I've spent time so far in general medicine
both on the wards and in outpatients. In adult medicine in India there are the
"dual epidemics" of lifestyle diseases such as high blood pressure
and type 2 diabetes, and infectious diseases, such as tuberculosis and dengue
fever. The combination of these along with the huge population stretches
resources almost to breaking point at times - late last year there was an
epidemic of dengue fever in Delhi, and on one day the medical team admitted over
150 patients to St Stephen's Hospital,
which unsurprisingly caused chaos, with beds stacked wherever they would fit.
The lifestyle diseases are very familiar
from the UK as are some of the infectious diseases, but with different rates of
prevalence and often with more serious complications as patients often seek
medical advice later than in the UK. Roughly 40% of the population of India are
thought to have TB, making it very high on the list of suspected diagnoses for
all patients, even if they just come into the outpatient clinic with a cough -
a little different to the UK! The way the outpatient department works is also very different to the system
I'm used to in the UK - all the junior doctors sit around a large table, and
patients come in and sit next to them. Often there are other patients standing
behind the doctors waiting for their turn, so it makes patient confidentiality
a bit tricky! There are no appointments, people just turn up when they need to
and wait for as long as it takes. As St
Stephen's is such a popular hospital ( as it is relatively cheap compared to
other private hospitals and has more resources than many Government hospitals)
the outpatients has a very high turnover of patients. Most consultations last
between 5-10 minutes, for which the patients pay 100 rupees. The junior doctors
have a very hard task to fit all the relevant questions into such short sessions,
and to make sure they have correctly managed the patient without missing
anything.
The financial aspect of healthcare here is again
something I'm not used to at all, having only been in hospitals in the UK prior
to this. Whilst an outpatient appointment is relatively cheap, roughly
equivalent to £1, investigations can vary in cost from 100 rupees for a full
blood count, to 2000 rupees for thyroid function tests. Inpatient treatment
adds to the cost yet again - the most basic bed on a medical ward costs 1300
rupees a night, then investigations and treatments can easily push the bill
above 20,000 rupees.
At first on the ward I was slightly
confused hearing the phrase "the patient is going llama" but soon
worked out that leaving against medical advice (LAMA) is what patients who can
no longer afford their treatment do. They are advised to go to a free
government hospital instead, but as beds in them are so sought after I don't
know how likely it is that they would be admitted. One patient I saw was still
dependent on oxygen when his relatives told the medical team that they wanted
to leave.
During quiet periods on the wards I've been
able to chat with many of the doctors about differences between life in Delhi
and London. Some have been shocked at the price of things in the UK, such as
the fact that the metro is about 10 times cheaper than the tube, and house
prices are unsurprisingly substantially lower here. One of the most
entertaining conversations I've had is about religion; several people have
expressed horror when I describe myself as an atheist and have really struggled
to understand what I mean. One doctor protested that I must have a God at least, and seemed quite
offended that I didn't, while another seemed to think this meant I lived an
amoral and lawless life! Despite this all the doctors have been really friendly
and helpful, explaining things to me and translating what patients have said, hopefully
this will continue over the next few weeks even though they've now discovered
I'm a heathen...!
No comments:
Post a Comment