...This afternoon, I visited the operating theater in the largest local government hospital for the second time. Last week, while viewing two simultaneous surgeries in the same hospital, another volunteer fainted and I nearly followed suit. I lost all vision right as I made it to a chair I had targeted. The sights, sounds, and smells are literally overwhelming to the senses. Fortunately, we remained fully conscious today to view what has to be one of the most shocking sights I have experienced since arriving. I'll elaborate more toward the end of the post.

I began the day making rounds with the hospital's dietitian. Each patient received two slices of bread, one liter of milk (which comes in a bag in India), a small block of cheese, and a little pad of butter to last for the entire day. Patients must use their own utensils, plates, and cups as the theft or waste of such items would be extensive.

The dietitian's main work was in the maternity and pediatric wards. Most of the babies here are born relatively healthy. However, child malnutrition is a major problem. The pediatric ward was filled with babies months behind their proper development. The doctors are quick to blame the parents' lack of education and poverty. Proper breastfeeding is common among the educated population but surprisingly less so among the poor. The main reasons for this seem to be that many of the poor women have to work to support the family, that they become pregnant again and can no longer breastfeed, and that they simply don't know what to do with their kids.

These twins, for instance, had been previously admitted to the hospital two months earlier. They are two months old and weigh only 2 kg (4.4 lbs) each. Their mother is uneducated and destitute. She does not breastfeed them and feeds them buffalo milk that has been diluted to approximately one part milk, two parts water. The mother did not even seem to know that the bottles of milk lying on the bed need to be held inverted so that the kids can suck milk from them. Many other children were suffering from upper respiratory infections from not being able to stay warm through the recent cold spells.

--About to remove a foreign body under local anesthetic--

This afternoon, we worked with the ENT specialist as he saw patients in the outpatient department and performed two emergency operations. I calculated the average patient consultation, from entrance to exit, to be between 30 and 45 seconds. The patients line up tightly outside the doctor's door. As soon as the patient being seen gets up, another one rushes in. Sometimes, they don't even wait and the line continues into the office. The doctor takes the patient's card, has him or her sit down, does a two or three second investigation of the affected area (usually with a flashlight), then prescribes treatment on the card and sends the patient to the pharmacy. This continues for approximately three hours every day.

Two small boys also came in with foreign bodies, one in a nostril and one in an ear. The nostril was cleared right in the office using local anesthetic. We helped hold the kid down and position lights so the doctor could see. The doctor used what he called a Eustachian tube catheter to pry out a necklace bead as the kid screeched in horror. I doubt he'll put anything in his nose again!

--Child crying as he watches an operation before his own--

We then made our way up to the operating theater, where we removed our shoes, put on flip flops, and walked past about a dozen patients sitting and waiting for their turns on the table. We entered an operating room with one table vacant. On the other, a fully-conscious man was having a lipoma the size of a softball removed from his left shoulder by a surgeon who looked more like a professional butcher. The child who had thoughtlessly put something in his ear was now carried into the room, past puss and bodily fluids squirting onto the floor to his own recently-vacated table. There were blood-stained gauze and clothes on the floor as well as used syringes and surgical tools. The child looked over at the other patient with eyes the size of quarters and cried in sheer terror. If there is ever a time for an observer to be able to feel the fear and anxiety of a patient, this was it.

The surgery proceeded as normal and a seed was removed from the little boy's ear. After a few minutes of resting on the table, the boy was picked up by his shoulders and pant legs and carried out to his mom who was waiting with all the other patients just outside the door. I doubt he'll put anything in his ear again!

Just about 45 seconds later, as I was walking out of the operating theater, the next patient walked past and lay down on the bed. At least the bed's warm, right?

I also took this picture of a wall outside the hospital today. It shows the typical costs of surgeries here versus what one would pay in a private hospital nearby. The conversion is 50 Indian Rupees to 1 USD. Where there is just a word in place of a number, that's Hindi for "free." As you can see, the most expensive surgery here is a laparoscopic cholecystectomy which, without any insurance, would cost Rs 5000 ($100)! For patients below poverty line, all medical care is free. I doubt they get the laparoscopic procedure though.

I also happened to peek into this room, which houses the backup batteries. However, the beatteries don't seem to work very well. Whenever the power goes out, which happens about five times per day for anywhere from 30 minutes to 4 hours, the hospital reverts to a large diesel generator. The generator takes time to start, however, so equipment even in the ICU and NICU are sometimes not operational for over a minute. Luckily, no patients here are on ventilators, or else that would become a serious problem. I have not been in the operating theater here yet during a blackout. But I'm sure it will happen and I'll report back.

This afternoon, we went to teach at the slum school. I didn't go last week since I wasn't feeling well, so the kids were very happy to see me and welcome me back. Their Math and English are certainly improving gradually.

We walked home with kids on each arm. I played cricket with the locals, showered, and then made dinner with my host-mom. Now that's a day!

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