The Intersection of Medicine and Culture in India

We have been able to observe a doctor both in the slum as well as in the polyclinic at the Asha office. It is fascinating observe the patients and the doctor and how they interact. Many of the ailments which afflict the slum dwellers are a result of their lifestyle. Their diet especially is low in key nutrients which leave the people vulnerable to illnesses which could easily be avoided. The amount of physical labor required of these people also is a detriment to their health.
The culture is one which believes that having many children is a blessing. One woman had suffered a "missed abortion" which we know in the US as a miscarriage. This had occurred 3 months before and she was advised to wait 6 months before trying to conceieve again. Her visit to the doctor this time however, was to ask how she could get pregnant, because there was a lot of pressure on her from her family. I saw several other women who visited the doctor because they were concerned that they had not become pregnant after being married or six months or a year. Once a woman is married, they are basically expected to start a family as soon as possible. The doctor at the polyclinic, an older, kind faced woman, assures them that they will in time. She explained that often, a patient will come in worried that something may be wrong and that is why they are not getting pregnant. The doctor tells them not to worry but sets up some tests for later that month. Often she revealed, the next time she sees them, they are pregnant. So she now has a reputation for helping that problem just by seeing the patients.
One woman came in with a bloodshot eye. The doctor examined it with a light and had her look different directions. She then touched the skin below the eye tenderly, and noticed a dark bruise descending from her inner eye out towards her cheekbone. She asked the woman what had happened and the woman said nothing, is it alright? The doctor turned to us observing and asked what it looked like to us. Reluctantly we suggested that it appeared she had been hit. That is exactly what the doctor thought as well. She prescribed an antibiotic just in case and told the woman to "be more careful". She then explained to us that domestic violence is fairly common here but that there aren't really any resources for women.
One woman, the president of the mahila mandal in w88 in Zakhira, came in complaining of leg pain and general achiness. She is 55 and recently had an operation to remove her gall bladder. The doctor explained that the pains she was experiencing were essentially psycho-somatic. Getting an operation is a daunting idea in general, and for a population of people who hardly ever go to the hospital, it is particularly upsetting. The doctor prescribed calcium and vitamin B complex. She says that these two vitamins she gives to basically every woman who comes in, because they are very often deficient. The patient usually feels better because these are good for the body, but also because of a placebo effect. The doctor at the polyclinic explained that similarly, she makes sure to have every patient lie down on the examination table, even if she is not looking for anything in particular. She explained that this process makes the patient feel taken care of and looked after. Sometimes just knowing that a professional is there helps them to feel better.
One of the most haunting images I have seen here in India occurred the other day at the polyclinic at Asha. A woman dressed in a royal blue sari, with pale skin and gold earrings, came in with her newborn baby. The baby was wrapped in a hand towel. It was ten days old but hadn't been eating properly. It was tiny. Its skin was so thin you could see its veins. It wouldnt stop screaming. He kept flailing his arms and crying in a birdlike way, repeating the same high pitched noise over and over. The mother tried to keep the towel around him as she lay him on the table, but he kept squirming and moving around. The doctor stood up and expertly wrapped him coccoon style in the towel. The two women then sat down at the desk to discuss the issue. I couldn't take my eyes off of the child and all I could see were its pale arms flailing in the air, his whole miniature body writhing on the table. The doctor then observed the baby breast feeding to make sure it was getting enough nutrients. She then sent for some medicine and mother and baby left.
One woman came in with feet swollen to double normal size. Only her toes managed to fit into her flipflops. She lay on the bed and explained that she had just come from her village. She was about 5 months pregnant but was not able to rest. Her mother in law was sick so she worked all day taking care of her. Her blood pressure was very high as well. The doctor explained that if the woman were able to rest and have a healthy diet, the condition would be easily cured. Unfortunately, it is expected for the daughter in law to care for her husbands mother, so it would not be easy for her to ask for time to rest. Hopefully now that she had the doctors orders her family would allow her to not work as hard.
Overall I have been impressed with how much trust these poor people put in doctors. Most of them did not grow up having any type of formal health care. I have been pleased that so many of these people take advantage of the facilities Asha has offered to them. However, one case which I observed, showed the other approach. A young woman suffers from diabetes. She is also highly allergic to many medications. Therefore she has elected to practice home remedies in order to deal with her problem. The doctor has tried to explain to her that diabetes is a serious condition which can lead to tragic outcomes if not properly treated. Unfortunately this patient does not understand or believe this and comes in only for basic tests but will not take any medication. I also was surprised to learn in another patient with diabetes however, that the doctor first suggests lifestyle changes, then emphasizes diet change, and only utilizes insulin as the last choice.
I am learning a lot and really enjoying my time shadowing doctors. It is so important to understand how interconnected medicine and culture is. Both doctors understand and consider their patients backgrounds and lifestyles before addressing the medical issue. They are sure to allow their patients to trust them, and make a personal connection with each one. Any large hospital is more impersonal than these clinics. Some patients visit the clinics after a hospital date only to understand what happened to them because in the big facilities they feel ignored and out of place.