Infrastructure in India is hard-core struggling. I have previously described the open sewage running along the streets and the holes spread throughout, including the manhole I almost fell through. The hostels in BHC are constantly updating things. There has not been one day where there was not construction in the international hostel. I noticed a hole in the wall of my room that lizards use as a highway, though I would rather lizards be using this than insects. The lizards are cute and harmless. The staff replaced certain sections of the roof, and they put up a seemingly random brick wall at the top of the stairs. KMC does even more renovating. I noticed today that the dietitians' office was not originally planned in the building. The walls do not reach the ceiling, and they are hollow. Also, the dry wall does not match the marble and granite design of the floors and other walls. Constantly, parts of walls, floors, buttons, wiring, and doors are being removed and replaced. My first day, when I walked into the IMCU, water covered the floors because one of the pipes had burst. I feel as if this is a common occurrence because KMC owns these huge floor squeegees that the staff was using to push all the water to one corner so that other workers could scoop up the water with dustpans and mops. Today, they were sawing out parts of the wall around some fixtures and replacing them. This was super loud and filled the halls with dust. This annoyed me, so I cannot imagine what the patients were thinking as they lay there in poor health, trying to rest. This is always odd to me because the materials they are using look to be of very high quality. It is all thick, heavy, solid granite, marble, stone, and real tile. My assumption is that the hospitals here are always so busy that there is more wear than normal. Another possibility is that the foundation was not laid well, so shifts in the building cause small damage. At any rate, there is always a lot of construction.
Today, I saw the PICU, the Pediatric Intensive Care Unit. Only one patient was prescribed a diet because all of the others were young, and breastfeeding is far more common here than in the US. When we walked in, the nurses pulled curtains around several beds since mothers had been breastfeeding when I entered. Being a male, they gave the women privacy from me. I also got to see one of the children receiving an albumin transfusion. He had nephrotic syndrome with poor liver function. His serum albumin was low, so they transfused it in the IV. The dietitian also prescribed egg white, which is high in albumin, so the the child would make some of his own.
One thing I saw frequently today occurred because new patients came. The dietitian prescribed a NPO (nil per os, meaning nothing by mouth) diet to many patients because they were to receive scans and tests that day and could not have any food in their systems. Because of this, she prescribed the NPO diet, and all of their fluids and nutrition came from IVs. As soon as she can, though, she will prescribe natural foods, in all cases. It seems that she does not like to prescribe the artificial protein and meal replacements and always takes the time to mention to me that natural is better. This philosophy is growing in the US, but it is common here. Many times, when people in the US hear I am a nutrition major, they ask why they cannot just eat what they enjoy and take a multivitamin. Here, that question would be ridiculous. I try to ask the dietitian why natural is better, but she does not ever seem to understand me. I think she does not understand because no one here would assume the artificial way was better. Another thing everyone always tells me is that all the food is fresh. I will get to observe some food preparation in the mess halls here in BHC next week, so I can speak more to this then! The dietitian explained to me how to make tea with the traditional South Indian method. You boil milk, add tea powder, boil for five more minutes, strain the tea, then add whatever sweetener you want. She explained, though, that even if I do this back home, it will not taste the same because all milk their is pasteurized and homogenized while many people here buy milk fresh from the farmer.
The dietitians visit every patient in the ICU, IMCU, CCU, and PICU daily to write diet orders and check on their progress. However, there are not enough dietitians (and healthcare workers in general throughout India) for her to check on the patients in the general wards every day. She only sees these patients every few days or if they are being discharged. This is probably not so good, though, because patients in the wards receive diet counseling, but they eat what they please either from the hospital mess or from the food their relatives bring from home. In several cases, the patients' diets are what lead to their hospital admission (like many of the cases of stroke, heart disease, complications from diabetes, and obesity). It would be wise for them to follow the dietitian's advise, but this often does not happen. One woman in the emergency room today had been discharged from Child Jesus Hospital. The doctors and dietitian advised her family that she should stay longer for observation, but the woman's sister refused. This is crazy to me because the woman had a tube feeding installed. Apparently, if I understood properly, this patient will be taken home with the enteral feed still installed. The dietitian explained to her how to prepare all of the foods, including how to mix the different protein and meal supplements. This woman, who knows very little about nutrition support, will be preparing all of the meals for her sister. I know she knows little of tube feedings because the dietitian took a very long time explaining, and the woman had many questions. The woman did not know the difference between the protein supplements and meal replacements. What if the tube gets infected? What if the sister accidentally pours something solid down the tube and clogs it? What if the woman accidentally pulls on the tube in her sleep and causes herself damage? What if the family does not stick to a rigid feeding schedule and the patient becomes malnourished and cannot receive the proper energy to heal? What if they feed her too much and she starts gaining fat? I have not shadowed nutrition professionals in the US, so I do not know if people go home with tube feedings, but this does not seem like a good situation. I need to clarify with the dietitian tomorrow to see if this is common or not. I know from my experiences that many families here want to leave the hospital as soon as the patient recovers somewhat, but this seems extreme to me.
Another thing I observed today is that many of the staff-nurses are not nearly as highly trained as the doctors and dietitians. Some of the diet orders were messed up today, and this could have serious consequences for patients. One nurse lost the lid to one of the artificial supplements. They were using a glove instead. I feel like this is a sanitation issue. For another patient, the nurses accidentally skipped several meals and snacks. The woman had not received food for six hours during the day. She became hypoglycemic with a blood sugar of 36 mg/dL. Normal blood sugar is around 100 mg/dL while fasting for a healthy person. In the time after a meal (postprandial), blood sugar tends to be around 140 mg/dL. I am sure this woman felt horrible with such low blood sugar and that she could not do much recovery without any energy to do so. One last insane thing I heard was the dietitian telling a patient who was being discharged to eat five grams of sodium per day. This just blows my mind. Most US dietitians would tell a patient to strive for 2.3 grams or less. Dr. Siva told me, days ago, that many patients eat 15-20 grams. I do not know if there is some confusion in the translation surrounding sodium, but this just seems too high. Although, I suppose that if the woman had been eating 15 grams, telling her to reduce it to five grams is an improvement. I just cannot see from where this recommendation is coming.
I ate with my hands for all three meals today, and it felt great! This is one thing I will miss when back home. While I will still have the ability to eat with my hands, I would probably receive unbearable, disgusted stares. I am learning South Indian cuisine well because the dietitians often laugh at me and ask why I eat something in a certain way. The answer is usually "well, I guess I have never really eaten this before." They laughed as I set my chicken drumstick down because I had left a tiny bit of gristle on it. (Side note: if you ever come to India, a drumstick is a vegetable, so you might be surprised if go to KFC and receive a sloppy green mixture rather than chicken). People here do not like wasted food, and they shred meat down to the bone. She told me that I did not know how to eat chicken and proceeded to show me her bare drumstick to prove it. Also, white rice goes well with rassam (a kind of dhal which is like vegetable soup), but I would think it went well with any type of rice. We also ate breakfast with the important BHC people after the opening ceremony this morning. The college started classes today, so there was a service and communion early this morning. Unfortunately, I woke up late and only caught the last 15 minutes, which is super unfortunate since the whole thing was actually in English. I did not feel too bad, though, because our RA, Solomon, was also very late. In my flustered hurrying to the chapel, I accidentally sat on the women's side. Even though this was a rough start, no one really minded; Dr. Relton invited us to breakfast with him.
Today, I saw the PICU, the Pediatric Intensive Care Unit. Only one patient was prescribed a diet because all of the others were young, and breastfeeding is far more common here than in the US. When we walked in, the nurses pulled curtains around several beds since mothers had been breastfeeding when I entered. Being a male, they gave the women privacy from me. I also got to see one of the children receiving an albumin transfusion. He had nephrotic syndrome with poor liver function. His serum albumin was low, so they transfused it in the IV. The dietitian also prescribed egg white, which is high in albumin, so the the child would make some of his own.
One thing I saw frequently today occurred because new patients came. The dietitian prescribed a NPO (nil per os, meaning nothing by mouth) diet to many patients because they were to receive scans and tests that day and could not have any food in their systems. Because of this, she prescribed the NPO diet, and all of their fluids and nutrition came from IVs. As soon as she can, though, she will prescribe natural foods, in all cases. It seems that she does not like to prescribe the artificial protein and meal replacements and always takes the time to mention to me that natural is better. This philosophy is growing in the US, but it is common here. Many times, when people in the US hear I am a nutrition major, they ask why they cannot just eat what they enjoy and take a multivitamin. Here, that question would be ridiculous. I try to ask the dietitian why natural is better, but she does not ever seem to understand me. I think she does not understand because no one here would assume the artificial way was better. Another thing everyone always tells me is that all the food is fresh. I will get to observe some food preparation in the mess halls here in BHC next week, so I can speak more to this then! The dietitian explained to me how to make tea with the traditional South Indian method. You boil milk, add tea powder, boil for five more minutes, strain the tea, then add whatever sweetener you want. She explained, though, that even if I do this back home, it will not taste the same because all milk their is pasteurized and homogenized while many people here buy milk fresh from the farmer.
The dietitians visit every patient in the ICU, IMCU, CCU, and PICU daily to write diet orders and check on their progress. However, there are not enough dietitians (and healthcare workers in general throughout India) for her to check on the patients in the general wards every day. She only sees these patients every few days or if they are being discharged. This is probably not so good, though, because patients in the wards receive diet counseling, but they eat what they please either from the hospital mess or from the food their relatives bring from home. In several cases, the patients' diets are what lead to their hospital admission (like many of the cases of stroke, heart disease, complications from diabetes, and obesity). It would be wise for them to follow the dietitian's advise, but this often does not happen. One woman in the emergency room today had been discharged from Child Jesus Hospital. The doctors and dietitian advised her family that she should stay longer for observation, but the woman's sister refused. This is crazy to me because the woman had a tube feeding installed. Apparently, if I understood properly, this patient will be taken home with the enteral feed still installed. The dietitian explained to her how to prepare all of the foods, including how to mix the different protein and meal supplements. This woman, who knows very little about nutrition support, will be preparing all of the meals for her sister. I know she knows little of tube feedings because the dietitian took a very long time explaining, and the woman had many questions. The woman did not know the difference between the protein supplements and meal replacements. What if the tube gets infected? What if the sister accidentally pours something solid down the tube and clogs it? What if the woman accidentally pulls on the tube in her sleep and causes herself damage? What if the family does not stick to a rigid feeding schedule and the patient becomes malnourished and cannot receive the proper energy to heal? What if they feed her too much and she starts gaining fat? I have not shadowed nutrition professionals in the US, so I do not know if people go home with tube feedings, but this does not seem like a good situation. I need to clarify with the dietitian tomorrow to see if this is common or not. I know from my experiences that many families here want to leave the hospital as soon as the patient recovers somewhat, but this seems extreme to me.
Another thing I observed today is that many of the staff-nurses are not nearly as highly trained as the doctors and dietitians. Some of the diet orders were messed up today, and this could have serious consequences for patients. One nurse lost the lid to one of the artificial supplements. They were using a glove instead. I feel like this is a sanitation issue. For another patient, the nurses accidentally skipped several meals and snacks. The woman had not received food for six hours during the day. She became hypoglycemic with a blood sugar of 36 mg/dL. Normal blood sugar is around 100 mg/dL while fasting for a healthy person. In the time after a meal (postprandial), blood sugar tends to be around 140 mg/dL. I am sure this woman felt horrible with such low blood sugar and that she could not do much recovery without any energy to do so. One last insane thing I heard was the dietitian telling a patient who was being discharged to eat five grams of sodium per day. This just blows my mind. Most US dietitians would tell a patient to strive for 2.3 grams or less. Dr. Siva told me, days ago, that many patients eat 15-20 grams. I do not know if there is some confusion in the translation surrounding sodium, but this just seems too high. Although, I suppose that if the woman had been eating 15 grams, telling her to reduce it to five grams is an improvement. I just cannot see from where this recommendation is coming.
I ate with my hands for all three meals today, and it felt great! This is one thing I will miss when back home. While I will still have the ability to eat with my hands, I would probably receive unbearable, disgusted stares. I am learning South Indian cuisine well because the dietitians often laugh at me and ask why I eat something in a certain way. The answer is usually "well, I guess I have never really eaten this before." They laughed as I set my chicken drumstick down because I had left a tiny bit of gristle on it. (Side note: if you ever come to India, a drumstick is a vegetable, so you might be surprised if go to KFC and receive a sloppy green mixture rather than chicken). People here do not like wasted food, and they shred meat down to the bone. She told me that I did not know how to eat chicken and proceeded to show me her bare drumstick to prove it. Also, white rice goes well with rassam (a kind of dhal which is like vegetable soup), but I would think it went well with any type of rice. We also ate breakfast with the important BHC people after the opening ceremony this morning. The college started classes today, so there was a service and communion early this morning. Unfortunately, I woke up late and only caught the last 15 minutes, which is super unfortunate since the whole thing was actually in English. I did not feel too bad, though, because our RA, Solomon, was also very late. In my flustered hurrying to the chapel, I accidentally sat on the women's side. Even though this was a rough start, no one really minded; Dr. Relton invited us to breakfast with him.
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