Rush to get there by 8, then IST strikes again. But amazing surgical rounds and got to see surgery! Again, a quick summary of the day. Yesterday we vowed to be on time, which is no easy task because it takes about an hour of public transportation to get there. There is a CMC bus that goes there every day, but for some reason this bus is strictly for staff and no students are allowed to ride... so instead we foreigners stumble our way through a new bus route that takes about 45 min and then take an autorickshaw from there about 12 km to the Karigiri Hospital. Fun times. The afternoon bus ride back is especially awful as the heat boils a metal bus packed full of people as it bounces back and forth down the road. But that's besides the point. So we busted it this morning and made it to Karigiri by 8:00 a.m. on the dot, cause that's when our printed schedule said that surgical rounds began. When we walked in to ask where we should go for rounds, we got a puzzled look and the reply that rounds don't start til 9:00 a.m. Ah, kharma ;-> Despite the frustration, surgical rounds were well worth the wait. We got to see more chronic wound pathology, abcesses, and writhing maggots in one morning than I had seen in my whole pathology course! The message in Dr. Paul Brand's book was really driven home for me to see, both leprosy patients and advanced diabetics, suffering from complications of painlessness. Of course, not all of the wounds we saw were from painlessness. No, Karigiri has adapted it's services as Leprosy has declined. What they learned from their pioneering work with leprosy, applies to chronic wound care regardless of the etiology. We saw a patient with frost bite from Nepal. We saw a local gentlemen who had fallen over with his motorcycle and suffered a severe 3rd degree burn to his calf muscle. We saw about as many non-healing diabetic ulcers as we did ulcers from complications of leprosy. I believe Karigiri will continue to provide a great service to patients in the years to come... diabetes is becoming quite an issue here in India, and posed to be every bit the epidemic that it is in the U.S. The morning of gruesome sights as bandages were removed reminded me how far I've come from my first anatomy labs... instead of being repulsed, I was intrigued by the science, anatomy, and care of each wound. We finished by around 11:30, which was a good thing - once we got back outside in the fresh air we all realized we didn't have much of an appetite just yet ;-> But by the time 12:30 rolled around and the canteen opened up, we welcomed the meal.
The afternoon gave us the opportunity to watch the surgical debridement of a foot wound that had begun tracking along the synovial sheaths that line the tendons of the foot... again the anatomy and science intrigued me, although I was still caught off guard by the way some things were done. For example, we all wore open toed flip flops into the OR. We didn't handle any instruments so I wasn't worried about my own safety, but it still made me uncomfortable after being conditioned to a specific model of surgery in the US. Pain control was given after the fact if the patient was able to feel it, and then it was only a local anesthetic. But they get the job done, they do it well, and they do it for a population of patients that 50 years ago wouldn't have dreamed of such care. An attitude I have discovered to be a good way to experience another culture - it's not wrong or right, it's just different. Regardless, it was an amazing opportunity and made the morning wait worth the trouble!
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