So I always said that I would believe Alan was visiting me when I saw him with my own eyes on Indian soil. Now in retrospect I feel rotten for ever doubting him, true to his word and after 29 hours of pretty solid travel between St Helens Merseyside and this corner of Tamil Nadu he turned up on the doorstep of the hospital. Understandably I was over the moon to see him and had to try and restrain myself from jumping around like an over excited puppy. He had just travelled by bus from Bangalore
Having worked ever so hard back home while I have been gallivanting here in the Indian subcontinent you might assume that I would want to give Al a well-deserved rest on arrival. Perhaps do some gentle sightseeing or tourist activity? But you would be wrong. The second day he was here was one of our operating days. We had a visit from our wonderful and eccentric travelling anaesthetist (there is currently no regular anaesthetist on staff) and so a list had been prepared. One of my mentors and the most senior clinician in the hospital is a very enthusiastic surgeon and was keen to show Alan how we do things here. So rather than putting his feet up I had Alan standing very resolutely on his feet for a full day of observing in the operating theatre, with teaching the medical students thrown in for good measure. He was an absolute hit but seeing as he is charming, professional and super brainy how could he fail really?
The next day dawned and you would now certainly expect me to let Alan rest, at least a little but no I had other ideas and bundled him off to see the mobile clinic in action. As the most junior doctor here (therefore more dispensable from hospital duty) and one who’s bones don’t yet mind too much being rattled around in a glorified truck over Indian mountain tracks I have taken over a lot of the mobile clinic visits and I felt that Alan would not have a full idea of what my daily routine here involved without seeing one of these first hand. Our day did not disappoint as it was a classic mobile clinic visit if ever there was one. Small children attending to have their weight charted and check-ups for those not growing as expected. The usual viral coughs, colds and stomach upsets of primary care medicine everywhere. Mostly treated with paracetamol and advice like “drink plenty of fluid” and “if it doesn’t get better in a couple of days come to the hospital”. Some of those with high fevers or who have clinical findings and are systemically unwell warrant antibiotic therapy or direct referral to the hospital and a lot of what I do is try and sort one group from the other. As usual there was at least one really frustrating and upsetting patient who despite being quite severely unwell and despite everyone’s best persuasion techniques just flat out refuses to come to the hospital for investigation and management.
One particular chap who fell into this group had essentially been too unwell to work for two weeks with cough, weight loss, fevers and intermittent vomiting. He looked skeletal and certainly needed us to investigate for TB. But even with us all (The three health animators, Alan and myself) sitting on the porch of his house and trying everything bar just picking him up and carrying him back to the van (he was certainly light enough) he just said he would come tomorrow. I don’t think that I need to tell you that he did not arrive in hospital the next day. Partly I think that patients like this are afraid to come but when it boils down to it we gave him all of the information, that it could be very serious or without treatment even deadly and he made his decision to stay in the village. I don’t for a second think this means that what we are doing is somehow wrong or not working but just that we are still part of a process that takes time. When the charity first started going into the villages years ago the tribal people were so scared that they literally ran away. Now more often than not they seek help and in the next generation I feel confident that patients like this will be more likely to come for the treatment they so badly need. We just need to keep going.
Anyway I seem to have gone on a very long tangent of thought there, hope you don’t mind too much. Friday came and still no rest for the wicked, or for Alan, as we had both been volunteered to take part in paediatric health checks at a new school taken over by the education branch of the charity. All under the full supervision of course of one of our senior hospital doctors. The thirty-odd tribal children in this school range from 5 to 14 years in age and only have one significant uniting factor, they have all dropped out of mainstream government schools. The general atmosphere was one of controlled chaos as the children lined up to be prodded and poked, have their chests listened to and their ears inspected. Because they were living in such close quarters and there were a good few cases of scabies and likely cases of worms we prescribed a blanket treatment for both conditions. Other than that I am pleased to inform that they were mostly in pretty good health and after their check-ups and a little lecture in hygiene and infectious disease from the Indian doctor they treated us all to a few rousing Indian songs complete with hand clapping. The lyrics of course were wasted on the English medical students, Alan and myself but the sentiment was lovely. After they had finished they demanded that we also sing… after a brief team huddle to discuss our options we went for “heads, shoulders, knees and toes” followed by “if you’re happy and you know it” both of which I feel went down splendidly with plenty of joining in from the kids.
Right then this must be far too much chat for now! I will write again soon and tell you all about the trip Alan and I made to Cochin
A x
As an illustration of this episode of blog I could not resist this snap which Alan took of me doing an examination on a young school kid. In case you are wondering I was trying to encourage her to stick her tongue out and say "Ahh", leading by example!
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