This week I started my elective training at St. John’s Medical College in Bangalore, India. I have decided to start with two weeks of orthopaedics. The morning started out with breakfast at the hospital canteen with Julia and Sandhya. For 30 rupees (about $0.60) I had tea and toast for breakfast. (I ate a banana before heading to breakfast for some fruit). The other German students joined us at the canteen and we walked to the Annex I where we are hoping to relocate during the two weeks we are kicked out of the Annex III due to the Bishop’s conference. As expected, it took way longer than it should have and was this complicated process to view the rooms then arrange for our two week stay. It seems like everything is set for us though and Friday I will be moving to the Annex I. It’s not as nice as the Annex III and we will most likely be sharing rooms and I am not sure if there is hot water. But at least we are on the hospital campus. And it’s only for two weeks. If it’s really miserable, I’ll be sure to take a weekend trip between the two weeks for a break!
|clinic exam bed|
I was worried that I would be late for my rotation. I got the orthopaedics office shortly after 9:30 and was told to go to the outpatient department (OPD) to meet with the head of the department and observe him for the day. When I arrived at the OPD, there were tons of waiting patients but no doctor. I asked if this was the place and was told to wait - he would arrive shortly. About an hour later, the ortho surgeon I was to observe arrived as well as one of the senior residents (ortho residency here is only 3 years after 5.5 years of medical school which is started immediately following high school). Clinic was completely crazy. Both the staff and the resident were seeing patients in the same room and I sat in a chair between them so I could observe both and get a sense of every patient. The two doctors were sharing a desk and there was no divider between the patients that each one was seeing. Privacy seems to not really exist here. Things were moving at a quick pace and I asked questions when I could get them in but mostly I just took it all in. We stopped for a coffee break about an hour and a half into the clinic. I finally got a chance to talk some with the staff doctor and tell him a little about myself and what I was hoping to get out of my time on the rotation. I said that I was hoping to get a sense of medical practice in India and see a wider range of pathology than I am exposed to in the US. I also said that I was hoping to improve my clinical skills. Both the staff and the resident were really helpful in showing me different exam techniques they used when evaluating orthopaedic patients. The clinic ended about 1:45 after seeing 41 patients. It really reminded me of the craziness of doing ortho clinic in Haiti...
Very few patients have an appointment – only 4 of the 41 patients seen today were scheduled. The rest of the patients walk in in the morning and are given a number in the queue then wait until their turn to be seen. The patients bring their own records to the clinic.
I was not disappointed in what I observed in clinic. There was the usual bread and butter ortho - back pain and arthritis - but also the unusual stuff that comes in the tropics and an unfortunate number of neglected cases that were not treated properly at the start due to lack of access and poverty. Tuberculosis is a big problem in India and is in the forefront of the differential for many clinical presentations. We had one patient today with TB of the spine. The other really interesting patient today was a boy who had been bitten by a snake and wound up with necrotizing fasciitis. He then had a mid-tarsal amputation of his foot to get rid of the infection. Now he has developed an equinous deformity due to unopposed plantar flexion from the achilles and is getting a pressure ulcer at the stump site. The staff surgeon is planning on correcting his deformity by removing one of the bones in his feet to bring the calcaneus and the calcaneus heel pad forward so that the weight of his body concentrates on that heel pad.
Speaking of interesting patients, I forgot to mention one other patient I met last Friday at the outreach clinic. It was a patient with Wilson’s disease which I have not seen before in the US. He had the classic Kayser-Fleischer rings in his eyes and a dystonia due to the copper deposits in his cerebellum. Great clinical findings to be able to make a diagnosis and treat him!
At the end of clinic, the staff invited me to the resident’s seminar at 2:30. Residents are responsible for giving lectures and are horribly pimped during their presentations in a very harsh way. The presentations are picked apart by the head of the department. I felt so sorry for the presenting resident. He seemed so nervous before the presentation started and was stopped on most every slide and asked a range of questions that he was expected to know the answers to, even the really obscure questions. At the end of the presentation, the head of the department told him what he should have also included and how he should approach his next presentation. His final conclusion - “It could have been better.” OUCH!
I came back to my room after the lecture and did some more handwashing of my clothes. I plan on reading up on TB tonight and am looking forward to a new day at the hospital tomorrow. Namaste.