Monday was the first day of the medical officers’ course which has brought 15 doctors from different parts of India to the Bungalow. We shared breakfast together and then walked to the training unit where classes were held. Dr. Loretta is an incredible teacher. She knows exactly how to command a class and combine lecture with discussion. We learned about the pathology of leprosy, drugs, immunological reactions, relapses, resistance, primary and secondary deformities, diagnosis, drug distribution, treatments and contraindications, among other leprosy-related topics. The next class was on eliciting patient histories. We were split into groups and assigned to unknown patients. We had to elicit a history from each patient, make a diagnosis, treatment plan, and construct a problem list. Then we presented each case in front of the class and got feedback and critique. We learned about the ideal patient history and examination (which is very time consuming) and the practical one where you focus on the most important aspects of the inquiry and neglect some of the other information. There has to be a compromise in the busy OPD because at the end of the day you have to see all 500 patients and throughout the day each patient must get quality care. Difficult to accomplish but there are some skills that help speed things up while maintaining thoroughness.
After case presentations each day we would go for lunch at the old bungalow which was always elaborate. After lunch experts from different departments- physiotherapy, surgery, prosthetics, counseling, community rehabilitation would come in to lead workshop in their specialties. This was very interesting and in-depth. Finally at the end of the day Dr. Loretta would teach another class in which any doubts from throughout the day would be clarified. The week of clinical intensive was reminiscent of the best courses at Bard. Classes were engaging and challenging. We took notes, had homework, and had to pass an exam at the end of the course. The best part of the course was patient interaction (of course this part was not reminiscent of college) . We saw so many cases and got to learn about patient examination by practicing it. At the end there was a little ceremony and we were each issued our certificates for the course.
I woke up in the wee hours of the morning feeling a dangerous lurching in my stomach. I thought: oh I really should take care of this now (get it out), but it was so early and I just fell back asleep. When I did rise in the morning, the poison in my stomach did too. It was not graceful. I sprinted to the toilet where I spent the whole morning vomiting. I became very weak, dehydrated, and spiked a fever. I would walk from spot to spot in the house falling asleep in each place. The effort between places was intense. I finally mustered the strength to walk to the hospital accompanied by the film maker. I collapsed against a pillar in the ulcer ward and was immediately approached by concerned patents. They called the nurse who whisked me away to the nurse’s station where she took my blood pressure, temperature, and gave me oral rehydration salts (ORS). I then took a long nap on one of the roofs on the hospital side before making the long walk back to the old bungalow. More sleeping. I ate a piece of a banana. I started feeling stronger. There was a plan to have a party in the old bungalow tonight because it was the Brits’ last night. We invited our party staff over and I slumped my head against the table. But then I started feeling much better and before all the guests and gone I was wide awake and feeling fine. Thapa stayed and we talked for a long time about religion (very dangerous topic and somehow I keep on getting into these kinds of conversations).
Today surgery was exciting because a camera man was in our midst. He took some amazing footage of reconstructive surgery of the hand, foot, and even a hernia. Walking to lunch he confessed eating might not be a possibility after seeing what we saw in there. That made me realize how accustomed I am to seeing gore and blood. I could probably eat a sandwich in the OT during a hydrocoelectomy if it weren’t unscrub. This also poses social issues because I have no problem discussing things that make peoples’ stomachs crawl over lunch. Im beginning to think I am developing social condition here- like I don’t know how to have a normal un-medical conversation.
After lunch I went to find Mukesh for an interview. The film maker wanted to capture his story. Hopefully that will help him, the poor guy. I heard that he has been discharged but he is being held at the hospital because his father refuses to pick him up. I went to the OPD after this and spent the evening with patients in the examining room. Late that night I accompanied the engineer back to the hospital to help build the solar cooker. We folded massive pieces of cardboard into 15˚ angles and covered the surface in aluminum foil. It was very chilly as we worked into the night. There were these weird iridescent beetles that ricocheted themselves 30 yards along the cement. When you touched them they would stand up on two legs flapping their wings like helicopter blades, rotating around while emitting a strange smelling odor.
These guests from England came today. They were really funny, light-hearted young guys— a sustainable engineer and a film maker. Immediately I thought of connecting the sustainable engineer with Krishna Gurung and the film maker with Jeff Johns. The engineer spent his time here building a solar cooker out of cardboard and aluminum foil and surveying the electrical and sewage systems on the campus while the film maker went about capturing daily life here and conducting interviews. The English guys also fell in love with Ram Ashish’s kids and spent hours trampling around and playing sardines with them outside. The film maker got footage of me in the OPD examining patients and taking their histories in Hindi. That evening everyone in the bungalow was completely exhausted and we all turned in around 11 PM.
1) it has aesthetic value, making use of the atrium at the entrance of the hospital
2) craft making as occupational therapy for the patients
3) craft making as empowerment, career development, and skill sharing
4) fundraising opportunity
5) colorful shop for out patients and hospital visitors to appreciate
We wrote notes for a while and then went on a nature walk around the campus to collect nature pieces and ideas. Thapa knows all the secret spots on campus. We explored a stream, collecting seed pods and leaves as possible materials for handicrafts. We climbed the crumbling cement wall to peep over into the neighboring jail. We collected peepal leaves, pinecones, and noted the location of felled trees for whittling. We climbed the watertower up to the tippy top. Looking down we could see yellow, blue, and white butterflies fluttering around in the tree canopies. Then we slinked back town the rickety metal steps, hoping not to have been seen by anybody.
We went to cottage patient lunch in celebration of Diwali. I asked if I could invite Sumit and when I told him he could come to special lunch he was so excited. He proudly carried his metal bowl over to the games arena where we would share a picnic on the floor. He ate many sweets and enjoyed the company of the kind long-term patients. After lunch he wanted to finish his car painting and ABCs. The kids were all hanging around the canteen watching us paint after lunch. They wanted to play inside the arena. Sumit, a bit of a trouble maker, unlocked the door and held it open for all of the kids. They dashed inside and began kicking balls, hitting birdies, and rampaging around the room. We played kick pass with one ball which soon turned into three balls because the kids kept taking more of them off the shelf. Finally I said enough and took Sumit back to his room.
It was a magical night. Ram Ashish’s family had decorated the whole bungalow in candles: on each step, along the cement wall, atop the roof, lining the sidewalk, on the back porch. the candles flickered as the kids set off fire crackers. We delighted in playing with them as the night sky filled with light streamers, sparks, blitze cracks, and smoke from neighboring celebrations and our own. We danced on the roof, setting off these mushroom fire streams that make a whirring sound as sparks shoot up vertically in a jet stream. We told the kids we would be back in an hour to continue celebrations with them, but for now we had to visit the hospital.
There Mukesh and Sumit were holding fire sparklers high above their heads laughing. They dipped fresh sparklers into a candle, then when the sticks erupted in flame the boys would spring to their feet and whirl around (kind of dangerously). After sparklers we snuck Sumit to the mess for special Diwali dinner. I asked the cook if he thought it would be OK to share with Sumit and he said no problem so we sat outside enjoying special treats. Sadly Sumit is not allowed to come to the old Bungalow and it is really hard for me to have to tell him this everyday that he asks. I brought him back to his room and returned to the old Bungalow for continued celebration of Diwali with Ram Ashish’s family. Vikas and the girls painted our feet with henna.
That night we had a party in the old bungalow because tomorrow is Diwali, a hospital holiday. It felt so good to relax, dance, and fill the house with friends, beer, and laughter late into the night