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June 8, 2009

In the general clinic

The physicians here have to be some of the most patient people I've ever met. Yesterday (Sunday) was my first full working day at the clinic, and I was shadowing a different physician (Dr. L) as he saw general patients. He and a second physician were each working at a desk in a single room about the size of the exam rooms I'm used to, and at one point during the Sunday rush I counted 12 people in the room not counting the two physicians and myself. That most likely included the two patients actually being seen at the time, an accompanying family member or two apiece, and then several additional patients (and family members) waiting to be seen by one or the other of the physicians. Patients sit on a stool next to the doctor's desk and present him with their paperwork, or at least that's how it's supposed to work, but at any given minute several waiting patients are also trying to present the doctor with their paperwork. And that's not counting patients seen earlier in the day who have their completed lab work in hand and who jump in as well to have their visit finished off. But it's all very polite and orderly - maybe every once in a while someone pushes their paperwork in front of someone else, but that's about it. An American HIPAA enforcement administrator, however, would probably succumb to a case of the vapors almost immediately.

Most of the actual examining is done with the patient sitting right by the desk, but there's also a small curtained-off area with an examination table for use when the patient needs to be examined lying down, or if the examination is going to involve disrobing more significant than the pulling-up of a pants-leg or the baring of a shoulder or midriff.

A quick tallying from my notes for the day shows 33 patients, ranging in age from a couple of months to 80s or so, seen between about 9:30 AM and 4 PM by the physician I was shadowing, but I know I missed several, so that's an undercount. My conversational and history-taking Nepali is nonexistent, so Dr. L tried to slip a few words of history/condition to me in English during examinations and as he took the paperwork for the next patient; cases I did manage to note included several possible cases of leprosy (referred to the official leprosy part of the hospital for further testing and treatment), postherpetic neuralgia, fungal skin infections, vitiligo, gynocomastia, acne vulgaris, impetigo with staph infection, scabies, orchitis, giardia, tinea corporis, tinea versicolor, dizziness with vomiting, cough with fever, possible rheumatic fever, and a huge ankle abscess immediately referred to the wound care clinic. Oh, and one case of hypertension.

A couple of things brought up by readers/emailers ("Hi, Mom."). Altitude: I'm not sure what the exact altitude is here at the hospital, but it ain't Everest Base Camp (5360 meters/17600 ft). Janakpur, the last airport flown into en route, averages about 70 meters (about 69 meters higher than Norfolk) and I'm guesstimating the hospital grounds at another 10-20 meters above that. So (a) it's not high enough to be cool in any temperature sense, and (b) it's not high enough to be above mosquito range. I don't have a thermometer at hand, but so far it strikes me as similar to summer Norfolk: hot and humid. It's just within bearable for this AC-spoiled westerner when the fans are working or there's a light breeze. When the power cycles off (and it's done so a couple of times while writing this), the fans die, the wireless signal indicator goes to zero, and I start to melt. And yes, all three of those make FB/gmail chatting on-again, off-again.

Close calls in traffic: a couple of current patients here, originally seen/operated on before I arrived, are two gentlemen who had their arms hanging out right-side bus windows when another vehicle got a little too close (traffic is on the left here a la the UK), so while my vehicle travel has been minimal so far, my arms are gonna be inside the vehicle at all times when such travel does happen.

Church service Saturday morning: involved a great deal of singing and the introduction of an out-of-towner who apparently said more in the way of brief self-introduction than the speaker was interested in translating; was not an SDA congregation so far as I could tell (but I'm still working on getting some of the church history/theology/etc); and I am pleased to report that some things are indeed universal: small boys the world over while away the service drawing and coloring, lying on their bellies on the sanctuary floor.

Posted by Brenden at June 8, 2009 6:53 AM


Comments

Ah it begins. Medical speak. Is there going to be a quiz after I read this? A couple more years of med school and I may have to carry around a DSM IV to cover the language barrier. Glad to hear that travel was good and your digs provide you with the basics like air, water, and more importantly wireless. Parker and I will be reading your posts regularly, both of us keeping our appendages in the bus.

Posted by: Sean at June 8, 2009 2:57 PM

Wikipedia is your friend and mine; for example:

http://en.wikipedia.org/wiki/Giardia

Posted by: brenden at June 8, 2009 8:24 PM

That clinic sounds like if Kinko's were an Urgent Care. But seriously, I totally admire you for doing this. You are inspirational.

Posted by: Elrond Hubbard at June 10, 2009 8:59 PM
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