Stacked deck

Things here have been extra busy the last 2 weeks with 2 of the junior doctors getting sick, one with Dengue, and 5 of the 8 docs here on vacation at one time. The last week has been just Karthik, me, and Ravi who is the doctor in charge holding down the fort. While busy, it’s also kind of fun to have our small team working together. We managed to see about 150 patients in the clinic yesterday, so that was an accomplishment. The next order of business is to work on hunting down all the mosquito breeding spots around the hospital and shutting them down, as we have now had 2 cases of Dengue contracted at the hospital.

One of the unsurprising things about working here is that while some of the diseases are the same that we see in the US, the treatments are often very different, either because of differences in the availability of resources, cost, or just regional practice differences. Regardless, the patients at this hospital get excellent care and the majority recover and have a great prognosis. Those who require a higher level of care transferred (or offered transfer, some decide not to go). This week I was painfully reminded that the gap between what is available to patients here and what is available in the US (or Europe or Japan) sometimes means life or death. I admitted a patient with pre-eclampsia at 29 weeks. The treatment for this life-threatening condition is delivery, and she was appropriately treated. The really different thing about this scenario compared to this happening in the US is that here is that no one resuscitates babies before 32 weeks. There is no institution to which we could have referred her that could have provided the care her baby needed for survival. During residency, I heard my attendings who have been practicing much longer talk about how fetal viability was defined much later even in the US before more recent advancements in medical technology. It feels shocking to go the other way—from a place where most 29 week infants do alright to a place where there is no chance. Because of where they are born. As an obstetrician, the beginning of life, viability, and the transition from fetus to baby remains a mystery to me that I actually don’t get too worked up about most of the time. But the anguish that mama had over the death of her baby—that is not a mystery. And it happened because of where she was born. I haven’t totally processed what any of that means, but present it as one of the many ways that the world is unjust. That there are several billion permutations of the cards you can be dealt, and some people get a really shitty hand.

In other news, here are some pictures of happier things, including inside of our house,a typical meal, a sunset walk, Karthik playing cricket, and a brand new baby goat. Who doesn't love baby goats?