This week we’ve been working in a small town in northeast Gujarat called Shamlaji. It’s named after a particular incarnation of Lord Vishnu and there is a very large and beautiful temple here in Shamlaji’s honor. The hospital we are working at is Shamlaji Hospital; it’s a government hospital that has been run by an American physician couple for the last 7 years. Drs. Joshi and Tolat have transformed this small facility in a remote tribal area from one that most local people avoided into a very competent and busy facility that registered about 68,000 new patient cases last year! They’ve made a lot of progress and have long plans to continue expanding their services and quality of their facilities.
Our project here has been two-pronged. They advertised heavily before we arrived for patients to come in and get screened by ultrasound for various aches and pains. The glamour of ‘sonography’ is very strong and brings in a lot of patients each afternoon. This screening has been very fruitful. We found several patients with hydronephrosis due to kidney stones, a few uterine tumors, and one particularly nasty looking liver abscess. It’s good for me because I am starting to identify what the abdomen looks like in the salt-and-pepper display of the ultrasound. And we are getting good examples of what an organ looks like when it is abnormal. The hospital has an operating room as well, so many of those problems we find during screening are often operated on here the same day or next day. That’s pretty much how we do it at home, so I feel pretty confident that the quality and variety of care we’re able to provide here meets a high standard.
Most of the operations I’ve seen in the past were laparoscopic, since that is so common now in the United States. The surgeons here are all trained internationally and have practiced abroad but have chosen to return to India and serve in this rural area. So they have the knowledge and ability to do procedures in a more technologically advanced manner. However the local infrastructure and availability of supplies is such that laparoscopic surgery is not yet possible at Shamlaji. So for the first time I’ve seen operations does in an ‘open’ manner, meaning through a 3-5 inch incision in the abdomen. It’s a very different sensation to see an appendectomy or hysterectomy open in front of you rather than on a TV screen.
The other aspect of our interventions is more discrete. We are continuing to do our breast cancer early detection and self examination education among local women. Each afternoon when the line forms for the ever-popular “ultrasound doctor” (i.e. – dad), the nurses siphon off all the unsuspecting women we can find and bring them to a quiet back room to learn about breast cancer. It sounds a bit shady, but the subject is such that if you give away too much about the topic before being able to explain it in full women become skeptical and don’t want to listen. So we tell them “hey, we’re going to teach you something special. This lady from America came especially to teach you, you better not waste this chance.” Hahaha… probably the America part gets them curious and they come to listen to my spiel. By now I’ve trained the hospital’s nurses so all I have to do is watch and help.
Essentially we explain that women can get breast tumors which can turn into cancer. Once a woman has cancer is very hard and expensive and painful to treat. But luckily women can learn this simple self exam to prevent so much misery. The toughest part is to emphasize that when breast lumps are small they are NOT painful. Most people here are very conservative with their medical treatment and frequency of visits to the doctor. So unless they think something is REALLY wrong they won’t come in. So we have to emphasize that you must do this exam BEFORE you have a problem; if you do it right the lump WON”T hurt; but you still should come to the doctor.
Once we get hands on with the breast model and show them what a lump feels like they really seem to get it. It’s not as hard as I thought to at least get them to listen and basically understand what we are explaining and its importance. Everyone has seen someone with cancer go through misery so they can relate that to their experience with the model. “It’s like a little peanut, right?” I tell them. “Oh yes, exactly tiny like a peanut!” Then they show it to each other, “Look I’ll show you, it’s here on the side.” It’s been working quite well.
Sometimes people feel wary of being perceived as Americans come to do ‘backward’ people a favor. I agree that this is not the way we want to be understood, and it’s sometimes tricky to consider how to approach doing some kind of service or charity without producing that image of ourselves. But the screening and education we’ve been doing so far in Shamlaji is an excellent example of how this perceived difference between “us and them” can be used to our advantage for the benefit of a population. They come for the screening yes, but you cannot separate the desire to visit the “American doctors” from that. For me the key is to do our work with the same standard we would at home, within the practical limitations of the area we are working in. Make the positive distinction that we are providing something that’s not available everyday. And in all other aspects of the visit, try to blend in as much as possible. Live like local people, eat like them, bathe like them… and TALK to them. So far as I’ve seen local people in any country seem to appreciate this, and understand that the fact that your services are unique is not something you are using to judge them or disrespect them and their way of life.
So we have 2 days left here in Shamlaji. We made one rural-site location similar to what we did in Shivrajpur on Tuesday and we’ll make one more such trip to the interior on Friday. Tuesday we saw 189 patients in about 2.5 hours, about a patient a minute, which got them the screening, education, and medication they needed. We’ll see how Friday goes. More on that in a few days.