Around the hospital

We’ve just hit our one month mark here at THI. As requested, I am posting some pictures of the hospital campus. (Rachel, I will post food pics when I remember to take them!)

The hospital has 35 beds, which are divided between the medical and surgical wards. The inside of the wards are very simple, just 2 rows of metal frame beds with a mattress and sheets. Patients are required to have an attendant with them, usually a family member, and that person is responsible for making sure the patient is fed. If major decisions about treatment need to be made (like surgery or whether to transfer someone to another facility), the patient is required to have family members present to be involved in the decision making.

The outpatient space consists of 2 main rooms with 3-4 providers each per outpatient clinic day, with private spaces for sensitive exams. Usually I sit with the other gynecologist and 2 of the junior doctors seeing mostly pregnant and gynecology patients, and Karthik sits with the male doctors seeing mostly men, children, and women without obstetric or gynecologic issues. This isn’t necessarily Karthik's preference, but he has found that women are quite uncomfortable with seeing him when an exam is required, so he has started sending them my way.

THI has 2 operating theaters. The original OT (pictured here) is now just for minor procedures like draining abscesses and stitching up lacerations. The main OT has 2 beds which are usually in use simultaneously during OT days. This is also where c-sections are done. I forgot to take a picture, but will try to remember and post it next time. The second picture is the pre-op area.

Attached to the OT is the labor room, which has 4 beds for laboring/ antepartum/immediately postpartum patients and a small delivery room is curtained off (pictured). There are also 3 neonatal ICU beds, which were recently full of 30-32 weekers who ended up doing fine and going home.

There is a building pictured below which includes the lab, pharmacy, X-ray, and a small dental clinic. The dentist comes 1 Sunday per month for consultations. There is also an ultrasound room next to the surgical ward. There is one ambulance which you can see in the picture, and a jeep that is outfitted like an ambulance as well.

On Monday, Thursday, and Saturday we have all-day clinic during which around 200 patients are seen. Tuesdays and Fridays are OT days where we do scheduled surgeries. Wednesday are for the “old age clinic”, which was developed for the older folks in the area, most of whom have hypertension and/or diabetes. However, it has turned in to somewhat of an outpatient day as folks have heard that we are seeing patients on Wednesdays and do show up even if they are not old. Sundays are free of scheduled things besides rounding, but labor is not scheduled so I end up working that day too.

There are a total of 8(!) doctors at THI right now, which is kind of a lot. The couple who started the hospital, Regi and Lalitha, are decreasing their clinical time so they are only there on some outpatient days and spend the rest of their time on administration and other projects associated with the hospital. Regi is an anaesthesiologist so is around when there are pediatric surgeries or cases requiring general anaesthesia. That is rare as most cases are done with spinal anaesthesia or conscious sedation. Ravi is the in-charge jack of all trades, and master of most of the trades too. He completed rural surgery postgraduate training program but oversees all of the clinical work, including the medical patients. Ravi is also one of the HEAL fellows along with us. He is a "site fellow", which means that he stays at his previous site for 2 years instead of rotating like we do. The other 3 docs are “junior doctors”, which means they have finished their medical school and completed one year of a general internship. In India, most people study for their residency entrance exam for a year or more after internship as the score on the exam is the sole determiner of what specialty is available to you. The junior docs at THI decided to work during that time as well and landed spots at this hospital. They are also excellent and have been hugely helpful to Karthik and me in navigating the system and interpreting for us. All 3 of them are interested in OB-GYN and it is kind of fun to have the sort-of equivalent of residents.

We live on the hospital campus, along with the junior docs. This is mostly good as we are immediately available if needed (it takes me about 1 minute to walk to the labor ward) and the hospital provides 3 meals per day for us. The less good part is that we have a hard time feeling like we are "off", as you might imagine. Here is our house. Again, forgot to take pics of the inside, will try to post some later. The last 3 pics are from right outside our house or nearby in the surrounding valley. The hospital is in the middle of a forest nestled between 2 mountain ranges. The area is really beautiful as you can see.

Like I said before, our internet access is quite limited, but we will try to post as often as we can. Please let us know if there are specific things you want to hear about!

Lastly, I just wanted to put in a word for HEAL, which is the program that Karthik and I are doing since the deadline for this years applicants is October 1. It is a global health fellowship through the University of California San Francisco, and is open to physicians who have graduated (or will be graduating this year) from Family Medicine, Med Peds, Pediatrics, Psychiatry, OB/GYN, Anaesthesiology, or General Surgery residency. The program is 2 years long and we rotate every 6 months between an underserved international site and domestic site (mostly Indian Health Services sites in the southwest). I have applied for a great number of things in my lifetime, and I will attest to the fact that this application is quite reasonable and not difficult to fill out! If any of ya'll reading this are interested or know someone who might be interested, please email me (erin lorencz at gmail dot com)!