They’re coming for me!

5/5/09

Today was all in all a good day. I now have internet access directly from my laptop, which is pretty sweet. It’s still somewhat interesting to sit in the out patient waiting room typing on my computer. I feel like I’m in a zoo when I’m in that room. Every guy and his mom (literally) have to stop and stare at the marvel of a guy typing on a laptop with his headphones in. I can understand why, but it’s not like I’m from another planet or something.. (then again, for these people, coming from the US is like coming from another planet!).

The surveys for the patients and the employees are almost ready. We just need to find someone who can help me with the Gujarati. I’m looking forward to speaking with the patients.

It’s really nice to get phone calls from people. I got two today! Like I mentioned yesterday, it still bewilders me to think about how I can communicate with people on the other side of the earth less than half a mile away from people whose livelihood consists of herding cows (although, once the day’s herding is done, they go back to their tiny mud huts to kick back after a long day in front of the family tube, which…for some odd reason…is likely their most expensive possession. It just shows the blanket effect of television in Indian culture, whether it be in luxurious flat in Mumbai or a mud hut outside Goraj.)

We again visited two villages today. There was a marriage going on, so the number of patients was much lower. Regardless, several kids came in, including a chubby baby. What was interesting was that the mother who came in with the baby also had a two or three year old child who was literally skin and bones. Scenes like these illustrate why it is understandable that India’s under 5 mortality rate is so high. In the rural setting, even if children are somehow born completely healthy, the first few years of life are very difficult with exposure to the environment and malnutrition. India, the land of contrasts. Kya karen?

Anyways, during the visit I had the chance to talk to Dr. Pandey for a while. We talked about our project for a little bit, but then the conversation switched to the Ashram and its management. Even in a place like Muni Seva Ashram that has supporters across the world, politics within the organization remains a problem. Once Pujya Anuben Thakkar (the founder) passed away in 2001, Dr. Vikram Patel took over. In the last 15 years, the Ashram had expanded rapidly. Now, a small trust oversees the entire Ashram, which they now see as being inadequate. However, for people like Dr. Pandey, it is difficult to implement any consistent policies since the administrative infrastructure is absent. It is difficult for someone who was involved with an organization from its beginnings to let go and let others manage. It became clear to me that especially in the nonprofit sector in India, the founder, donors, and other stakeholders egos are consistently fighting for glamour. (I must qualify that isn’t the case with ALL organizations, but it is evident with the ones I have interacted with so far.)

We also talked about the types of diseases he sees. Apparently, Gujarat has one of the most developed rural infrastructure systems in India. While I found this somewhat appalling, I did see electricity lines, schools, a resemblance of a road, and water access at every village I had seen so far. Hypertension is very common, even though these people are quite lean and often malnourished. This wasn’t a case of the affluent sicknesses, but rather, it added credence to the finding that Indians have one of the highest rates of cardiovascular problems in the world. I was also curious about what it was like practicing medicine in rural India, so I asked him if he ever misdiagnosed a patient. He started telling me about a case of a 13 year old boy who came in with symptoms of vomiting blood. Dr. Pandey checked his heart, found that there was some problem, and decided to prescribe steroids without checking any other part of the boy’s body. The next day, the boy started to vomit blood massively, and he was rushed to the hospital. In the end, he was given blood, and he eventually stabilized. I found myself thinking about the book I had just finished, How Doctors Think, in which the author outlines the various cognitive errors that doctors make. In this instance, it was a clear case of “search satisficing,” where the physician stops searching for a problem once the first one is found. It was interesting to me how common these cognitive errors were in doctors, especially those that became used to certain types of diagnoses.

I’m making friends with some of the other docs in the Ashram as well. One of the invited me to play table tennis with them the next time they played. It was a refreshing conversation!

On an important note… apparently insects think they can just invade my room. I found a little crawly guy in my toothbrush case for the third time today! There are a couple tiny holes on the bottom they somehow manage to get in. Also, I got bitten by mosquitoes for the first time today. I swear, this is just the beginning. I can’t wait till the rainy season…