Thursday, February 25, 2010

Hospital Day Four

Got up early and head out to set up for the video conference. Things got crazy as soon as we set up and figured out that we could not see the other conference room. They could see everything and hear everything we were uploading but we could not hear or see them. I scrambled to try and figure out if this was a setting that I had control over. Eventually we figured out that it was not something I could fix and we opted to try another route. Someone had a magic jack and so we plugged that into Doc’s computer and called over to the conference room. We had to set up the router so that we had more than one connection to the internet, and I was afraid that it would hurt our upload speeds but it did not. So Doc had to wear an earpiece and conduct the interview that way. It wasn’t ideal but it got the job done. We started out by bringing out some of the crew we had been working with throughout the week and introducing them. Then we got the staff that worked at the hospital that had been helping our crew care for the patients all week. The kids and families all lined up at the window outside of the entry way, which is where we were conducting our broadcast. We didn’t get to move the camera outside or up the hallway of the hospital because we had to stay in one place in order to use Docs computer to get the audio with the San Diego room. We brought a few of the families inside and had a few questions for them on camera. It seemed to go over really well and was a big hit with everyone who participated. Word came back to me after that no one had fallen in asleep during the conference and there was standing room only! It was a victory:-) We managed to make it through the whole thing without losing our connection once which seemed like a miracle.

After the conference wrapped up I worked on wrapping up the cords and breaking down the mobile cart we had built. The guys who work here at the hospital all helped me with wrapping the cords and putting things away. They were so great and helpful. I also learned from J how to wrap my cords so that I could throw them down the hall and they would not be tangled.

After getting everything put away I was told that a few people were going to go into the street and shop so I asked if I could go and take pictures. I jumped in the car with another one of the photographers, C, that was on the trip. We went to a store where there were Sari’s and the women proceeded to purchase a few items. I took a few pictures and then sat on the side wall inside of the store waiting. One of the guys we were with looked at me and laughed. When I asked why he looked and me and said you are sitting here like you own the store! I jumped up and quickly moved but he said it was ok. I had no idea that the store owners sat at the front of the store. Soon it was time to leave and C and I went with 3 of the guys who had brought us. They said we were going to go on a tour of Damoh and see the old Damoh and the new Damoh. We went slowly away from the store and asked if it would be ok to roll down the windows so we could take photos. They said it would be fine and to let them know if we wanted them to stop. We started down the street and immediately a man approached us and offered us drinks. We politely said no thank you and he insisted. He kept saying the drinks were free they were on him. Eventually one of the guys in the front told us that it was his friend and that it was ok to accept the drinks. They had a good chuckle while we were thanking the man for the drinks. He handed us Mountain Dew and Coke in plastic bottles! We had seen Pepsi and Mountain Dew but everything was in glass bottles and a few aluminum cans. We stuck our drinks in the seat next to us and continued to take pictures. We headed up to the top of a hill where we could see old Damoh on one side and on the other side was New Damoh. It was a very beautiful view point. There was farm land and we saw the pipes that they used to bring water into Damoh. We were told that they bring water in from some dams that were near. As we were taking pictures on this hill top, it seemed from out of nowhere a man, woman and a dog came up the hill side and he starting speaking very loudly and waving his arms about. We thought he was upset and C looked at me and asked if we should run for the car. One of the guys we were with said it was ok and then translated to us what the man was saying. He said he was praying to his god that we were happy. We breathed a sigh of relief and ended up getting in the car anyway. We thanked him and then went on our way. On the way back to the hospital compound we were driving through town when the Magic of India Man, a Sadhu, approached the vehicle. He approached on the opposite side of me and I had my camera ready so got the picture. Its one of my favorite pictures. IT all happened so quickly and was gone just as quickly. We finally arrived back at the hospital and our grand tour was over.

I was so grateful that I was able to see the beauty of Damoh and take pictures of it.

Wednesday, February 24, 2010

Hospital Day Three

I stayed with J in the am at CICM(Central India Childrens Mission, I was referring to it as the orphanage,where we are staying) That was good because it allowed me to catch up and post a few pictures to the blog. Then at noon I was called over to the hospital because the monitor we were waiting to get had arrived. We plugged it in and tested it. We had to adjust a few settings but eventually we got it to work. After we got it to work we had to put together a way to get it all together and make it portable. I got some help from Mister MacGuyver in building a unit that would fit our purpose. We managed to use zip ties, duct tape, and velcro! It is quite the set up now.

Im between the set up I watched a little slide show that J had put together. He is filming here and taking pictures and I asked him if he could throw a little something together that we could share over the teleconference if things did not go as planned. He also took some time to show me a few of his photography lesson that he uses to teach his kids back home. I learned an amazing amount of useful information. I am learning how to better utilize my fancy camera:-) Its amazing that some of the rules of photography I was doing just naturally without knowing they were rules!

I then took the traveling Gnome around on a picture tour of the hospital. He had quite the adventure and we got alot of really nice photos. The crew here is just amazing. I am in awe over how well they function together and what a beautiful job they do with these patients. There are many issues that pop up over here and nothing seems to slow them down. The power here gets cut off at 6am-10 am and then again at 5pm to 6 pm. The hospital then has to go onto a generator. There is usally a lag time in between when the generator kicks on and the power is cut off. It only took me this long to figure out that it happens every day at the same time.

My ride over to the hospital this time was at noon. It was quite neat to see the town in full swing. Kind of like a monday in the US, everyone was back to work. The driver told me that Damoh is known for making Bidis which are little cigarettes. The families roll bidis and get paid 40 rupees for 1000 bidis.It takes them all day to roll 1000. When I asked him how much does it cost to feed your familiy for one day here he said about 240 rupees to feed a family of 4. One US dollar is worth 45 rupees. Also I learned that Damoh has 1.5 million people here. I am not sure what the amount of landspace is but it is incredible! After investigating a bit more Damoh has about 150,000 people in the town itself but the District of Damoh is 1.5million people. Damoh is 2821 sq miles, which is close to the size of Delaware at 2489sqmi.

When I arrived I was given the monitor for my project. The only known flat panel high definition televinsion in Damoh. We hooked it up and tested out the Lifesize. Its the portable unit we use for the telemedicine conferences. We managed to get it connected, just had to change the dns server address and a few other settings. Our speed was pretty poor 126kb but it was possible that it might just work. So we went to planning how we would conduct the conference. We planned to try and show them what life was like here in Damoh at the Hospital. How there are so many cases of Cleft lip and palate here the numbers are just amazing.

The staff set up large tents which the people stay in while they are here if they cannot afford to stay elsewhere. They travel many hours by bus, some of them walk for days or weeks to get here. Sometimes many of the family members come along. Sometimes its only the father or grandfather. They cook on open fires and bathe by dumping water over themselves.

It took a few hours to get set up and after the planning we loaded up and got on the bus back to CICM. Reports from the other crew came back that the mayor of Damoh had come to visit the hospital after the first bus of people had left (which I was on) Interesting that he chose to come after 9pm. At any rate I hope it was a good visit for the people who run this hospital.

Still hoping that things will go off without a major hitch and the live broadcast works!

Tuesday, February 23, 2010

Pictures

From India


From India


From India


From India


From India


From India


From India


From India


From India




From India
India

Hospital Day Two

We arrived at the hospital and started to work right away. I worked on getting schedules up and printed. Once that was finished I made a trip over to the tent that was beyond the garden to take some pictures. I took quite a few pictures and spent about an hour in there with the families. Then I went back into the hospital and was given a new assignment. I was to interview the first three cases for thursday morning.

We are hoping to be able to broadcast live that morning back to the telemedicine center at UCSD. That was my major assignment for this trip to make the tele broadcast work. Upon arrival and unpacking I figured out that I did not have the hdmi to dvi adapter that is required to hook up the unit to the monitor. Without that I cannot see what I am doing in order to get things up and going. When I realized that this peace of equipment was missing my heart sank. How could I have forgotten this? I double checked that all the wires and cables we needed were in the box more than once. I took the equipment out multiple times also but not once did I think of looking for that adapter. The adapter screws into the back of the monitor and the last few times I broke it down I just left it screwed into the monitor. I started to run through my head how on earth I could have left that at home and where it could have been. I took a deep breath and looked through all our boxes once more. I was not expecting to find it but had to make doubly sure it was not there. Yet another lesson even two to be learned here. Always make a packing list and tape it to the inside of the box so that I can ensure this will never happen again. Lesson two letting go. I wanted to cry for a brief moment when I realized we would not be able to run the show without this. Breathing in and out I let go of these thoughts and the new thought that entered was “The Magic of India”. I went right to the tech support people that were here to help us and told them I needed this piece and asked them if the knew where we could find one. Then I also relayed that if we could not find one any flat panel hi definition television would work. The set out to try and find this for me. Another issue for the broadcast was the internet connection. When we first arrived it was getting 28megabits per second down and 03 up. It was also dropping the connection every few minutes. When I first looked at the computer set up here I had to reconfigure the network wetting because there was no working internet connection. Once I reconfigured it I was able to test the speed. It is hooked up through a dsl modem. After figuring this out I once again went to the IT crew and asked them if it was possible to get the internet running any faster. They told me they would work on this but it would probably take 3 days to make it happen. Without a faster speed we would not be able to live stream with our equipment. Once more I breath in and think “The Magic of India” and left them to figure out their work.

I set out on my task at hand, I had to find someone who would interpret for me and translate so I could find the families with the 3 patients. I found Sanjay and communicated to him my needs and he told me we would go over to the other building where they had a pa system set up he would make an announcement so we could find the families. I went back in the breakroom and got C. to come take the photos while I did the interviews. We set out to the other building and the calls on the pa were made. It took a few minutes but the first two families appeared in the reception area where we were standing. I intereviewed and this is the information I came up with.

  1. 1. Pawan Patel is 8 months old 9 kg male, Left Cleft lip repair. He and his family live in a town called Rithi. It is a 3 hour bus ride into Damoh. He is here with his 25 year old Mother, Raina, and maternal Grandmother. They heard about the surgery clinic at a fair festival celebration in their town. They got a handout from a booth. They say this surgery is going to change his life for the better and are very thankful to have the opportunity for the surgery because they could not afford a surgery like this. The father is a laborer and could not come because he was at home working. They have one other son who is 3 years old.
  2. 2. Mantri Kushwahar is a 9 year old 19kg male, Palate repair case. He and his family are from Fatehpur which is a 6 hour bus ride into Damoh. HE is here with his father, who has one other son. He is a Vegetable Vender but does not grow the vegetables only sells them. They came here for a previous surgery in 2007 with leap and during that time the fixed the cleft lip and also his right forefinger was burned and contracted so they fixed that also. He is in his second year of school studies and brought his books so he could study for his tests when he gets back home. His favorite food is Apple and his favorite game is pulling a tractor around on a rope, he drags it behind him. When he grows up he wants to become a doctor. When I asked him how he feels about the upcoming surgery he said he is happy about it and very thankful that he will be better.
  3. 3. Sibendra Patel is eleven months 20 days old 8 kg female. She is here with Father and Mother who are 26 and 24 and have been married for 4 1/2 years. This is their first child. They live in Rewa which is 4 hours to Damoh by bus. The Fathers younger brothers wife is here with them and they are staying at their house. Father works at HeroHonda the motorbike company as a packer. They expect that this will change their child’s life forever and make it better than ever before. There are no other children with clefts in their village and this is the first one in their village and all the surrounding area. They have no worries or questions about the surgery as they are putting their child in the hands of the surgeons.
I got all this information together and started to get the pictures together for the powerpoint presentation. While in the office/breakroom one of the crew came in with a stomach ache and not feeling well. He, P. sat down and rested a while. We had another crew member that had fallen and sprained her wrist on the first day at the hospital so it was wrapped up. She,G. also had a tooth abscess in her mouth and probably needed a tooth pulled. G. was taking antibiotics and went over to the dental clinic to see if they could drain the abscess and asses the situation. G. and P. and S, the director of the program went back to where we were staying.

We had a lunch of what they called fajitas. It was the flatbread they make with chicken and vegetables inside. Also there was a chicken broth and a little dumpling place in a cup for us to drink. I am really enjoying the food here. Everything I have eaten has been good. I love the curry potatoes and spinach stuff they make.

Throughout the day the hospital staff are really great about offering us tea and drinks. There is a fridge stocked with bottled waters (Aquafina) and bottles of Pepsi, Mountain Dew and a few others. The Masal Chaia tea is so great.

The day continued on and it was getting rather warm outside. We had air conditioning and a fan running in the medical hospital. The break room managed to stay at a fairly nice temperature. As the day went on I started giving should and neck massages to the crew. By this point everyone was getting pretty sore. Doing multiple surgeries one on top of another with limited amounts of supplies and equipment is really draining. They were all so appreciative of the massages. After that I returned to editing pictures.

Next thing I know Doc comes in and says to me, come in here I need your help. I drop what I am doing and go into the OR3 room. There is a patient on the table and she says to me scrub in I need your help. I had to pee and should have gone before coming into the room but when she called me it sounded urgent so I didn’t dawdle I just rushed over. I scrubbed up and got my gown on and prepared to assist. Patient was a 22 year old male with a major burn. He was deaf and could not hear, I think if I remember correctly there may have been some sort of explosion and that is how he was injured. His burns happened two years ago. I am not sure if he lost his hearing due to the accident or he had hearing loss before that. The portion we were working on was trying to free up his shoulder so he could lift his arm. Doc made the incisions and started to free up the arm. I was pulling on his arm and using a great amount of force to stretch his arm up. eventually she got down to the ligaments and then went to work on the skin graft. She had to cut across his lower abdomen almost form hip to hip in order to get enough skin to close the wound under his arm. Eventually Dr. R came in to assist in sewing up the skin graft while Doc worked on the abdomen. Once the patient was closed up they put a cast on his arm and he was ready to be woken up. The next obstacle was that he needed to be in an upright position and they didn’t have a medical bed that could do that here. So we had to improvise and quickly. In comes Mr. Sony! Mr. Sony is super fantastic he is so creative and handy. He came in and then tied a stool up on the gurney and put pillows behind it to make it a functional upright spot they could transfer the patient to. Eventually the patient was slowly becoming awake. It was very difficult not being able to talk to him as he came to because they wanted him to be still and not thrash about so he didn’t rip open his stomach sutures. They got him transferred and into the recovery room and then the nurses from the hospital staff said they would stay with him because they could not safely transfer him to the other building where the rest of the post op patients were.

The rest of our crew cleaned up and loaded on the bus to go home. Word was that G had been throwing up and was increasingly more sick. She is also diabetic which can create additional issues. Everyone was in a hurry to get back and check on her and see how they could help her. Doc ended up staying with the patient as well as the two anesthesiologist N and L. Everyone else traveled back home on the bus for dinner. It was just after midnight by the time we got home. We ate and the doctors went to check on G. They ended up draining the abscess and hooking up IV fluids. After eating we al went to bed. By the time I got to bed it was after 1 and I hadn’t seen Doc so I have no idea when she got home.

We woke up in the morning to find out that another of our team was ill and had diarrhea and vomiting. J had been sick since 2am and so they started an IV drip on her and gave her some Zofran and anti-biotics. While everyone was organizing the plan for the morning I went to find someone to open the office so I could get schedules printed up for the day. I got that taken care of and Doc was working on the powerpoint presentation. I had to email it off to the people back in the USA she was arranging the conference with. The power goes out here at least once every morning when everyone gets up and starts using appliances and turning on lights and such. That kicks the router off and I have to get them to open up another locked door to reset the switch for the router. Every door here still uses skeleton keys and its quite funny watching them try each key to figure out which one works. I am sure the ones who use the office know which key it its but I usually find anyone I can grab to open it for me. While I was working on this a plan was created to move G to the OR in order to clean out the abscess. J was going to be staying here and would need someone to look after her and change out the IV fluids. I was designated that person because S. had done it the day before. S told me she would come relieve me at noon so that I could go out on the trip outside the hospital compound to take photos. We, C, J and myself were supposed to be taken out into the town to take photos because it was going to be an active day at the market. Tuesday is the day that everyone takes off here which is why we didn’t go yesterday. Anyway sitting here has given me the ability to update the blog and type this out. Now I am going to go find the wifi connection so I can send it to you all:-) So far I am feeling great and doing wonderfully, lets hope I stay a part of the group that doesn’t get sick!
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Interview questions

One of the many reasons I am on this trip is to get a Live broadcast of the hospital here and during one of the operations. We are going to be sending the feed back to the telemedicine building at the UCSD medical campus. If things go well I will need interview questions to ask so I need your help. If you could ask the team we have here or even the families or patients questions what would they be and what would you want to know????

Sunday, February 21, 2010

First Day of Operations

Well up on and off all night long. I was snoring and keeping Doc awake. I couldn’t breathe through my nose very well, my throat was sore so breathing through my mouth sucked too. I was so exhausted that I would dose off and no matter what position I was in I would start snoring. I wanted Doc to be able to get some rest but that was not going to happen so I just got up and started to work on the updates.

Right now I am sitting in the office of the hospital. There are operations going on in the two OR rooms 3 surgeons operating on 3 different patients.

We were supposed to start at 8 but this being the first day working out all the kinks we started at 9. I think that is pretty fantastic considering all the hurdles.

Once it hit 6am I jumped up out of bed and pursued trying to make copies of the schedules that Amanda was up all night typing up. The internet service stopped working(found out later it was because the power went out) and I didn’t have the two schedules, one we made the night before and the one Doc just made. I failed to bring a flash drive and only brought my large hard disk which is only configured for a mac so wont be read by a windows machine which is what they have in both offices. I had to get crafty and load the files onto the cf card I had for my camera using the card reader. Once I had the file on the card I had to get online and download the other file which I had saved on google( I make a draft and attach a file and then just save it). Things got so complicated. I grabbed my laptop and started looking for someone who could let me into the office so I could fix the internet connection. I walked around and could not find any one who even lived there. No one was out yet. I had to go to the bathroom and had been holding it for a few hours already trying to get things done. I went back up stairs(we are staying in room r3 which is up on the second floor) but the bathroom was occupied. I am sharing a room with the director of the trip S. and Doc. There are 3 beds in our room as well as our own separate bathroom with a full bathtub and shower. I was still trying to get the internet working but having no luck so back out for a search for someone who could let me into the office. We were supposed to eat breakfast at 6:30 and leave on the buses by 7. It was 6:25 and I did not have the schedules printed up which is what the top priority was. I finally found someone and was let into the office. He went into the back and turned the power to the internet back on. A few minutes later my connection was up and working. I got the files I needed down loaded and set off to printing them. Doc came back down to find me and see how the progress was going. I was still working on it but making progress, not about to give up to go get food. Then another one of the staff came to stick his head in and let me know I should go eat. Doc went back up I finished up and printed out the copies and then went up to go to the bathroom then into the dining room to eat breakfast. I had to eat as fast as i could and then grab my bag and get on the bus to head to the hospital.

We arrived and I started working on the internet connection so I could check the upload speed. I also worked again on printing out schedules. I got the files to the computer but I could not print because the printer was out of black ink. I worked my way around this by changing the text to color. I tried dark blue, dark purple, and green. Then I ran out of paper. I asked for some paper and eventually someone came in and handed me two sheets. It was quite funny and we all got a chuckle out of it. I told him I needed more and off he went to make it happen. That is one of the great things about India, here you ask and they do what they can to make it happen.

I walked around outside and took some pictures out there, they walk and travel for weeks to get here for this week in hopes that their child will be one of the ones to be fixed. There are big tents where they camp out and wait to see the surgeons, and then wait to have surgery. The families are really great about having us walk around and take pictures. Some of the kids really love it and some of the kids are shy. I took quite a few photos and then headed up to the dental clinic. There I met up with one of the nurses who was teaching a mother how to use a breast pump. Her son was 3 months old and weighed 2.2kilos. She also had a daughter that was 2 years old. After talking with her they figured out that the 2 year old was still nursing and the baby was trying to nurse. There are so many of these kids and even the adults who are malnourished. The man who takes all the video and pictures for the mission told me that in the summer it gets up to 104 and there is no water anywhere. They have water at the mission and the purifier runs 24 hours a day and up to 600 people a day line up for the water. So water and food are major issues here. I also learned that most of the girls are married off by the age of 14. The nurse was showing the parents how to use the cleft palate bottles and also she gave some of the families formula.

Things I need to bring the next trip over here, good hand pumps for expressing breastmilk, slings to hand out to the mothers, EC information in Hindi to hand out, clothing for the babies, prefolds? potty bowls?
multivitamins? maybe chewable for the kids.

I got to scrub in on a hand surgery today....too tired to write more going to bed now.