A weeklong oral examination for the final year residents in psychiatry has made this week somewhat chaotic so far, but Moriah and I somehow managed to find our way to the grand rounds being held by the adult inpatient team. In the states this sort of meeting would likely be held in an auditorium or large conference room. Certainly we wouldn't dream of having clinical discussions regarding newly admitted patients in a courtyard ten feet away from the inpatient unit.
But that is exactly what we did today. We met in a large circle, very close to the path we've been using to walk to the pool, which cuts right through the inpatient wards, and discussed the patients that had been admitted of the weekend.
Neither of us could hear at all, as the residents and consultants spoke in very low voices, perhaps because they were no more than ten feet away from the patients they were talking about. The sounds of the motorcycles, birds, and giant fruit bats made this hushed tone impossible to understand.
After this discussion, we were introduced to a very nice clinical psychologist named Noel, and he served as our translator as we walked through the wards to see the patients. In another stark contrast to American psychiatric wards, in India there were no locked doors, very few security guards. Noel was actually a bit surprised to hear about all of the precautions we take. The patients who were judged to be a danger to themselves or others were kept in the acute care room, which was one room with 10 beds, and more nursing staff, but again, the door was open. The hospital depends a great deal on the family staying with the patient to keep them from leaving the hospital or worse.
Most of the inpatients were being treated for schizophrenia, and most of them were newly diagnosed. We saw a number of farmers who had attempted suicide, all of whom used pesticide, apparently a very common story in rural India. Last year the monsoon seasons were particularly poor, and many farmers had extremely poor crop yields, leading to a dramatic increase of farmers attempting/committing suicide.
In yesterday's post I mentioned that in order to be admitted to the unit, at least one member of the patient's family must agree to stay with them. This was also true of some other units in the hospital, and we were told this was to keep costs low. However, the concept was made into doctrine by the first chairman of psychiatry, Dr. Florence Nicols. And while for the poorer patients, they did require the manpower, Dr. Nicols made this a firm rule even for those patients with the means to pay someone to stay with them. She viewed it as a way to learn more about the family dynamics as well as allowing the staff to educate the family on the nature of the patient's illness and how it would be managed. I believe it has another very interesting effect, in that it may be less disruptive to the patient's life. In our system, a psychiatric admission is a traumatic experience itself, as the safety that comes with our hospitals comes at the expense of most personal freedoms like wearing your own clothes, having a cellphone or even having ready access to the outside world. This hospital really didn't feel like a hospital at all.
Because of this philosophy, the inpatient ward has a community or village feel. In fact, moriah and I had been walking through it for the last three weeks, thinking that we were walking by staff housing. Not once did we consider we were walking through an inpatient psychiatric unit.
In the afternoon i attended the psychiatry consultation clinic at the main hospital, where they saw patients who had been seen by other outpatient services, and were being referred to psychiatry. At this clinic I heard about the most heart wrenching story I can imagine. He patient was a thirty year old man who had presented to the GI clinic with some abdominal pain and diarrhea. Medical evaluation was not remarkable, and when they learned more about his personal history, they referred him to psychiatry. Only a few months before this he had an argument with his ten year old son, and pushed him down to the floor, and the boy hit his head and died. Not from the fall per se, but because the fall caused a bleed in a brain tumor that he had which had not been diagnosed.
But that is exactly what we did today. We met in a large circle, very close to the path we've been using to walk to the pool, which cuts right through the inpatient wards, and discussed the patients that had been admitted of the weekend.
Neither of us could hear at all, as the residents and consultants spoke in very low voices, perhaps because they were no more than ten feet away from the patients they were talking about. The sounds of the motorcycles, birds, and giant fruit bats made this hushed tone impossible to understand. After this discussion, we were introduced to a very nice clinical psychologist named Noel, and he served as our translator as we walked through the wards to see the patients. In another stark contrast to American psychiatric wards, in India there were no locked doors, very few security guards. Noel was actually a bit surprised to hear about all of the precautions we take. The patients who were judged to be a danger to themselves or others were kept in the acute care room, which was one room with 10 beds, and more nursing staff, but again, the door was open. The hospital depends a great deal on the family staying with the patient to keep them from leaving the hospital or worse.
Most of the inpatients were being treated for schizophrenia, and most of them were newly diagnosed. We saw a number of farmers who had attempted suicide, all of whom used pesticide, apparently a very common story in rural India. Last year the monsoon seasons were particularly poor, and many farmers had extremely poor crop yields, leading to a dramatic increase of farmers attempting/committing suicide.
In yesterday's post I mentioned that in order to be admitted to the unit, at least one member of the patient's family must agree to stay with them. This was also true of some other units in the hospital, and we were told this was to keep costs low. However, the concept was made into doctrine by the first chairman of psychiatry, Dr. Florence Nicols. And while for the poorer patients, they did require the manpower, Dr. Nicols made this a firm rule even for those patients with the means to pay someone to stay with them. She viewed it as a way to learn more about the family dynamics as well as allowing the staff to educate the family on the nature of the patient's illness and how it would be managed. I believe it has another very interesting effect, in that it may be less disruptive to the patient's life. In our system, a psychiatric admission is a traumatic experience itself, as the safety that comes with our hospitals comes at the expense of most personal freedoms like wearing your own clothes, having a cellphone or even having ready access to the outside world. This hospital really didn't feel like a hospital at all.
Because of this philosophy, the inpatient ward has a community or village feel. In fact, moriah and I had been walking through it for the last three weeks, thinking that we were walking by staff housing. Not once did we consider we were walking through an inpatient psychiatric unit.
In the afternoon i attended the psychiatry consultation clinic at the main hospital, where they saw patients who had been seen by other outpatient services, and were being referred to psychiatry. At this clinic I heard about the most heart wrenching story I can imagine. He patient was a thirty year old man who had presented to the GI clinic with some abdominal pain and diarrhea. Medical evaluation was not remarkable, and when they learned more about his personal history, they referred him to psychiatry. Only a few months before this he had an argument with his ten year old son, and pushed him down to the floor, and the boy hit his head and died. Not from the fall per se, but because the fall caused a bleed in a brain tumor that he had which had not been diagnosed.
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