For the first two days this week, I've been heading over to SRH's sister hospital, the Ramdev Rao Memorial Hospital. It's a general hospital, not free but very reasonably priced - there doesn't seem to be anything like health insurance in India, so when you're paying for every single lab test, you really want them to be cheap. (And necessary!) The eponymous Ramdev was the husband of the woman who founded SRH, so they're sort of buddy institutions, happy to trade around a goofy foreign medical student for a day or two.
And it was great to get back into a general hospital setting, if a bit different than the US equivalent. Lots of the staff there are retired government doctors, who did their time in the Indian equivalent of Cook County Hospital for decades before scoring a spot at RR Hospital, with its grilling 9:30 AM to 1 PM schedule (including a tea break). That usually means they're teachers, which is a great benefit for me. I spent my mornings with a posse of older pediatricians and gynecologists, tagging along as they showed me where to identify tuberculosis in a child's chest x-ray, or how the Indian vaccine schedule works, or why they suspected Dengue fever in a very sore little patient. Lots more of the Indian doctor brusqueness, even with kids - but I guess when parents assume that coffee is enough breakfast for a kid hospitalized with malaria (families bring in their own food), a little scolding might be warranted.
Since it seems that my doctor life is probably heading in an Ob-Gyn direction, I had a special interest in seeing how that particular morning clinic went down. Dr. Chaya had me plopped down on the other side of her desk as she zoomed, zoomed through the two dozen or so patients queuing outside her door (no appointments here). Between reading her notes over her shoulder, picking up decidedly non-Telugu words like "meningomyelocele", and getting the occasional explanatory tidbit throw my way, I feel like I learned quite a bit.
The majority of the visits were antenatal or infertility visits; as Dr. Chaya explained, life is all about getting married and immediately having babies for most young Indian women. Family planning is a big issue in India, which Indira Ghandhi herself endorsed many years ago, but most planning happens post-kids. If they're interested in a small family, women quickly have their two children by their early 20s, then go in for a permanent contraception method afterwards - sort of the reverse of the US. Likewise, infertility workups happen way earlier; as opposed to US fertility clinics, where half the patients are women over 40, we were working up childless 21 year olds yesterday.
Most of the patient problems and medical services offered were remarkably the same as the US, though perhaps not as numerous - urine pregnancy tests, blood counts for anemia, ultrasounds. But every so often there'd be a quick blip that I was far from home. In the ultrasound room, for example, Dr. Chaya was pointing out heart/head/femurs of a fetus, then quickly mentioned, "and you see, this is an XX fetus". I looked a little confused, and she noted in a quiet voice that it is illegal in India to tell mothers the sex of their fetuses on ultrasound, for fear they'll abort the girls. Thus, the "XX" or "XY" medical code. I also noted that all women's medical charts have their marital status in prominent lettering on the front page; doing a vaginal exam on an unmarried woman might be a life-ruining event for her, if it throws her virginity into question later on. Yikes.
So two very interesting mornings, although probably too short. I was just getting used to the flow of things (and the delightful tea). One more day with the HIV kids' ward at SRH, then repacking my life in my trusty suitcase.
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