New Perspective

Hi everybody,

Hope you all are doing well back home. We're all doing well, and I think I speak for everybody when I say "THANK YOU" to all of you for being so concerned about us. Hearing from all of you has really meant a lot to each one of us.

I think I also speak for everybody on this trip when I say that our experiences over approximately 10 days have really given us some new perspective in a lot of different ways. I think you have all read our blogs from last week regarding our excitement for some of the programs here that really amazed us with their efforts, so I don't need to say more about that aspect of new perspective.

This past weekend, the blasts definitely had their impact. It really is quite a different experience to read or watch the news on CNN each day and hear about the 30 or 40 people across the world who died because of blasts compared to when you're actually in the city where the blasts took place. You see and feel the effect on yourself, the people around you, the city as a whole. This morning, we were scheduled to go to one of the 2 hospitals where a lot of the victims had been taken from the blasts on Saturday night, but the security levels are so high right now, strikes were taking place today nearby, family members are swarming the hospitals, etc. that we were advised to hold off from going to the hospital at least for today. We may be there tomorrow morning, and I can only imagine what things are like right now, especially for the family members of those victims in critical condition. My prayers are with all of them.

Today, we went to NIMS, which is a different hospital here in Hyderabad, and even there, we had a moment of silence and saw a lot of grief on the faces of the medical faculty as one of their doctors had passed away in the blasts. Anyways, I think you all get the idea. Wish we could do something more about it. For now, glad we're alive and well. Let's all pray for the victims and their families.

Continuing along with today, I think we all had quite an educational experience that offered some fresh perspective. We went on rounds today for several hours with one of the medical teams at NIMS hospital. These rounds were GREAT in many ways. Residents (five of them) were not paged or called a single time by a nurse or anybody else for any orders. The attending literally was teaching for 3.5 hours while we were with them, and we left before rounds were over. So how could 3.5 hours of rounds be great for residents with so much work to be done, right? Well, when our group left their group, we also realized that the residents didn't really have any orders to place afterwards, any discharge planning to solve, no to minimal notes (I'm pretty sure none). Only limited things could be done, so there wasn't as much work afterwards. They were just learning from their attending and focused on thinking about their patient's care. After lunch, they had time to come attend lectures (topics included HIV Perspective in India, Candidemia, and Rhinosporidiosis) for a couple of hours (in addition to the one hour conference that we all attended this morning). Imagine if we had 3-4 hours of teaching rounds and 3 hours of lecture/conferences every single day. Obviously, our systems are different - there is only so much that can be done for these inpatients due to the lack of money. Lab tests, imaging, treatment options are all limited due to cost. Before every potential diagnostic test is ordered, the attending discussed the costs involved and whether it would be feasible to pursue further diagnostic testing for these patients. Often times, the efforts were focused on empiric treatment rather than any labs or imaging with the goal being strongly on getting the patient better with what the best clincal diagnosis was rather than using any of the cost on extensive labs or imaging. Not too much focus on evidence based medicine. It really was quite interesting to see. The ward consisted of 20 beds across one huge room (talk about your geographic localization). In this entire room, there were only 2 iv poles hanging - one person getting IV abx and one getting a blood transfusion. Nobody was on nasal cannula. Diagnoses being discussed on these patients included HIV opportunistic infections in the lung (i.e. PCP, pneumonias, TB, fungal infections), malaria, TB, snake bites, leptospirosis, brain mets, lung effusions/lesions, HIV medication complications, DIC, lactic acidosis, etc. Somehow, they all looked fairly healthy. Just an incredibly unique experience.

Not even half way through the trip, eyes are wide open!

Keep in touch,

Vijay