Tingriti: Day 3

For the last day of clinic in Tingriti I was stationed in pediatrics with Dr. Reshmi. This rotation is less hands on than the other stations, usually because Dr. Reshmi can speak Hindi so she does the history and exam on her own. She is really good though at keeping you up to date
on what is going on. She would take multiple breaks throughout the history to let us know what she was finding out. Unfortunately there were only about 5-6 children who came to clinic today so we didn't get to see many children. Many parents would bring their children in with complaints of "weakness". Dr. Reshmi said that she had seen a lot of this chief complaint and that the children was usually quite healthy. Usually what it boiled down to was that the mother thought the child was not eating enough and was too skinny. Dr. Reshmi said that she had several patients bring in overweight children with the same chief complaint and reasoning. The little boy to above had a broken elbow that was never fixed properly so that when he would hang his arms by his side his right arm would bend medially, instead of laterally like normal. The only real treatment for him would be surgery to correct the normal anatomy in the elbow. We talked with
Hem to see if we could help subsidize his surgery, but I don't know what ever happened to that. In a previous clinic I saw an injury very similar to this in a 71 yo female. In her case she also had a anterior dislocation of her shoulder that had not been reduced for 20 years! She said she had a cast on her elbow, so she had obviously been to someone to fix it and they must not have set the bones correctly before placing her in the cast. We had a Orthopedistnamed Dr. Ravi along with us so I took it up to him for a consult. He said that reducing the shoulder at this point would provide no help to this lady because all the muscle and cartilage in the shoulder would be so atrophied that it would either fall right back out or it would be in place and just not work. Since she had been coping with this injury for so long and because of her agehe said that surgery was not really an option. The little boy to the left with the cut hat had come in the previous day with lobar pneumonia. He had coarse crackles and wheezing that was loudest in one particular lung. Dr. Reshmi said that even after one day of antibiotics she could tell that he was doing better.
I was hoping to see a case with some worms because the previous day in pharmacy we handed out a lot of prescriptions for albendazole. Most of the children had come in the previous day, including the more interesting cases. There was one child that had what we decided was viral warts all over his hands. I think that we gave him acyclovir to help. I got to see him when he came through pharmacy to get the medication.

Before clinic even started today Chalini tried to open a window by pushing on the glass. The glass gave way and when she jerked her hand back she lacerated the inner surface of her distal forearm and it started gushing blood. The doctors are concerned about the loss of sensation in parts of her hand although they think she is going to be fine.

The whole clinic was pretty slow so we finished about an hour early. A few of us hiked up to a Monastery were we where showed around by one of the young monks. We are actually not sure if he was a monk yet. The monk told us all to sit down and he shared with us the Buddha store through a set of pictures. The inside was quite peaceful, but there were many things that to me seemed tacky. There were lights around a framed picture of the local guru the Dali Lama and a strange flashing pixel screen in one corner. Other than that there were large posters of what I guess were the different Buddhas. Outside was a temple/monument that was situated between an enormous rock face on one side and a peak of a smooth and grassy mountain on the other side. It was a cool place.