Rainy Saturday afternoon in Hyderabad

I figured since I hadn't posted anything for about a week that I should probably do so, even though I don't think I'm going to reinvent the wheel with my blog after reading everyone else's from this past week. As everyone else has said, we are having a great time with each other and have quickly set up what can probably best be described as a very dysfunctional family away from home. One of the attendings from NIMS (Nizam Institute for Medical Services, where Dr. Y has been spending most of his time) who had lunch with us, was quoted as saying we were "interesting" and found us amusing, which Dr. Yadavalli says she meant in a good way, but I think the jury may still be out on that one. We've had terrific Indian food all week and as Jess said are seldomly left without a cup of tea in our hands or our bellies empty(in response to Dr. Armitage, I think tea at conferences and available somewhere at 4pm would improve resident morale tremendously, if nobody else's then at leaset mine).
Currently, I'm sitting in the internet cafe downstairs from our apartment, listening to the rain falling and with every good intention to work on presentation I'm giving this upcoming Thursday on C. diff, which surprisingly is said to not be a very big problem in India. Earlier in the afternoon it was a beautiful day, but now its been raining for about the past hour. Since getting back from a morning of lectures and briefly rounding with a hematology team and discussing a few cases, we've been playing this as a typical lazy Saturday afternoon with a good deal of napping and lounging. Bindu's having the most excitement as she is (finally) Sari shopping with one of Sujan's aunts. This morning, Dr. Yadavalli gave a talk to the internal medicine department at NIMS (Nizam Institute for Medical Services) and then one of the professors in the microbiology department gave us talks on the Chikungunya and Dengue fevers.
As everyone else has said, this week has been a tremendous experience with our exposure to the Sivananda Rehab Home. I was most amazed with their coordination of medical and social services for the leprosy patients, first by treating them (antibiotics and correcting disfigurements secondary to their illness) and then providing vocational training so that they can return to their homes and be able to be provide for their families and be an active member in their community. Ultimately the best part of these services is the restoration of pride in these people who may have been shunned by those around them because of their condition as there is a great deal of social stigma in India regarding the illness.
As everyone else has said, the leprosy care is just one aspect of the work done at Sivananda. They are involved in the national TB program, which Bindu previously described and are expanding their work on HIV, including a new program dealing with reducing mother to child transmission.
The one thing I have to add to everyone else's comments from this week and I have found interesting is the difference in the differential diagnoses here. From speaking with the residents on rounds this morning and from our experience with the TB program, much of what the internist sees is infectious and their primary causative bacteria are completely different from ours (for example on rounds this morning we saw aplastic anemia secondary to what they thought was an unidentified hepatitis virus, malaria and leptospirosis). Their first thoughts to cases are often such illness as tuberculosis, malaria and chikungunya, illnesses we only have a very limited exposure to or none at all. I asked a resident this morning how often he sees cases of malaria and he said usually one to two every other day and speaking of chikungunya, this area had 8,000 cases (I think, it may have been 80,000, but I thought best to underreport) in a recent epidemic in this city of 4 million estimated. If you think about it, in our most notable insect-borne illnesses we have seen about 2000 cases of West Nile and 20,000 cases of Lyme disease per year in the entire US population, compared to just this one locale (and its outlying areas). Pleural effusions here are looked at as tuberculosis first, anything else second. Well its about 5:30 here now and we're planning on starting our evening on the town in about half an hour so I'm going to get going. Guess I'll get to working on the presentation later. Hope everyone is doing well, keep us posted on what's happening back at home. See everyone back at Case in a couple of weeks.