Last week, I observed in the pulmonary medicine department in Santhiram and continued working on writing an e-book on Bharosa. Here is a little bit of what I have done.
Pulmonary Medicine and Issues of Tuberculosis
These signs are in the waiting room of the pulmonology department in Santhiram.
The general set up of pulmonary medicine is very similar to that of general medicine. Patients are seated in the waiting room that’s right outside of the office, and each patient is called in one by one. Most of the patients who come to this department either have tuberculosis (TB) or asthma. Prevalence of TB in India is high due to various reasons. With a population of over 1.3 billion people and overcrowded streets, there is a higher probability of being infected with M. tuberculosis. Also, high poverty rates and decreased access to health care reduces the chances of being diagnosed with and getting treatment for TB. Discontinuation of TB medications continues to be an issue. Some patients come in, saying that they stopped using their TB medications after 3 or 4 months, rather than the recommended 6 months, because they were feeling better, but now, they are again sick.
Currently, TB medications are provided for free by the government of India in a concerted effort to decrease TB incidence rates in India. As a doctor in the pulmonary medicine department in Santhiram had told me, patients are diagnosed with TB in hospitals; the patients then present evidence of this diagnosis at specific centers in villages, where they receive TB medications at no cost. If there comes a point in the next ten years were TB medications are no longer provided for free, then the incidence rates of TB will increase dramatically, according to another doctor at Santhiram.
So, if so many patients come in with TB, how do the doctors ensure that they do not get infected? The OP room is highly ventilated with three large windows and numerous fans so it is very unlikely that TB will lead to infections in the room. Also, the patients are asked to cover their mouths with cloths because they may cough. In terms of diagnosis, many patients are asked to get a chest X-ray and a bile test (if the patient has been coughing bile), which allowed for diagnoses that ranged from TB to cancer during my time in pulmonary medicine.
This is the pulmonology out-patient room that is ventilated to highly reduce the chances of infections.
Here is a sample of the notes that I take while observing in Santhiram. Most of my notes include histories and diagnoses of patients, and any relevant information that the doctors or students tell me. I numerate each of the patients’ stories that I have seen so that I can know how many cases I have been introduced to each day.
Here is a sample of notes that I took during my time in the pulmonology department.
The best part about observing at Santhiram is that each day is so dense and so different that I learn so much about medicine and public health in different perspectives every day.
The e-book that I have been working on preparing during the past few weeks is on the establishment of a support center for women and children in Hyderabad called Bharosa. I visited this center last winter while I was working on writing a journalistic article on the work of non-governmental organizations (NGOs) in reducing child labor trafficking in India. I had already been interested in learning about human trafficking before I wrote that article, but the interviews that I had conducted, the places that I had visited, and the stories that I had heard during that winter had turned my interest into an issue that I wanted to actively help decrease (for example, by raising awareness of the many elements that provide context to this issue).
Bharosa is a support center for women and children in Hyderabad.
Bharosa was established in Hyderabad with the intention of providing a one-stop crisis center for women and children. This is meant to help reduce revictimization because usually, victims go to police stations, courts, and hospitals where they are repeatedly asked to recount the abuse; however, in this one center, legal and medical services are provided by trained and sensitized employees to ensure that victims feel safe. Psychological and counseling support is also offered to help victims recover from abuse. Within just one year, this center has helped over 1000 victims.
I will write about the audio files and the documents that I read for the Bharosa e-book in another blog.