Starting my OG rotation

Two nights ago we attended the international welcome party on the CMC college campus. They had three girls do Indian traditional dances, which was fun to watch. The picture to the right is of one the girls dancing. Then they fed us some dessert thing that looked like a piece of poop on top of ice cream. The ice cream stated good, but not the poop looking thing. That night, I slept awesome. I think I am finally getting over my jetlagged. I am dreamimg more often than I ever did in the states, which is great. I usually never remember my dreams but I am here. I still think it is the mefloquine I am taking that is having this affect on me.

My observations of the clinical setting: The next day I started on OG II. This team was doing outpatient work on Tuesday morning. The ob/gyns gave me the same feeling that they do in the states: overworked and bitter. They have this kind of apathetic attitude, where they kind of ignore you b/c they are so busy to make time to explain stuff to you. I wasn't the biggest fan of the ob/gyn rotation at UTHSCSA so this brought back bad memories for me. Most of the time I just sat there trying my best to stay awake as they interviewed the patient since I couldn't understand anything what they were saying. The patients generally looked a lot older than their stated age. I guess b/c they live a very hard, rough life. Most of their husbands looked like they could be their fathers. Plus their husbands sure did do a lot of the talking eventhough the issues the women were coming in for had nothing to do with them. I always believe: if you don't have a vagina, you don't have anything important to say to the ob/gyn.

The residents speak Tamil (a South Indian dialect) to the patients and English to the other doctors & nursing staff. About 80% of the clinic time was in Tamil, with the occasional English was directed at me when I would remind the residents to tell me what was going on. The room was set up in a small examining room that was basically the size of the rooms we use in the outpatient clinics in the states. But here, doctors share this one room and use one table with one computer. Most of the charting is done by hand with lab values checked on the computers. The patients sit with each doctor along with whomever they brought with them to the clinic visit. Then there was a flimsy curtain in the room for where patients would be given PVs (this is their lingo for pelvic exams). PVs are only done to married women, b/c they don't want to break women's hymens prematurely. It is funny how in the US we assume everyone is having sex, but here they assume otherwise. The table had no stirrups and there was a window wide open right next to the bed. CMC hospital has no concept of privacy as you can see. Each patient sat on the this same bed with their legs spread open. The table was never wiped down between patients. Residents did wash their hands after each examination, but they used the same towel to wipe their hands each time, which bothered me a little.

The residents did not have the best bedside manner either. We are taught in medical school to be very gentle with the pelvic examination and make sure that the patient is well aware of every step along the way. Here they just tell the girl to hop on the bed and hurry up and drop her panties & spread her legs. They grab a very small spectulum out of a jar (which I think they call a spatula here and it looks more like a anoscope than the type of spectulum we use in the states), put some lube on it and stick it in without warning the patient. They also use a tongue blade to collect cervical cells. Can we say ouch? I kept on wondering if they ever leave splinters on a lady's cervix with this method. Another painful thing to watch was the fact that they do not use jelly when they do pap smears, b/c it will messes up the results of the smear. So they stick the speculum in the ladies vagina dry. OUCH!! Besides the PVs, the entire physical examination only involved looking at the patients conjunctiva, feeling their thyroid, and asking them to stick out their tongue.

Also the doctors rarely made eye contact with the patients as they talked to them. They mostly spent most the time writing. And if a nurse walked in or medical student walked in with a question for the resident, they would totally ignore the patient and concentrate on the questions asked. Sometimes the doctors would leave the room for an hour or so eventhough their were still a pile of patients to see. They use a number system here for the order they see patients. So you wait in the waiting room until your number is called, but I do not think most patient understood this concept and kept on coming into the very small examining room and standing in the background thinking that would make them be seen faster. The doctors did not seemed phased by the fact that everyone in the room that wasn't even related to the patient was able to hear the HPI the patient was giving. They never even introduced me to any of the patients and just told the patient to sit and start talking about their problems.

Interesting patients: A 40y/o woman came in with complaints of problems urinating. She had a tertiary cystocele & rectocele and pelvic prolapse. I have never seen anything like this in my life. Her cervix was practically sitting outside of her vagina. They swabbed her cervix with it sitting on the table. The worse part was that the lady also was suspicious for pulmonary TB and the attending didn't know this and told her to cough so her cervix would pop out. Then the resident told the attending about the lady's TB and she said "Oh shit," which I thought was hillarious since she was the first Indian person I have heard curse down here. And of course we did not wear masks when we saw this patient, so now I think I may have TB also. I also saw a lady with an extensive episiotomy. I am not sure what degree it was, but it looked bad and big. I guess they don't stitch them up right away here and just let them heal by secondary intention and approximate the edges later. We also had a 27 y/o lady come in with lower abdominal pain likely due to PID. In her chart it said that she didn't believe her husband was having an extramarital affair. I wanted to ask her where she thought the chlamydia or gonorrhea that lead to her PID came from.

The best part of the whole day was when the 2nd year medical students showed up. They were so cute and little, which makes sense since they are only 2 years out of high school. They were super nice and asked me lots of questions about where I was from. I was really surprised about how much the other residents pimped them though. Eventhough, I felt ignored most of the day during my time on OG, I did enjoy seeing the difference between practicing medicine in a developing country vs a developed one. You never realize how blessed you are until you see things on the other end of the spectrum.

Pictures above:

1) Indian traditional dancer

2) This is the entrance of hospital

3) This is the front of Ghandi street, where we do all our fabulous shopping.

4) This is Masala Dosa, another traditional South Indian breakfast dish. It is a crepe stuffed with potato mixed with masala spices. The stuff in the little cups are chutneys for dipping.