The Saiffee Hospital
[We operated here this morning and then traveled to the Nair Hospital for the public hospital experience. An unbelievable contrast to say the least.]
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(Apologies ahead of time for the very long blog...) : /
Trade Union Strike/ The 48 Hour Bharat Bandh
Yesterday my attending told me that it would not be safe for me to come into work due to the strike. Starting Feb 20th and through today, Feb 21, there was a nation wide Trade Union Strike. All over the news there were stories of the 48 hr Bharat Bandh and how it would affect India's economy. The strike was called by many union groups, such as the Indian Trade Union Congress (AITUC), Centre of Indian Trade Unions (CITU), All India United Trade Union Centre (AIUTUC), etc, and was supposed to consist of all rickshaws and taxi cabs refusing services. Buses and trains were apparently still in service and were flooded with crowds trying to get transportation. One article claimed that the Unions wanted, "concrete measures to counter inflation, steps for employment generation, job security, and raising the minimum wage Rs 10,000 per month along with daily allowance." On the opposing side, another article wrote that the president of ASSOCHAM (R. Dhoot) was trying to appeal the strike by saying that India's economy would take a huge hit during the two day strike (a huge part of the population here depends on cabs and rickshaws for transportation). Dhoot claimed, "While we share some of the concerns like rising prices, the solution lies in working together to ensure that the situation is brought under control by raising production and pumping up supply." ..interesting...
Early in the morning yesterday in Ambala, Punjab, one of the trade union leaders and treasurer of the ALTUC Union, was squatting at a bus stand in support of the strike and was killed by a bus that would not stop. After he was killed, people reacted in violence with destroying the bus, and setting cars and buses on fire. There were protest marches and police covering the streets to keep the violence under control.
Although I didn't go to work yesterday, I was told to go to the Saiffee Hospital this morning at 7am for a case. I was unsure if it would be safe to take a cab due to the strike...but I was told I would be fine. "Just wear your white coat and tell them you're a doctor." As I drove into work, there were barely any cars on the road. Empty buses, taxis, and rickshaws were lined up parked along the side of the roads. Usually there is constant noise with honking and loud engines revving up around me, but today the roads were very quiet. It usually takes 45min-1hr to get near Bandra, but this morning it took less than 15 minutes. I couldn't tell if the streets were abandoned due to the strike or just because it was a little earlier than I typically leave.
Typical traffic
Traffic this morning
On the way to Saiffee
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Case at Saiffee Hospital- the privately funded health system
After my day at Saiffee, I asked if I could take a look at one of the public hospitals. I was told to take a cab to "Nair Hospital", find the OT, and tell them I work with Dr. Tibrewala. I hopped in a cab and arrived at the Nair Hospital. This is a charitable hospital open to the public. Although <<2% of the GDP is dedicated to the public health system, many people have told me that much of that money slips into the hands of the middle people, and doesn't actually reach the poor and needy populations. They tell me that there is a a lot of corruption here. I have heard that the public health systems are very different than the private hospitals here, but I'm not quite sure what to expect....
And again...
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The Nair Hospital- the public health system; Connected with the Topiwala National Medical College
When my taxi arrives at the Nair Hospital, I pay my 35 rupees (less than a dollar) and hop out. As he drives away I look up at the entrance to the hospital. There are two security guards standing near the wide open entrance. People are wandering in and out, laying on the sidewalk, and sitting in little groups. As I enter the hospital, I get a strong dose of a distinct musty odor. It smells like an old building, with damp wood, after a long rainy day. The building is dim and damp, and my first impression is that it looks like a large abandoned building found in Detroit. There are only a few benches along the wall and a Buddha statue in the middle of the room. People are crammed on the benches and others camped out on the floors, sitting in little groups or by themselves. Some have little sheets or blankets that they brought, and others are just laying along the bare ground. When I walk in, every single person looks at me and stares. I try to ignore it and pretend I know where I'm going. All I know is that I need to find the Operation Theatre. Past the elevators, there is a door covered by old cardboard boxes taped to the wall. The hallways and doors to different rooms have Hindi characters painted at the top. The only thing written in English is a hallway to "Casualty" (emergency room). After walking around a little bit, trying to figure out which floor the OT is on, I finally give up. I turn to a guy near me, "Excuse me, Aapgo maloom OT hei? What floor? Um.. Ek, dow, teen, char... OT kidthar hei?" (do you know where the OT is? one, two, three, four... where the OT is?). I hope he understands my broken Hindi. He tilts his head side to side and says, "Haa. Paanch." (yes. five). I smile, thank him, and walk over to the "lifts" (elevators).
People are flooding into the hospital and gathering in groups around each lift. Personal space is a very different concept here. When they ride in elevators, there is no room for space or air to breathe. They cram in as many bodies as possible until every single inch of space is used. I glance around the room hoping to find the stairs instead... I find the stairs next to what looks to be an abandoned room. It has old furniture toppled in large piles, an area where the ground has flooded a little bit, and I see a large rat scurry across the floor from the pile to hide along the corner holes in the room. I get a little shiver down my spine hoping that little fellow doesn't find his way to my feet. As I walk up the stairs, there is dirt on the walls with writing and some graffiti. I finally make it to floor paanch and walk until I see the hallway for the OT. There are people laying and sitting on the filthy ground, perhaps waiting to be seen...I'm not really sure. In my head I am picturing places where chairs could be placed for them, walls to be painted, old broken wooden doors to be replaced, the need for air fresheners, perhaps a few warfarin tablets for the rats, open windows, and a good floor scrubbing. As I enter the hallway for the OT, I meet some of the surgeons. I tell them that I'm visiting from America, working with Dr. Tibrewala, and was just wondering if I could see what a public hospital is like. One of the residents offers to show me around. He is very nice and speaks English very well :) It makes it easier for me to understand what he's saying. And one of his good friends is an internal medicine resident at U of M! I tell him I'm from Ann Arbor. Haha. I have met so many people with links to Michigan. Such a small world sometimes!
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First he takes me to the "casualty" (ER). People are being carried on thin metal stretchers from triage to the wards. He tells me that this is where they first arrive and are triaged to whichever medical service they need. It is a small area with a few thin white metal beds lined up in a row. Next we go through the hallway and up the stairs to the pediatric floor. The ward has a similar layout to old war movies I've seen, with all the little beds lined up in rows, and one main desk for the nurses and doctors. We say hello to a peds resident, and I ask her what types of pathology they see here. She tells me that respiratory illness is the most common. TB is very common here because of everyone living in such close corridors on the streets. The children who are suspected of being seropositive are all placed in the same room together (...not exactly a good thing for the little ones who are in fact seronegative....). They also see a lot of congenital malformations, tons of infections- fungal, parasitic, necrotizing fasciitis, and lots of GI cases (gastrointestinal). She was telling me that one little boy had severe diarrhea and had 3 siblings recently pass away. They couldn't figure out what it was, but now they're starting to think cystic fibrosis, which is rare for them here. It's interesting to see that our common medical conditions are rare to them, and their most common, unusual for us. She tells me that they also see a lot of malaria, dengue, TB, leprosy, malignancies, and malnutrition.
As we walk through the halls, pungent smells of chemicals are flooding into my olfactory system. It gives me a headache. I can smell the sweetness of diethyl ether that they use a little bit here (which is very flammable..), and other chemicals that I can't quite pinpoint. One the next floor, I get overwhelmed with that familiar smell of formalin used in cadaver labs. It burns my nose. The resident tells me that they have a whole floor full of cadavers used to practice surgical techniques and learn anatomy. There is a lack of ventilation throughout the entire hospital and strong odors are taking over my senses. My head is throbbing a little bit. And it is very hot.
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Next we head to the surgical floor. The nurses at the desk say hello and I get to practice my Hindi. They laugh at me and think it's very entertaining... As we are chatting, a guy with a splint on his right arm from a brachial plexus injury comes up to us and starts talking. The resident translates that this patient is very good at reading people from hand writing, and he was wondering if he could see my writing. I smile and laugh a little, unsure of what to tell him. I know I live in a world of medicine, evidence, science, logic, and tangible proof, but I can't help wondering what he has to say. They pull out a piece of paper and hand me a pen. (it can only be written in ballpoint, not the ink kind that I use- perhaps so he can see how hard I press into the paper when I write). I laugh nervously and say, "ok sure." So I write, "Hello. My name is Jenn. I have been in India for one month, and I love it here. The people are very kind." And hand him the piece of paper.
He looks at the handwriting, then stares up at me, then back down to the paper again and nods his head. The resident translates to me when he starts speaking, "He says, 'Oh, you have the sixth sense?' " I laugh out loud nervously and say, "Do I? Is he asking me if I have a sixth sense? Haha. Um. I dunno." The resident replies, "Yea, he asks if you have the sixth sense. Like sometimes you can feel if a situation is going to turn out bad and it does. Or with reading people, are there certain people that you just get a feeling about, a sense, sometimes eerie feelings when others don't, and then later you find out the reason? He says you get a sense about the future and then things come true. Like when you have dreams about a situation and then they become real. He says you trust your gut because you have a sixth sense." ...Perhaps it all means nothing, but I'm not really sure how to react. I think to myself that I do get dreams that happen later in real life. Like before my grandpa was diagnosed with lung cancer and died, I dreamt it and told my boyfriend at the time that I was nervous about him getting sick. Then I felt very anxious and kept having dreams that I was going to lose people in my life. My boyfriend at the time told me I was just paranoid. Two weeks later, my grandpa was diagnosed with lung cancer and died, and then the rest of my grandparents and my dog died all within the next couple months before I had to take the MCAT. Once they passed, that feeling went away. Also, when I worked in the jail in Madison, WI, there were inmates that I would get a specific, deep in my stomach, eery feeling about, and then later when I happened to find out what they were going to prison for, I would find that they indeed had done terrible things. (It was a min, med, and maximum security jail). I didn't get this feeling about all of the inmates, just certain ones. It was something about looking into their eyes, you could just feel it. ....So yea.. I have had dreams which later occur in real life, and I get a weird feeling with certain people. And have indeed made huge life changing decisions based on an eerie feeling and my gut.... But this is ridiculous right? This is probably what he tells everyone because everyone gets those feelings. So I say, "Haha. Yea, I guess. Doesn't everyone have that?" And the resident tells me, "I don't, but some people have it."
Then the resident translates as the guy continues, "He says that you may appear fragile, but you're very strong. You are not afraid of situations where others would feel frightened. And you react to chaotic situations in a very calm mannered way. This will be good for your career. When people around you are scared, you can use this to calm the situation and make it better. He also says you are a very hard worker and love multitasking. You try to do everything and won't stop your task until you get it done, perfectly. When you are given a job, you will do it for 12 hours straight if you need to, in order to get it done well, how you want it, like a perfectionist. You have worked hard your whole life and things have not been very easy. He says you will work to get to the top, but you would never step on someone's shoulders to get there. You respect people and believe in being a self made person." "He says you have a calm confidence. Even when people don't believe in you, you are confident in yourself and know that you will get the job done." He pauses. "Is this true? Any of it?" I laugh nervously again. This is all very strange to me. "Haha. I mean yea, I guess it's true. I've had jobs my whole life, and I think everyone in medical school and residency needs to be able to work hard and multitask right?" Yea...what he is saying is true..but I suppose it would be for anyone.
Then he starts asking very personal questions about my life, growing up, personal relationships and I kind of want him to stop. Some of the things are right, but some of them are not. He continues with my future and the resident translates. "He says you will have very good health. No major illnesses. You are a very healthy person. And...." But I don't want him to continue! I don't want to know my future!! Even if I don't think I believe in this stuff, I don't want to live my life wondering if he's right about when I'm gonna die, my career, relationships. The unknown is what makes life so interesting. So I say, "Haha. Ok ok. Well thanks a lot. That was really interesting." The resident laughs at me and says, "If you give me your email I'll send you whatever else he says." I laugh and say ok. I don't want to be rude, but honestly I don't think I want to know anymore....
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After that strange little experience, we turn around and the entire surgical ward is staring at us. We walk along the lined up patient beds and the resident explains some of their cases. There are several patients with amputations and many facial malignancies which are large and distorting their facial features. He talks about how common oral buccal mucosal cancer is, esophageal cancer, and basically all head and neck cancers. They do a lot of flaps and amputations here. They also see a lot of pancreatic cancer and gallbladder malignancy. He says people will come in completely orange with obstructive jaundice because they have no idea that they should see a doctor. There is a huge lack of education and people are just oblivious to their health problems. They tend to give it spiritual or religious meaning, and explain illness as worms or bad spirits. There are no screening standards here (like colonoscopies, mammograms, etc), so the diseases they see are in extremely advanced stages, leaving the patients with a very low chance of survival.
We walk around a little bit more and I tell him that I'm going to see Kerala this weekend. He gets really excited because he is partly from Kerala, and goes on and on about how much he loves it, the spices, the temples to see, the rice fields, many places to visit, and so much green! After we chat a little bit, he tells me good luck with the rest of my travels, and I thank him for the very interesting tour of the Nair Hospital.
The nurses on the surgical floor
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