Post 3: Tima

Post 3: Tima

This picture was taken after the ACLS workshop.  I am wearing the white coat in the center, with Drs. JK and Santosh Gupta on the right of the picture.  We are surrounded by the staff of junior doctors.

Haridwar is a very holy city in the Hindu religion.  The holy river Ganges flows through Haridwar, and there are lots of temples and ashrams here.  Every evening on the banks of the Ganges, a special prayer ceremony is held called Har-ki-Pouri (see the video above).  The Guptas took us to see it this evening.  It's a beautiful ceremony attended by thousands of people.  There is music and singing, and lots of offerings are made.  My favorite part is the cute leaves filled with flowers and candles that people float down the river.  Actually, my favorite part is the street food we ate from the market afterward!

The ACLS workshop was a big hit.  The residents seemed to know the basics, but it was clear that they hadn't had any formal ACLS training-- and probably hadn't ever been to a workshop before.  I spent about half the time giving a lecture on the algorithm and the Hs and Ts.  Then we divided all 12 residents into four groups, and each group ran a mock code.  Anita played the dummy and did a great job.  We practiced adequate chest compressions on a couple of stacked pillows.  Apparently the bag-mask was "superinfected" according to one of the residents, so we couldn't demonstrate how to get a good seal on a real person, but we did our best.  They had a bunch of questions at the end which was great!  

Today after rounds I did outpatient clinic with one of the attendings here.  In the US, the average PCP gets about 15 minutes per patient….. so that's about 16 patients per half day?  Here they see 60 to 100 patients per half day.  I timed it at 2-3 minutes per patient.  This includes "charting"-- actually, here each patient carries around his or her own medical record including all tests and reports, and the attending just writes a one or two-line note after the clinic visit.  A universal medical record of sorts.  I actually think this record system works pretty well-- all physicians have all the information on every patient, which is more than we can say for our own patients in the US.  We saw some pretty interesting cases-- tuberculous involvement of the skin which is pretty rare, psoriasis, lots of anemia, and lots of COPD and heart disease.

I had been getting a little frustrated with the clinical care here and I think it was because I wasn't really sure of my role at this hospital.  But we had a good discussion with the Guptas and decided we were going to spend more time in the ER, since that seemed to be where our clinical impact was greatest.  That seems to be working out well.  Having seen patients in the wards, ER, and outpatient setting, I feel like I am starting to figure out how medical care is done here.  Physicians here are incredibly talented at diagnosing and treating infectious disease, and I have learned a lot about the presentation and treatment of malaria, TB, scrub typhi, etc.  But there is a long way to go in the treatment of non-communicable diseases, especially cardiopulmonary disease and renal disease.  It has taken some time to adjust, but I think now we have an established role that includes a lot of teaching.  We are basically giving the residents a simplified core curriculum similar to what we give to our new interns.  Hopefully we will teach something that will last longer than the short month that we are here.