Out here in the field

Unexpectedly very exciting day yesterday! I've been hopping from department to department this rotation - leprosy last week, then HIV, and then yesterday beginning with the tuberculosis (TB to friends) department. TB's obviously an important disease in terms of public health, but the treatment is more a matter of dogged persistence than instant gratification - patients take 6 months of 4 separate antibiotics, three times a week, with regular checks of their phlegm to see if the infection's out of their lungs yet. If they're clear at 6 months, they're pronounced cured and sent on their merry way. It's the same treatment, roughly, as in the US. No whiz bang surgeries, no fast cures.

However. Since the great Dr. Beine has just returned to Germany for two months (he refuses to operate in the hot months, believing patients don't do as well), the task of emergency leprosy surgeries falls to Dr. Reddy, the tuberculosis doc. Apparently there's not the surgeon/non-surgeon divide here that we cling to in the US.

In any case, that's where I spent the morning - watching septic surgeries for leprosy patients' ulcers and doing my best not to pass out. Those of you who are a little squeamish might want to skip down - I LIKE surgery, and I was feeling a little queasy watching this. (Matt, looking at you here.) As I mentioned before, the main complication of leprosy isn't the leprosy infection itself, but the fact that patients who can't feel their feet tend to get nasty infections on their soles. When this gets down to the bone ("osteomyelitis" - infection of the bone), it requires quick intervention. No waiting for Dr. Beine allowed.

So patients hobble down from the inpatient wards, the women dressed in their everyday saris and the men in business casual shirts and linen pants - the operating theater waiting area looks more like a bus station than anything else. One by one, they expose their uclers, gingerly walk themselves into the OR, hop up on the operating table, prop up their injured foot and wait patiently. Dr. Reddy (clad in typical street clothes, a cotton mask, and wearing the clean blue plastic flip-flops that wait in neat rows outside the OR door) dons his resterilized latex gloves (waste not, want not, folks), swabs on some iodine, and basically goes to town.

Now, these patients don't feel much in their feet - obviously, or they wouldn't have the ulcer to begin with. But watching a surgeon start cutting away at skin on an awake, unanesthesized patient is tough to watch. The only purpose of the surgery, really, is to get that infected bone out of there. So the doc goes digging and cutting, down through the ulcer, until hitting bone - where he proceeds to scrape and dig, a lot more vigorously than I was comfortable watching. This is made harder by the fact that many patients still retain some sensation in the middle of the foot, near the infected bone, so they start to wince and writhe a bit as the doc goes on scraping. Eeeeeaaaaah, said my brain. Luckily I was wearing a mask to cover what were no doubt uncool facial expressions.

[Squeamish readers, come on back.] In any case, I made it through without embarrassing myself in a fainting spell. (Did that on my first day of surgery rotation. Ah, memories.) We zoomed through four or five surgeries within 90 minutes or so - turns out that OR turnover time is incredibly quick when the patients walk themselves in and out, there's no anesthesiologist, and no one cleans the room between patients! Who knew? By mid-morning, we'd already seen some new TB patients in the outpatient clinic and were taking a social chai break with Dr. Sugunamma. Dr. Reddy was done for the day at 2 PM. Whole different kind of schedule here, readers.

Off this morning to one of Dr. Reddy's rural field clinics, where TB patients get their meds only under observation - turns out we humans are much more likely to follow up with 6 months of antibiotic therapy if a stern nun is watching us take them. Nun-o-phobia should be an acknowledged psychological entity.