Today I had my first day in leprosy outpatient. I’m shadowing Dr. Bhaskarao, who is in his later 60s I would guess, and has a very fun personality. He is short, round, wears wire-rimmed glasses and has a white mustache. I think he feels cool having me follow him around and ask a million questions. He is very patient with me, a good teacher, and loves to tell everyone “this is my assistant. She is from America.”
Leprosy outpatient is unlike anything I’ve ever experienced of medicine in the states. The patients shuffle in and produce pressure ulcers ranging from the size of a quarter to the size of my fist. Most of them are kind of green and oozy (ack! gangrene!), while others are dry and resemble holes. The ulcers and infections are not painful. In fact, the lack of feeling caused by the nerve damage is really the reason they get so many ulcers to begin with (but if you read “the crash course” post about leprosy, you already knew that).
Dr. B. showed me how to properly palpate the ulnar (near the elbow) and common peroneal (near the knee) nerves to see if they were thickened. He also showed me how to test for anesthesia, which is the very complex process of poking the patient with a pen and asking, “can you feel that?” Many of the ulcers are treated with oral and cream antibiotics, and dressed in sterile bandages. Some need to go for debriding surgery, and those patients get admitted to the ward. I have photos of some of the more gnarly ulcers which I will not post, as they are pretty grotesque. I can certainly produce them by request if you are interested.
The nerve damage also affects the muscles. About 20% of leprosy patients experience either “claw hand” or “drop foot.” In clawing the fingers curl downward, but the palm remains open and the hand freezes in this position. A reconstructive surgery of tendon grafting can straighten the fingers and place them at an angle with the thumb to that the patient can feed his or herself, work, or even drive. In drop foot, the muscles behind the ankle contract, and the resulting position is a pointed foot. As you can imagine, this patient’s mobility is severely compromised. Reconstructive surgery, along with special boots (which are manufactured on the compound) can allow this patient to walk again. Its pretty amazing.
In some ways, working in leprosy is easier than working in HIV. While the images in leprosy are certainly more striking (deformities, ulcers etc) there is a lot that the doctors can do to help treat the patient. Some days in HIV I want to beat my head against the wall, because all we can do is treat symptoms, work against opportunistic infections, and try and prolong a patient’s life. Its certainly an uphill battle. Not to say that leprosy isn’t, but its definitely a nice change of pace.
While I was in the ward, the phone rang. A nurse popped her head into the office, and gestured that the phone was for me. Me? Who is calling me? “Hello?” I said.
“Hello” an unmistakably American voice answered! “This is Jann, I was calling to let Dr. Hrishikesh know that I am coming tomorrow at 11am to see the children.” I almost dropped the phone. I couldn’t believe how much I had missed the sound of my own language. Here I was, talking to a fellow countrywoman!
“Hi Jann” I said back, trying to sound professional, casual, and to contain my excitement. “I will let Dr. Hrishikesh know. I’m new here at Sivananda, and would like to meet up with you tomorrow as well, if that’s okay.” From there I explained my connection to SRH and found out that she is living in Hyderabad with her husband, who is here on business, and her daughter for a year. They are from Seattle. I am very excited to meet her tomorrow.
After work, I went to go play with the children–which is always the bright spot in my day. Even though we don’t speak the same language, we are communicating pretty well. Two of the girls speak English, and the rest of the children pick up on what I am saying very quickly. Its fun to learn each child’s very definitive personality. Children are children no matter where in the world they live, or background they come from. Some of the kids are leaders, some are shy. Some are competitive, while others are very creative. Each one is different than the next, but they are all really awesome.
The children were a little burnt out on “goats and tigers” today, which is reasonable because we have been playing it everyday. (Its hard to describe rules of different games, so we’ve been sticking to what we know.) Today, however, I gathered the kids around and said, “ok guys, its time for a new game.” They repeated after me, “New game.” And murmured among themselves, ” new game.” I never know if they are repeating me because they understand me, or if they are just trying to encourage me by saying whatever I am saying.
So I taught them duck-duck-goose. They are so cute, and they did really well. They haven’t quite internalized the concept of “goose” yet, so we really just played “duck, duck, DUCK!”
I think tomorrow I want to move on to freeze tag.
lots of love,