Gutka - eating death

This week (3 days a week in the ward) was fast-paced info-packed, highly educating and gave a real thrill. I've learned a lot in these past three days about life and goings on in the Surgical ward. I now appreciate the University's move to assign three days wholly to clinical studies each week, rather than the old system where students had to visit the wards for two hours daily. With this new system in place, we can feel the difference - there is actual structured learning going on and we have time, each day we're there, to explore, investigate and learn about diseases and their treatments.

This week, the focus was on physical examination of the abdomen for different signs and symptoms of disease. The major cases that presented in the wards dealt with Cholilithiasis, Pancreaitis, Parotid and other swellings. In fact, we even had a case where a 16-year old boy, Aquil, had a swelling on the left side of his neck - a result of addiction to "gutka" - the menace that's consuming the poorer sections of society.

Gutka is a chewing powder-like substance that is manufactured by low-class, unhygenic industries with a lot of trash and grabage ground into it. It's wholly carcinogenic (cancer-causing) and addictive as well, for the drugs that are added to it. This poison is sold for just ONE rupee (about 1.4 cents!) so that young children in poor localities are entrapped. Aquil lay quietly on the hospital bed and when I asked him questions about his lump, he answered reasonably. I was thinking, 'It could be enlarged tonsils.' Then, I asked him to open his mouth. Lo and Behold! Through whatever little of his mouth that he could open, all I could see was a dark-red, swelled up oral cavity. The answer was obvious... it might be cancer of the oral cavity because of Gutka.

The whole story came pouring out. Turns out, the mother also ate Gutka occassionally and thus, her son wasn't very receptive to her scoldings. Aquil's younger brother had more sense, we found out. According to Aquil's mother, her younger son advised and insisted upon Aquil to give up Gutka. And despite the pain and swelling, and the hazardous implications of those, Aquil still eats Gutka when no-one's watching. It was sad to see that boy, once reportedly healthy and now looking that he'd lost weight (difficulty and pain in swallowing made him avoid eating food). We gave Aquil a slogan 'Zidd ya Zindagi?' (which roughly translates as, 'Stubborness or Health?')

Aquil was discharged temporarily and he'll be back in the ward soon for surgery. When I see him again, I'll be sure to tell him off seriously. Perhaps I took take along a garbage bin and show him the ingredients to his Gutka addiction. And also, it would be advisable to refer him and his parents to a rehab institution for such addictions.

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Viruses & Cancer: Double Trouble

A lot of ground-breaking reseach is currently underway to better understand the link between viruses and cancer. Read about it here.

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Dr Purr-fect

Who wouldn't want a fuzzy wuzzy cat doc? A sure way to lift a frown to a smile. If you think this is a joke, you'd better read up about Therapy Cats and their benefits!

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Meet the Patients!

Tuesday was my first day of clinical experience. All in all, it was an exciting experience and our group learned much, right from the start.

We’re a group of eleven girls in our clinical group and we’ve been assigned clinical posting three days a week, 8:30 am to 2:45 pm with a half hour break in between. The hospital that’s our ‘classroom’ for these three days is Civil Hospital, a public-sector hospital in the heart of Karachi. Despite having limited funding in many wards, Civil Hospital has some of the best doctors in Pakistan and it thus makes sense why people from widely varied areas of the country come here for treatment. For the students at Dow Medical College, Civil Hospital eventually comes to hold the same value because of the fine learning experience and opportunities here.

Clinical postings of the different clinical groups in our class of 2011, last one month each. Our group’s first posting was to one of the Surgery wards. Surgical-IV turned out to be a great place to start the clinical learning. The ward has been extensively renovated and the doctors-cum-teachers were very, very professional. There were none of the ‘Aww, you’re new third-year students! How cute!’ kind of exclamations. In fact, in our very first class, we were introduced to the art of patient 'history-taking' by one of the senior doctors. After that preliminary, it was time to meet the patients! Finally! We divided into batches of four and went off to the beds.

Dr Junaid introduced us to a patient and having requested her not to tell us what she was in the hospital for, he left us to start on our ‘Unsupervised hour’. The lady who was our first patient, received us well, even though she was sleepy. We quickly asked the questions that we could think of, including her personal details. Dr Junaid then returned to make corrections and highlight areas we had missed out. It turned out that our clumsy guesswork was correct – she’d had Cholilithiasis or ‘Gall stones’ and had just had surgery for gall bladder removal.

We made better progress at the next bed then. Our next patient, Yasmeen, was from up North, and we needed her attendant to translate for us. Yasmeen was sitting up on bed and seemed quite happy to chat with us students. We asked her every question we could think of, consulting her report-file as well for pointers on anything we’d missed. We were sort of right this time too, without having any X–rays with us. She had difficult in swallowing (dysphagia), vomiting, cough for the past five years, with associated weight loss but no loss of appetite. We guessed at Achalasia – a disorder in which the lower part of the esophagus fails to relax to allow food to pass into the stomach, resulting in food accumulation, distension (dilatation), vomiting and infections.

Our groups then met up again to present our cases to the Associate Professor, our teacher for the day, Dr Farzana Memon. We sat with her for about two hours but how the time flew, we never found out! Being our first day there, we didn’t do well on case presentation and thus, Dr Farzana focused on the discussion of one case – our apparent Achalasia case. I was never part of such an interesting medical discussion ever! She literally delved into the case with us, discussing each symptom, the various possible causes, eliminating each one. She also explained the diagnosis to us and the potential for benign or malignant growths, which was later confirmed through X-rays. Yasmeen, our patient, seemed to have Achalasia, plus some other growth around the middle of her esophagus that was choking it. A CT scan plus biopsy would confirm whether the growth was harmless (benign) or harmful (malignant).

Thus rounded-up our first day in the wards. Next time onwards, it will be more extensive I expect and as our history-taking skills improve, with a lot of hard work, InshAllah, it will get better and better. For us, the first day was an exciting and eye-opening experience. The friendly attitude of the staff calmed our fears and worries and in fact motivates us too, as in the case when Dr Farzana said, at the end of her class, ‘If you work hard and take interest in the wards, you might be even able to suggest treatments by the end of the year!’ Now that was just COOL.

(I'll be taking pictures of the ward soon, InshAllah, to put up here!)

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