World Leprosy Day

Today is world leprosy day. Many places that normally don't think about this disease will be raising awareness and support for these patients. Here at TLM everyday is leprosy day. While we had a special presentation about the history of the disease and the decline since the implementation of multi drug therapy, rounds are the same - monitoring the healing of ulcers and improving lesions and joints with therapy. I am concerned about one of our patients that I also saw in clinic on my first day. We admitted him for a deep plantar ulcer. After two debridements, it has not improved. After an xray it showed bone involvement. Monday we will remove the right big toe from this 25 yo. He is in college and seems very smart. This operation will help his current ulcer to heal but with altered anatomy, he will be more likely to get ulcers in the future. He will have to pay close attention to his feet. I am hopeful that since he is so educated that he will understand the importance of prevention. Most of the other leprosy patients are not so thoughtful. They are counseled over and over but don't seem to have the forethought to take care of their dry, fissured feet before an ulcer devolops. Pray for the counselors and PTs as they have the most difficult jobs in training patients and please pray for my patient's ulcer to heal with the operation that is performed. I look at my feet which are very comfortable in my Chacos even if they are dusty from the dirt roads and I am thankful that they tell me when I have a rock in my shoe and how to balance my weight just right so I don't have too much pressure in one area. Look at your feet...and be thankful.

Pics

We were so excited to have fresh fruit. This is a papaya that we combined with bananas, apples and grapes and had an awesome fruit salad. Notice my Indian shirt:)
Here is am with my sweet patient with type LL leprosy right after the second debridement.

Here is the campus kitchen. This is the room that the rotis are made. The lady on the left makes hundreds of them. They are very tasty. The lady on the right - Monkarna is one of our cooks. We like her food the best. She speaks some English and loves Hannah and I. They are cutting the veggies with a "knife" that they ancher with their foot.

Here's the Taj in Agra..we have professional pics that have Hannah and I in them but not digital so we can't upload them.

Well, hope that gives ya a quick snap shot of life here in India. Take a look at Hannah's bog to see more!

Giddy is Gone

So after two days of dressing changes, it was time to debride and cut some more of the dying toe off. This time I was able to make it through the whole procedure without any quiziness! My patient was later that day diagnosed with the most severe form of leprosy due to her stopping her treatment too early back in 07. She will now have to be on treatment for two years which brings its own set of complications such as skin discoloration and hypersensitivity reactions. She is soooo precioius though. Every time we round on her. She cover hers face with her sheet and just hers eyes stick out above the sheet but I can tell she is smiling by the squint in her eyes. I just go up and grab her hand and give it a squeeze...I think she is my favorite patient now...This morning I discovered that she had not taken her medicines and had just stuck them under her pillow for safekeeping I guess. Patient education is huge here. The doctors don't do much of it because they have hired a full time counselor to sit with the patients and take as long as is needed to walk them through how to care for their wounds, take their meds and what signs of infection would need to bring them back to the hospital. We learned that there are no appointments. Patients arrive early in the morning, line up and get a number. If their number is not called that day they have to come back the next day to be seen. The setting is also differnt. The docs sit at desks and the patients come in to see them. Two docs to a room with a shared exam table that has a screen to give some privacy but not much and often private parts are exposed to all in the room. Even AIDS diagnoses are given in front of all in the room. I am sure my next TB skin reaction will be positive as it is more common than the common cold here. I could recognize a TB chest xray in my sleep by now. Yesterday was the most exciting day by far for me as we got our first exposure to the OR. How different! Hannah's blog goes into more detail but I hope to spend more time there suturing which is much more diffilcult without the right sized needles and when the suture falls out of the needle if you don't rethread it every throw! 

Tonight we are headed to the  market which should bring some relief as far as the monotany of our diet...also we are makeing key lime pies for the picnic on Monday which is a national holiday celebrating the Republic forming. Yay for holidays and lots of food:)

BTW...giddy is the indian term for nauseated:)

Giddy

Well it is day three in the clinic. On day one, the morning started out pretty slowly with chapel, rounds and clinic patients. I was seeing leprosy patients and we admitted a couple for plantar ulcers which are very very common. One lady came in with a lion face of a leper. She had started treatment in 2007 but quit taking the meds for who knows what reason since they are free for everyone who needs them. One thing that we noticed right away is the smell that she brought with her into the room. Lokking at her feet we knew that we should leave them wrapped in her cloth and take her to the "casualty" or ER for a debridement. I was the lucky operator. I am getting nauseated just writing this. Her big toe was about half gone and the rest was necrotic all the way down to her mid foot. I was instructed to cut and pick until fresh skin could be seen. As I began to dig, I noticed that what I was pulling out was actually tendon and bone along with the granulomatous tissue. She seemed to be in pain which made me hesitant to proceed. I was assured that she cold not feel it and that her groans were more psychological than actual pain. As I dug deeper, I began to feel sick. I just tried not to think about what I was doing and get through with it. I had to brace myself as I was digging deeper. When my gloved hand touched her foot and all I felt was mush...I couldn't ake it any more. The room became dark and quiet and I knew I had to sit down before I fainted. Thankfully everyone was sympathetic and patient with me. I was sick all evening and went to bed early. We have rounded on her twice since then and she is so grateful to me for "torturing" her. We will restart her on leprosy meds and teach her "self care" which includes SSO or soaking, scrubbing and oiling their feet. THey don't sweat so their feet get cracks and fissures and ulcerate and infected. I know her smile including her only two teeth is one that I won't forget.

Holy Cows!

We landed in Nagpur and our excitement was building by the second. We were greeted by two gentlemen from the hospital and a bulky red SUV that served us well on our four hour drive to Kothara. The drive was an amazing one. The city of Nagpur is also known as the city of oranges. The whole drive was lanscaped by orange groves here and there. About halfway here we started seeing mountians that remind us more of northwest AR than the rockies but still a lovely backdrop to the fields of wheat, cotton and of course oranges. While we had heard about how animals tend to have the right of way here in India and we saw a few on our drive to the Taj, we were amazed at how many cows just stand in the road and don't move an inch for the traffic!!! The whole drive we kept seeing small heards of cattle with ir without their "shepherds". At times, we had to stop and let the cows, sheep, and whatever else decided to dominate the road have their way. Well, that was our journey here. We are nice and settled in our house right next door to the doctors who are the directors of the hospital. In fact, I am in their house using their computer for this post:)

A family for a day

Hannah and I made the trip to the Taj yesterday! Our trip consisted of the two of us, another american from conneticut who sells helicopters - cool, and a austrian also here on business and our Indian driver in a nice Toyota SUV. We had so much fun seeeing and sometimes laughing at all the interesting sights along the road during our 4-5 hour drive each way. Drivers here receive money from shops for bringing tourists there so we made several stops doing this. While we could have refused, we just enjoyed getting out of the car.
Our driver did not speak much English at all. At first we thought he was telling us that each shop was his shop. Until we realized that he procedes everything with "my". Here is my hotel, my picture, my fort... he would say. I could not stop laughing at what a lack of communication can lead to...because we really did believe him at first. It also reminded me that I should try to understand the concept of what people are saying and not just the words...handy idea when it comes to medical care where miscommunication is more costly.
At the Taj, security was "tight". Greeted by armed guards and security check points was expected. We knew we could not take electronics or food so left our i pods and snacks in the car with our driver. I did not know that I would still break the security rules. There is a separate line or queue for women. While being felt up for secret weapons another female guard carefully went through my bag. I could tell she was more curious at what everything was. She played with my pepper spray that I had left on the outside of my bad but thankfully it did not fire and she just left it alone. Then she found my National Geographic that I had been reading on our car ride. This is not aloud she quickly states. I was in disbelief. She started flipping through the pages immediately while I was still standing there. I was confused since I had my bible and other reading material in my bag as well. I refused to let here keep it and my guide had someone outside hold it while we toured. Coming out I found that they had been passing it around and did not want to give it back. I did get to take it with me but with a greater appreciation of what I possessed! Who knew how much of a ruckus that would cause!!!

Jet Lag???

Just a quick note before breakfast but more to come soon...
We made it!!! It is now finally starting to seem like a reality that we are in India. As I sit and hear the busy honking of horns, smell the fog/smog that fills the air and woke up to chanting from a near by temple, it is for real. Hannah and I slept in a clean and comfortable quite spacious room. We are provided breakfast and have a pretty fast internet - it might be faster than my struggling computer back home! Well, it's Hannah's turn to update:)

On the Road

NYC: We are taking advantage of our 9 hour layover. Hannah's good friend from college Sam just moved here. She is taking us to the MOMA and a few choice eateries too. I love all of the diversity. I would be happy just people watching but off we go:)

Still in Arkansas

Yay! This is going to be such an adventure!!!!! Today my goal is to "forget" all the things that make me worry - like school and residency. I am going to mentally chill. I have been putting my stuff into storage and have noticed that I accumulated so much...stuff. I have also been packing for my trip. Guess what I am taking...stuff. While living without anything is not an option, I am sad about how many things I own that I don't use or need. So, I decided that my new goal is to simplify. I think that going to work in India will be the perfect setting to find out what that means.