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!

"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.