evangelynn. For those not in the know, dermatology's the study of diseases involving the skin.  My training in this speciality  so far compromised of two clinics and some evening teaching in deepest darkest Somerset. Needless to say that I was never that inspired, firmly believing that a lot of the pictures shown looked exactly the same. As part of finals we had a list of about 100 different conditions that we had to be able to recognise, half of which I'd never heard of beforehand. 

If I was given that list now I'd probably be able to say that I've seen over 90% of them first hand! 

In Britain the commonest complaints are eczema, psoriasis, acne and skin cancers. Here, psoriasis, acne and eczema are common but cancers are extremely rare as the skin colour of Asians protects them.  To make up for the work load (and there's a lot of workload with 3 full time dermatologists) there's a lot of vitiligo - skin losing its colour, that would be unrecognisable on most white people, and then a whole host of stuff that I'd only thought I'd ever see on Google images when preparing for exams.

To the medically minded readers these include bullous pemphigus and pemphigoid, discoid lupus, neurofibromatosis, cutaneous amyloidosis and pityrosporum folliculitis to name but a few excitingly named ones.

Even though you may think that there's little point in being able to recognise these conditions I'm really pleased that Dr Evangelynn is asking me to make a spot diagnosis on almost every patient. At some point in my career I'm bound to see some of these rarer conditions, and it's been useful to be questioned on the "bread and butter" that will undoubtedly come up in the future. Two clinics in Yeovil didn't give me much chance to do this, and Google tends to display the extremes.

I'm also learning to see why doctors would pursue a career in this field - it's extremely satisfying to be able to diagnose based on your sight and knowledge alone. At the same time there are a lot of patients who don't necessarily fit into one box meaning that you'd never have a day when you've been 100% certain of your decision 100% of the time. 

It also has a pretty good quality of life!

Generic photo of hospital entrance again, because blogs look better with pictures

In other news, yesterday I had the great joy of eating my meals in the guesthouse with a British couple, Amelia and Andrew, who were visiting for the day having spent time at home fundraising for TLM and therefore wanting to see the work that was done here. I was very surprised when Amelia mentioned that we share a mutual friend back in Bristol! It was good to swap stories with them, exchange tips on travel in India, and talk about where we used to live in Clifton - talk about the world being smaller these days!

To follow at a later date: "Learning to Love Surgery" - I'm half way there, believe it or not... 

Spiced Coca Cola and a Korean Blessing

What I got up to on Saturday...

The hospital's open on Saturday mornings, so after a morning at work I took a trip out of the campus. I'm not allowed out alone due to the fact that I'm not only one of, but all three of, young/white/a woman so this was quite an event! 

A girl I'd met here who is on work experience between school and University had invited me to her house and then for a bit of shopping. I felt very honoured to meet her family and to be shown her home. Prathna's parents work with the church and attached school so her house is within a larger commune resulting in little private space and  eating and bathing that would be considered public by British standards. Everyone was friendly towards me and I can see that this kind of communal living must be a fabulous place to grow up in. I met her parents, sister and grandmother.

Outside Prathna's Grandmother's home

We then ventured into Allahabad and visited two clothes stores and a third shop that provided me with rations of biscuits and a bar of Dairy milk. The week before I'd bought two 'kurtas', which are long colourful tops worn with trousers. They're much cooler then the shirts I'd bought with me, and are very lightweight. On sunday I discovered another fact too late much to the peril of my white clothes - the colours run in the wash! Prathna persuaded me to spend more money on a fancy kurta from an upmarket store that she said looked Indian enough to wear back home. After shopping, she bought me food from one of her favourite street side eateries. We shared a chicken biryani and paratha with small mutton burgers. I was then told that I just HAD to try coke masala, a local favourite drink. Masala is the Hindi word for spices, so I was a little apprehensive. I was right to be apprehensive - the mixture of spices, salt, pepper and cold coca cola is enough to confuse any non-Allahabadian's taste buds. I can almost certainly say that it was a once in a lifetime experience! Even the experts leave the dregs at the bottom.

Yummy authentic Indian takeaway

I was returned to hospital and heard singing coming from the chapel. I ventured closer to discover that it was fit to burst with inpatients watching a dance. 

Terrible photo, but you get the idea

This turned out to be annual entertainment from a group of Korean-born-but-now-living-in-India Christians. The two hour long session comprised of traditional dances followed by a Bible based drama and group prayer session. They were intrigued by my presence (neither a leprosy patient or of Asian origin!) and I was given one of the scarfs and boxes of national sweet treats that were being handed out to the patients. They then asked whether they could pray with and for me. So, after an already busy day, a Welsh girl was being sung a Korean prayer in India. 

I'm sure that stranger things CAN happen but I can't pinpoint anything that matches this in my lifetime!

Me with the group

A Multidisciplinary Approach

Time for a medically based blog to prove that I'm not simply sat around eating curry and watching cricket.

I'm coming to the end of my rotations around the different departments of the outpatient section of the hospital, so feel that I can justifiably write about how impressed I've been with the way they all interact.

I've spent time with:-
1. Charting paramedics
2. Physiotherapists
3. Laboratory staff
4. Pharmacy
5. Opthalmologists
6. Receptionists
7. Occupational therapists
8. Counsellors
9. Workshop staff

Still to come - 2 days with the nursing staff before I spend the remaining 6 weeks with the medical team.

I'm still resisting taking photos of the hospital and patients but found this on the hospital website, which I'm sure I'd be permitted to borrow! It's of the occupational therapy room:-

Occupational therapy, copyright tlmnaini.org

All of these teams work closely together physically, with their rooms coming off a large waiting area, signposted in English and Hindi. What I've been most impressed with is the fluency by which they communicate with one another. Firstly, the entire system is computerised (something that the NHS needs to work on) so each department's patient list is displayed in front of them. Patients are then called using an intercom system or many just turn up at the doors (always open - patient confidentiality doesn't seem to have a place in India) and try and argue their way to the front. Secondly, a patient can see every single one of the above listed departments in one day. Some have traveled over 12 hours to get here and so there's no option of waiting a few days or weeks to see the therapists, it all needs to be done now. Incredibly, the system works.

An example case of a new patient presenting with a claw hand:-
Mr X will be given a slip of paper at reception which will have his name, number, and first room number on it. For this patient he'll first be seen by charting, who will take one look at his hand and note him as a leprosy patient. He'll go to the lab to have skin smears taken. The results of these will be ready in 2 hours, leaving him plenty of time to make his away around the other rooms. Firstly he'll go to the counsellor who will be the one to give him his diagnosis. The counsellor will answer any questions he may have, explain about the disease, reassure him, and explain about the importance of self-care and drug taking. Next stop - physio. They'll use a microfilament to test sensation of both hands and feet, similar to what a GP in the UK will use to test sensation in diabetic feet. They'll also test the patient's strength, looking for damage to the motor parts of the nerve. Our patient with the claw hand will have damage to his ulnar and median nerves. The physiotherapist will quickly test the patient's vision and if it's noted to be poor they'll visit the ophthalmologist who will write them a prescription for glasses and assess them for any eye complications of leprosy. Claw hand will make it difficult for the patient to eat his dinner, so the occupational therapist will see him and provide an assisted spoon. At some point in this process, usually near the end, the patient will see the doctor who will write him a prescription for his MDT (multi drug therapy) that he'll collect from the pharmacy. For the sake of completion, our patient has lost sensation in his feet so the physio will refer him to the workshop where within two hours he'll receive a personalised, measured to fit, handmade pair of sandals!

It's very impressive.

As an aside, I can't find a way to reply to comments, so this is to say that I am reading them. And for Pamela - I'll pass on your regards; Neelmani remembers you well!

Of Mosquitoes and Cricket

So it's been over a week since I left the UK - that went quickly!
I'm being kept very busy with a hospital day lasting from breakfast at 7.30am to closing time at 5.30. With a bit of internet time, a much needed shower and dinner there's not a lot of time for sitting around.

My home for the next 7 weeks

Mosquitos - I became aware on Monday of the appearance of small dots over my wrists. They didn't look like a stereotypical bite so I ignored them. By that evening they'd become pretty obvious and I counted 8 over the upper half over my arms and back - clearly gained during my sunday night sleep. I hadn't packed antimalarials as this area is 'Low risk' and hadn't opted for the very expensive Japanese Encephalitis vaccination! Panicking, I arranged my net in a makeshift fashion using two dining chairs either end of my bed. I also discovered that I'd been provided with an overnight repellent that's plugged into the wall. Combined, I can safely say that I've suffered no further trauma and can tell you that a mosquito bite takes almost exactly 5 days to fully heal. I feel a great sense of triumph over these little creatures.

A working, if not attractive, mosquito net

Cricket - This story starts on Monday afternoon, when I turned on the television in my room and was greeted by a blank blue screen on all channels. Bye bye to the three English film channels I'd discovered the day before. I soon discovered that I was not alone - in Tuesday's "Times of India" (a fantastic read - also doubling up as a mosquito swat) an article told me that 75% of the city's televisions had gone similarly blank due to the switch over from analogue to digital without the provision of a digital box. This made me feel much better. Though I naively believed I'd have a lot of time to sit around watching films my disappointment was nothing compared to the thousands of Indians keen to watch the IPL - Indian Premier League. A cricket thing. Judging by the "Times of India" this is a BIG thing. A HUGE thing. It even has an opening ceremony. Since then there have been riots in Allahabad by ' the common man' who cannot watch the IPL without a working television. Staff all over the campus are talking about cricket and yesterday I spent my dinner time  watching Mubai vs Bangalore - the TV in the canteen gained a digibox on Wednesday. I was told that the IPL earns more money than the British football Premier League. I found this hard to believe but was then told the cost of the adverts, which I calculated to be about 10,000 pounds for 10 seconds of fame, and there are a lot of adverts! Each time the bowler changes or a man is batted out there are two advert breaks. The IPL is set to last two months so I'm going to become an expert on Indian cricket.

Hospital wise I've spent time in the physio department, lab and medical records since my two days in charting. More of that to follow, but I felt that I should spend this post introducing you to two of my new cultural experiences!

Day 1 at the hospital

So I arrived safely! Overnight trains are an amazing idea, I'm not sure why Britain hasn't become up to date with them. Probably because they'd only be of use from Northern Scotland to Cornwall but still... the idea that you can travel over 600km AND get a good night's sleep is brilliant.

We drove from Allahabad station to the hospital in Naini - the traffic was absolutely crazy. Road rules are non-existent and road markings may as well not be there. I went out in the van again later that day in order to gain some rupees and suffered from a couple of episodes of sharp-intake-of-breath-in-vehicle syndrome. I was told "They say if you can drive in Allahabad you can drive anywhere in the world" and I believe it! A man walked out straight in front of us travelling at 40 mph ish with no intention of standing back or stopping, so we had to take a noisy swerve in order to avoid him. The fantasy idea of riding in a rickshaw has gone out of the window as I wouldn't want to be sat on the back of a bike in traffic like that. Mirror, signal, maneuver doesn't work either as most people drive with their wing mirrors tucked in, presumably in order to squeeze through the middle of two vehicles to overtake in a two lane road...

Enough about the traffic! The hospital site is lovely and I made a few friends over cake and chai (a tea with loads of milk and sugar) after the Easter chapel service. The campus is much bigger than I expected offering lots to do and many people to meet. I'm fairly limited to talking to medical professionals due to my inability to speak Hindi, but a smile, nod and 'Namaste' gets me on the right side of most of the locals. This morning I was grateful for a song book which used the English-style alphabet rather than sanscript, so I could sing along even if I didn't know what I was singing.

Today I was orientated around the ward and outpatient department. I spent today and am spending tomorrow in the 'Chartering' room, which is like the triage area of an A&E department. Under 30 seconds is spent with each patient to determine whether they are considered leprosy or general. By this afternoon I was fulfilling the role of the female staff member who is on annual leave by examining the female patients alone, noting any skin lesions ('patches') on areas of their body that would be unsuitable to be examined by the male staff. I'm glad that I'm already being useful!

I'm afraid I don't have any photos yet. I'm trying to fit in and not appear too tourist-y, but I'll get some taken and uploaded soon.

Best wishes from Naini - the computer room is mine to use after working hours so expect to hear more later in the week :)