Dr. Chellapa and life in the hospital.

Finally what you've all been dying to hear about .

Dr. Paul S Chellapa is the doctor who I've been obseving for several days now. He has been a practicing doctor for 40 years. I'm not sure how old he is, but I'm assuming around 65. He has his MBBS, MS, and FICA (also some other degrees I dont remember the abbreviations for.) His speciality is in ENT (ear nose throat.) But on a daily basis is a primary care provider, oncallogist, pediatrision, and general surgeon only to name a few.

The doctors life:

On my way to kairakudi Austin told me about how doctors in India live like kings have large nice houses and drive nice cars. I told him it was the same in the states. While by Indian standards this is true, by western standards the doctor's possetions would be considered normal while his lifestyle considered elegant. The doctors house is a pale green two story surrounded by a barbwire fence whih keeps the guard dog , whose only weapon is his bark ( and the rabbies from his bit) at bay. The inside of the house is kept clean but lacks a modern feel. All of the lighting is flourescent and everything in the house is from Ca 1970. One of the first things I noticed when entering his house were the large pictures of Jesus on the wall (the Dr. is christian) I have only ever seen the entry way, living room, and dining room. Will and I are not invited to the upstairs. Dr. Chellappa has somewhere around 5 or 6 servants/drivers/maids. Their are three women who do the cooking and cleaning and live with the doctor and his wife. He also has a driver who I also believe yard work. In addition to those four he has a sort of personall assistant who will sometimes drive us and also works in the hospital and performs such tasks as answering the doctors phone or telling a nurse to get the doctor some juice/water/tea (yes the nurses get the doctor drinks and also food from local street vendors.)

The clinic:

Simply put the cleanliness of the clinic scares me. Now that that is out of the way I'll explain a normal day. The doctor sits in his office at his desk with a stack of 4x6 sheets of paper, these are the complete medical records of patients. He then simply goes in order and the patients are brought in to the office by one of the 4 or so nurses who are constantly running between his office the injection room and the wound dressing room. The doctor will see a patient make some orders then the nurse will take the patient fill the orders if they can be at the clinic and then the patient will return to see the doctor. While the first patient is gone a second patient will enter and so on through out the day. The doctor NEVER washes his hands between seeing patient even if he has just squeezed puss from an absses. The tools he uses through out the day are kept in a rusted metal rectangular pan. Once they are used he puts them in a small steel bowl under his desk and when he runs out a nurses will clean them. This is unless he needs a tool and he ran out, in which case he will just use a dirty tool. His ottiscope has only two plastic replaceable tips that never get replaced or cleaned, they simply go from infected ear to infected ear. Their is no sharps box in the office either (or the clinic as far as i've seen) None of the needles have any king of quard on them and get passed like a basketball between the doctor and the nurses. I stay very diligent as I would rather be a hobbit in mordor then get stuck with a needle in India. My day as of lately involves sitting on a folding chair observing the daily work. Later this week or early next week I should start being to help in a more hands on approach. I'm sure that i've left something out that i will add later but thats all for the clinic for now.

Surgery:

I am in great self debate about the surgeries I've observed. They seem near torture and here is why. 3/4 surgeries observed so far where done only under local anesthsia. Those done under local were an appendectamy and two deviated septum repairs. The patients remain poorly draped in questionably cleaned cloths. It is gut wrenching to watch *grusem be ware* a patient moan and wringle in pain while flows from their nose and mouth soaking the sourronding cloth as the surgeon chissels away at their nose. However the doctor is performing needed surgeries with what he has and what the patients can afford. An average surgery at the clinic costs about Rs11,000 (~$200) Their sterile technique is beyond questionable and when asked the doctor said that infection rates are low at his clinic. The first thing that made me question their technique was when I was made to wear a pair of "surgigal flip flops" in lew of my Chacos. Beyond that their were not other requirements for William or I. We simply wore our days clothes, and mask and cap of course. Many of the nurses including the scrub nurses simply went barefoot in the OR. None of the equipment in the OR is disposable (except for suringes) Anythign in their that is metal has a reasonable amount of rust on it and the only modern equipment is the puls oximeter everything else is Ca1960. Again I'm sure I forgot some stuff but this gives you the gist of it.

The clinic:

The Chella clinic was converted by Dr. Chellappa from an old building 30 years ago and nothing with in it has been updated. Their are 10 beds in the hospitals 2nd and 3rd floors. It is in general a dirty place that I would not even eat food were it made inside let a lone go their for a doctors apointment. however the doctor charges only Rs50 for an appointment (~$1) this way the local people can afford it.

Bellow are various pictures I took yesterday includign pictures of William and I in our first auto-rickshaw ride :S pictures of the outside of the clinic and more pictures of people on the street.

screw it pictures take too long here maybe tomorrow.