nutrition - cooking and discussing

We travelled to a place called Chittalapakkam today, where we discussed nutrition first with very small children and then with their mothers. We met in a balwadi or creche. We discussed the importance of fruits and vegetables, drinking milk, and washing hands. After this, we went to someone's home, which was really a hut, and made high-nutrition rotis (indian flatbread) out of wheat flour and gram flour, carrots, spinach, and other vegetables. They were made with minimal oil and and not fried. We took these back to the balwadi, distributed them to the children, and discussed them with the mothers.

It was actually interesting to see what the mothers know. Some know that carrots are high in vitamin A, which is good for the eyes. Others still think eggs aren't good for kids who have jaundice. The level of general education is very low in these communities - among everyone but especially among the women. But the health education is somewhat reasonable in the places that are being reached by the government health centers, which speaks well for Tamil Nadu's implementation of the national health programs.

One program that we saw here was the mid-day meal scheme. Under this scheme, children are fed a well-balanced meal, including an egg, everyday for lunch at the creche and even at the schools, up to the 7th grade, I believe. This serves two purposes: one, at least one good meal per day for the children, lowering incidence and severity of malnutrition, and two, incentive for parents to send their children to school. This is another highly successful program.

good news.

I gave my first good news today to a woman with her first pregnancy. She walked in and handed me a positive pregnancy test stick, asking me to interpret it for her. I told her it was positive, after which her eyes misted over. It was a moment to remember. I then gave her advice on folic acid tablets and proper nutrition and wrote an order for her first trimester scan. It was really something I was happy to be part of. After that I had several small children with coughs and colds, and then we travelled further towards mahabalipuram to a small anganwadi where we measured weights and head circumferences. The weighing apparatus was rudimentary at best, with a spring balance suspended from a ceiling beam, tied to a small rucksack converted into a hammock. The children varied from being well behaved to feeling terrorized by 6 doctors looming over them with measuring tapes.

The area is interesting, alternating between beautiful hotels and resorts and tech parks, with interspersed huts and tiny buildings like the ones we work in. I'm glad to have this brief experience with medicine as it is being practiced in the peripheries.

back in business

It's been difficult to keep updates going when I haven't had much to say, much to talk about. But I saw - and treated - my first cases today.

Rather than try to keep this as a sort of entertainment for potential readers that may or may not exist, I thought it might be nice to keep a portfolio for myself of the cases I've seen and the experiences I've had. If entertaining stories come up, great. If not, that's fine too.

Yesterday was my first day actually seeing patients. I'm working at the Voluntary Health Services, down Old Mahabalipuram Road. It's a dusty little place, with a few old buildings that look like old timey schoolhouses. It was frightening to sit at a desk with a patient seat in front of me. My first patient sat down, addressed me as 'madam' and proceeded to tell me her name. Remarkably, it was the same as mine. I thought that was kind of a cool little sign.

I saw 4 or 5 patients yesterday, all with colds and sinusitis. One woman had what I suspected to be a chronic bronchitis. She had diffuse wheeze and creps heard throughout the chest, with some bronchial breath sounds as well. She complained of 3 months duration of cough with copious sputum production. We interns all had various suggestions, such as bronchiectasis, bronchitis, even walking pneumonia. The medical officer suggested that these all may be zebras. Think simple, he said. Don't suggest investigations you know your patients won'tundergo. So we prescribed amox for a mild LRI, cough syrup, and an aminophylline. And then we sent her home.

What a strange approach!

I wonder, what does she actually have? TB? COPD? Will she get better? Or will she keep taking short courses of antibiotics periodically prescribed by doctors who just want to get the patients to go home?

Another young woman came in and told me that she was diagnosed with "sugar", meaning diabetes of course. She says she hasn't taken medication for one month. Why, I ask. I had to work, she says. The problem is that for her, this is actually an answer. It is valid. If she takes time off of work to go pick up her medicines, she will lose a day's salary. She doesn't come to the clinic until she is too weak to work. I have pins and needles, she says. I am dizzy and weak. Fatigued. We ask her if she's done her blood work. She tells us that she has just given blood and that the report won't come until tomorrow. I prescribe her inj. B complex - for her satisfaction or for my own, I don't know. I ask her to come back with her blood reports tomorrow.

I know I won't see her again.