May 28, 2012 – SaVe Me, I’m MeLtInG!!!!!

My sister and I were both ready to go at 9:30 this morning. We were going to the hospital to start our days of observation. (Me with genetic counseling and her with the general pediatrics doctors). And let me start this post off by saying that it is currently 48 degrees Celsius (around 117 degrees Fahrenheit) and I am dying. 

 

This is the main teaching building for the Government Medical College

Dr. Jain is the head of the Pediatric division at the Government Medical College in Nagpur. I didn't know this when I was coming here but the Medical College here is the apparently the largest medical college in all of Asia which is pretty crazy. The campus is huge with various buildings for the dental, medical and nursing schools in addition to hostels and the actual hospital facility itself. There is a separate buildings just for infectious diseases which I think is pretty astounding for the city. We haven't had a chance to take pictures yet but hopefully that'll be rectified soon enough. The hospitals in India continue to amaze me. There are just sooooo many people. You can't turn anywhere without running into someone. People are lined up along the hallways, there are some individuals that are napping. People are being rolled around in gurneys and wheelchairs. Some people are walking around holding onto their IV lines. The scene is so completely different from the States that it's hard to wrap my mind around it no matter how many times I go to a hospital here. My sister and I split up this morning to each go and do our own thing. 

I was to be following Sanjeewani today who is the genetic counselor for all the sickle cell and thalassemia patients. Because of the high prevalence of Sickle Cell in the area every pregnant woman that comes through the hospital is screened for sickle cell and thalassemia traits. Each morning around 50-60 women are screened during the Antenatal clinic. They are group counseled in the beginning and given general information about sickle cell and thalassemia. A general family and medical history is taken from each woman and ff the woman tests positive then the husband/partner is then requested to come in for screening as well. And at this time they have a more detailed counseling session explaining inheritance and more details about the condition. Mothers are also offered the option of the having percutaneous umbilical blood sampling (PUBS) or better known as having blood drawn from the umbilical cord and tested to see if the developing baby has sickle cell or thalassemia. Dr. Jain explained that they don’t feel comfortable offering amniocentesis for the purpose of sickle cell screening due to the high rates of limb abnormalities associated with the procedure here and the cost of the procedure.

The Antenatal Clinc (ANC) was supposed to last from 9:30-1:00pm but the heat definitely ended up getting to me because I only lasted till 11-11:30am before getting sick. Great first impression to make but sitting in a room with 30 pregnant women and 1 fan in 118 degree weather is not my idea or my body’s idea of a good time so I ended up excusing myself before I got sick again. But I did have the chance to observe and learn how women are informed about testing and what sort of information is collected from each individual before they get their blood drawn. It is definitely a different atmosphere from what I am used to at Pitt. There is absolutely no privacy whatsoever as the women disclose their medical and family history. And everything happens very quickly as well. Each woman spends about five minutes giving information pertaining to their family and medical history. It is definitely a rushed process but with the amount of individuals that come through the ANC clinic everyday and only one individual to talk to everyone and collect all the necessary information I guess there is no other way to do it.

We took a small break for lunch and then I joined Sanjeewani as she made her rounds through the different wards. After lunch she typically goes to the delivery ward and speaks with all the new mothers that had not previously been tested for SC or thalassemia traits. Sanjeewani explained that every day there are around 40- 50 deliveries and that she goes and talks to mothers that have not been to the hospital at Nagpur for their prenatal care. Today there were 38 mothers in the delivery ward and 9 of them had not been tested so Sanjeewani had to go and talk to them and obtain their consent for testing. It was definitely interesting going to the ward. All the mothers, new babies and female family members were all crowded in one room. Only mothers that had delivered by C-section had a bed to lie on. The rest of the new mothers just had blankets on the floor that served as their bed and their babies were lying on the floor next to them. In my first day here I have learned that I do not do well standing or sitting in overcrowded rooms. As Sanjeewani was talking to the 9 mothers that she had to test I could feel myself getting faint and feeling like I was going to get sick so I had to excuse myself once more.

I spent the rest of the afternoon with Dr. Jain who in some ways quarantined me to an empty conference room. She was worried that I was overheating myself and wouldn’t let me do anything for the rest of the day which I was actually super grateful for. Normally I try to power through but I could tell that I was drained and exhausted and needed to be in a cool room and not in a hot, crowded, noisy hospital.

We left around 4:30pm to come back to Dr. Jain’s house where both my sister and I ended up crashing and not waking up for dinner or much until the next morning. 

The weather for the rest of the week. I don't know how I'm going to make it.