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The Weekend

We have not had internet access for more than a week (for that matter no electricity or phones) and so I’ve been journaling every couple of days and now that we have are at an internet café I’ll post the journal entries under the day they were written and thus you’ll see several entries from the last week…just didn’t want to confuse anybody. You can start reading the new entries from the one titled “ACA” and then work forwards up to the latest entry titled “The Weekend.”

On Friday we conducted the OPD in breakneck speed as usual and topped the 215 mark. We had several TB patients admitted on Friday including two patients who had been having fevers and night sweats for over a month. Both were young patients: a man in his twenties and another in his thirties. They had both lost a lot of weight in that time and when they arrived at the hospital they were gaunt and frail. We started them on a direct observed therapy protocol and will discharge them in a couple of days once their fevers recede and they can be followed up by a health care provider in their local villages.

On Friday we also admitted a nine year old boy who had diarrhea for two days and then suddenly developed flaccid paralysis of his upper and lower extremities. Originally we thought it was polio but the parents were sure that he had received a full course of the vaccine. Our next working diagnosis was Guillain-Barré syndrome because of his history of weakness. About 20% of the acute flaccid paralysis cases at Makunda are Guillain-Barré syndrome and the rest are polio. The parents were understandably shaken and in tears almost any time we talked with them. We decided to run some basic electrolytes which showed severely decreased potassium levels. By the next day, after we had given him potassium, he was like a completely different boy with full ability to walk and move around. Praise God for a great recovery for this child!

One of the other things I’ve been so surprised by during our time here has been the frequency at which I’ve heard patients ask the physicians here for an abortion. Of course, Makunda does not do abortions and the physicians counsel the mom to deliver the baby and then give the baby to us and we’ll provide the baby with a home. Abortions are illegal in India but there are apparently still quite a few doctors that do it for money that is exchanged under the table. In India it is also illegal to inform the parents of the sex of the baby because so many families here choose to abort if the baby is a girl because of the lack of value for females within Indian culture. Yet it still happens and there are more boys born than girls in India. I guess the one difference that I see between the US and here in terms of abortions is the types of people that ask for abortions. In the US most of the abortions tend to be unmarried, single females while here they tend to be married women. Usually these are women who already have several kids and do not want to have another one. I’m not quite sure why these moms don’t choose to get a tubal ligation rather than wanting to abort when they get pregnant but perhaps it is partially due to lack of education and partly due to the fact that in India there must be consent from both the wife and husband before a sterilization procedure can be done.

My role in the outpatient department and hospital has also started to change. Because of the sheer volume of patients I’ve started seeing patients with some help in translation from either another physician or nurse. This experience has made me realize how much I rely on obtaining a good history to determine the diagnosis. I’m learning to be better at my physical exam because that is often my most reliable source of information to help me understand a patient’s condition. I’ve also started taking a more active role in the hospital and now frequently round on 30-45 patients with the help of the nurses and try to make treatment decisions for the patients whose cases are uncomplicated and then filter out the very sick patients so that Dr. Ann can round on those when she gets done with her other responsibilities.

On Friday night, Dr. Anand and his wife invited us for dinner. We enjoyed some great Indian food and Karuna and Luke enjoyed playing with Hannah and Deborah, their children. We also got to spend quite a bit of time talking about the history of Makunda, how Dr. Vijay and Dr. Ann ended up here, and about EHA as an organization. It was good to hear about EHA’s emphasis on reaching the poor and marginalized with good quality healthcare while at the same time not separating it from the good news of Christianity. We were also excited to hear about the many different types of hospitals in EHA’s network that all seem to focus on different areas of ministry and work with different people groups. There are hospitals that focus primarily on rural work with an emphasis on pioneering missions and other hospitals that are larger with multidisciplinary practices that allow for postgraduate medical training programs. We are still praying about the type of practice we’d like to join once we finish residency in emergency medicine but it seems like EHA has the right vision for reaching India. We are eagerly looking forward to meeting with some of their administrative staff when we travel to New Delhi on our way back to the U.S.

Saturday marked the departure of Dr. Ancily who returned to Tezpur to continue her family medicine training there. She will be sorely missed because of her great attitude, patience and willingness to teach. She had come to Makunda for two weeks because our OB/GYN doctor and a neurologist were both away during that time at other hospitals. Before starting her training at Tezpur she had worked for seven years in several other North Indian hospitals and so it was great to get her clinical insight into many difficult cases. Because of her departure, the clinic on Saturday felt even busier than normal even though there were only about a 150 patients. The clinic goes for six days a week with only Sunday off. On Sundays, there is no outpatient clinic but we still go in to round on all the hospital patients and take care of any new admissions.

We had three c-sections on Saturday afternoon along with another case of cerebral malaria. This man was infected by both strains of malaria (Plasmodium falciparum and Plasmodium vivax). He was delirious and agitated when he arrived at the hospital and so we had to give him quite a few sedatives and physically restrain him to keep him from hurting himself. We also had another patient admitted to the ICU with extremely high fevers who was negative for malaria infection. After further testing, it was discovered that she had typhoid fever…the first case I’ve seen since starting medical school.

Melissa and the kids walked up to the hospital on Saturday afternoon because we were hoping to be able to get to a nearby village to get internet access. However, we found out that the internet connection was not working because we’ve not had electricity for more than a few hours for the past week. In some ways the lack of connection with the outside world has been probably the most difficult adjustment we’ve had to make during our time here. We have no idea what is going on in the rest of the world. We have not been able to call our families since we arrived here because on our first night here there was a bad storm that had taken out all of our phone lines. In some ways the lack of connection to the rest of the world has also been a blessing because there are no phones to answer, no e-mail to check, no news to find out about. It has given us more time to do other things but it has definitely been an adjustment.

Sunday was our first partial day off. In the morning the kids went to the Sunday school at the school with the hostel students while I went to round on patients. Around 10 AM we started the campus chapel service. It was good to hear about how God has been working in the lives of the staff and to hear the message about God’s love in Christ Jesus. Later that afternoon was the weekly soccer match. The last two weeks the hospital staff had won against the school staff. This week that was not to be so. The school staff which mainly consisted of sixth and seventh grade boys and a couple of teachers thoroughly put the hospital staff to shame and beat them 2-0. Christo played for the first half of the game but after sweating like he had never had before decided to call it a day and let someone else substitute for him. The game was well attended with almost 200 people watching from the sides! Apparently it was quite a bit of entertainment for this area because many cars and bikes that were traveling on the road next to the field stopped to watch the game! We think the school team definitely had the advantage because the boys from the school had way more stamina than the 20-40 year old men playing from the hospital staff.

After the game we walked to the nearest village to see if we could get phone access to make an international call and to our delight the phone exchanges were functioning again after the power had returned. We got to talk with both Christo’s and Melissa’s family for about 10 minutes each and they were both glad to hear from us. Christo’s mom and dad had tried repeatedly to get in touch with us but because all the phone lines had been destroyed in the last storm there was no way for them to get in contact with us and thus they were so glad to hear that we were doing well here.

Prayer Requests:

1. Praise God for keeping us from getting too sick so far. Please pray for continued good health especially for the kids because they keep getting bitten by every type of bug.
2. Pray for the staff at Makunda who are under incredible pressure to care for a tremendous number of patients. Pray for God’s grace and strength for them.
3. Pray for us as we fit into our role here. We would like to work on some tasks here that will hopefully allow them to streamline the way in which the hospital and school runs.
4. Pray for the patients that many who are animists, Muslims, or Hindus would see the love of Christ in the staff and seek spiritual healing as well.

Along with this post, we’ve put up some pictures from Makunda.