June 19 – Return to the Ulcer Ward

Well Dr. Jacob was right, it does get easier. After breakfast we went back to the inpatient ulcer ward for the daily dressing change. There were some pretty intense cases. One man had a big hole where his big toe used to be, and you could see some bone in the hole. To clean some of the wounds, they pour hydrogen peroxide in which usually results in a big eruption of pink foam, kind of like a baking soda and vinegar volcano. After observing for a bit the nurses got us involved slowly, first bandaging the ulcers after they had already been cleaned and covered with gauze. Then I cleaned a skin graft with gauze (which looks pretty gross, just a big expanse of pinkness). After that I even cleaned with gauze one of the deep wounds, sticking my forceps right into this person’s foot to clean everything out. The nurses were all very helpful and showed us everything to do. The other good thing is that the patients more or less have no feeling down there, so they’re pretty detached from the whole procedure and you don’t have to worry about hurting them. There was also an interesting case with a young boy who has had a recurring ulcer on his foot, but was also quite swollen around the ankle. They made a small incision to let out the fluid. It turned out it was synovial fluid that was building up there, which kind of looks like vegetable oil. Dr. Jacob took some pictures of ujs while we were working which I’ll try to get a hold of.
In the afternoon, we tried figuring out the scheduling program, and then we went to see Deepak (one of the young outpatient clinic doctors) do skin graft surgery. This surgery was a partial skin graft surgery, so only the top layer of skin was removed, in this case from the thigh, about an inch square. This was then transferred to the ulcer on the foot, and stitched into place over the large hole. It’s a relatively straightforward procedure. We talked to Deepak a bit afterward about the surgery and about medical education here in India and in the United States. He also said that on future graft surgeries he may let us assist in some way…I’m not sure, how, but should be interesting.

For the rest of the day, we struggled with that Scheduling Database program. It’s not the most fun to use, and deleting things is usually bad news and not handled very well, and copy things is impossible as far as I know, which makes for some repetitive data entry. Boo. Joanna would love it.


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