March 6, 2006

Today might end up being the best day of the internship. It’s not as if the other days were any less productive or fun. Perhaps I just appreciated the day more, or had a more positive outlook than other times. It started off like other days, but with the added complication of living in a separate accommodation from my companions. When I finally arrived at my destination, a municipal hospital named V N Desai, I had to wait around for the other students. We spoke briefly but effectively with the Medical Superintendent before moving on to our rotation. The attention she gave us was a reflection of how the rotation went. We first went through the male medical ward followed by the female medical ward. In both, the doctors were extremely nice and willing to teach. In the past, at other hospitals, the doctors usually did not have enough time for detailed instruction. This is understandable because of the sheer volume of work to be done. So as a result, we would spend a lot of time floating from one bed to another, or sitting in a chair while patients would flow past us in a constant stream of complaints, and consequentially see a large quantity of people but feel less edified at the end of the day.

This time we saw very few patients—no more than a dozen—but each person represented a new case to be explained and provided new insights as to how illness affects the body. A man suffering from tuberculosis was no longer just another case of TB, but became an opportunity to learn how different diseases affect the lungs and can be differentiated by x-ray. A woman with chronic obstructive pulmonary disease turned into a lesson on how lung problems create problems on other parts of the body. And once again I saw a rheumatic heart disease patient.

The woman was a young thirty-five. Thin and wasted. She had developed heart murmurs over the last few years and was presenting further complications. Too fit to suggest atherosclerosis or any such heart failures, and too old to hint at congenital heart defects, she was in need of surgery. Unfortunately she won’t be getting it. Too poor for any kind of corrective surgery, she will have to rely on prophylactic medication. Of course this means continuous compliance, something she’s probably too poor for as well. All this adds up to a very bleak future.

After leaving the hospital I got to see an elephant.

In the afternoon we spent about three hours at a place called Humsafar learning more about gay men in India. This is the only government sponsored outreach organization that targets gay men. Sodomy is illegal in this country and sex, especially gay sex, is extremely taboo. Humsafar provides counseling, community outreach activities, a medical clinic and HIV testing. We spoke with a couple representatives there and will go back tomorrow to talk with the counselors and doctors. Through all this we hope to see a larger picture of the HIV situation in this country. Cultural pressures are such that 27 % of homosexual men in Mumbai are actively involved in a heterosexual marriage as estimated by some studies. This is the most liberal city in India with probably the most open gay population. Tomorrow we hope to learn more about all this. It was interesting to see our coordinator’s reaction. She was obviously uncomfortable at the beginning of the visit and planned on leaving early to get back to her office duties. Eventually she stayed through the whole tour and seemed to enjoy the experience. When I asked her what her mother would say if she knew of the visit, she replied “She would kill me.”