JUL-B-9
THE MEDICAL PROGRAM
AND THE MEDICAL EDUATION PROGRAM
AND THE INTEGRITY AND CREDENTIALING OF
EACH
THE EARLY MORNING RIDE UP TO KHARDUNGLA,
HIGHEST MOTORABLE ROAD PASS ON EARTH,
ELEVATION 18,380 FEET—
ENOUGH FOR ANOTHER HEADACHE
There has been a difference of opinion, again, about who is the leader of the team in tow important regards. First, there are twice as many people signed in to this Ladakh-03 trip as can be comfortably supervised by one medical leader in their first-time ever interactions with patients who are expecting a group of visiting international consultants, and get, at best, freshmen medical students, for which the medical leader must carefully supervise each interaction with each patient. That becomes difficult when 28 naïve clinicians are confronted by 300 patients in each of our overwhelmed clinics so far. Second, there are right ways to go about the medical education process, and not any one interested in joining to take over my spot, and paying their own expenses
So, yesterday morning, when Ravi
was still in bed, I went over with the students what was expected of them, in
increasing efficiency in seeing more patients more rapidly and still protecting
the educational quality of the program with the presentation of two patients
per team each evening for the tutorial that will be the educational future of
each of them in any program they enter.
I believed that was reasonable, and it would also involve only one third
the students each evening selecting from only a few of the most instructive o
each day’s 300 patients.
THE EARLY MORNING RIDE UP TO KHARDUNGLA,
HIGHEST MOTORABLE ROAD PASS ON EARTH,
ELEVATION 18,380 FEET—
ENOUGH FOR ANOTHER HEADACHE
There did not seem to be time for the educational tutorials, but there was time for the ride up to Kardungla for the ten minute stop to pose for photographs at the sign marking the highest motorable road on earth—a ritual I have now done for the fifth time. This brought us back her to the Hotel Khangri late for a hurried breakfast, and then a takeoff for the Agling Clinic fully three hours later than the time when patients and our translators were awaiting us. In a very crowded room, all of our stations were set up and doing very rapid review we saw as many patients as the prior days, including several very sick ones.
As we sat at the courtyard awaiting the delayed start for our drive up to Kardungla, Ashlea came downstairs with her long blonde hair being combed out wet with a simple request at the reception: “Could you turn on the power to my room so that I could use my hair dryer? I will only need it for ten minutes, and it is the least you can do as a favor, since it is a familiar comfort to have my usual beauty needs.” Just what is involved in priming the generator with diesel fuel and getting the machine cranking up in order that the accommodation of one first world demand is met probably never occurred to her, but they did eventually do it. “They know my name and room number, since I am down at reception so often since I have so many needs to request.” Yes. This might define the difference between the first and third worlds in their needs and demands rather succinctly.
I have marked the altitude, latitude, longitude, and pulse oximetry for each of several sites in the course of an interesting day.
PLACE LATITIUDE LONGITUDE ALTITUDE O2 SAT PULSE
KARD 34* 16,47 N 78* 76,26 E 18,380 FT 70% 78
SPUL 15,300 FT 78% 78
LEIL 12,500 FT 90% 68
AGLI 34* 07.43 N 77* 33.04 E 12,800 FT 90% 73
I have the GPS marks for the two blanks above, but do not want to get the GPS out just now to record it, so trust me on the fact that the pulse and O2 Sat vary with the altitude and that we have varied over a mile today.
The clinic was the third and most crowded of the days we have spent in the three venues around Leh in the various clinics. The total patient count is about 850 so far, and we have three more venues for patients to be seen in the Ladakh-03. The students have been performing reasonably well under tight supervision, but it has been hard to get them back for their single most valuable part of this program, the tutorials in the evening when they are all eager to scatter and blow off the lecture and didactic part which will make their second and third years so immensely more enriching, when they see for the second time that diseases entities presented to them, and recognize them, with the added advantage of having the “clinical hook” to hang them on—the patients they are seeing and have to summarize in presentation. It is easy for the non-medical people of the trip to consider this little nicety entirely dispensable also, so give it a lick and a promise, and nobody will have to be accountable for the quality of their academic work. So, we will be working on that when we are in the more remote regions where there should be far fewer distractions in the from of running off to see if it is true that there is an ice cream place somewhere in Leh, as they are so gullible as to believe, and that they can assuage their usual habits even in a remote region in satisfying their craving for grease and high calorie sweets. This part of the culture bridge has yet to be crossed, since we can take the first world freshman out of the Starbucks but cannot take the ……….: