Today was a very good day. I must keep this entry brief, though, as we leave for Pondicherry in an hour! This post will be list-style with the patients I saw. The first was in the post-operative care ward after having received open heart surgery. He was prescribed a non-veg artificial protein replacement. This is the first artificial non-veg item that I have seen. This was prescribed because it had non-saturated MCTG, or medium chain triglycerides. These are easily digestible, meaning they take little energy to digest, and they provide a lot of energy, which is needed for recovery after surgery. He was on an all artificial diet through the enteral feed other than one serving of rice porridge (kanji) and some water. He needs an artificial diet because the energy and nutrients are easily absorbed in a low volume, which is needed so that critical patients can put all of their energy into recovery rather than digestion. Another patient had a BMI of 14 kg/m2! Underweight is less than 18.5 kg/m2 (the 2 is supposed to mean squared, but I cannot figure out superscript in blogger). She was in such a poor condition that she had to be on an incubator to help sustain her. She was prescribed a NPO diet, meaning that she would consume nothing, either orally or through an enteral feeding. This is because this patient was in very poor condition and would receive all nutrition through IV. One thing I learned about IVs is that they carry protein, carbohydrates, fat, and all of the vitamins and minerals. I thought they only carried basic nutrients like protein and glucose. A different patient who had his IV removed, since his condition improved drastically, had an increase from 1.4 grams of protein per kilogram bodyweight to 1.7 grams per kilogram. This is because he is receiving all nutrition orally now, and he must receive more protein to recover since he no longer receiving it through the IV. It takes more energy to receive it through digestion, so he will get more of it.
One patient that was admitted today had been having problems at home. His solution was suicide by taking rat poison. I learned that suicide is somewhat common here. I already knew that farmer suicide rates are high because they live very difficult lives. Apparently, many people feel this pressure. Many students who are 12-13 years old drink ink if they receive bad marks. This is in response to the huge pressure placed on them to get good grades. Others choose oleander seed, which is poisonous, or Harpic, which is toilet cleaner. This patient took three tablets/doses of rat poison, and it lodged in and blocked his digestive tract. Because of this, a NPO diet was prescribed. If he eats any food, it will cause further blockage. Additionally, the water and fiber in the food would further dissolve and disperse the poison, which would increase the absorption and possibly cause death.
One other crazy thing is that the dietitian told one patient to consume eight grams of salt each day! Yesterday, I reported that she told a patient to consume five grams. This is only because she was a renal patient; the normal suggestion for patients with healthy GI tracts and organs is eight grams per day! I do not know if there is some confusion here in the translation, but this just seems incorrect to me. The dietitian tells people not to use table salt with their foods, but this would hardly help reduce sodium intake because nearly every food here is cooked with salt.
I also learned that Brahmins, the highest and priestly caste, experience high rates of heart disease. One woman who is a Brahmin came into the office today for counseling. She had received cardiac bypass surgery in the last week, and had come to see the dietitian. Brahmins are strict vegetarians, but they prepare every food item with ghee. Ghee is very high in saturated fat. With the added combo of not ever doing any physical labor, since Western technology is taking over here, this woman became obese and developed plaque build-up. She reported never doing physical activities. The dietitian counseled her to walk 20 minutes each day and to cut down on the ghee and coconut oil in cooking.
Today was my last day at Siva Sakthi Nursing Home. It was actually very sad. Over just two weeks, part-time, these people have become my friends. They are so accepting and hospitable. They bought a cake and lit candles today to celebrate my health and well-being. They gave me gifts of a hand-carved wooden elephant and a nice pen. They told me to come back to India with my wife, and if I ever need a place to stay in Tamil Nadu, their doors are open. They also told me to come back one last time before I leave in July. This was all so nice. I will miss their familiar, smiling faces each evening. However, it is time for me to go, as next week I have more to see. I will remain at KMC in the days, but in the evenings I will visit banana, mango, and coconut farms, rice paddies, and dairy farms. I will also observe the food services here so that I may see the planning and preparation for all of the students who arrived this week and started classes. I will also have the added benefit of, hopefully, learning how to make some Indian dishes. I am so excited for all of this!
We leave for Pondicherry now in only 30 minutes, so it is time to wrap things up. Expect another post on either Sunday or Monday, June 19th or 20th. Thanks for reading!
Above to the right is Dr. Mano, a doctor in training. Above to the left is Keethdana (not sure on the spelling) who is a staff-nurse.
This is Somosa, a mix of onions, carrots, potatoes, and spices breaded with maida flour and deep fried.
Here are some hospital clowns. I was called from the dietitian in the ICU today to come meet them so that Kauvery Academy (who runs the training program at KMC) could photograph and video me trying to dance with them. They realized I was horrible at dancing and told me to just be while they danced around me.
This is Dr. Abi, a doctor in training.
Here is Lakia and another man whose name I cannot quite remember. Lakia records patient information, and this man runs some part of the business side of things. Notice me trying to take the picture in the classic "happy stare" rather than smiling.
This is the cake they bought to celebrate my last day. So sweet!
Here is Dr. Sakthivel Sivasubramanian, on the left, and Dr. Sivasubramanian, on the right. This is the father-son team who runs the hospital. Dr. Siva is holding some jam from Concord, NC that I brought as a gift!
Here are some more of the staff, including Solomia, Morgana, and Keethdana. I am not sure of the names of the other two.
Again, here is Keethdana. She always wanted to take a lot of pictures.
No comments:
Post a Comment