Coimbatore, India - July 7, 2004
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Tuberculoid Leprosy patient in the leprosy/TB clinic in rural area of Coimbatore. Note the resorption of the nasal bone, lateral loss of the eyebrows. This patient is relatively shunned from the community and has turned to asceticism, which explains the white powder on his forehead and the long, long beard.
Our day started off quite early. I awoke to find three more mosquito bites on my legs to add to my already impressive total. I looked out my window of the University’s guest house to hear birds chirping atop the many towering coconut trees. I went into the bathroom and was cordially greeted by the lizard hanging on the wall. He was busy filling his stomach with as many fleas and mosquitos as possible, and in my room, he was in heaven. I poured a few gallons of cold water into a bucket as I started my daily bucket bath which felt so great in the hot Indian sun.
After eating a rushed breakfast, Kartik and I reported to Dr. Sivamani, Assistant professor of Community Medicine at PSG College of Medicine. He informed us that we would be shadowing Dr. Lakshmi, a dermatologist, to a leprosy clinic in a little tiny village. My heart skipped a beat. Here was an opportunity to see some medical cases that people in America only dream about, as sadistic as this sounds. As Dr. Lakshmi greeted us, we were immediately buried in a serious of "factalanches". She was incredibly enthusiastic and knowledgeable about her field and was the consummate teacher for her. She made us understand how terribly difficult it was for individuals with Leprosy to seek treatment. See, transportation is a big problem in India. Traversing even 1 kilometer can take a whole hour! So poor people living in the satellite villages near a big city such as Coimbatore have to spend a whole day traveling to and from the PSG medical hospital. And as Lakshmi points out, one of the biggest challenges of health care is access. Leaving your home and your work for a whole day can make the difference of starving or having a meager amount of food on the table. It is for this reason that we, the medical professionals, must come to the patients.
My initial academic enthusiasm was almost drowned in the site of such human suffering and sorrow that I saw at the clinic. Leprosy is quite visually appreciable. Patients have large, red, edematous rashes all over their bodies. Because of the horrible neuropathy that they experience, many exhibit foot drop and claw hand. Many times they have bone resorption in their phalanges, so patients would come in horribly deformed and crippled. The face was the most telling sign for leprosy. The nasal bone became resorbed, eyebrows would fall off and patients would exhibit lion-like faces.
Perhaps the most horrible aspect of leprosy is the social stigma behind it. Actually, doctors will never use the term leprosy to describe to a patient what is ailing them. Hanson's disease is the more politically friendly term for the affliction. For women especially, being labeled as a leper can be devastating. Immediately they are thrown out of their husband's home, disenfranchised of not only a place to stay, but their own children. Dr. Lakshmi was a careful as can be when informing the patients of their condition, making sure never to use the word leper in front of them.
As we piled back into the van to take us home, our heads were swimming with knowledge, experience, and also sorrow. This is the greatest thing about going to India, your appreciation for the things you have is magnified 10 fold. I hope that one day, the medical system can reach out to individuals even in the most remotest of villages; I hope we can eradicate this gruesome disease once and for all; I hope that one day the women of this great country can be treated with the dignity, respect, and compassion that they deserve; And I hope that I keep coming back here to make a difference, even when I am much older.
Shrinivas Hebsur, Med 2 (Class of 2007)
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