Joe and Lotte at the Sambhavna clinic in Bhopal, India - Blog number 2

Sambhavna blog number 2

The last few days have involved Sambhavna clinics, Hindi crash course, a good exploration of Bhopal and
an intriguing visit to Bhopal Memorial Hospital.

Patients presenting this week have shown a wide range of symptoms from classic GP bread and butter to leprosy, malaria and malnutrition. Despite the exotic location hypertension and diabetes are still the big health problems.
Asian genetics along with the fried sugary diet predisposes the Indian population to this. The gas effected population has been shown to suffer from endocrine diseases at a higher rate from the general population. This may account for the fact that even very slender men and women suffer from type II diabetes.

The main malaria parasite in Madaya Pradesh is Plasmodium Vivax, the main globally is Plasmodium Falciparum. We’ve only seen one case so far this week however as the monsoon arrives the rates are generally expected to shoot up with the perfect
conditions being provided for mosquito development.

Leprosy is less common in Bhopal though we have seen a patient and a few others with the condition in the town. Whilst people fear the condition it is not contagious. The cause is pro longed exposure to Mycobacterium Leprae throughout childhood. This bacterium is a close relative of Mycobacterium Tuberculous, the culprit of TB. The main problem in Leprosy is peripheral nerve
damage, this leads to loss of sensation in your hands and feet. This typically leads to terrible burns and other injuries as the victim can no longer feel soft touch, pain and temperature. This explains the common picture of missing digits and toes. The term ‘handicapped’ originates from lepers begging in the street with a cap in hand. Our patient had presented with his first burn on one foot which he had initially been completely unaware of.

Malnutrition is a major health problem, about half of the patients suffer from anaemia, in children this restricts growth, development and causes the bizarre symptom of “pica” – a graving of inedible things – like soil; not so healthy! We were also surprised to see a frequent stream of patients with low blood pressure and fainting which Dr Wazeem explained was again due to anaemia.

A parallel with England we’ve noticed is Vitamin D deficiency in women due to full body religious dress such as the ‘Burka’.
As the area surrounding the clinic has a very high muslim population we have met many patients at risk of osteoporosis and hence fractures.

Alcohol is culturally less acceptable in India and considering the heat we’ve experienced in the past week its not surprising!
Consequently there is little alcoholism but instead other substance abuses such as tobacco chewing which can lead to specific problems such as macula hemorrhages. Sadly its so scandalous for women to drink alcohol that Lotte couldn’t even enter the off license two nights ago!

We have found the opthalmology clinic, where we learnt this, a true example of efficient professional practice. In two hours every Tuesday and Wednesday a young eye surgeon pops over from her full time job to see around 25-30 patients with her nurse assisting with visual acuity tests. This would be unheard of in an NHS primary care centre but the result is all patients are thoroughly checked and provided with correct prescriptions. This monitoring is invaluable for hypertensive and diabetic patients whose eyes are particularly vulnerable.

So aside from the work we’re getting to grips with the hindi language and trying it out as we explore. We’ve made two visits to an incredible art gallery and studios on Lake View called Bharat Bhaven. Panoramic hill views frame the site and a white stone and marble sculpture garden peppers the lawn. Inside we visited a friend from a previous encounter in the grounds and were shown round the subterranean gallery, garden studios, Indian theatre and hotch-potch pottery workshop which Mr Paul Hardman would surely approve of, shelves overflowing with queer biscuit fired faces. The old city was the next stop, so old there was no room for rickshaws and mopeds, a welcome relief. This area is a maze of crooked streets, rainbow mountains of cloth, golden/silver sheen from metal workshops and a mesmerizing aroma of strange perfume, bursting bakeries and incense. Our best meal so far in india took place here in unassuming street vendor.

Final thing to mention is our visit to the somewhat controversial Bhopal Memorial Hospital. This is a few km away from Sambhavna and is funded by an out of court settlement by Union Carbide. A puzzling feature was a lack of paediatrics, orthopaedics or obstetrics and gynaecology departments. Apparently the research at the time of planning over a decade ago showed no evidence of health care
problems in these areas. From a medical perspective the facilities were incredible and within half an hour of entering the building we were whisked to theatre by the head cardio-thoracic consultant to watch a mitral valve repair upon an 18 year girl with rhuematic disease, a condition almost unheard of in Britain, especially at that age. The hospital is stuffed full of art commemorating the chemical disaster
painted by artistic patients. We’ll be visiting again to explore further in what seemed an incredibly equipped hospital providing free care to gas victims but with an incredibly bad reputation from the locals.

Enjoy the pictures, they are all related to what we’ve blogged

Heard about a heat wave in england? hope your having fun :)

Pyar hona Joe and Lotte

xx