Day 3
Wednesday was another interesting day at the hospital. The OPD was relatively slower compared to the number of people we saw on Tuesday. We probably saw around 150 patients on Wednesday. We’ve been trying as hard as possible to learn Hindi/Bengali/Tribal Languages but it has been difficult because we’re learning some words from each language and some patients only know one out of the three. Both of us continue to see how important it will be for us to learn the language once we return to India so that it can facilitate our ability to talk with patients, students and neighbors alike. Especially when it comes to explaining the great news of Christ to our patients, it is so much more effective to communicate in their heart language rather than having to rely on a translator. So it seems most likely that when we return we will spend the first year in intensive language study so that we can communicate fluently. I’ve also been praying that God would give the gift of tongues or at least make it easier to pick up several more languages since that is such a necessity here.
Because of my limited understanding of the language, I’ve become more aware of how important a good physical exam is to help diagnose the problem because I often don’t have the clues from a patient history that are typically there to help me come to a diagnosis. Before coming here, I had never listened to fetal heart sound with a stethoscope, instead it was always with a Doppler probe. But with all of our antenatal checkups, we have no Doppler probe and thus a new experience was for me to learn how to listen for the fetal heart with a regular stethoscope – something that I’ve had a difficult time hearing well.
We see a lot of skin diseases here because Makunda has become quite famous for their dermatologic diagnostic abilities because of some telemedicine. Whenever we see a skin condition that we are not quite sure of, Dr. Ann takes a picture of it and then e-mails it to a friend at CMC Vellore who is a dermatologist who takes a look at it and tries to make a diagnosis based on the photograph. So far this week I’ve seen several patients with leprosy, tinea versicolor, atopic dermatitis, psoriasis, and multiple other infections/dermatitis of unknown etiology.
What has also been interesting to observe has been how the OPD also functions as an emergency room. Seriously ill patients are carried into the OPD and the families often lay them on the floor until one of us is able to come and take a look at the patient. We had a patient who was quite delirious from cerebral malaria come in to the OPD today. Another patient came in screaming in pain from what appeared to be an acute abdomen – later an abdominal ultrasound showed acute gallstone pancreatitis. Another patient came in who looked completely emaciated with severe muscle wasting and a blood pressure of 80/40. It looked like either an AIDS patient or someone with a very large tumor burden but as of now it is still an unknown etiology and thus we admitted them for a further workup.
Probably the most distressing case today was a 13 year old boy that came in with chronic mastoditis. This boy had been complaining to his family about ear pain for three months. The family initially ignored it but then did homeopathic treatment for several months before finally traveling 100 km to get examined at the hospital once the left mastoid area had ulcerated out and pus was leaking out of the side of his head. This poor boy was so embarrassed about the ulcerated mass behind his left ear and the large mass behind his right ear that he wore a handkerchief around his head to prevent people form seeing his ears. By the time we examined him, he had completely lost hearing in both ears and needed to be operated on by an ENT surgeon to just debride the pus and granulation tissue out of his mastoid air cell and the rest of his inner ear. What was tragic about this was that this was completely preventable had the family sought appropriate care even one or two weeks after he started complaining of ear pain. A simple course of antibiotics could have prevented his horrible complication and now this little boy will never hear again.
We also had a little girl of about six who came in today with vaginal bleeding. A couple of days ago she was playing in a local pond with her friends and in the process a leech had entered into her vaginal vault. She had then bled for several days because of this leech and by the time she came to the hospital she was anemic from this blood loss. Thankfully the leech had fallen out by the time she came to the hospital and thus we admitted her to replenish her fluids and to observe her to make sure there was no further bleeding.
Even though we got done with clinic early around 4 PM we still had to several more operations in the evening and thus I got finished with the day around 9 PM. The first case was a hernia repair that went very smoothly. The second was a lady with a rupture ectopic pregnancy who had bled out about four units into her abdominal cavity. Her hemoglobin was seven by the time she got to the hospital. We resected both of her fallopian tubes (she did not want to have any more children) and removed several liters of blood from her belly. We then had two more c-sections. One was for a lady that was brought in urgently from the village because she had lost about 500 ml of blood vaginally and the mom was 34 weeks along. When we removed the placenta we saw a large retroplacental hematoma – good thing we did the c-section that night rather than waiting one day like we had originally planned. The other was an uncomplicated c-section. For those of you reading the blog, if any of you have access to an old fetal heart rate monitor / tocodynamomometer please let me know because the hospital has been looking for one for several years but because of the expense, they have not purchased one yet. It would be really useful in situations when we have to decide on when to c-section or not and when we need to keep a better eye on how the baby is doing while still in the uterus.
