Week 2: Than Gaon

June 9th, 2008
Our first day in Than Gaon. We are all staying on the Nature Quest property (which works with CFHI and is based out of DehraDun) in three small "cottages" with twin beds and most importantly mosquito nets. The power is unreliable at best and we eat all of our meals outside, but it is beautiful nonetheless and is like luxury (kind of) camping. Mostly everyone seems happy to be away from the city and the honking.

The clinic where we are working with Dr. Paul is also located on the property. The clinic is fully funded by CFHI and this is readily apparent: The sanitation practices are definitely more widely enforced (Dr. Paul cleans the thermometer after each patient) and there appears to be an ample inventory of medications and medical supplies. The patients who come here receive their care and medications at no cost as a result of the funding from CFHI.

Dr. Paul has been the only practitioner here for the last six years. His previous medical background includes working in every village in the state of Uttranchal where we are staying. At his clinic here in Than Gaon he sees patients from nine surrounding villages, some of whom have to make a 7-10 hour journey by foot to reach him (we are about 1.5 hours drive from DehraDun but most of the people living in this area could not afford transportation to DehraDun let alone the cost of medical care). Dr. Paul practices a blend of Western and Ayurvedic medicine. The Ayurvedic medications he gives to his patients are primarily manufactured using the plants and trees that are planted on the Nature Quest property.

Dr. Paul sees patients in the clinic on Mondays, Wednesdays and Fridays and travels to the outlying villages Tuesdays and Thursdays. He has an in-patient bed in case a patient needs to stay overnight or if he has to deliver a baby. Dr. Paul stays in Than Gaon Monday-Friday and then returns to his wife and youngest child (who is in High School) on the weekends.

The first patient we saw today was a young man (late 20s-early 30s) who had fallen on his face while suffering a seizure. Dr.Paul put him on seizure medications and told us how patient compliance is a problem with patients like this because when they don't have seizures they decide it is no longer necessary for them to continue to take their medications. Dr. Paul typically puts his epileptic patients on these medications for three years. Even though the medications he prescribes can be obtained for free, patient education and follow-up is key. So really, not that much different than in the US!

There were many patients, particularly children who came in with coughs and colds. The monsoon season is starting earlier this year and with this change in season comes an increase in colds. This influx of patients gave the six of us ample opportunities to practice our lung exams!

One woman came in complaining of lower abdominal pain and pain with urination. Dr. Paul determined she had a Urinary Tract Infection and prescribed an injectable antibiotic and lasix (a diuretic). I thought this was interesting, lasix for a UTI? Of course I called my stepdad/physician/professor (along with my wonderful PA mom) and asked if he agreed with this treatment plan after I gave him some background on Dr. Paul. In typical John fashion, he paused and said, "Interesting." He went on to say this was probably a great treatment plan for this particular patient to facilitate emptying their bladder (when the kidneys are not involved) in the face of a questionable availability of clean water. In his own words, "These physicians who are healers and use the combination of Eastern and Western medication to individualize their treatment plans are definitely onto something." So if you see John planting some herbs out back at Aegis not to worry.

It is very interesting not only seeing how a well-funded, well-run free clinic in a rural area can operate, but also how Dr. Paul is able to integrate this Eastern and Western approach to medicine. How incredible it is for him to give his patients medication that he makes himself, furthering strengthening the ever-important bond between physician and patient.

During our afternoon break I got to take a nap. I don't remember the last time I took a nap in the middle of the day! We ended the day with evening yoga with our yoga teacher, Dvrinder (who lives in Rishikesh--where we were last weekend). It was so relaxing.

June 10th, 2008
We started our day with yoga at 6:30am for a more rigorous yoga session than last night's relaxation yoga. Poor JP, the only guy who is in our group was having some trouble with his flexibility (and with having to be surrounded by 5 girls all day), but he was a trooper and hung in. The rest of us did well, struggling mostly not to fall asleep during the visual relaxation portions of the yoga session.

After breakfast we went on a two hour hike to the village of Numiyas. It was only about a 1.5 hour hike but we had to stop frequently to allow the man carrying the medical supplies (around 50kg in a backpack) to rest. It was an incredible hike. The views of rolling green hills, farm land, cows, goats and even a 2.5 foot long lizard made the journey unforgettable.

There were not a lot of patients to see, but it was a learning experience nonetheless in seeing how a travelling medical clinic is run. There were a lot of children with a build-up of ear wax--so not too different from Aegis.

We were served tea and cookies and packed lunches of chapati (kind of like tortillas) and masala dosa, yes we are spoiled. When we returned home Jen and I had a chance to sit down with Dvrinder, the yoga teacher, and pick his brain about where to travel and what not to miss. This weekend we will be going to Agra to see the Taj Mahal!

After dinner Dr. Paul announced that one of the workers (Omrinder) is celebrating his one year wedding anniversary and we had soda (Coke and Limca--kind of like Sprite) to toast the occasion. Somehow we got into a discussion about how everyone's name at Nature Quest has a "rinder" in it. We could not stop laughing, not only because probably 90% of the time we pronounce every name of everything wrong, but also because we started coming up with all different ways to use "rinder" as a name...."mmmmmmrinder" "grrrinder" you get the point. Dr.Paul caught on and started to name off all the "rinders" in the village including "Omrinder, Dvrinder, Mrinder, Grinderrinder, Hrinder." At this point Dr. Paul had introduced everyone other than the cook so we asked him what his name was. Dr. Paul responded, "Him? That's Baboo." Our laughter was uncontrollable, however this seems to be status quo around here with Dr. Paul's elaborate stories and phrases.

For instance, on Monday Dr. Paul had a patient come in complaining of right shoulder pain. Dr. Paul told us how the man had an 8 foot long snake wrapped around his leg and how he killed it. He explained the man was plowing a field and felt something near his abdomen and looked down and snake was wrapped around his entire leg. He proceeded to use a piece of the plow (unclear which piece) and use it to stab the snake and kill it. Of course we didn't believe him for a second so we asked Dr. Paul to ask the patient to show us with gestures what happened to him. Sure enough he acted it out and later the story was confirmed by another worker. We asked him why he was here for shoulder pain when he had fought off an 8 foot snake. Dr. Paul responded, "This is man, not Tiger." We all could not stop laughing. This proved to be one of many Dr. Paulisms that were quoted throughout the week.

June 11th, 2008
Today we were back in clinic and got to see a few patients we had seen on Monday. One was a 1.5 year old girl who had fallen into the fire while her mother was looking away to tend to her other child. The girl's parents took her to a clinic closer to their village and paid for the burn (which included most of the back of her head) to be dressed and treated. It was not done correctly and got infected. It was so bad according to Dr. Paul that when he first saw her all he had to do was press gently on the wound and pus came squirting out. The girl's father now makes the 3 hour each way journey to see Dr. Paul every two days for dressing changes. Her mother is nine months pregnant. The girl's wound is still extensive, but looks impressively better than it did on Monday and appears to be healing well.

Dr. Paul had a wide variety of patients coming in today: People with diabetes for medications, fungal infections, anemia, a family with an allergic reaction a plant "in the jungle" and a boy with flatulence. Dr. Paul's response, "Gas is expensive in India."

We had a chance to ask Dr. Paul more questions about Indian culture. In particular we asked him about the marriage practices. He told us the marriage age of women depends on their education background. If a woman is well-educated she will most likely not get married until age 25 when she has finished school and "got settled"/started a career. If the woman is uneducated (and likely to live in more rural areas) they get married as young as age 15. The legal age for marriage in India is 18 for women and 21 for men, but if they are younger and living outside of the city as Dr. Paul says, "Who is there to report them?" Then he told us about marriage practices in Rajikstan and how women as young as 10 years old are "promised" for marriage. He also told us how in Rajikstan when a husband dies his wife must be cremated with him "by the river." We are not sure if this is the case, but it's pretty crazy to think about either way.

After lunch Jen, Val, JP and I decided to walk with one of the workers to the "river." I don't know if it is an American thing but the four of us were picturing this easy river stroll. This was not the case. The stroll consisted of 30 minutes of hiking on an almost entirely steep downhill, single track, rocky pathway for half an hour. But the river and the huge rocks we got to sit on and cold, clean water were well worth the effort. Val and I both felt a bit sick we think mostly due to the heat. I don't think I have sweat so much my entire life as I did these last few weeks.

More to come tomorrow...