Sunday, May 31, 2015

Sunday wrapped up the religious retreat at the medical center. The previous night, several of us were invited to Dr. Clement’s home to practice playing Amazing Grace for the morning prayer. As there were only two available violins, I opted to strangle a few cats (read: play) the night before and let Christine and Nora have all the fun at the actual prayer service. Keiko played the piano while Gina strummed some chords on the guitar. Despite Derick’s angelic, soprano voice, he refused to delight the crowd with his raw talent. Dr. Clement and his wife were incredibly welcoming, sharing something along the lines of Indian lemonade and a snack that reminded me of pakoras (a fried snack: Google it, they’re deliciously addictive). To everyone’s delight they also videotaped our professional-level playing.

At the prayer service on Sunday morning, everyone played beautifully—including Keiko, who did an excellent job of faking on the keyboard (it was stuck on a setting that played synthesized 70’s-like music on half the keys). The prayer attendees loved it.

Almost everyone at the medical center is fairly religious, which is apparent even in their medical practice. For example, when Nora and I witnessed an emergency caesarean section, they actually took the time to sit the girl up before giving her the epidural to pray collectively. I’m not sure how prevalent that is in the OR in the United States, though I think we were both a little surprised. The rest of the day was relatively slow as it was meant to be a day of rest. We attended evening rounds later with Sanil, who was a fabulous friend and teacher during our stay.

While it didn’t occur the same day, the c-section was certainly one of my most memorable experiences during the trip and as such, I think I should do it justice. Previous to this, I had never witnessed a live birth, but following the case, Nora and I left with the impression, “I think I’ll consider adopting” (joking).

But really. The experience was certainly the most violent thing I have ever witnessed. Something along the lines of the movie Alien (you know that scene where the alien baby comes out of her stomach? Yea, like that). The baby was breeched and in fetal distress, making the situation urgent. Nora and I were called out of Dr. Muralidar’s primary care office to witness it. In the OR, Dr. Chako—a feisty, 80-something-year-old woman who would rival any Bengal tiger or US surgeon in the stereotypical attitude (sorry Nora and Al-Faraaz)—was the main surgeon. Without sparing a moment after the prayer and scrubbing-in, she squarely planted her flip-flopped feet, took her attack stance and dove in. Dr. Chako made a huge incision across the entire abdomen, with more urgency than precision from our viewpoint, and as she could not get a firm grasp on the baby without it slipping back inside (this occurred several times), she reached in up to her elbows to pull the baby out from underneath. This still proved rather difficult, and eventually, the baby came out, one leg at a time, bloody, blue, completely limp and not breathing. She immediately started compressing(?) the baby, shouted to a nurse who rushed in and immediately put it under oxygen. About 5 minutes later, to everyone’s relief it started breathing. Nora and I hoped the baby was not left with any significant brain damage, though I’m not certain at this stage of our education how long it takes for something like that to occur.

At any rate, it was truly an experience. Upon my return to Rush, I asked a few doctors if c-sections are typically so “violent,” and it appears that this experience was not so incredibly different from the norm. Who knew? It certainly left me with a lot of compassion and respect for women. 

How can I sum up my parting thoughts on this trip? Impossible. It was such an incredible experience, from both a cultural and medical perspective. To anyone thinking of going on a trip in the future, do it. It’s highly independent, difficult at times and you’re required to leave your American ego and luxuries at the airport door—squatting shower when the water is actually working, no AC (so I nearly feinted once from the heat; I’m no worse for wear), fans when the electricity works, rice and curry for days (even when it’s good, 3 times daily every day is a bit much) and spiders, bugs and lizards to keep you company at night. It’s character building. But working in the mountains with rural villages, contrasting how medicine is performed on the opposite of the world where resources are low, and discovering an entirely different culture, it’s the experience of a lifetime.

- Kristen

Saturday, May 30

The weekend we spent there was not particularly medically oriented but I felt it gave us a great insight into the cultural aspect of what the people in the community do on their spare time. On Friday night, a pleasant couple from the UK arrived to lead a Christian retreat. They explained that they are missionaries stationed in India and had spent the last few years preaching there. I found it fascinating that they were so efficient at eating with their hands (a task I was never able to  master).They told me that it definitely took them a few years to get used to it but that now it felt strange to use utensils. 

Saturday morning, we woke up and headed to breakfast. Breakfast was my favorite meal of the day simply because of the amazing chai they prepared (they also have beans for breakfast sometimes, which I loved). After that, we headed to the church that was located uphill. The retreat was very interesting. The missionaries did not speak Tamil so they used an interpreter. I found the topics of the retreat to be pretty liberal but somewhat culturally insensitive. There were very bold statements made about differences of family life in America compared to family life in India that seemed to be very black and white. I could see how it would send the wrong message to someone who had never been to America but did somewhat clarify for me the reason behind misconceptions that some villagers had about life in the US. Overall, I felt the people of the community really appreciated the messages the missionaries were delivering. It seemed to be a great way to meditate and give them a break from their weekly routine. 

After the service, Christine and I decided that we really needed some more Dark Fantasy. Dark Fantasy were these amazing cookies that we were hooked on the entire time there. As we were going to the store, we also decided that we needed to get a ball, then quickly realized that sending Christine and I out alone was a bad idea. We knew we wouldn't stop until we found a ball and ended up walking to Anaikatti to purchase a ball and a bigger cup for me to drink chai out of. Anaikatti was great! It was a small village in the middle of nowhere with everything you could possibly need (except toilet paper). We knew that this was where we could find a ball so we asked around and were directed to a small store where we got two balls and I purchased a Disney princess sippy cup. We suddenly realized that we were running late for "band practice" so we quickly headed back with our balls and princess cup. 

Earlier that day we had been asked to play "Amazing Grace" for the Sunday morning service so we headed up to the doctor's house to practice. He had 2 violins, a guitar, a keyboard and an awesome accordion that he was really good at. We practiced the song a few times and I still thank Nora for her patience with my lack of musical skills. It felt really good to play the guitar in a group again and especially because it seemed to make the doctor really happy to have us over to play music with him. We practiced for a while and then it was dinner time. We had dinner, some of us went on evening rounds while others showered and then went up to practice again to get ready for the next morning.

Friday, May 29th

It's day two and I'm almost certain that everyone woke up this morning at 7 am thinking "Wow, what have I gotten myself into?" followed immediately by the realization of "Man! My back is killing me!" The modern luxuries of living in a developed city like Chicago are now a thing of the past. There are no stand up showers, just a bucket of water and a pail to rinse. We have to use our toilet paper sparingly as we fear we may run out before the end of the trip and the local shops do not carry more. We're lucky if our mattresses (more like mattress pads) are more than 2 inches thick on an uncomfortable, completely flat metal platform. This is jungle life amongst the Irula tribal people of Tamil Nadu and Kerala and all of the patients treated at Bethany Medical Centre are subject to these same conditions, if not worse. They are usually all smiles though when we round in the wards, especially the younger gentleman in the corner of the male ward (yes, wards are separated by gender) with a diabetic ulcer on his amputated left foot that never seems to heal fully who is a permanent resident at the hospital as he has no other place to live. I am amazed at how Bethany would make an exception to let this differently abled patient with no home or family live full-time at the hospital; I doubt that would ever happen in the US. Now it makes more sense to me why he is always smiling.

As we round, I'm deeply humbled by how the patients and their families stay overnight for days in the wards in these extreme conditions of 95 degrees Fahrenheit and 95% humidity. There is no A/C, no fans, no privacy, limited personal space and certainly no entertainment. I seriously wonder how they manage to pass the time day in and day out. My mindset quickly changes as I tell myself, "If they can survive this, so can I." It's experiences like these that remind me of the tenacity and power of the human spirit and exactly why I wanted to go into medicine. The human body is amazing and capable of so many more things than we know of. I can only hope to elucidate a few of these things in my future career as a doctor.

Being here feels a lot like summer camp, where many of my favorite memories from childhood live. We wake up and get breakfast at 7:30 in order to make morning prayer by 7:45. Bethany is a Christian hospital and prayer is a part of their daily schedule. Morning prayer is a new yet familiar routine for many of us, but a far stretch from our normal lives as students. We briefly take a break for some masala chai and then attend rounds at 8:30. When you first step into the wards, there is a distinct, overpowering icy-hot, menthol-like smell. Unlike a lot of other noxious stimuli, however, this smell never lets up and is oddly comforting. It then becomes immediately apparent that all eyes are on you. As you walk through the wards, each patient looks longingly as if the fate of his life or death lies in your hands. We are definitely not used to this kind of attention back home as lowly first-year medical students, and we feel a bit overwhelmed by the true lack of real clinical knowledge we have to help treat all of these patients. But much like the leap of faith I had to make during each of my summer ropes course classes, we dive in and finish rounds without a hitch, learning at least 10 new things that morning. For instance, we witnessed a positive Hoffman's sign in a man with thalamic pain syndrome after having a thalamic stroke. A Hoffman's sign is often described as the Babinski sign of the upper extremity, but is more so an indicator of hyperreflexia and corticospinal tract disease. Another woman who ended up staying at the hospital the entire time we were there was thought to have Munchausen syndrome as she would seemingly make up symptoms to fit what the doctors thought might be going on or claim she had various new symptoms every day likely to receive more medication and care at the hospital. There is such an interesting dynamic between the patients and Bethany, especially with Dr. Muralidar. Patients come in from sometimes 40-50 kilometers away just to see him, demonstrating the tremendous respect he has gained in this community.

After rounds end, Jen and I report to Dr. Clemet's outpatient office, where he sees at least 20-30 patients a day. Complaints ranged from injuries due to a door shutter falling on a patient to third degree burns on a patient's face and arms due to a road traffic accident. Later, Jen, Derick, Gina and myself briefly observe an ultrasound radiologist that comes to Bethany every other week to scan typically pregnant women or any other case that may require ultrasound.

We then eat lunch and take an afternoon break from the sun. Eventually Derick, Christine, and I take a walk up to a former volleyball court and search for some peacocks. We also try our hands at makeshift baseball and cricket before getting eaten alive by mosquitos and calling it a day. After an hour of rest and sudoku, we go to evening prayer again and eat dinner. We then attend evening rounds and are finally ready for a much needed night of rest. The days are long, but we seem to get an incredible amount of work done. I can't wait to continue this adventure tomorrow.