Sanitation?

Today was my first day of field work! The schedule was quite different than anything I have experienced before.  In the morning, I arrived at 10:00 a.m. and left at 1:00 p.m.  I then returned later at 5:30 p.m. and continued until 7:30 p.m. The hospital was called Siva Sakthi Nursing Home and it specializes in diabetes and endocrinology.  Siva and his son Sakthi run it, and it is a Hindu hospital.  Because they are small and there are so many patients, there are methods in place specifically to reduce patient-doctor interaction.  There are staff-nurses as well as lesser doctors who take information from the patients.  Patients then go back to wait until the main doctor will see them.  A junior doctor also stands next to the doctor to take notes for him so that he can finish his assessment without pausing.  Within the first hour I was there, one of the less-experienced doctors showed me a seven page diabetes form for a patient with diabetes that she fills out with patients.  After explaining each part to me in detail, she asked when I would like to see my first patient, asking “would you like to see one now?”  This blew me away.  After hardly being there, she was asking me to measure a patient’s pulse, blood pressure, weight, height, breathing, cardiovascular health, their appearance and mood, presence of edema, jaundice, clubbing, malnutrition, and many other attributes.  I have never done this before, and I know I could get in trouble in the US if the Academy of Nutrition and Dietetics found out that I did something I was not qualified for.  I explained this to them, and they decided that observation will be best while I may later record dietary information from patients. 

Above is the first squat toilet I have come in contact with.  I awkwardly took off half my pants and held them while I went because there was no hook to hang them.  Thank goodness I brought tissues to use for toilet paper, or I would not have been a happy camper.  With no hand washing station, this worries me even more about sanitation because of the practices of the doctors.  As you can see, you flush with a little bowl of water.  

I was shocked at the sanitation measures here, or should I say lack there of? I saw one doctor checking the tongue and lymph nodes of one patient, then had another patient come in to check a skin rash without washing his hands first! I saw him stick his hand in a woman’s pants to ultrasound her uterus and surrounding structures to then ultrasound someone else a minute later without washing his hands or the ultrasound equipment! There was no hand sanitation by washing or hand sanitizer at all.  Then, one of the staff members had a birthday, and cake was shared among everyone.  They all ate with their hands without washing first, and they work at a hospital! The time with the patient is also limited, as I have mentioned.  At one point I was confused because when one patient left, another came in through a door behind the curtain in the ultrasound room.  She undressed and laid down so quickly that I thought it was the same person, though I had just heard the other patient leave.  The doctor has no time to think or breath, but he shows no fatigue.  I guess this is why he must take a four and a half hour break in the day.  It is so hectic.  In 30 minutes one doctor saw four patients, interviewed two potential nurses, and turned away a man soliciting medical supplies.  Despite this quick treatment, Dr. Siva has worked at this clinic of his for 40 years and claims he knows everything about all of his patients. 

Below is the wedding invitation for the wedding between Dr. Relton's son and his bride Glenny next weekend.  So excited for this!

In the second part of the day, I met the dietitian.  Dietetic professionals are so limited here that she works part-time at Siva Sakthi Nursing Home and full-time at Trichy’s largest corporate hospital called KMC.  The doctors have requested dietitians from Qua Nutrition, a private nutrition group, but they claim that Trichy is too small for one of their professionals to spend any time here.  Because of this, Dr. Sakthi has requested to send dietitians there to train and come back, but this is a problem as well. 

Here, it costs 100 rupees to see Dr. Siva, and 300 rupees to see Dr. Sakthi.  This is $1.50 and $4.50, and some people have trouble paying for it.  Dr. Sakthi told me that a professional or doctor may get paid 40,000 to 70,000 rupees each month (around $500 to $1,100).  While this is huge compared to an uneducated, skilled worker at 8,000 rupees per month, this is just so little.  I understand that in the US we are paying a higher cost of living and for things such as schools and infrastructure and whatnot, but I make 100,000 rupees per month at Turtle Creek Nursery, far more than a highly qualified doctor here.  This is crazy. 

I look forward to going back tomorrow as the dietitian has shared many PowerPoints and diet pamphlets with me, and I may get to see more diet assessment tomorrow.  While they are still using a version of the food pyramid here, other aspects of nutrition assessment seem exactly the same.  Hopefully I can report more tomorrow when I see more patients with the dietitian.  I feel much better now, as the whole staff seems to have adopted me.  They love to talk to me and ask about differences about the US, and they to try to teach me Tamil words, of which I have learned two.  Hopefully I will get more. 

Last note: yesterday was my birthday and it seemed so arbitrary over here since I know so few people, and there was no celebration.  Solomon did shake my hand, though, and asked for blessings from God on my behalf and wished me a good life.  This was something no one had quite done before, and it was very nice.  Thank you to all who wished me a happy birthday!