Hospital Work Day 2

Dr. Siva told me that as a patient-oriented, family-style clinic, he often ignores rules and regulations so that he can put more focus on the patient.  An example of this is that he will ask one patient he was working with to go back to the waiting room if an emergency patient comes in because he is one of only two doctors there to see them, so he will drop one patient for another.  He also mentioned that he knows that sanitation here is not as thorough.  One patient at the hospital had been in Trichy for only one day on vacation when he ate some fruit and got some pathogen.  He is now stuck in the hospital on an IV.  Another patient I saw had advanced diabetes and had developed a foot infection.  Two of his middle toes up until the ankle had been eaten away so that bone, fat, and other tissue was exposed halfway up his foot.   It was covered with a loose piece of gauze.  I feel as if you cannot really recover from that here.  Another interesting case was a man who came in complaining of vomiting. He had recently started eating a lot more fruit and became ill.  The doctor’s solution was to eat less fruit.  Surprisingly to me, this was not an infection, but sickness caused by toxins in the fruit.  As in the US, farmers or transporters will sometimes use gas to accelerate ripening after transport.  In the US, ethylene is used, which is a natural plant hormone and not damaging to humans.  In India, calcium carbide is used which reacts with the air to produce acetylene, similar to ethylene in properties and function, but carrying contaminants harmful to humans.  This man became sick after eating too much acetylene and other toxins.  Dr. Siva also showed me several organs on the ultrasound machine and how to identify them and their parts.  He showed me fibrous tissue versus healthy tissue, which can identify a chronic versus acute disease.  Overall, there were several interesting patients today. 

Here is an example of the foliage here.  As you can see, it is very thick for being a college campus, and bamboo grows everywhere!

 The leaves are huge here!

Here are two shots from the road today.  I will try to take better ones tomorrow, but just from this small side road you can see carts, lorries, bikes, and scooters.

The dietitian today told me about the diabetic diet prescribed here, which is much different than in the US.  Diet here is sometimes very bad, leading to malnutrition in not only children but adults as well.  The reason for this is that many people will consume rice only, with little else.  There is very little protein, vegetable, or fruit consumption.  One reason for this is that eating healthfully is expensive, and Trichy is an agricultural area with many poor farmers.  Another reason, the doctor explained, is that people are lazy, and making rice is much easier than making several dishes.  A stock diet here, prescribed to every diabetic patient, is to eat two chapatti (which is like a wheat tortilla), rice, and vegetables at each meal, varying the vegetables each time.  Fruit is also to be consumed occasionally.  While this diet seems to me to be very high in carbohydrates, it seems to work for patients here. I assume this is because, if done properly, it will all be complex carbohydrates.  Strangely, fat and protein are to be kept to a minimum.  One reason for this is that these foods are high in calories, and many diabetic patients here are obese. However, it seems many healthy foods must be left out of the diet.  One example of this is that nuts are to be avoided entirely, and meats are to be consumed only once per week.  There are also many delicious, traditional sauces, daal, and chutneys here.  Some are made with oils and sweet ingredients, while others, such as sambhar, are simpler with only vegetables and legumes.  When I asked the diet of the hospital workers, it seems every meal is the same with idli, chapatti, or plain rice with sambhar.  It is immensely surprising to people to hear that Americans eat meat every day.  Tomorrow, the dietitian will explain more diets to me for other diseases such as cancer and cardiovascular diseases. 

The hospital staff is very friendly.  They ask many personal questions, and most have invited me to their homes.  This may be out of politeness, but it seems that I am an alien to them, and they want as much time as possible to learn about America and my views.  Today, some of the staff asked to take a picture.  I assumed they meant with me, but they then took a picture of me standing there by myself.  This was strange to me.  Another difference here is that timing seems suggested rather than definite.  Frequently, Solomon gives us times to meet with him, only to be much later himself.  Also, the doctors told me to arrive at 8:00 a.m. this morning.  When I arrived, no one was there other than the janitorial staff, and the doctors did no arrive for over two hours.  I did not purposefully arrive late for the evening shift, but I did not feel bad about oversleeping.  While I know this is probably an overstatement that no one follows a strict schedule, it seems as though time is less organized here.  Another cultural thing about English is that while we may have multiple ways of saying something, here the English is more limited even in the fluent speakers.  An example is “I don’t understand.”  While this phrase is understood, people do not understand if I ask “Why?” Inflections are also different here, so I cannot tell sometimes if people are asking a question or giving a statement.  One last example is that this girl always comes up to me and smiles.  The English speakers tell me that she is very naughty and wants to come to America with me.  I had to ask them to explain.  Naughty means something different here.  Rather than sexual or meaning something disobedient or bad, it means playful, quite innocently. 

One last note: I mentioned previously that there were boy soldiers training here at the college.  Apparently, this is a summer camp.  Boys, and a few girls, from agricultural villages come here to train part time, then go back to their villages for school or work.  Most of these boys go on to be soldiers, but it is a choice.  Also, I will try to take more pictures at the hospital, but I am not sure what is allowed and what is not.  For example, there is no patient-doctor confidentiality because they show me any patient information I ask about, but I do not know about pictures.  

Below I finally took a picture of three people on a bike, squeezing between us and a dump truck.   This is so common that an accident would be horrific.  Most people do not wear seat belts in cars, let alone on a scooter.