Exploration

So I have been in Pune for a week and I’ve learned so much. For the last three days we have had anatomy lessons with the Dabacks, we learned about medical emergencies in pregnancy: abortion, ectopic pregnancy, v. mole, hyperemeisis, retention of urine, pregnancy induced hypertension and eclapasia and lastly placenta previa- all conditions that occur during delivery. We learned how to diagnose these and how these emergencies are handled. We also learned embryology- fertilization, development of egg and sperm, growth of fetus and placenta. This will make us more prepped for clinic and surgeries we observe.

That knowledge already proved to be useful because I had the opportunity today to observe three procedures- a cauterization of cervix for a patient who had pre-cancerous cells for Human Papilloma Virus, a medical termination of pregnancy and tubal ligation. The MTP/TL case was of a 24 year old who already has become pregnant twice, two abortions, two babies, she was coming to have a third abortion and to have her fallopian tubes ligated to prevent any other further pregnancies. Interesting thing is that from a health standpoint, there was nothing wrong with the 7 week old fetus growing in the young woman, but in India, if the baby can cause “psychological stress” on the woman, the pregnancy can be terminated to prevent this already overcrowded country to bring unwelcomed babies in the world. This invites controversy as abortion is a hot topic in the US. Watching the physician suction and scrape the inner lining of the uterus, it was sad seeing blood fall that most likely contained the small growing fetus. The Tubal ligation was performed laproscopically so we were able to see on the screen where he inserted a small white band to block blood circulation in the fallopian tubes and prevent pregnancy. It was incredible to watch. The patient was so scared going into the procedure, she cried and called for her mother. I’m not sure if she had anyone with her but she came in the morning and 5 hours later she was having the procedure in the private Siddi Hospital. This is one very different aspect of healthcare in India, patients are seen the day they come in, because there is no guarantee they will come back if given an appointment; in contrast with clinics and hospitals where appointments and surgeries are scheduled months in advance. Both procedures were a total of 12,000 rupees, which is $240, insanely cheaper than in the US.  Even after the procedure she was shaking and scared. I can only imagine how frightened she was given her age and lack of previous medial history. It probably did not help that 4 seemingly “doctors” (us pre-med students) staring at her blankly as she had to spread her legs apart and receive anesthesia. The physician took photos with his camera that went though her navel during the procedure, he printed these photos to give to the patient along with his name and the procedure he performed. It struck me that these patients probably often forget what procedures have been performed and this serves as their way of knowing. The entire experience was incredible, from just being a part of the busy hospital setting in India to standing next to the physician who was physically burning the surface cells of the cervix of a woman; I can still remember the burning smell.

I love spending time with my group. We have gotten so close and one thing we have learned very quickly is that in India, there are no secrets. The entire group knows of my indigestion from goat curry that was made aware during yoga the next morning. All adults here, when they see whispering, will call you out immediately. So as you can imagine, there is no gossiping, a very American way of communication. Regardless we are having a great time exploring India, we walk a lot in the sun so I have sweat buddies, roommates, colleagues, and good friends all bundled into 6 people.

The food is delicious, and Marathi food is nothing like the Indian food I have at home. And the mangos are MUCH sweeter. We made mango lassi the other day!

Random fact #4: There are NO white people in Pune. This is evidenced by the swarm of motorcyclists who turn their heads while driving at full speed at the sight of white people sweating bullets on the side of the street. I get even stranger looks for being with these white people wearing American clothes. Many of the children have never seen a white person in their life, only in movies and photos.

Tomorrow we are going on our day trip to Pune so visit many sites. Next week we have clinical rotations followed by two days at a rural site, next weekend we are headed to Aurungabad and the following weekend to Goa for some beautiful beach time.

Keep checking up to see some cases, I’ll be sure to post about the unique ones.