"Thanks for Removing the Tampoon"

All this blogging and one comment? This will not do!
Today we rounded and then traveled with an attending- Dr. George to RUHSA- a rural health clinic 40 km outside of Vellore. Here we saw many interesting patients.
But first, on rounds we saw a sad case of osteopetrosis- the child actually seemed pretty happy, talking and talking (maybe 15 months old) and was without cranial nerve involvement yet. But the mother spent time playing with her and alternately crying softly. She was simply here for transfusion- predicted life expectancy of 2 yrs.

All babies here have NG tubes- no OGs in anyone! They were surprised we ever used OG. Another baby had curiously had O2 stopped overnight but O2 sats are not monitored- only checked once a day! She looked good but lordy that would scare me, especially with these apneic little ones.

RUHSA was another experience entirely. First we worked in the clinic- a pediatrician "child specialist" comes once a week and then the local guy who runs the ward rounds with him.
Notes:
1. Everyone who can, gets iron and albendazole. Iron and albendazole. over and over. Many have intestinal worms and so many are anemic (only noticeable when checking gingiva and nail beds). Half the moms get iron also.
2. A good 8 yr old malingerer with abdominal pain. Dr. George threatened him with a NG tube- but he persists in missing school and coming to clinic, costing his family lots of money. Everyone who has seen him classifies him as such- he runs into clinic and pulls up his shirt to be examined, then cries when you touch him! Who knows, but I think they have this one in the bag.
3. Absence seizures- they treat with valproic acid- cant get ethosuximde, but everyone here says they get just as good results with the valproic.
4. We saw an 8 yr old with HIV- unilateral cervical lymph node swelling. And probable PCP. She was completely out of it. Has been taking retrovirals off and on- very tough with few pediatric options and resistance.
5. A child with breathholding spells. About 2 yrs old. SO pretty young for purposeful behavior. The options were seizure, behavioral, and weirdly, iron deficient anemia?! I asked why they were considering this- helps with Valsalva and return blood flow or something?- and Dr. George says he has no idea, but they've seen it before.
6. Young girl with sweaty and itchy palms. They sent her for thyroid tests at the CMC. She was very scared- crying and anxious enough thyrotoxicosis could be possible.

Wards:
The baby of a diabetic mom was delivered and they required the resident to try to get IV access. So we accomapnied to the labor ward. This was the first time I was kind of shocked at the conditions. The baby was a good apgar 9, cheesy, and hanging out on a table. Literally, a fold out table without borders or sides on which they put a cloth and there was a lightbulb above for warming. He had on a few cloths. Granted, its already ridiculously warm in there. But a light bulb for a warmer and I know newborns don't roll too much yet but...
The moms were worse. There were 5 beds- basically a metal table completely flat- maybe 4 feet off the ground, with a depression at the end. Some had stirrup like metal juts- others just required sliding down. The mom who'd had this baby was completely asleep, full sari on, lying on that table.
Two others were in labor- both in their sari's, one with it hitched up and feet flat on the table. But she was contracting and moaning occasionally. What is unbelievable is that we rounded and came back 15 min. later and there was another baby there on that dusty dirty table!
And a bucket under that woman who wasn't even pushing 15 min before had that beautiful third stage of birth in it!
Seriously crazy. Always gross.
We were kind of eyeing that baby cause it looked so pale. But its eyes moved about and seemed to be ok. The two nurse/midwives were wandering about and unconcerned so we took it that the baby was fine.
The title of this blog is a sign that was hanging in the labor ward. Tampoons. We asked Dr. George whether a Tampoon was a tampon and he said he was not an OB and had no idea what a tampon was and would not like to know. He's a very good spirited person.
And religious- we listened to Indian Christian gospel songs all the way in his Suzuki. And weird arrangements of Broadway hits by Indian musicians on the way back.

The pediatric ward is also scary. It was an open room- maybe 20 by 10 feet with 7 children in it. Some wandered to other's beds. The babies were in makeshift warmers with light bulbs for warmth. Of course, the whole place is open and few lights- shade is cooler, so there is a breeze. Also wasps landing on us while we rounded. Lots of children wanting pictures taken. Loud systolic murmur on small baby with ASD and VSD, failure to thrive, there to finish an abx course.

Other stuff:
Many Muslim women in black kaftans with head coverings. Some with face coverings. All must be hellishly hot.
Grandmothers tend to sit in front doorways behind screens in rural and urban areas here. Its funny- you see this face low to the ground, watching the traffic outside, in every single house. I imagine Georgie everytime.
We had Dr. George ask the parents why every child has a thread around his belly with an amulet. They told him that the elders say they must have it, so they do. They have no idea why! Bharvi did note that some places they note a family or town's deity and are for protection. Some of these kids had the amulet and a rosary. One 5 yr old boy had a very grown up leather watch. He cried and cried during auscultation and then kept checking his watch saying it was time to go. That was pretty funny. Especially in the land of no time.