Clinic Day in Bilaspur

4 February 2012

Clinic Day in Bilaspur

It was a one hour drive to reach our first clinic site of the month. We had a delicious and filling lunch at the hotel before we left, complete with bananas, porridge, eggs and chapatti. It was another bumpy ride through dirt roads to reach the clinic on the other side of the valley. We were using a small local hospital as our clinic for the day. I was to be completely in charge of the gynecology clinic with two medical students working with me. We had some dusty speculums, lubricant, cotton swabs, urinalysis dipsticks, and hemoglobin finger sticks.

By the time arrived, the porters had already set up a large canvas tent that would be used as the pharmacy. They had unloaded lots of large metal chests filled with different medications. The staff took us on a tour of the rest of the hospital. The hospital was tiny deserted. It was cold and damp inside with concrete floors and walls; some rooms lacked electricity. Triage was set up in the foyer, medical and pediatric clinics were in bare rooms upstairs, and my gynecology clinic was delegated to the labour ward.

In the labour ward there was a small damp room with two single beds. The mattresses were sagging in middle and there was dirt and debris on them. A used syringe sat on the window sill. This was a recovery room. The next room was the Labour Room/O.T. (Operating Theatre). It was a large room with one ancient appearing OR light. There was a barbaric old delivery bed/OR table with an IV poll attached at the top. The room reeked of toxic smelling antiseptics.

There was a metal shelf at the end of the OR table with some steel trays. Inside of one tray were some rusty and dusty instruments that were far from sterile. There was a faded red rubber catheter, lots of clamps, ring forceps, and curettes. Another tray had two small sets of delivery forceps. There were lots of gauze pads. By one of the windows was another shelf with a baby scale. I was impressed with the tray full of medications which had most of the obstetrical drugs that one would need in an emergency including oxytocin and every other uterotonic, magnesium sulfate, anti hypertensive medications, steroids, and a small selection of antibiotics. There was even a neonatal endotracheal tube and some IV tubing. In a closet we found some IV fluid bottles; they only came in 500ml amounts unlike the standard 1 liter in the US.

A group of women who were nurses at this local hospital came by to meet us. They were curious to see what a western doctor thought of their facilities. Frankly, the delivery room scared the shit out of me; it was something out of a medical horror movie. If this room scared and obstetrician who is used to seeing massive amounts of bleeding and other gory sights, then you can only imagine how frightening this place would be for a patient. Many of these village women have likely never set foot into a hospital in their life before they are brought in, in painful labor, to push out a baby. I felt scared for them because there was nothing at all comforting or welcoming about that room. I asked when the room had been used last; they said they'd had a delivery just yesterday.

We had a steady flow of GYN patients throughout the day. The complaints were pretty standard to what I am used to having at home: heavy periods, itching, vaginal discharge, irregular cycles, pelvic pain, post menopausal bleeding. The difference was that I had even less resources here than I was used to even at my very basic US public hospital. There was no way to do pap smears or endometrial biopsies. The oral contraceptive pills in our pharmacy had recently expired so I had little to offer the women with heavy or irregular bleeding besides a prescription to go to local pharmacy. We had one woman who had become anemic enough that she was eating "soft rocks" off three ground. Anemia seemed to be quite prevalent here, likely exacerbated by the vegetarian diet low in green leafy vegetables and high in rice and potatoes.

It was awfully damp in cold in our examination room. As the day wore on, I borrowed more and more additional clothing layers from my co-workers. I looked like a bag lady towards the end and even wrapped a shawl around my head. It didn't help that the jet-lag was so powerful either; I had trouble even keeping my eyes open while the medical students, Vikram and Jen, were interviewing patients. It felt like a particularly rough post-call day. All I wanted was a nice big cup of chai tea and a bed. I fell fast asleep on the car ride home, despite the incessant bumps and holes on the road.