To start, I want to say that I am fine and the attacks in Mumbai did not affect me as I was in Jamkhed. But they did have an effect on CRHP and some of its guests, and the attacks will certainly affect India, their international business, and relations with Pakistan (although the extent of the ISI’s involvement is not entirely clear). It is of high concern throughout the country and seems to be one of the largest terrorist attacks in a country that has among the highest number of terrorist attacks per year in the world – although Maharashtra, and especially Mumbai, are not usually the locations.
Secondly, pick up this month’s (December) National Geographic magazine! There is a nice article with photos on CRHP Jamkhed and it goes into detail on the history of the organization and its work in the area and abroad. If you’d like to see it online, click here.
This last month since the course ended has centered on the hospital – the first floor of a two-story building, complete with three wards (male, female, maternal), two operating rooms, an x-ray machine and a pharmacy. To say that CRHP and the hospital staff get by with little funding and fewer diagnostic tools does not do the work justification. It has been an eye-opening experience to watch Dr. Wout and others work through differential diagnoses and work with the patient’s family to provide the care needed.
Each hospital bed is like its own family reunion as a schmorgusboard of relatives, friends and fellow villagers sit on the floor for days, weeks and sometimes months with the patient. If transportation is too expensive or the distance too long, then the family is forced to live in the hospital for the time being. CRHP hospital takes advantage of the extra ‘staff’ in the hospital to put them to work and the family members are in charge of giving meds, bathing and feeding the patient, and informing the nurse to fever and unusual pain. This family-provided service is essential to give the limited number of nurses and fewer doctors the time they need to attend to emergencies, incoming patients or surgery.
At first the hospital was overwhelming and even intimidating. I was struck with the incredible number of patients, the variety of disease, the extent to which diseases disabled the patient before seeking care, and just the overall pain that accompanies the third-world hospital. I had never before seen deformities caused by leprosy (feet curled upward, hands = stumps and face sagged to the point of pain), the shrunken look of tuberculosis (often accompanied by HIV), the miniature size of a baby born at 1.5 kg’s (3.3 pounds), or the ease of peeling off the top layer of skin on a child with third-degree burns. The constant loss of light/electricity during surgery, the lack of oxygen tanks when they were most needed, and the absence of splints, crutches and wheelchairs made it difficult to keep sane with so much need surrounding you.
Eventually these difficulties began to fade as I got into the flow of the hospital and triumphs & remarkable patients came to the forefront. The patients are tough as hell and live with excruciating pain for months before coming to the hospital. Patients walk on fractured hips and broken legs, sit on huge pus-filled abscesses, deliver babies without anesthesia, and work in the farm with a miserably-smelling completely-necrosed foot remedied only by amputation. The joys of the patients and families become our celebrations as most recover from the problem that brought them there and they feel emotionally recharged as they have been afforded the care they need and deserve, often regardless of pay (CRHP raises funds to support poor patients). Patients who get better after receiving malaria treatment, having their cataracts corrected, or delivering via cesarean section will graciously thank you and bring happiness and smiles to the hospital and staff.
We have also adopted a new saying in the hospital – “Stop acting like a man” (comparative to the common phrase acting like a women) – when people are crying and need to toughen up. During surgical procedures or in dealing with pain, it is usually the men who whine the most and demand the most attention. In refixing a broken wrist, men will scream in pain as women grit their teeth and get through it. It has become an ongoing joke in the hospital but for me it has become a rather prevalent theme in Jamkhed and I am always humbled by the strength and perseverance of these Indian women.
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India is indeed a very complex country. When I went there, my mother and dad basically played massive boss on me. I was just a kid then when I visited and I didn't realize of social and cultural barriers until my parents made me realize them.
The problem is that India is based on cheap labor whose environments are very unsafe. You can get your own cars made, you can get anything made. But with things such as making cars, these owners of these self made shops have their workers do stuff that in the United States would be violating the law (i.e. assembling parts, dipping various parts in caustic and carcinogenic substances).
There is a need for India enact sweeping and large public health changes, especially in terms of environmental health.
The problem is if that India makes these laws against unsafe work practices, these workers jobs will be at jeopardy.
If you try to solve a health problem, it can lead to a public uprising. It is the duty of the government and outside agencies to fully inform these people that their lives are at risk and find them other jobs. If India is to advance as a country a strong public health infrastructure needs to be in place, and I'm happy that the outside world is realizing this and trying to help out India on this issue.
I'm glad to hear that your safe! Keep on downing the chapathi's and Indian food. I'm heading on over to Tufts Med next year!
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