Sunday, March 13, 2011

Homeward Bound

As I wrote this blog (2 days ago), I was sitting on the train back to New Delhi. Although so much has happened in the past 7 weeks, as I sat there and looked around I felt like I was on this train just last week, coming to Herbertpur, not knowing what would await me there. I have such a mix of emotions as I’m leaving. I can’t say that I want to stay, and yet at the same time I can say that I’m sad to leave. There were many times when I wished that I would have a good excuse to book an early plane ticket home! But I’m so glad to have been here for the length of time that I was. These last two weeks were especially good, as I really felt a part of the community at Herbertpur. I want to say that the experience was wonderful, but not really wonderful in the sense that I might have expected it to be. It wasn’t always easy, fun, and exciting; it was often difficult, emotionally exhausting, and frustrating. But I saw a glimpse of what life might be like at a mission hospital, and God is revealing to me so much about my relationship with Him. I hope that as I come home, I can continue to reflect on these experiences and that God would continue to lead me and teach me. The highlight of this experience was by far the people that I met. They are not only welcoming and friendly; they are servant-minded and passionate about their work and about their Lord.

I wanted to share some reflections about the medical experience that I had here, and some of the problems that are very endemic to this country. Something I didn’t expect coming here was the incredibly high rate of suicide attempts. It seemed that at least once per day, a patient (most often a woman) was admitted with organophosphate poisoning as an intentional suicide attempt. Unfortunately, not all of these individuals survived. OP poisoning is a huge problem here in India, and Herbertpur hospital is part of a study creating a protocol for managing OP poisoning. The high suicide rate is a result of the easy availability of organophosphates (chemicals used as pesticides), the terrible poverty that so many people live with, and the lack of appropriate mental health care in the communities. When I went into the villages for our mobile clinics, we saw patient after patient with vague complaints of chronic pain, restlessness, and fever. (I learned these words in Hindi very quickly!). It seems likely that a lot of these complaints are actually manifestations of significant depression and anxiety.

Another huge problem in India is tuberculosis. I knew this was endemic to the country, but I had no idea how much so! I was astounded by the number of cases of TB I saw. Although most of them were pulmonary TB, I also saw TB meningitis, TB peritonitis, spinal TB, miliary TB, and so on. You pretty much have to suspect tuberculosis in any patient complaining of a cough lasting more than one month. I don’t think I saw a single “normal” chest x-ray here. (I’ll probably have a positive PPD test when I come home and will have to go on Isoniazid for 9 months!)

There are many things that were very frustrating about practicing medicine here. Many of the patients we saw are uneducated and illiterate. Many don’t know anything about their health conditions. They want a magic pill for every symptom they have. We often tried to explain that he/she doesn’t need a certain medication, in an attempt to save them money, but they would always come back and say “where is my cough syrup?”, “I need something for fever”, “I need something to increase my appetite”, “I have burning in my chest”. Only once can I remember a patient that actually asked us to take away some of her medications! I was expecting a general rejection of western medicine here, but I found the opposite.

I often felt like I was practicing “second-rate” medicine. We were so limited by the exams we could do, the labs we could order, and the history we could gather. Were we making the accurate diagnosis? So may times we were forced to treat based on symptoms, hoping that we would be managing the disease. If we had to refer a patient to a higher center for diagnostic tests, we just had to hope that they would follow through and come back. I wanted to be helping these patients, and yet I felt unable to do so sometimes. I felt like I wasn’t able to perform at my best. I tried to remind myself that limited treatment is probably better than no treatment at all, but for someone like myself who has a “Type A” personality, I wanted to do more! Why does this patient have persistent tachycardia? Why does this young woman have unexplained hypokalemia? Why does this patient have a chronic cough but no other signs or symptoms of heart failure, COPD, pneumonia, or asthma? Their sputum is negative for tuberculosis but we will treat them as positive for TB anyway because nothing else has worked!

The enormity of the problem seems insurmountable. There is a belief system in the minds of patients, as well as many nurses, that is difficult to change. So much of the problem lies in health system infrastructure, follow-up in the communities, lack of primary care and outreach, and definitely a lack of education. How do we change these things? I found myself discouraged by these things; I often felt like what I was trying to do was just not enough to really make a difference here. But then there were the cases where patients really got better, when medicines really made a difference, when someone grasped the problem at hand. These were the success cases that I treasured. I guess those are the things that keep mission doctors going.

As I leave India, I will have a lot to think about back home. How does God want to use me in my future? How can I use my training in the next 4 years to best accomplish His purpose for my life? I know that the faces and circumstances I saw here will change the way I think about medicine. I guess we will see where that leads me….


Prayer Requests:
- Dr. Chering: She is an internal medicine doctor and the head of the family medicine program at HCH. I have never met any woman so dedicated to her patients! She is on call every night, she will go online in the middle of the night to take special classes that are being broadcasted from the United States. She expressed some fatigue and stress to me during my stay. Please pray that God would give her rest, rejuvination, and clarity of mind.
- There is an emergency medicine team from the states at Herbertpur for 3 weeks. This is a great opportunity for teaching and assistance in the hospital. I pray that God would be able to use them to give some rest to the doctors at Herbertpur, as well as use them to provide teaching to the junior doctors and consultants

Praises:
- I praise God for His protection, faithfulness, and guidance over the past 7 weeks
- For Goli, Daniel, Kian, and Ramin. It was a huge blessing to have this family with me.
- For safe travels and good health!

Wednesday, March 2, 2011

"Holy water"


This past weekend I traveled to Hardiswar- a Hindu city along the Ganges River. The three main gods in the Hindu religion are Brahmin, Vishnu, and Shiva. The Hindus believe that the Ganges River flows from Shiva’s hair; Shiva is the god of destruction. Therefore, the water in this river is believed to be holy and the Hindus make a pilgrimage to the Ganges to bathe in the water, bury the remains of their dead loved ones, and to collect the holy water and sprinkle it on their temples.

When we entered the city we encountered hundreds of men carrying apparatuses that looked like they belonged in a parade or a circus (pictures above!). Over their shoulders were these long brightly decorated rods that had objects hanging from each end and lots of streamers, garland, trinkets, etc. It turned out that each end had a decorated and covered bucket that contained water from the Ganges; these men were collecting water from the Ganges and walking days on end to reach their home temples and sprinkle the water on them.

We were lucky enough to stay at the home of a very nice Indian family we had met a few weeks ago. They cooked us delicious Indian food (yay!!) and they drove us around Haridswar and took us to the temples and the nightly celebration along the river. Two things struck me about the temples: one, they were almost gaudy with color and display, and two, men are making a lot of money off of them. Not only do people throw money onto all of the statues and altars, but there are tables set up all around the temples (sometimes practically inside them) selling souvenirs and Hindu objects of worship. The scenes reminded me of the time Jesus overturned the tables of the money-changers and drove the sellers out of the temple during Passover. How little people have changed over the centuries!

That evening we went to the Ganges River where there is a ceremony every night at 6:00 pm. There were thousands of Hindus there, many of whom were camped outside in tents and the backs of wagons and trucks after having made a lengthy pilgrimage to the city. Everywhere you looked were people selling prayer beads, statues, food, and decorative objects to use for making their rods and buckets (I wish I could remember what they are called!). At 6:00, after the crowds are assembled along the side of the river, people begin taking little boats made of a large leaf filled with flowers and light them on fire before releasing them into the Ganges to float down the river. It was such a spectacular sight.

As I was watching all of these people and festivities I felt such a mix of emotions. The colors, the people, and the celebrations were fascinating. But there was also a pervasive sense of darkness and sin that permeated everything. Haridswar is rampant with HIV/AIDS, drug abuse, child prostitution and sex trade. When I looked around me, I saw thousands of people who need Jesus. I wanted to shout out that there is a loving God who loves them regardless of caste and wants to rescue them from this life of darkness.

All in all, it was a wonderful weekend!

Prayer Requests:
- There are so many patients with very little resources and inability to pay for extensive medications and investigations. The hospital itself is not equipped with a lot either. Please pray that the medical staff at the hospital would make wise decisions in how to treat and what to treat.

Praises:
- A new junior doctor (aka. Resident doctor) came yesterday. She just graduated from medical school and will be training here for at least 3 months. She seems very enthusiastic!
- God is continually teaching me what it means to trust in Him. Although it’s not always easy, I am so thankful for this experience. In learning to trust Him, I’m learning to not worry about what tomorrow might bring, and instead rest in knowing that when I need strength, faith, or courage, He will provide it at just the right time.

Thursday, February 24, 2011

Over the Hill and through the Woods...

I had a few interesting experiences this week. I went to another mobile clinic in a Muslim village, but this time I was the only “doctor” going! As I’ve mentioned before, the hospital is very short on residents right now, so there is no doctor available to go to the villages. Daniel and Goli (the physicians from Switzerland) have volunteered to go while they are here, but Daniel was sick this week and Goli stayed with the children. So that left me =) I was excited and a little nervous to be going alone. I’ve been to two mobile clinics before, and I knew that this one in particular has fewer patients that come every week. But I was thinking, “I’m not a real doctor yet! What if I don’t know what to do?” I said a couple of prayers on my way that there wouldn’t be anything really scary awaiting me, and that I would make good judgements. Praise God, nothing I saw threw me for a loop, and I think I managed the patients well. I referred one woman to the hospital to get an ECG because I think she has atrial fibrillation, so I hope she goes and has that followed up on.

After the clinic, we drove on to another village to attend a woman’s self-help group, which is part of a larger community health project led by people connected to EHA and Herbertpur Hospital. It was so interesting! This particular village is very large- over 7,000 people live there and it is a Muslim village. There are ten women’s self-help groups within this village, each with 12-15 members, and they have been meeting for 6 years. The groups primarily talk about ways to be economically self-sufficient (saving money, starting a business, etc), but they also address problems such as alcohol abuse and smoking. Women from this group have taken loans from a bank and started their own shops, and some have bought buffalo and sell the milk from the buffalo. Every month they deposit 100 rupees (~2 US dollars) into a collective savings fund. Over the past 6 years they have raised over 100,000 rupees (~2,300 US dollars)! That is a lot of money here in India, especially for impoverished people. It was so great to hear them talk about their plans to join other women’s groups and create a larger co-op where they could collaborate and invest in something larger to make money from. The women spoke of the difficulties they face- most are illiterate and uneducated, they all have families and houses to care for, and they have few resources. But their faces were glowing with their accomplishments. They asked me (through Mr. Robert translating for me) if women in the states sit together like this (they were all sitting on a dirt floor in a dirt and cement house) and what sort of jobs women do. I smiled to imagine women at home being comfortable on a dirt floor with flies buzzing around and going home to haul cow dung from the yard and spread it on the floors of their homes (this is what they do here)- I tried to answer in a way that was encouraging.

This weekend I’m taking a trip to Haridswar and Rajistan with Goli, Daniel, and the children. These are two cities that are part of the Hindu holy pilgrimage along the Ganges river. I’m really excited to see another city and learn a little more about the Hindu religion here. Pray for safe travels!

Prayer Requests:
- Angela left this week (she was another student from Texas here for 3 weeks). The day she left I started feeling much more homesick than I have in awhile. It gets lonely when everyone around me is speaking Hindi, allowing my thoughts to wonder towards thoughts of home. During these moments, I have been praying to the Lord and asking for joy and strength, knowing that He is all I need and He promises to fill me and lift me up. True to His character, the Lord has come through each day and made it wonderful, but I still struggle in the mornings. I would appreciate prayers for this during my last weeks here.
- Continue to pray that the Lord would provide more physicians here, especially in OB/Gyn and family medicine. (Two rural surgery residents that had been at another hospital for the past year returned this week- so that helps out a little bit!).

Praises:
- My Grandpa had a pretty major surgery last week, and it went as well as we could have hoped for! We were all very worried, considering his age and comorbidities, but God is so good and has granted us more time to spend with him. Grandpa got to celebrate sis 89th birthday on February 22nd! I wish I could have been there, but I’m really looking forward to celebrating with him when I come home.

Sunday, February 20, 2011

The World Cup!




February 19th marked the beginning of the World Cup - not the Soccer World Cup we all know and love, but the Cricket World Cup! Cricket is very popular here, so everyone is pretty pumped for the World Cup. Apparently, India has a really good shot of winning the tournament. The pastor at the church here loves cricket (he’s been talking about the Cricket World Cup since I got here!), so he organized a cricket tournament amongst the men that are a part of the church congregation. Today, just outside the hospital, I witnessed my very first game of cricket. It was really fun to watch, even though I still don’t understand any of the rules! But everyone was really excited and laughing, and the weather was beautiful.The picture above is me and Kian cheering on all of the players! The World Cup goes for 6 weeks, so this tournament is being held every Sunday for the next 6 weeks. Maybe I’ll learn some of the rules by the time I leave.

I also experienced my first bit of India gastroenteritis this week, but praise God it only lasted 24 hours =) Three other people also got sick this week so I’m thinking something in the mess hall was not quite right…. I was helping with a C-section and was about to re-scrub for a 2nd one, but I had to ask to leave! Dr. Daniel just smiled and told me to go rest. I felt a little silly =)

I spent this week on OB/Gyn again and I was reminded of the huge need for an OB/Gyn physician here. With the loss of two rural surgery residents in the past 3 weeks, Dr. Daniel and his wife, Dr. Jennifer, are covering the OB/Gyn outpatient department, maternity ward, and OB/Gyn surgeries (in addition to their normal tasks). I really enjoyed getting to spend more time with both of them this week (Dr. Jennifer even invited me over for pancakes!!), but I wish I could help them more with the workload. From what I can gather they have had a difficult time recruiting OB/Gyn doctors to come here. Being a mission hospital, the pay does not compare to what one would make at a government hospital, and the workload is pretty large.

I hope everyone at home is doing well. I miss all of you and enjoy hearing about everything that’s happening at home. I hear the Badgers are doing pretty well on the basketball front?! That’s so exciting! I hope to see a good March Madness when I get back!

Prayer Requests:
- Please pray that God would provide more doctors to work here at Herbertpur. The few doctors that are here work very hard and are very dedicated to their patients, but it’s virtually impossible to provide the best patient care being short-staffed.
- Although I am really beginning to feel comfortable and enjoy my time here, I still have days where I really struggle with the food and feel very hungry- this continues to distract me and make me yearn to return home even when everything else is going well. Please pray that I would be able to look past this and trust in God for my needs.

Praises:
- I am so happy that the family from Switzerland is here! Goli and Daniel are wonderful, and I love their two children – Rami is 1.5 years old, and Kian is 3 years old. They are adorable! It has been so nice to have a family to spend time with and talk to. The boys are getting pretty comfortable around me and will sit on my lap and they love being tickled and swung around; it’s a lot of fun! I really praise God for bringing them here for the two months that I am here as well.

Tuesday, February 15, 2011

Surprise!

Being about midway through my time here in India, I thought I would share with you a few of the customs and practices here that I have experienced. Although I tried to imagine life in a developing country, I’m realizing that I still came with so many assumptions about the way “life works”, when in reality- it really doesn’t work that way! (Most of these are silly things, but a few more serious)


1.Prior to leaving I thought about how much hand sanitizer to bring along. I only brought 2 small travel-sized bottles, and I remember thinking “Oh I’ll be in a hospital- they’ve got to have hand sanitizer there!” Wrong. Hand sanitizer may be at every doorway in every patient room in the States, but here it is a far-away sink with one common bar of soap and a common towel.

2.Sticking to the hand-cleaning theme- everyone here eats with his or her right hand. I was warned about this, and I thought, “Oh I love eating with my hands!” But I envisioned having things that were easily picked up by my hands, and I thought there would be a ready supply of napkins for the mess! But wrong again. You are supposed to take your right hand, mix up all of your rice with the dal or the curry, and sort of shovel it into your mouth, without the assistance of napkins. Actually- it’s near impossible to find napkins anywhere. Even most of the stores in the market don’t carry them. There is again a common sink and towel to clean off with at the end of a meal.

3.I mentioned the Valentine’s Day Couples Dinner- well what I didn’t think about was the difficulty of cleaning up over 40 serving bowls, 60 coffee cups, and large pots without rags, paper toweling, etc.

4.Leaving the cleaning theme- the hospital here has only one ventilator. Today, we intubated a pregnant woman who had sepsis and acute pulmonary edema, but because she also has tuberculosis (like almost every patient here), we couldn’t put her on the ventilator because the hospital wouldn’t be able to use it again on anyone else. After bagging the woman myself for what seemed like forever, my hands really started cramping up so the nurses started taking shifts. In the end, the family-members were taught how to give air through the bag and they are now responsible for continued ventilation. I’ve seen this happen 2 other times. I never even thought about intubating a patient and not putting them on a ventilator- it’s so routine back home.

5. Yesterday we went to the operating theatre with a woman who had a ruptured ectopic pregnancy. The procedure was done laparoscopically, but there was a lot of clotted blood mixed with tissue and Dr. Daniel couldn’t break it apart enough to pull it out of the port-hole in the patient’s abdomen. Back home, when trying to remove larger tissue pieces laparoscopically, we have fancy equipment with pouches on the end that can be opened up inside the patient, enclosed around the particular tissue to be removed, and slowly pulled out. But that stuff is too expensive to be used here, so Dr. Daniel asked one of the staff to go and get a condom! At first I was confused- then I realized, he planned to insert the condom into the woman’s abdomen, place the tissue inside the condom, and then grasp the condom with the laparascopic equipment and pull it through the port! It was genius and it worked brilliantly! I tried not to laugh as I watched the condom being stretched out insider her abdomen!

6.“Sterile” in the operating rooms and ICU here means everyone taking off their outside shoes and putting flip-flops on! I still find it so strange to be in the middle of a surgery and see everyone wearing sandals. I’m a little afraid that someone might drop a bloody scalpel on his or her foot!

Although there are many more things I’ve gotten used to, I don’t want to bore anyone! =) I just find it interesting that almost every day I run across something that makes me think “wow, I really take this or that for granted back home”. So many things that I view as “necessities” really are luxuries. I keep realizing how easy it is back home to find joy and contentment in my friends, family, and things around me. God is teaching me to find my joy in Him alone (I'm not good at it but I'm working at it!).

Prayer Requests:
- I had an uncomfortable situation with a young guy on the street this past weekend. Nothing bad happened in the end, but he harassed me and made me feel very uncomfortable. I hate feeling so vulnerable as a female traveling by herself, and now I’m a little nervous to be walking in this particular area. I would appreciate prayers for protection and for wisdom about where to go and not to go.

Praises:
- Life is getting easier for me here, so thank you for your prayers! Although God is still stretching me, I’m learning more what it means to trust in Him for my needs and my happiness.
- Goli and Daniel (the couple from Switzerland) officially have a translator working with them in the hospital. Goli was able to see over 40 patients by herself in the outpatient department this morning; this will really help the staff manage some of the volume of patients. It will help me as well when I’m working along with them!

Saturday, February 12, 2011

Love is in the Air!

With Valentine's Day just around the corner, there is a large "Married Couples" Dinner happening tomorrow night in the building where the church service is held each week. Apparently, the event is a big deal. All the couple are supposed to dress their best, and then there is a judging and the best-dressed couple wins a fancy dinner out in Dehradun. Initially when I heard about the dinner, I was a little bummed because I obviously wouldn't be able to join! (No- I have not fallen for any Indian boy, nor have I been arranged to marry anyone here!). But I was asked yesterday to help with preparations and with serving the dinner, so I gladly accepted!

The other student here from Texas (Angela) and I spent last night and a good part of today cutting out paper hearts and flowers, decorating plastic bottles to serve as flower vases, decorating paper plates and bowls with markers and shiny red tape, and blowing up heart-shaped balloons. Let me tell you- planning a party here is nothing like at home! You can't just go to "Party City" or "Target" and buy decorated plates, center pieces, etc. We went into the market, and Jubin (a nurse here) took us to the decorations store- it was about 6 feet wide and 12 feet long, covered from floor to ceiling with ribbons, paper, glitter, gems, I don't even know what else! You tell the man what you want, he brings out whatever he has and you pick from it. You may not end up with anything that you want, but you make do with whatever you can get. It's very amusing.

So tomorrow we will spend all day decorating the church area for Valentine's Day. Then we get to judge the couples for the best dressed....and hopefully get to enjoy some of the food as well (I heard there will be ice cream!!).

Quick update from my last blog:

The man I mentioned in my last blog (with the infected foot) came to the hospital yesterday! Praise God! I was in the casualty department when I saw a familiar-looking man getting an injection. When he sat up I recognized him and was so relieved. He walked over to me, took both of my hands in his, and thanked me for helping him. He wanted me to know that he was getting his antibiotics and all of his medications. He said he hoped that I would come back to the village again! It was really great to see him there.

Thursday, February 10, 2011

Mirzapur


Mirzapur is the name of the village I traveled to today with the hospital’s mobile clinic. Every Thursday one of the doctors, a nurse, and a public health worker set up a clinic in a village about an hour outside of Herbertpur. Mirzapur is a mostly Muslim village, and there were a lot of interesting sights to see! Although apparently, we were the most interesting sight there, since the female physician from Switzerland (her name is Goli) and I drew stares from everybody that we passed! The kids would follow us down the street and whisper to each other. It was very amusing.

The clinic itself is in a 10-foot by 10-foot cement room along the side of the road; it’s locked up during the week and we store a desk, chairs, and medications inside for the weekly clinic on Thursday. All the patient’s charts from that village are also stored inside. In theory, the mobile clinic is wonderful, and they do manage to accomplish a lot with limited resources. But I realized today that patient after patient comes in with the same complaints- fever, body aches, back pain, fever, neck pain, fever, cough, etc. We didn’t have a thermometer with us, and no one actually measures their temperature, so these vague complaints are difficult to treat! And we can’t draw labs or get x-rays, so physical exam and history becomes very important. Also, I have noticed that almost every person we see is taking Amitryptiline, a drug that is rarely used in the United States in elderly individuals because of the associated side effects. When I asked the junior doctor why, he said that people complain of “uneasiness”; basically their description for anxiety, depression, and inability to sleep- and this is the medication always given. I was uneasy about prescribing it.

The craziest thing I saw today- a man came in complaining of back pain (go figure). But I noticed that his foot was covered in bandages, and these bandages were soaked through with yellow-redish fluid. Although the man insisted he was only concerned about his back pain, Goli and I insisted that we unwrap his foot (I think it would have gone ignored if we hadn’t been so forceful about it). As we lifted up the wrappings, I was shocked to see that all of the skin and subcutaneous tissue from the entire top of his foot was missing! I could see down to tendons and bones in an area extending from his toes to his ankle! It was crazy. We tried to describe the urgent need for treatment in a hospital and the dangerousness that is associated with walking around on this sort of thing. We referred him to our hospital, so I really hope he goes!

One of the things I will just not get tired of seeing here is all of the monkeys! They are everywhere and they are adorable (although they can be vicious and I usually try to keep my distance!). Along the road today there were hundreds just perching on rocks and branches, and little baby monkeys too! I loved it.

Prayer Requests:
- The hospital is very short on residents right now. Due to a variety of circumstances, they have lost 3 in the past two weeks, leaving only 2 left. This is a huge job for two residents! Please pray for guidance as the medical director and family medicine program director make decisions about leadership and recruitment. And pray also that God will provide more Christian physicians to work here.

Praises:
- The husband and wife from Switzerland think they have found a translator to help them in the hospital! This would make us much more useful in the casualty unit and outpatient departments, if we could see patients on our own without tying up someone else in translating for us.
- Thank you for all of your prayers and support!