OCT-B-4

THE FIRST CLINIC DAY

BEGINS WITH A RUN AT KALIM PONG

October 8, 2003

I am early. I am sitting on the porch overlooking the garden and the valley beyond with the fog and cloud shrouded peaks of the Kanchenchunga Range covered from view. It is humid and not cold, so I am dressed in my running gear, which is about the only other change of clothes I have brought with me since my clothes and sleeping bag, and most important, rain gear, are all in the checked bag now impounded in Kolcata—and irretrievable according to Hem. The only way to get it back would be to fly there, and spend the time and hassles fighting with the customs officials and pay a very large fine—so, like almost the whole of the other pre-arrangements I have made in India—this one is a total loss.

I am waiting for Jackie, the family practice resident from Travis Air Force Base near Sacramento to arrive, since she wants to do a short slow run on the steep hills of the Kalim Pong crest along which the narrow road runs. At this hour of the day we will not have much in the way of diesel smoke belching truck traffic, but will still have the residual of the night’s dog fights still going on, amid the crowing of roosters. I am eager to do a few runs while here, since, of course, I return to the MCM. But, the lack of anything like a dependable and reasonable shower facility and the absence of towels—again, in my checked bag—inhibits a vigorous training program.

We had our introductory meeting last night by candlelight, since the electricity had gone out early in the day and we had only the light of a few lanterns and the candles. The power came back on during the dinner, so we could finish the fiery hot concoctions labeled as Nepalese specials. I went to bed early, attempting to re-adjust my trans-global clock, and am up early now awaiting the start of the pre-arranged six-thirty run.

THE RUN ON THE HILLCREST ROADS

OF KALIM PONG WEST BENGAL, BEGINS A RAINY DAY

It rained all day. It was a fine mist, from the kind that perpetually shrouds the big mountain at this time of year. We ran up hill for the start of the run and threaded the narrow streets along the steep precipices for the first half opf the run, after most of the dogs had given up their prowl for the night and before the heavy truck traffic had begun for the day. I ran with Jackie, the Air Force woman who has a base in Travis Air Force Base outside Sacramento and could be sent anywhere the Air Force wishes her to be as a Family Physician when she finishes her residency as she has already done all her life as dependent of her father who had done the same thing.

We returned for breakfast, then loaded into small vans where for the third time, I seem to have lost a precious commodity—an unexposed roll of film—I had stuffed into the packet of the vest that leaks everything put into it—even now that I have put safety pins along the slash pockets so that it is now hard to get anything into or out of it—except film rolls which migrate out with a secret desire to go abroad without me.

A HIGH VOLUME CLINIC AT THE PRIMARY HEALTH CENTER IN THE RIVERSIDE VILLAGE OF TEESTA

We set to work in the fairly efficient teams I had organized with four groups: 1) General/FP headed by Jackie; 2) Peds; 4) General/Surgery; and 4) Ob/Gyn, with a rotation of one person from each team into the others due tomorrow. We had a very large group of patients awaiting us which got larger as we were there, pushing through the doors at an increasing rate. But this is a group of mainly senior medical students, so that it worked rather well, since I do not have to explain both the clinical skills involved in the history-taking interview and the physical examination, then explain the pathology and pharmacology (neither of which a freshman medical student would have had as that point in their career when I supervise them in Ladakh.) So we pushed right through what should have been lunch time, only at two did we try to close the door and go to the pharmacy to eat a box lunch. When we returned, their were even more people, pushing on the doors which we maintained by closing them and a queue of scores of people impossible to go in and out of accumulated at each door. At the end of the day around five o’clock there had been 325 patients registered and another 60 seen beyond the registration process, jumping the queue when they had worried that they might not be seen if they did not rush to the doors and fight their way to the front.

We saw many interesting patients amid the usual run of those who h ad already been cared for somewhere in town and were coming for a second opinion on whether their treatment had been appropriate. A couple of women had epidermoid carcinoma of the floor of the mouth or the tongue, previously undiagnosed, for the habit of chewing betel nut. We had one fellow who had a fever jaundice and large lymph nodes who has no doubt got a lymphoma—whom we referred for management to the local physicians whom we are unsure of whether they can handle that. A few of the local practitioners were there, not so much to be instructed, or to pick up the referrals we would pass to them, but to get medicines for their wives and mothers for symptoms they would describe with the patient unseen. The BMO (Bloc Medical Officer) was there for the first half of the morning, and we could send him the patients who would need chronic care, such as the young child with cerebral palsy who needs braces for his right leg, and was seen only once by the Red Cross..

We returned in the rain to have a brief patient presentation session, and go over several more of the patients: a gardener with sporotrichosis, a festinating man with Parkinsonism, a child with anisocoria and rotatory nystagmus, and others before dinner and an early turn in to do more of the same tomorrow in a more remote clinic.

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