OPC

OK, so this will be short because I wrote this long blog and then my computer turned off and I lost it. NOT because we are in a developing country where the electricity frequently turns off. NOT because the equipment is shoddy, which it isn't. But because I am a total spaz and kicked the cord.
So outpatient ward is crazy: two residents today, one room, 144 patients, ppl walking through. One exam table (a flat board on stilts) One stool- for patient. Parents stand. All day, no break.
Interesting patients of the million:
1. 15 y/o M with swollen knees, ankles- serious arthralgia causing crying and anguish coming in. Broke his foot when couldnt walk due to pain and fell. Admitted for acute rheumatic fever vs rheumatoid process. Gonococal arthritis, while unlikely, was totally not on the radar for differential. They looked at me like I was a space alien.
2. 9 y/o M with syncope and LVH on EKG. Will get echo. Until parents can raise money, sit when getting faint.
3. Small corn on foot. 40- Rs for corn removal. That's like 90 cents. Why they came so far when child barefoot anyway all day walking on cow poo? You got me. Probably, as the attending pointed out, because another family member was having major surgery or something and everyone gets checked out while they're here.
4. 11 y/o M with pectus cavus- recurrent lung disease but prob not due to cavus. Parents, btw, look exactly the same. Which prompted me to ask about consanguinity in India which they noted was pretty common.
5. Wilson's kid for checkup- got the see the Kaiser- Fleischer rings! Green/Gold above iris.
Improved and walking with support.
6. 11 y/o M with what seemed clear Tourettes syndrome. Neck tic. Parents did not like this though and had a long convoluted story of a bite on the foot and relapsing fevers. The attending had me secretely watch the child has he hung around outside the room and I reported the tic continued, albeit at a lesser pace. Strangely, the residents were really nervous about ruling out WIlson's and got all hung up about getting a ceruloplasmin and an optho consult. I thought that was a strange move. They noted they had never prescribed psych drugs and didn't know about this pimozide they thought he might use.
7. Sudden onset blindness in 5 month old. Put on anticoagulants and monitored. Strange regain of vision 4 months later (most of it as far as we can tell.) Parents said they prayed for a long long time.

Observations:
1. Asked about child abuse- attending said she had heard of one case and wondered what indicators we had that it was going on. They don't see much OR they don't diagnose much OR there isn't much. I will go with a combo of the formers.
2. Doctors are fairly harsh and businesslike with patients and parents. Children who cry are sent out if they are too loud. Occasionally, a child will get to play with a tongue depressor to quiet them. Otherwise, out. I drew pictures on one and then they sent out all the upset ones so I didnt' get to give it away. A few male pediatricians smile at the babies and play with them, but that's it. Parents must be extremely respectful and never question or bother when the MD is consulting with another doctor or discussing another case.
3. No toys with patients= no foods. They may have water in a bottle, but nothing else. There was a guy dressed up in raggedy monkey outfit teasing kids outside the rooms. This was new. The head of nephrology yesterday expressed her frustration at not having anything like Child Life or toys or things to help distract children when they have procedures. There is one tricycle in the ward which is used by a fast, daring sibling who must want to be a rickshaw driver.
4. Rickshaws are awesome. I wish we had them in the US (except we'd probably find a way to make them more lethal). Its like a cheap wild ride through town- so fun. I feel like Mr. Toad everytime.
5. Exams are pretty rough- no niceties, but that is fine. Mostly, they are just not necessary for most patients in this system and I have never seen parts of the exam done. No lymph nodes, thyroid, any genital anything, strength, abd auscultation.
6. Flowers in the hair- did I mention? Everyone has these lovely white adn orange flowers briaded together they buy on the street and they smell amazing.
7. A bunch of people live here who appear South Asian- not sure if they have come for medical training or were a part of an earlier migration. But it is interesting.
8. BTW, short sleeves totally ok. I should never have listened to those other bloggers! Crazy pants, they are!
9. Occasionally, I see male cross dressers- they are a special group here- appear and make noise at weddings I've read in the book. But a startling sight when seen--in the midst of all these saris on tiny women, a 6 foot sari!