Tuesday, August 9, 2011

CMC Vellore

By: Kim

CMC Vellore has been amazing. The diversity of patients we saw was mindboggling, and at times it felt like we were on information overload. Our days usually start at 8 in the morning. Some days we’d end at 2pm, other days we’d end at 9pm.

Our first day started at the CHAD (Community Health and Development) Department. We rounded with a physician and saw a variety of patients: a child with rickets, a 12 year old boy with seizures and cerebral palsy, a child with ascites, a typhoid patient, pregnant women who had pre-aclampsia and possibly neurocysticercosis, etc. We went out to the villages with the nurses to make home visits to a young girl with seizures and a couple of pregnant women. We listened to the fetal heart sounds and palpated the fetus’s head, back, and limbs. After heading back to CHAD, we learned about the developmental milestones for a newborn, and the different neurological tests you would do on different age groups (primitive, spinal, brainstem, midbrain, cortical). Lectures were sprinkled onto our schedule, such as the TB medication lecture and the history of CHAD. By the end of the day, we were pooped, but managed to use the last bit of our energy to research some of the drugs and diseases Dr. Chandy assigned.

The rest of our week followed a similar schedule.

One of my favorite patients at CMC is the dextrocardia patient we saw at the internal medicine ward. Instead of his heart normally pointing to the left, it was pointed to the right! The doctor then checked for situs inversus by percussing his liver. We found that, indeed, the patient did have situs inversus and his liver was on the opposite side as well. It was great seeing percussion, a skill we learned in our Clinical Foundation course, being effectively used to determine situs inversus. The physician then explained why it was better to have situs inversus with dextrocardia rather than having normal visceral organ orientation with dextrocardia.

The endocrinology clinic was also a blast. We all sat in the endocrinologist’s office while he brought patients in for us to diagnose. The first patient had a huge goiter, exopthalmos/proptosis, eyelid lag, and an irregular menstrual cycle. Her symptoms pointed to hyperthyroidism. The second patient had a moonface, a small humpback with striations, and a cough. Can you guess what he has? We all shouted “Cushings Syndrome!” but it turned out that he was just a slightly overweight man with hypothyroidism! The last patient came in with high calcium level, nausea, weight loss, general aches and pains, and muscle weakness. She has parathyroid adenoma.

With the little foundation of knowledge we have in cardio-pathology as incoming second year medical students, the stethoscope project has given us a slightly better grasp of heart murmurs and pathologies. We’ve listen to patients with rheumatic heat disease, eisenmenger syndrome, tetralogy of fallot, transposition of great vessels, ventricular septal defect, atrial septal defect, aortic regurgitation and stenosis, mitral regurgitation and stenosis, pulmonary regurgitation and stenosis, and tricuspid regurgitation. We use the APTM technique and learned how to differentiate between a systolic and diastolic murmur when listening to a patient.

For the visual learner inside of us, the dermatology clinic gave us much to see. It was shocking seeing the rarer diseases we’ve only read about in textbooks, such as pemphigus vulgaris, psoriasis, and leprosy.

If I had to sum up my experience at Vellore in two words, I’d pick crazy and educational. It was crazy in two senses. One, our schedule was as busy as the streets in Vellore.  And two, seeing everything—from the variety of patients to the environment at the slums--for the first time was extremely shocking and took a while to sink in. It was educational, too, needless to say, but not only because of the numerous patients we’ve learned from, but because of the inspiring physicians, social workers, and village health workers we’ve met. Below are some of the quotes I’ve written down from physician and social worker during a lecture or conversation.
Quotes from some of the physicians and social worker at Vellore:

“Bye bye baby or bye bye practice.”
-During our discussion between the Indian health care system (more primary care, more patient-doctor relationship, less paperwork and hassle with insurance companies, but higher infant mortality) and the American health care system (more paperwork, more hassle with insurance companies, but lower infant mortality)

“In India, you can have the perfect solution, but it needs to be effective in a less than perfect system.” 
– Dr. Anu. During the TB lecture, Dr. Anu talked about how a solution or intervention may be perfect on paper, but ineffective in an actual community. One must take into account factors such as drug incompliance, cost for the patient, transportation for the patient, and the social environment the patient goes home to after leaving your clinic.

“I may be only one, but I am one. And just because I cannot do everything, I can do something. And I will not let what I cannot do interfere with what I can do.” 
–Sushil, after our visit to the slums, speaking about the overwhelming feeling you get seeing the huge disparities in social and health care. But just because you can't "do everything" does not mean you can't do anything. One of my favorite quotes of the trip.

“Completeness with brokenness.” 
– Dr. Tharion. After our visit to the Physical Medicine and Rehab clinic. Dr. Tharion talks about the architect of the temple at the clinic, purposefully built with “incomplete,” interposing walls, and relates that to his patients, who many never heal completely and may remain “broken” on the outside, but they still and will always have the chance to be “complete” spiritually and mentally on the inside.

1 comment:

  1. I landed up on this page after googling my name, but it was nice to read your blog and I too share the same feeling on the health care system. Both the US and Indian health care system have their pros and cons and I cant say one is better than the other or how one could change things for the better. It is an interesting blog.