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Day 15 - Hiking 1

After the rounds and clinics, we went for a walk around the hospital, trying to climb some peaks. Since the last walk to the lake, we are pretty sure we can orientate quite well around. But the weather is not really good and it was raining.

Enjoying the view?

Day 16 - My first POP

Today I told Bhim about how we use to learn all the theories but never get a chance to do it ourselves in the university. Then his reply was so easy, ‘You will be doing the next POP.”

It wasn’t a long wait, there was a boy who came in and needs a POP. So, as promised, I got the chance!

Not hard at all. LOL. Anyway, this is the experience I want. It doesn’t matter whether it is going to be my work in the future or not.

This is Bhim Bahadur. Lol. Bahadur means brave because he was a watchman for the hospital and had seen bears and tigers during the early years. During those years, the hospital was not as well equipped as it is now and the nurses are scared to go to the ward at night to change the drips and etc. So everything was done by Bhim the watchman, and slowly the doctors decided to send him for proper education and today, he is the main assistant in surgery and the one who will do all the POP in this hospital.

Playing with light when the power is out.

This is how they travel to the hospital.

Day 17 - Hiking 2

Decided to try our luck and walk to some other peak. The view is breath-taking but too bad the majestic view can’t be express fully in small pictures.. You need to see it for yourself.

I’m enjoying the view, but too bad you only got to enjoy viewing me. LOL.

Day 10 - The Walk to Lamtaput

Since today is a Sunday, we decided to walk to Lamtaput to get our Indian sim card again. It was a 2km walk to Lamtaput and a 2km walk back. The scenary is great! Have a look.

Love this picture. Very green indeed!

At the 1km Lamtaput mile stone.

Laughing at the small goat.

Day 11

Nothing special today, just normal ward rounds and clinic, we cycled to Lamtaput again to get the sim card as the shop was not open yesterday.

Day 12 - The Bear

The weather is getting cold as it starts to rain almost everyday. Yesterday night when Dr. Ravi was out for night round, he spotted a bear near the mess eating jack fruit. There is a bear talk in the hospital and night rounds become quite an adventure as we will have our torches and constantly looking out for big black creature that moves around.

Day 13 - The Bear II

We heard the bears fighting yesterday night, they sounded like big dogs, very big dogs. LOL. I’m lucky that I was in my house and only sit quietly listening to their growlings when the electricity went off. Oh, did I mentioned before that power shortage is very common here. There can be 5 to 6 power cuts a day. Even thou there are 3 dams built around this area to produce electricity but power cut is still very frequent. Bad governing I think.

Today we had a tea break in the evening in Dr. Vinod’s house as well. Discussing pulmonary hypertension over tea is really stressful but fun as well. I guess this is exactly how it would be when a specialist sit down and have tea with the junior doctors. LOL. This is my first time as well.

Oh, forgot to mention, today is chicken day. LOL.

We went for a walk with Dr. Emil as he has a half day off and there is no rain. We tried to walk to the lake but the lake is still not full yet. Even thou the streams are forming but most of the land is still dry. You can see us standing at the bottom of the lake-to-be. Orissa really has breath-taking sights! I just feel that I’m very close to nature. It is just us, the land, and the sky.

I’ll let the pictures do the talkings.

Waiting for Dr. Emil in front of his house and getting ready for a long walk.

Can you spot me? I’m that small spot at the lower left corner. Just to show you how big is the tree.

Fishermen trying their luck.

Dr. Emil and I at the lake-to-be.

I like wide space.

After this picture I successfully (accidentally) made some of the soil fell into the padi field due to my weight and the whole pool turned red. Nevertheless, I ran away before anybody notice.

Nature is the best!

Day 14 - The hunt

Morning and afternoon went off just like normal days but at night we went over to Vijay’s and Arun’s place. Both of them are our radiologists. “The X-ray guys”. Both bachelors. LOL. We went out crawling in the dark hoping that we could meet up with the bears. But luck is not on our side. Or I should say we were actually lucky to not see the bear?

There were pictures of victims of bear haul. With eye balls dangling and stories about a whole straight to the brain. Meeting a bear is certainly not a thing that I would experience but hell, if it is with the X-ray guys, then I think I’ll be safe.

Anyway, the mission is a failure.

This is how it looks like outside the wards at night.

Beginning on hunting in front of the x-ray guys room.

Coming up, my first POP by myself and Bhim! Days in Asha Kiran Hospital coming to an end.

Day 8 - Visit to Balel

Today is my lab day. Well, nobody decide it for me but I think today I’ll be a lab boy instead. So I meet up with Pankaj who is working there and he showed me how things are done and before long, I was poking people’s finger and preparing smear. Pankaj gave me a chance to mingle with the microscope as well, so I had chance to see PV and PF’s cells, AFB and etc. Not bad at all! I actually enjoyed it, because it makes me felt like I’m helping, althought it is just for a little bit. (better than getting into the way).

In the afternoon we visited a village called Balel. This village is situated quite a distance from the hospital and the purpose of this visit is to inform the villagers about the hospital’s services. It is the first time that I saw a witch doctor as well.

They have lotsa cows in the village.

People gathering up and listening to us. It is really stress having to sit in front of so many of them.

A view of the village during a walk.

The water source.

Sometimes in the clinic, we can see children complaining about mild fever for a very long time (usually due to either malaria or sickle cell disease) and during examinations, would review burn scar of crosses or circles on their abdomen. According to the doctors, these are the doings of the witch doctors. What a bad way to treat! The witch doctor was there trying to tell that our treatments are useless and his is the correct way. (duh~)

Oh not to forgot to mention that today is the day we meet up with Dr. Emil, who just got back here today because he had a holiday due to Malaria. He held the highest record now, 3 times in a year.

Day 9 - Saturday is Market Day

The nearest ‘town’ is 2km away. It is called Lamtaput. Well, the town is actually smaller than a town but you can get some basic stuffs there. I’ll let the pictures do the talkings.

See the colorful vegetables they sell there.

But they are more or less the same thing all along the street, the so called ‘town’.

Lamtaput town, Koraput district. Villagers can travel from very far away just to get their daily needs.

Me looking all stress up by the environment.

Coming up, night rounds with bears and the majestic scenaries!

Day 3

Today is a Sunday. We woke up with some mild headache because of the Chloroquine we took yesterday. We don’t have Malaria, it is just for prophylaxis. Well, nothing much for today as we slept most of the time due to the headache. A baby was admitted today with fits and fever, and if you read my post about my first time doing a cardiac massage, well, this is the baby.

Day 4

Today consist of practically the same ward rounds and clinic hours. We observe and observe and observe. What’s special about today is that Mr. Jacob, one of the staff of Asha Kiran Society explains us what Asha Kiran is all about. Besides hospital, they helped the locals by educating them, doing agricultural work and linguistic work. Basically something like analyzing their language (which is very different for each tribe), try to record them down with words, and teach it back to their children.

Day 5

I had already blogged about today, if you are still interested in reading please click this link here.

Day 6

Today is Wednesday. It’s the chicken day! Well, in a week, only Wednesday and Saturday will be of non veg meals. Wednesday is the chicken day, and Saturday is the fish day, other than that, we will have vegetables and curry and eggs sometimes. Suddenly, chicken has a whole new meaning in my life. I never know that I will miss it when it is not there! LOL. Living for few days without meat is really weird.

Today is my turn for surgery. Observed and helped out with some of them. Learned a lot of course as Dr. Ravi likes to ask. Hahaha..

Day 7

Who said medicine is all about human? Today we went to examine a sick pregnant cow which is not eating since yesterday. After some examinations, they all agreed that there is a weird lump around the neck and to give the cow some nutrient, we need to infuse it.

But how to?

It end up with some big IM injections and BIG tablets (meaning forcing the cow’s mouth open, throw it in and pour in a lot of water.)

That’s me in the clinic. And the one next to me is Dr. Vinod, my idol -lah.

You guys might wanna read on the previous India Day 0 - 2 as I put in pictures and altered it abit already. More interesting stuffs to come!

Well. Had my infectious exam this morning. Kinda’ had a long wait for my turn as well, basically some 20-30 minutes questioning per student. I was in the first batch. The questions are okay. It sided me thou, and luckily I didn’t get something which is too rare until I can’t remember. Let’s see my questions:

1. Measures to liquidate epidemiological center/nidus? (Argh, don’t know what it is called in English). Epidemiological inspections.
2. Brucellosis. Clinical, diagnostics, treatment, prophylaxis.
3. HIV. Clinical, diagnostics. Aids associated diseases.

Scenario : A case of Ornithosis/Psittacosis/Parrot fever - luckily I revise before I go.

Basically my theoretical questions are not too bad. And after the exam, I decided to reward myself with some McD burgers and 1 liter of Sprite.

Kesian? I think this is good enough for me -lah. Up until now, my brain worth nothing. So 2 burgers still kinda’ overrated my brain. Haha. Maybe when I start working, my time will worth more. An hour 5 ringgit maybe? Haha.

Next paper to come.. Wanna take a nap first!

Tomorrow is my infectious paper. I got one word to say today.

Yay, finished first paper for this whole exam this morning. Phew~ One less burden FOR THE TIME BEING! Didn’t slept well yesterday night but now want to enjoy for a while, before starting on my next paper’s preparation later this afternoon. Enjoying my black stuffs (not Guiness, I wish I have them here! It’s Coke!)
Let’s see, these are the questions I got for today.

1. Differential diagnosis of joint diseases - I think this question is unfair. It is a lot of question in one question, which result in me using up a lot of my power!
2. Present-day treatment for nephrotic syndrome - This question is funny. My book is up-to-date so I don’t really know what is the old-day’s treament for nephrotic syndrome. So obviously all I know is ‘present-day’. I don’t have so much time to read old books, I believe most students don’t, esspecially when there are a lot to remember nowadays.
3. Aortic stenosis. Etiology, pathogenesis, hemodynamics, clinical, diagnostic and treatment. - This question, for 3rd year one. So I’m lucky I met it here in 5th year.

That’s all! Pretty straight forward. I think there are giving us a nice starting ‘honey-moon’ first as I’m surprise there wasn’t any case to diagnose or any analysis to analyse. Heard that we will be getting everything in surgery.

My messy table for this first paper. All the volume 1 & 2, pediatrics and even obstetrics books are out. Can clear them up to one side now =)

p/s : I booked my ticket to India! Hopefully this will be a life changing trip! Looking forward for a lot of manipulations and surgeries. But one fact you need to know about me, I like Surgery (and study them) more than Internal Medicine but I NEVER, I repeat, NEVER, get a 5 for Surgery. Something always happen. Don’t know why. An opposite story of a great surgeon to come? Doubts..

Let you all have a glimpse of my studying table in the kitchen. Hehe..

Got food, got drinks and got books. It is curry chicken with tomatoes and macaroni! Almost perfect. Would be better if got bed!

Just simply draw this while revising and wanna stick it to the wall near my bed. Hahaha. I found out that we seem to remember very basic stuffs when we know more things. Back to the basics!!

Exam mode is on the go. I’ll try to be as brief and only write down some stuffs that I think is worthy to be shared.

Rheumatoid arthritis – chronic systemic inflammatory disease of the connective tissue characterized with erosive inflammatory process of the joint and extra-articular presentations.

There are a lot of classifications in Russia (better remember a few to tackle the exam).

• By numbers of joints involved - mono, oligo, poly- arthritis.
• Rheumatoid arthritis with extra-articular manifestations.
• By rheumatoid factor – seropositive n seronegative
• Stages (radiological) – 1. Periarticular osteoporosis, 2. 1+narrowing of joint space, 3. 1+2+multiple erosion, 4. 1+2+3+ankylosis.
• ?????????????? ??????????? – 0-?????????, 1-???????????????? ??????????? ?????????, 2-???????????????? ??????????? ????????, 3- ??????????? ? ???????????????? ????????.

Clinical presentations – Boutonniere’s deformity, swan neck deformity, Baker’s cyst, ulnar deviation, deformity of MTP joints. And a lot more, read yourself lah!

I like to remember (first 2 is always mentioned in Russian books).
Felty’s syndrome – RA + splenomegaly + low WCC
Still’s syndrome – polyarthritis associated with high spiked fever, sore throat and erythematous rash.
Sjogren syndrome – keratoconjuctivitis + disease of connective tissue (autoimmune exocrinopathy)
Caplan’s syndrome – necrotic granulomas in lung + RA in coal miners.

Diagnostic

They like to ask what is RF – it is an antibody against IgG (also an antibody). Can’t find more detail info about this. Anybody want to contribute?
New diagnostic that you MUST remember is anti-citrulline-antibody – also used for diagnosis of RA.
And many more which you read yourself.

Criteria for diagnosis ARA 1988 (any of the 4 or more)

Morning stiffness > 1 hr, arthritis of 3 or more joints, arthritis of hand joints, symmetrical arthritis, rheumatoid nodules, RF, radiological changes, duration of 6 weeks or more.

Anybody have a mnemonics for this? Or free to make one? But I think this is easy to remember. I would remember it this way:

The disease is called RA, u must say 3 things starts from ‘R’, which is R nodules, RF, and Radiology, 3 things about the ‘A’ - arthro (joint) - which is stiffness, symmetrical and mostly hands. The other one is to differentiate whether it is reactive or RA itself - 6 weeks to do so.

Treatment – DMARDs, NSAIDs, prednisolon, surgery, physiotherapy.