Final Rotation: Medicine

For my final rotation here in Vellore, I choose to do general medicine, in order to get a feel for the different types of pathology seen here as well as general administration of care. As I noted during my first week of OBGYN, the most striking thing I have so far noticed about disease management at the main CMC hospital is how similar it is to our management system in the United States. Each morning, the attending rounds with the interns and residents, overseeing the management of each patient and enhancing the knowledge of the whole team by teaching about each case. The patients are generally receiving top of the line diagnostic tests, including MRIs, biopsies etc, as well as the being treated with the same exact medications utilized in the US. And much of the pathology is similar as well. I have already seen a fair amount of hypertension and diabetes complications, including congestive heart failure, strokes, kidney failure etc. There are some cases of more unusual pathology which is less commonly seen in the US, such as rhematic heart disease (which can result from untreated strep throat) and disseminated tuberculosis. However, I would say the most notable difference between the pathology here and what I am accustomed to at home is the often advanced stage of the pathology on presentation. Because there are more barriers to healthcare here in India (poverty, rural communities with limited healthcare access, service of a large population etc), patients seem to wait longer before eventually deciding to present to the hospital. For example, on the ward today I saw a 42 year old male patient with a history of diabetes who initially presented to an rural outpatient clinic complaining of decreased vision in his right eye and pus dripping from his right nostril and right ear for more than four months. After extensive work up, it was determined that he had mucormycosis (a severe fungal infection, increased risk with diabetics) and he was treated with intensive antifungal treatment for two monthes at this outpatient facility. However, the longstanding fungal infection did not respond to antifungal treatments alone and on admission to CMC, the doctors realized the infection had persisted and tracted back into his cavernous and sphenoid sinuses (essentially, the fungus had invaded part of his brain). He required extensive debridement by neurosurgery and additionally, his right eye had to be removed and the eyelids sewed together to completely eliminate the infection. He is also requiring intravenous antifugal treatment postop. Of course, the outcome in the US may have been the same, but because this man works as a farmer in a rural village, he most likely delayed seeking treatment until he could no longer tolerate the symptoms and became worried enough to get help. And even when he did initially seek treatment at a rural hospital, it was substandard. At the point he was admitted to CMC, the infection was already so extensive it led to him losing an eye. Despite the poor outcome in this man's case, and perhaps in many other cases with advanced disease presentation, the majority of patients here at CMC and in the directly surrounding communities are receiving adequate healthcare in a society that is stricken by poverty and afforded very few luxuries. Thanks in large part to the charity given to the hospital, the physicians are able to care for their patients using the best tools available and do their best to overcome the social circumstances, which heavily influence the variety and severity of pathology seen here.