Tuesday, April 14th: “Can you feel that?”

I’ve been back working in leprosy this week. Today, a bunch of patients were referred here from a nearby hospital as suspected leprosy cases.  Now, as you recall from earlier blog posts, leprosy is a disease caused by a bacteria that ultimately results in decreased to lost nerve function in peripheral nerves (but you knew that already, of course). So to diagnose a patient with leprosy a few things go down:

1. The patient will have a “skin smear” taken. In a skin smear, a little clump of tissue is clipped off the patient’s ear lobe. Its heated, stained, and looked at under the microscope.  If there is massive amounts of mycobacterim leprae then voila!  You’ve got yourself a diagnosis.

Here’s the hangup: if someone doesn’t have a positive skin smear that doesn’t clear them as being leprosy-free.  In fact, many leprosy patients test negative on the skin smear since you have to have a pretty heavy load of bacteria to get them to show up in your earlobe. So there needs to be another way to diagnose leprosy.

Enter Lilly.

Lillykutty, better known as Lily to her friends, is a total character. She is the head nurse in the leprosy ward, and she is a tiny woman with cracked teeth and thick glasses who has no qualms whatsoever about bossing people around and showing everyone how its done. “How what’s done?” you might ask. Ah, poking.

So today, Dr. Thirapureddy told me to help Lilly. As soon as I appeared in her doorway, she grabbed me by the arm and half walked, half dragged me outside the office and out into the sun. “Here!” She trust a pen into my hand. I looked over at the blank chart sitting on the wall nearby, thinking that I might be taking notes? She called the first patient out here into the open air foyer, also directing him into the sunlight. “Off!” she said in Telugu and this young guy flipped off his shirt and dropped trou right on command. Standing there in his boxer shorts, Lilly looked at me and then cocked her head towards him. “Now, we poke!” she said sharply. “Gently, of course” she added as an afterthought.

We asked the young man to close his eyes, and gently poked his skin with the tip of our pens. “Can you feel that?” I asked him. He nodded.

“Where?” Lilly jumped in.

The young man pointed to his arm, about 8 inches away from where I had touched him with the pen. Lilly clicked her tongue. And we poked some more.

We poked all over his arms, poked all over his legs. We even poked parts of his face. Lilly carefully sketched in the chart the areas where the patient had no feeling. She also pointed out to me some dry patches of skin in the same areas that had no feeling. “You see,” she said, “no nerve function means he cannot sweat in these places. And no sweat means dry skin. So if his skin is very dry in the same place he has no feeling, it is usually leprosy.”

So there you go: Leprosy Diagnosis Method 2. Poke with pen, scan for dryness.

She finished the chart and handed it to me. I walked with the young man into the office to see Dr. Thirapureddy.

“How was it?” he asked.

“Good.” I held up my pen to show him, and slid the chart to the doctor.

He nodded knowingly and opened the chart, scanning it quickly. ”Ah Lilly” he sighed “she is the best.”

Sunday, April 12th: balloons

Today was balloon day! Being Sunday, I don’t have to work, and the children didn’t have school. Its also incredibly hot (41C).

My aunt Clara (my remote partner in fun) sent me a packing full of “punching balloons” which are enormous balloons that have a rubber band attatched to them so you can bounce them around off your fist, flat surfaces, or friends.  As soon as I opened the box, I knew this was going to be a good time.

I brought the whole box over to the orphange (there were 35 balloons, so everyone got one) and the children swarmed me. I had them line up (we’re slowly and steadily making progress on waiting turns) and passed out the balloons. Then, I demonstrated how to blow them up.  Apparently, if you’ve never blown up a balloon before, its not the most natural concept. Most of the kids ended up just slobbering on the ends of their balloons, blowing air in and then having it compress back out into their mouths. After a few more trial runs, the bigger kids figured it out. Between myself, Goulthami, Lalitha, Sridhar and Davedenum, we got all 30 of them blown up with only minor hyperventilation.

Tying the balloons was another issue all together. Once the balloons were all blown up, the children had to hold them pinched shut and stand in line again so that I could tie them off.  Everyone was being very patient. I had finished tying about 6 balloons and those children with the tied balloons were off thwumping and shrieking and playing when someone in the back of the tying line accidently dropped his balloon.  

The rogue yellow balloon zoomed around the room and the children screamed with excitement. Just then, 24 more balloons started zooming around the room and just as many children broke into giggle fits. And we had to blow them all up again.

It was a great day. Total chaos. We did manage to get organized enough to play “keep the balloon in the air,” and “pickle in the middle.” We had balloon boxing matches,  made balloon towers, and played balloon tag. Best of all, we managed to pop only a few of them. 

Monday, April 6th: A lesson. Meningitis and Compassion

Life out here  is hard.

Today I went into clinic, and we had a patient with really advanced AIDS. He has progressed into the “wasting syndrome” and additionally is suffering from other symptoms from an additional opportunistic infection. This OI seems to have localized in his nervous system, and it is affecting his ability to walk and it is causing him intense pain. This patient was carried in this morning by two members of his family.

He was too weak to eat, so Sunita puréed him some rice, which his wife spooned to him. I just kind of watched this couple from afar, and thought about how difficult their lives must be.  Rubina, always the oracle who answers all of the questions I can never really articulate, broke my contemplation: “he has been out of work for 8 months, they have no food for the children.”  She is working to connect them with a program that provides food and clothing to destitute HIV patients.

I thought about this all afternoon. About hunger. I imagined this couple’s children, and superimposed the faces of the children I see each day on the street into my vision of their family and their struggle.  I suddenly felt more grateful for the sticky rice I eat day in and day out, and the vegetable curries Sunita piles on my little tin dish.

As the day was winding down, Dr. Suggunama (we call her “madam”) informed me that this patient needed to have a lumbar puncture (a spinal tap)  in order to collect some cerebrospinal fluid for lab analysis. She invited me to observe.

Uncle helped position the man into the fetal position, his back facing us. He was so gaunt his skin stretched over his vertebrae like tight leather, and I could clearly see the demarcation from where madam would pull the fluid.

Now, I’ve never had a spinal tap, but I can’t imagine its entirely comfortable.  On top of that, this poor man was already in so much pain he couldn’t walk—much less have a needle stuck into his spine.  Uncle held him, so he could stay steady. As madam started the puncture, this man began to whimper and eventually he cried in discomfort. The whole time, this man’s poor wife was standing next to me. She began to wail so loudly and so severely, I thought she might hyperventilate. Uncle shot me a sharp look, so I took this lady by the arm and led her outside.

Once in the sunshine, I sat her down under the tamarind tree where she continued to wail. This woman’s voice was full of agony and pain. I went to the kitchen and found a small bottle of cold water and brought it out to her. I sat with her as she sipped it slowly, and then she slowly slumped into my lap. Quietly, she shook as she wept into my Punjabi.  Immediately, I began to cry as well. Then how strange, I thought. This woman and I don’t speak a word of one another’s language. We’ve never met. I don’t even know her name. And yet, her sorrow is my sorrow and here I am, sharing in her pain.

The biopsy revealed that the patient had cryptococcal meningitis. I turned the sharp focus knob on Mary’s microscope and got a clear look at the tiny blue circle on the slide that was the cause of all our tears this afternoon. Madam had to refer him away to a bigger clinic. I thought about my time at NIMS and imagined this man and his wife navigating through the giant crowded hospital, weak and brokenhearted.

As they carried him out into a waiting vehicle, his wife followed behind with her head bowed. I whispered a prayer for them both, and then they were gone.

Friday March 24th: Idle

My mornings generally go like this:

I wake up, and groggily stumble around my room for my contact lenses and flip flops which I pop in and on, respectively, and drag my way over to my shower. Once in the shower, I turn on the faucet to fill my 5 gallon plastic bucket which I unceremoniously dump  over my head, washing off the nights worth of dust and sweat (have I mentioned how HOT it is here?!) in one big wave.  After some vigorous scrubbing, I brush my teeth (with treated water, of course. No dysentery for this girl.) and find myself a skirt and a blouse off my clothes line worthy of the day.

After greeting Gopal, my nightwatchman (“Goodmorning madam!” “Namaste Gopal!”) I head down the path and across the bridge (over a creek that is dried up and full of wild flowers and greenery) over to Sunita’s kitchen for breakfast.

9 weekdays out of 10, Sunita makes Idle for breakfast (pronounced eed-lee).  It’s a traditional South Indian breakfast made up of ground rice and dal.  Dal is a legume that is often used to make thick stews, but for breakfast Sunita puts it, along with rice, into a mortar and pestle type machine and grinds it down into a coarse meal. She mixes this with some oil and water and pats it into flying-saucer shaped cakes.

At this point I should clarify, that there are no ovens at SRH. An oven is considered something of a luxury, and isn’t generally utilized in all the cooking done here or in lower income brackets around the country. So Sunita “bakes” her idle-cakes in this funny little box which is made out of aluminum. It’s a cube about 1.5 feet in each dimension, and the front has a little garage-like pull down door. She slides the trays of idle into the box, puts some water in the bottom, closes the front, and lets them steam.  When they come out, they are little white cakes that have a texture similar to taking white wonder  bread, breaking off the crusts and smushing it into a dense bread ball (sort of?). With the idle cakes, Sunita serves chutney, which is a general name for a dipping sauce. The breakfast chutney is made from nuts that seem to me halfway between a peanut and a pine nut. She grinds these nuts down into paste and cooks them with red chilies and oil.  Every morning at breakfast I have to bargain down to two idles (Sunita can be unrelenting and tries every day to give me four) and I get a scoop of chutney. Its pretty hot, so I mix sugar into mine. If you stretch your imagination really far, its kind of  like eating peanut butter bread.

So this morning, when I walked outside to greet Gopal and head to breakfast, he had a package  for me (“Parcel madam!”). Weee! I was so excited and a quick glance at the return address confirmed the package was from my Aunt Clara, so I could assume it was full of fun surprises for the children.

I tore it open to find sidewalk chalk, jump ropes, beads, glow sticks, and a number of books and flashcards. At the bottom however, there were some special treats for me! These treats included some Luna bars, chocolate (melted, still delicious), and a “just add water” pre mix for banana-nut muffins.  A shame, I thought, since I had no way to bake them.  I considered mixing in some water and pan frying the mix into pancakes. But then, I got a better idea.

I walked over to Sunita’s kitchen, mix in hand, and presented it to her. She gave me a quizzical look, and said, “what is?”

“American Idle!” I answered.

Her eyes got big as she scanned the front of the package. A foreign label reading “Betty Crocker” and pictures of bananas, pecans and muffins.  A smile broke out and she repeated “American idle!”

I showed her how much water to add (3/4 of a cup), and we got right to it. She grabbed the pans, we patted in the batter, and stuck them in the box.

After about twenty minutes I had no idea what to expect. Sunita was excitedly telling the whole staff about our culinary feat earlier this morning and invited Uncle, Rubina, Mary, Shobba and Marheswarie over for some “American idle.”

We pulled out the trays and the muffins were totally edible! They were shaped like flying saucers, and a little bit chewy, but overall everyone was thrilled.  Especially me.  Sunita was very excited and told me that she loves “American idle,” and is going to try adding bananas and nuts to her recipe.

So there you have it: American Idle, the breakfast of champions!

India Idle and Chutney (with sugar)

Thursday, March 19th: Trauma

Today Thanmi picked up a rock.

The HIV branch of SRH was started three years ago. At the onset, 20 children were brought to live here, and the remaining 10 were added over time. To be admitted, the children need a total of nine certificates including both parents’ death certificates.  Initially, many of the children were brought here by government social workers. They had been orphaned and living on the street. Other children were brought straight from their parent’s deathbed. Thanmi, however, is the exception to both of those cases.

She is 11, and grew up in a village area in rural Andhra. After her father died of AIDS, the people in the village realized that her mother was a carrier of the disease, so they killed her. Stoned her to death. Thanmi was 7 at the time, and witnessed the whole thing.

Its barbaric and horrifying, and the very sad reality is that these villagers made a utilitarian decision. They believed that if they didn’t kill Thanmi’s mother, the disease would spread throughout the village and kill everyone.  So they acted out of ignorance and fear, possibly moreso than agression. I’ve turned it all over in my mind hundreds of times, wondering who to blame for the very emotionally traumatized child that has been left behind.

As a whole, the children are amazing, but there are challenges. For example, sharing and waiting one’s turn are difficult concepts for them, but understandably so since they are so counter-intuitive to the laws of survival. The bigger kids learned to live on the street, and I can’t imagine it took long for the younger, more impressionable children to pick up these habits.

Additionally, all of the children struggle with the emotional difficulty of losing their family, leaving home, and realizing that they are sick with the same disease that killed their parents. They know they are “different” and sometimes expresses that they feel alienated.  But overall they are joyful children, and they really do a good job of looking out for one another.

Thanmi, however, really seems to have some deeper emotional issues. She is beautiful and charming, but she can swing manic depressively. One minute she is climbing a tree as high as she can calling for all to see,  and then suddenly withdrawing and displaying angry or aggressive behavior.

SRH has hired a counselor for the children, but frankly I don’t really think this guy is adequate to do the job (the administration has expressed the same sentiment).  Child psychology is gaing momentum in the US, but there aren’t many resources for it here.  The man who works with the children is some kind of therapist who usually works with adults.  He observes the children once a week as a group, and engages them in yoga, deep breathing and meditation. That’s all fine and good, but in my mind, many of the children need one-on-one counseling with a specialist, especially Thanmi. The medical and administration staff has been working tirelessly to try and find a child specialist, but there aren’t really any to be found.

So this afternoon I was on the playground paying “Amina Katamina” (which is the India version of “Miss Mary Mack” for those of you who played it at recess) with a few of the girls when I saw conflict a-brewin’ across the yard.  From a distance I saw that Thanmi wasn’t waiting her turn for a game, so one of the other kids pushed her out of the way as she tried to shove herself forward. She tripped and fell on the ground, landing hard on her backside.

I walked towards them to dissolve the argument and referee the game, when I saw Thanmi’s hand instinctively reached for the ground next to her. Her fingers clenched on a stone about the size of her fist, and her eyes narrowed. I sucked in my breath sharply. Then I barked out her name.

Immediately she snapped out of it, dropped the stone, and picked herself up. She ran over started to wimper and tell me how she got pushed.  I told all the children firmly, “fighting. no.” They all nodded solemly, Thanmi included, and we went on with our game.

I don’t know much about child psychology, but I worry about Thanmi.   She is watched closely for signs of hurting herself or the other children. Mrs. Rao and the whole SRH staff are aware of her behavioral issues and are desperately trying to get her the help she needs.

This poor little girl has been through so much trauma. And I worry about how she has internalized it. I can’t stop thinking about how when she felt threatened, Thanmi reached for the weapon that took her mother and caused her so much pain.

They are working on a solution for her. She will be starting an anti-depressant medication, and hopefully therapy soon. In the meantime, she is watched, cared for, and loved. I just pray it will be enough.

Wednesday March 11th: Once upon a Holi

Once upon a time there was an American girl named gina, who moved to India for a little while.  She made friends with a bunch of children, who taught her Telugu games and crazy dances.  One day, the children got very excited for a holiday called “Holi.”

“What’s a Holi?” the American asked.

“Holi is when we play colors!” they said.

So gina went to the market with two of the older children to find some “colors”.  On the way, an Indian man stopped the three,

“where did you children find this woman?” he asked accusingly in Telugu, gesturing to the white girl.

The children snapped back, “she is our sister.” All three beamed knowingly at one another, joined hands, and walked away.

They found a stand with a cardboard sign reading “Holi colors 5 rupees” and bought packs of bright blue  and pink rice powder, stopped home at Guest House 1 to get some water balloons for good measure, and were on their way.

At the children’s home,gina expected the children to all gather round and paint peacocks and flowers with the rangoli powders. However, 60 little hands reached into the colors bag, and the children started running. But not before *poof* one of them threw a generous handful of colored powder right in the unsuspecting American’s hair.  This was supplemented by the splash of a water balloon to the back of the head.  It was then that she knew, it was on.

An epic battle ensued. Blue versus pink, the children all clutched their packets of colors for dear life, and took off across the yard.  Corners were staked out for ambush, balloons were launched as soon as they were tied off, and pink and blue children ran shrieking everywhere. The American girl ran through the whole thing with a stupid grin on her  face as she was “colored” from every possible angle.

In the end, balloons were popped, colors exhausted, and everyone posed for pink and blue photos.

Happy Holi to all, and to all a good night.

The End.

Friday March 7th: Closure

This afternoon I was tap-tap-taping away on the computer in the HIV office, scrubbing data and listening to James Taylor on my ipod–when she walked in.

My little buddy’s mom. The first time I met her, she was admitted to our ward about two weeks after I got here. She is HIV positive, had TB and was very very sick. Additionally, she is a widow and had her little son staying here with her since he had no one else he could stay with.  I got to be very close friends with this little boy, and was feeling personally invested in whatever would happen to him should his mother die.  Then one day I came in, and they were gone. Discharged very suddenly. It was very difficult, emotionally.

But now she’s back! I almost shouted in my excitement when I saw her being examined by Dr. Sugumma, but instead I waved.  She gave me a tired smile back, and nodded. I ran into the hallway to see if my little buddy was waiting outside, but she came alone.

She is terribly weak. Two of the nurses gently helped her into the ward and put her into bed. I didn’t want to ambush her, and she fell asleep immediately.  I was burning inside to know what happened to him. Where is he? Is he safe? But I had to wait.

While she was sleeping, I was pacing around the office like an animal. There was no way I could sit in front of the computer screen with all my pent up anxiety. Rubina saw my distress and suggested “go home gina. Wash your face and eat one of your pomegranates.” As always, Rubina is terribly sensible and peeling a pomegranate is one of my favorite ways to kill time.

I walked home, and started peeling my pom when my eye caught a recent package sent by my mom. She sends me lots of care packages full of little treats and toys for the children. This most recent package contained several prints of the photos that I email home to her. Her idea was that I could hang up the HIV children’s pictures in their home.  I immediately started tearing through the photos. Amid all the smiling, dancing, often cheeseball pictures of the orphans, there were two photos of  him, my little buddy.  One flying his kite on pongal, and the other of him standing next to his mother grinning over Rangoli paints.

After some time I walked back to the ward. Not only was she awake, but  she was waiting for me.  I sat beside her bed and she laboriously explained what happened using her broken English, my broken Telugu, and alot of gestures.

She had finally relented and got him tested. He is HIV positive, which is really the confirmation of what all of us had expected and feared. She had held off for so long because she hoped that after she died, someone from her family would take him in. Unfortunately, as she continued to get sicker, she realized that she had to do something. He’s been admitted to an HIV orphanage with a good reputation in northern Andhra. There he will be safe, and  recieve good medical care, schooling and food.  Her eyes welled up with tears while she told me that she knew she was being selfish trying to keep him by her side through the end of her life. She knew that as his mother, she had to do what was best for him. So she prepared a place for him to go, and said goodbye.

I produced the photos of her son, and immediately we both began to cry. I promised her that I would send the photo of the two of them to him, and gave her the photo of him flying his kite.

She eventually fell back asleep, clutching his picture to her heart.

Monday March 2nd: silliness

Well, it took 15 days, two hospital visits, a suite of blood tests, a truckload of anti-pyretics, and more naps than I believed humanly possible: but I am finally feeling better! Hooray!

I am back in action. I went into work today and left the lizards to have run of the house.  I am collecting more and more lizards everyday who are seeking refuge from the heat outside.  It is getting to be incredibly hot.  Today the high was well over 90 degrees, and there is no air conditioning on campus! I’ve been drinking inordinate amounts of water, which seems not to hydrate my internal systems, but rather my clothes via my pores (grooooss!)

Very little excitement on the clinical front today, so that meant lots of data scrubbing for me. Data scrubbing is painful, because it involves trashing any entries which are just too bogus to function. And in a retrospective study from a smaller HIV clinic like this one, there is alot of bogosity (not sure if that’s actually a term used in the stats field, but it should be).

So during my first day back to work, I carefully sifted through my two months of work, and just unceremoniously wiped out huge chunks of it.  In some ways its kind of fun, or at least mildly ridiculous. The thought process is something along the lines of  those cartoons you always see where the protagonist has a little angel on one shoulder, and a little devil on the other.  Only my shoulders have little  scientists, with tiny lab coats.  The good little scientist says very matter-of-factly: “oh? the only available CD4 count was taken 9 months before the clinical visit? these are silly numbers that don’t make any sense! You must delete them!” But as my data set gets smaller and smaller the little bad scientist gains some clout, and becomes harder to ignore.  The bad scientist always seems to speak in a nonchalant, yet sneaky little whisper: “Oh, my, you just deleted about 50 hours of work in one fell swoop. Why don’t you hit ‘undo’ and adjust your parameters and try to make the data fit…”

(dum dum duuuum)

Dr. Yadavalli, if you’re reading this, please don’t panic. I would never sell you out to the tiny bad scientist that lurks somewhere in the back of my head.  He’s probably just a mirage that pops up in all the heat, anyhow.

Tuesday February 24th: NIMS

Still sick.

These last days have been the pits. Still fever-y, throat is still sore, lymph nodes are still the size of one of Jupiter’s moons (albeit, one of the smaller moons I would say).  Also, my poor laptop is dead. dead. dead. Which means no movies. And very little contact with the Western hemisphere.  I’ve finished reading (and then re-reading) all my books. So I pretty much nap all day.  I’ve been averaging about two hours of sleep for every one hour of being awake. In between naps I listen to my ipod. Which, by the way,  Jackson Browne is excellent “sick music”. Next time you come down with something, download “Running on Empty.”

So on Sunday I convinced Theresa against her better judgment to go with me to the bookstore, in order to replenish my reading stock.  We got a car to take us down to Bhanjara Hills (which is the poshest area in Hyderabad.) They have a mall there with a McDonalds (that delivers! oh la la!) and a bookstore that carried novels from the UK. Theresa was nervous about me being anywhere but my bed, but I was ecstatic to be in  a bookstore–my home away from home (away from home).  Theresa kept telling me that I looked like “a jumping fish” because I was so excited. Books! I bought 12.

I was more content than the lizards who live in my sink (i’ll tell you what, those lizards are happy campers) because I had booooks! Novels! Long ones!  But my poor mother (and father, and boyfriend, and grandmother, and extended family members, and close friends) have been very worried about my non-specific India fever. I had zero response to the antibiotics, which successfully ruled out strep. And I was starting to develop a “rash” which is really just a few red dots on my torso.  I have been inciting mass panic in Cleveland, so I agreed to go to a major hospital for blood testing.

While everyone else in my life was worried about malaria (dum dum dummmm), I was worried about getting stuck with a needle. I spent waaay too much time seeing patients with blood borne diseases like HIV and hepatitis to feel comfortable being pricked in an unfamiliar hospital, in an unfamiliar country.

So today I went to NIMS (a large hospital here in Hyderabad) with some general angst. This time I was on the other side of the Indian health care system, and had no idea what to expect.

Being at NIMS was just surreal.  I timidly walked into a sea of indian people, just waiting.  The outpatient department is an open air square, and the perimeter has offices and labs all around.   In the middle of this huge space were hundreds of people, just waiting. The sun shines down into the space, but otherwise it is pretty intimidating with all the concrete, tile and fluorescent lighting–a far cry from the painting and fountains at UH! There don’t seem to be any appointments in the out patient department. You just walk in, register, and wait.  Sometimes all day, I suppose.

Dr. Y’s colleague who agreed to see me was named Dr. Subblaxmi, and she was very kind. She emailed me her office number, and told me to just come right in at 9:30. I bypassed all the paperwork, long lines and waiting. She handed me a form, I filled it in, and we were good to go.

Dr. Shubbalxmi was in her 40s I would guess, and usually works with HIV patients. But she saw me as a favor to Dr. Y.  After checking me out she ordered lots of blood tests, just to be on the safe side. My palms were a little sweaty, and I asked her if all the needles were disposable. She looked a little affronted by the question, and nodded with a raised eyebrow.  She even asked a male nurse to take me to the blood draw station.

Sitting outside the station, I was feeling pretty anxious. There was an 11 year old boy sitting next to me with the same uncomfortable expression. I reached into my purse and gave him a Mickey Mouse sticker.  We were both worrying about the needle. I took great comfort in my solidarity with this little man. When it was my turn to go in, he gave me a grimace that said you can do it! I nodded back at him solemnly.  I took a deep breath, and in I went.

I’m pleased to report my blood draw was completely uneventful, and my angst was an overreaction. I saw a needle come out of sterile wrapping, and go into a biohazard bucket, so all of my concerns were met.  They  tested me for malaria, dengue, encephalitis,  hemoglobin, ablumin, WBC, total lymphocyte, and a whole bunch of other tests I couldn’t distinguish on my chart.

After the blood test, my male nurse escort led me through another sea of waiting sick people, and dropped me off at radiology.  Here, I waited an hour.  In radiology I was most struck by a sign above the room where the ultrasounds were done. I even copied it down, it read, “Determining the sex of the foetus in any pre-natal diagnostic test is a seriously punishable crime for those who do it, those who get it and those who advocate it.”  Why is it illegal to determine the sex of a fetus you may ask? Because girls get aborted. No one wants girls, they are too expensive to marry off and a burden to their families. It made me really sad.

I had an ultrasound done on all my internal organs. Why?  I’m not entirely sure.  I’m guessing because in severe malaria cases the spleen gets enlarged due to the destruction of the red blood cells? But I don’t have an indication of malaria from my bloodwork, so it seemed a little superfluous.

There were no ultrasound techs, the radiologist operated the machine and went over with me everything as it was happening.  All of my organs are great. Not like I expected anything not to be, but I guess the doctor also wanted a status update on my spleen, liver and appendix.  All of which are fine.

Interestingly enough, all of my ultrasounds, printouts and consultation with the radiologist cost me 300 rupees, or $6.  My bloodwork was more expensive, for over 10 tests it was 1,200 ($24).  My travel doctor at UH, Dr. Armitage, told me not to worry about any kind of health insurance because its cheaper just to pay out of pocket- and he sure was right! Apparently you can get a total hip replacement in india for like $5,000.  Crazy.

I tested negative for all the scary jungle stuff (I could hear my mom’s sigh of relief halfway across the world.)  In the end, we went with an unofficial diagnosis of “acute mono.”  There was never a confirmation of Epstein Barr virus in my blood, but I had raised white blood cell count, and the “rash” I had is a pretty typical outcome of patients with mono who take antibiotics due to misdiagnosed strep.

It also explains all the napping.

lots of love,

g

Wednesday February 18th: “Sick” or “gina versus OR pt. 2″

Ugh. I am sick.

Before you panic, I am doing just fine. Obviously, being sick is bogus and I just lie in bed all day reading–but I’m not in any danger, or scared or anything. Based on the response my fever and sore throat have gotten from the faculty, however, you’d think I contracted the bubonic plague. Let’s go back to the beginning…

Yesterday, I had the chance to redeem myself in the OR. I was shadowing Dr. Anthreddy, our number 2 surgeon, and he had a reconstructive surgery that involved grafting the tendons in a patient’s hand (which was very cool). The surgery lasted a little over an hour, and I really enjoyed observing. The patients are locally anesthetized and then the tendons are delicately sewn together in order to reform the limb into a more useable form. Sometimes this takes multiple procedures, and lots of physical therapy. In the end however, the patients can feed themselves, sew, drive or work in ways they couldn’t with the previous state of their hand (which is also known as “clawing.”) Its remarkable how much these doctors can accomplish with the resources they have.

The reconstructive OR was a far cry from the septic OR. This room smelled strongly of “ dettol“ which is a PCMX disinfectant that has a sour, musky smell. Our scrubs were mint green, and our facemasks were made of cloth (as opposed to paper). The surgical nurses removed scalpels and tools from big metal drums that had been heated in a sterilizer to over 100 degrees Celsius. Syringes were made of blown glass, and bright lights overhead illuminated patients draped in sterile sheets. The whole setup reminded me of something out of a 1950s movie. Dr. Beine was working on a foot reconstructive less than 10 feet from where Dr. Anthreddy was working, and I was observing.

When the procedure was completed, Dr. Anthreddy and I went to the small office next to the OR in order to discuss what I had just seen. There was a second small procedure scheduled, so we were taking a quick break. I was sitting across from him listening to him talk about tendon anatomy, when I suddenly felt woozy. “I’m sorry Dr. Anthreddy, I’m not feeling well” and slumped to the floor. Passed out cold.

WHY is this happening AGAIN?!

When I came to, a whole gaggle of worried looking Indian nurses were standing over me. I was shivering so one of them stuck a thermometer in my mouth. I had a low temperature of about 99 degrees. Thats strange, I thought. I went back to my room, and slept the rest of the day.

Well, when I woke up this morning I got my explanation. I was sweating with a fever, my head was aching and there was an all too familiar pain in my throat. Oh no. Here we go. In case you are unaware, I am the reigning monarch of strep throat. I get it at least twice a year, every year. It would just figure that I managed to pick it up in India.

I went over to the administration office to find Dr. Anthreddy in order to explain/apologize for my fainting yesterday, but he wasn’t there. I waited for a half hour, but he didn’t come and I didn’t have the motivation to romp all over campus and try to find him. I left a note on his desk saying that I was sick, I would be sleeping at home and to please call me when he was available.

I went back to my house, and about 40 minutes later someone was knocking at my door. None other than Dr. Hrishikesh, flanked by two more of our doctors, Dr. Viajaykumar and Dr. Thirapureddy were standing on my front step making a house call! (Either they were very concerned, or there’s not alot going on today?) I really like Dr. H alot–he reminds me of my grandpa. When I opened the door he said gently, “hello great lady. I heard you were not well. Why didn’t you call me?” The three of them escorted me to the hospital 200 feet away from my door to get checked out.

When I walked into our very small hospital with the chief and two SRH doctors, everyone jumped a mile. People started moving very quickly, buzzing into intercoms hastily, “the chief has come” and the hospital director (also my neighbor) approached us, clearly shaken by Dr. H’s unannounced arrival with myself and the other two clinicians in tow.

“What can we do for you, sir?” he asked.

“Regina is sick,” Dr. H answered.

So much pomp and circumstance! I was ushered into the administrator’s office, where he, another doctor and four nurses cooed over me, under the watchful supervision of my entourage. I felt a little silly with all the fuss. When they said “what is the matter” I answered, “well, my throat hurts and I have a fever. I think its probably strep.” With all the staff whirling around me, you’d think I was presenting something a little more significant. Cholera, maybe?

They stuck a thermometer in my mouth, and an hour after taking an extra strength tylenol, I still had a fever of 100. They looked in my throat which was very red (and had some tell-tale white patches) and diagnosed me with “tonsilitis.” They offered to admit me to the hospital to remove them, I almost laughed. “Um, thats okay. I could just use some penicillin.” Well they didn’t have penicillin, so they gave me ampicillin, which is still a beta-lactam and should do the trick just fine. So I was pleased.

Dr. H also informed me that in 6 years of medical students from American and Germany staying at SRH, I was the first to get sick (that wasn’t GI related). So I suppose I’ve made my place here, something to be remembered for.