It's Saturday afternoon here. We briefly rounded this morning, following the patients who've had tender transfers done (I'll explain that later) and who have ulcers that are healing. Basically, the leprosy bacteria attacks the nerves in the periphery (the hands, feet, and eyes), which are cooler in temperature--perfect environment for the bacteria. Those areas of the body incur damage, thus rendering the patients without sensation or ability to move muscles and tendons. These leprosy patients might walk miles on a blister on their feet until it becomes raw and infected, but they'll either not notice or won't care because it doesn't cause them any pain. They might eventually come to the hospital only to receive leg or finger amputation because of gangrene. We have several patients on the ward now with only stubs left for toes or fingers. Sorry to become so graphic but one particular leprosy patient who's had the disease for a while came in last week with scores of maggots just crawling around in his open foot wound. I got the special job of removing them and cleaning out the ulcer! In case you're curious, turpentine and ether knock the maggots out so that they're easier to remove...just for future reference. And with the smell of gangrenous flesh to go along with the sight, the work is definitely not for the squeamish!
The medical supplies they have here are definitely limited (and usually not what we're used to in the U.S.) but the staff make good use of what they do have. They also have ingenious methods to treat various conditions, some pioneered by Dr. Paul Brand at Christian Medical College in Vellore. For example, the sensation in the cornea (the clear portion on top of your iris and pupil in the eye) is often lost, so the patients don't feel the urge to blink their eyes, leading to dryness and ulceration. The nerve supplying the orbicularis oculi muscle that closes your eyelid is also damaged, so the patients cannot completely close their eyes, a condition called lagopthalmos. So, in order to protect the cornea and prevent complete blindness, surgeons stitch the edges of the eyes to only expose the sclera--a procedure called tarsorraphy. We have seen patients, however, who come in too late with permanent damage to the cornea. As the case with all diseases, the key is early detection and treatment to prevent severe and permanent effects.
One really cool procedure they do during reconstructive surgery camps a few times a year is tendon transfers. The ulnar and median nerves in the arms are often damaged, causing claw hand deformity in leprosy patients. Imagine trying to go about your daily life with your hands stuck in a "clawed" position. It's no wonder that many leprosy patients are reduced to begging since they can't continue whatever occupation they had. So anyway, the damaged and fibrosed nerves in the arms/hands are replaced with healthy ones from elsewhere in their body, in hopes that their fingers will become functional again. The results are absolutely amazing. One guy was sitting on his bed during rounds, just beaming and grinning from ear to ear because he had his cast taken off and his fingers were making waving motions. He was showing us how his fingers were stuck in a claw hand and now is almost fully functional. He's still being kept in the hospital so that he can get daily physical therapy to keep the transfered tendons from becoming stiff and fibrotic as well. Sam, the physical therapist, uses ultrasound and heat from paraffin wax to improve the fingers' mobility. Which leads to a completely different topic :) Sam brought snacks for all the medical staff on Friday because he got his results from his qualifying exam for PT and he'd come in first in his college. Laurel and I have happily noticed that it's a custom here to provide snacks for people anytime something good happens. One staff member became a new dad on Wednesday and he brought yummy fried snacks for everybody. We hope lots of good, auspicious things happen to people while we're here! :) Monday is Republic Day in India, which means that it's a holiday for everyone (yay!) and the staff are having a potluck cookout for lunch. Laurel and I have been assigned dessert so we're attempting key lime and lemon cream pie. The guesthouse kitchen is woefully lacking in kitchen tools and ingredients so we'll have to go to market today and maybe use Dr. Anand's kitchen. I'll give a report on how the potluck goes.
A last minute note: I helped with surgery yesterday in removing 26 sebaceous cysts from a scrotum! Yuck! #1. We had no idea those even existed. Yes, Laurel and I are seeing many things we've not seen before. #2. They reuse gloves, needles, and instruments here!! They sterilize them in an autoclave. Definitely not used to that, since we discard most things in the U.S.--especially latex gloves! #3. They wear rubber flip-flops in the OR!! The outside shoes are taken off and the flip-flops put on before going into surgery. The scrub nurses in the U.S. would flip out if they saw this. #4. The scrubs are really really short. You'll see what I mean when/if we put pictures online. By the way, the OR is called the Operating Theatre, or OT here. Probably a Britishism from the old days when surgeries WERE a spectacle for the public to behold.
As far as outside the hospital, the weather here has been just gorgeous--sunny, with a slight breeze. The campus is filled with flowering trees and greenery. Just beautiful. On the other hand, there are lots of screeching monkeys, some which walk right up to our door and windows and stare at us, and lots of mangy, skinny dogs. The hospital is situated on either side of a small highway, so Laurel and I see interesting scenes: lots of yellow and green autorickshaws with dozens of people stuffed inside, beautiful women wearing gorgeous, brightly-colored saris, cows pulling wagons, and random, roaming cows and goats. There's a line of mountains to the north of us, making for gorgeous scenery. Dr. Steve, a staff physician, said that a group of us could try to tackle one of the mountains one weekend. We can't wait!
This is our guesthouse, which is quite large with about 6 rooms. Laurel and I are fortunate to each have a room with a bathroom! It's pretty noisy at night though, what with monkeys jumping on the metal roof and melodic car horns on the major road by the campus.
This is Dr. Jai Xavier showing us a woman with chronic cataracts that infiltrated the anterior compartment of her eye. We see a lot of severe diseases since the patients come to the hospital only after a long time. In the background is the hardworking aide Lakshman who does everything from bring in patient slips and clean the examination rooms to bring in tea for tea breaks. The doctors call him on the PA system frequently.
These are the adorable "fisher" girls who performed at the Republic Day ceremony.
Central Paratwada! This is where we bought our groceries this past weekend and were spectacles for people to stare at. Little kids came up and said "Good morning, sister!" Laurel and I would definitely NOT be able to find our way around these streets.
The OT --operating theatre. Notice the flip-flops and the short scrubs...hehe.
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