May 29th: Day Two: Yay for not getting sick :-P

Once again the morning started with Dr. Jain stuffing us. A bowl of cereal cannot compare with the amount of food Dr. Jain expects us to eat every morning. She said she was going to complain to my mom about how we aren’t eating anything and that we aren’t eating healthy since the only thing my sister and I really eat is all the murukku that she keeps buying us :-P Neither of us can resist murukku and it doesn’t help that she keeps refilling the jar.

I spent the day with Dr. Jain in her outpatient clinic. Once again it was a crazy hectic morning but I was really curious to see how patients were treated and what the process was like. It’s a completely different world over here which is really unfortunate because some of the testing that really needs to be done isn’t because the families cannot afford the tests. There was a boy that came in today that was suspected of having Duchenne’s muscular dystrophy. One of the interning doctors came to talk to Dr. Jain about this boy. He just looked at the boy and thought the symptoms might be characteristic of DMD and told Dr. Jain. The first question from Dr. Jain was whether or not a family and personal medical history was taken (which is the first thing he should have done) but he had not done that at all. Dr. Jain did perform a clinical examination and talk to the family about the onset of the various symptoms. She ordered a teat to check the creatine kinase levels on the boy to see if the levels indicated the possibility of DMD. Unfortunately the test was not done because the family could not afford the test. It’s really sad that a test necessary to confirm a diagnosis could not be performed because of money. I know it happens everywhere but the frequency at which it happens here is astounding, frustrating and depressing.

Along the same lines there are a number of children with various metabolic conditions but the high costs of the diagnostic test prevents children from receiving a diagnosis and having a treatment/management plan that can help prevent the onset of symptoms. A simple ferric chloride test is done that can say whether or not five to six different metabolic conditions are present but that’s as much information that can be gleaned from that test. The test will not say what type of metabolic condition is present and the extra tests that are necessary to determine the exact condition are not affordable. We have learned throughout all of our classes that identifying the various metabolic conditions as soon as possible will allow us to help determine a special diet and treatment plan that can prevent the onset of irreversible symptoms but here in Nagpur that is not possible. The hospital can only offer care to help treat and manage the symptoms as they present. There are a number of patients with various genetic conditions in the hospital but the diagnosis is primarily made clinically because the lab tests that are needed for confirmation are not feasible. Family histories can help determine the pattern of inheritance if multiple members of the family are affected but when inheritance patterns can’t be determined through a pedigree, families can only be advised about the possibilities for family planning information and given risk probabilities.

Not a lot of money has been allocated by the government of India towards identifying and treating genetic conditions. Malnutrition and infection are higher on the priority list and the majority of government funding is allocated towards those causes. Sickle cell and thalassemia have received a lot of funding because there is a high prevalence among the tribal population and in recent years the government has been funding programs and initiatives specifically targeting the tribal individuals.

I learned a lot during my trip last year but this the first time that I have been in a government hospital and had the chance to spend an extended amount of time observing. Living in the States we take a lot of things for granted and its being and observing situations like this that makes you take a step back and think.

Today was definitely a better day than yesterday and I learned a lot from Dr. Jain and the other staff members.

Here are a few pictures from the hospital

Walking down a hallway. This was one of the less crowded ones. 

There are dogs and cats that just freely roam the corridors

 

The outside of the hospital. "The Play Area" Look at how rundown everything is

This is not what a hospital should look like

The view of the hospital from across the street

Dr. Jain’s cook decided this morning that he was taking the evening off and that Dr. Jain should take us out to eat so we decided to go to the Venkateshwara temple and out to eat after work. The Venkateshwara temple was gorgeous and reminded me a lot of the SV temple back home. Going to the temples in India always reminds me that temples are what unify Indians from different states. Temples around the country are definitely the monuments that Indians visit when they go to different parts of the country and no matter how many temples you go to you will never find two that are exactly alike. My sister and I have been dragged to our fair share of temples throughout all of our visits to India and when we go to different states in the US because somehow my mom always manages to plan our family vacations and trips so that a temple is part of the itinerary. While going to the same temple gets a bit boring I’ve gotten the chance to see some pretty nice new ones during my last trips. Unfortunately we weren’t allowed to take pictures at the temple and there was a security guard outside so I couldn’t sneak a pic either :-\

By the time we went to dinner it was closer to 9pm and I was both exhausted and not hungry but refusing to eat would probably make Dr. Jain angry so my sister and I forced ourselves to try a little bit of everything. She took us to a Maharashtran buffet so we had the opportunity to try a variety of different dishes. They were a number of different dips and sambars with rice, naan, pappad, uthappam, mango pudding and a variety of other things that I don’t know the names for. All in all it was a great dinner but we were definitely ready for bed by the time we got back.