Elephant Hill

We have spent the past few days working at a hospital called Karigiri. This hospital is just a hop, skip, 25 minute bus ride on the #1 and 15-20 minute autorickshaw ride away. Karigiri is translated as Elephant Hill, named for the flat topped hill that can be seen in the distance. This hospital was built by an American doctor, Paul Brand, in the 80s. This hospital was built for people with Hanson’s Disease or Leprosy. Yes leprosy. During our first day we were able to learn a lot about the research projects they are working on here in India where leprosy is much more prevalent than in the United States. We have learned that though this disease has been plaguing people since the time of Christ, no one actually knows how it is transmitted. There are theories and the researchers here are swabbing the nares of relatives and neighbors of newly infected patients to see if there is a correlation. Though they don’t know the route of transmission, doctors have known for some time that Dapsone can treat it. And they are testing drug regimens as well.
On the second day at Karigiri we went on surgical rounds with an orthopedic surgeon. It was amazing, horrifying, and so humbling at the same time. We walked along busy leprosy wards seeing patients, mostly men as they are more susceptible to the disease. Leprosy is caused by bacteria that attack nerves, especially those on “cold” areas of the body such as fingers, toes, superficial leg and face nerves. This nerve destruction leads to a deadening and then a total loss of pain sensation in these areas. It is similar to the neuropathy that diabetics experience on a larger scale. Due to their lack of pain they are prone to infection, ulcers, abscesses, and absorption of bone and tissue. Many of the patients we saw had little more than nubs on the tip of their hands; they had multiple contractures and ulcers on distal surfaces. Some of these ulcers were as deep as the tendon and bone with tracking fissures and sinuses. The doctor unwrapped saturated gauze as the patients looked on unflinching. They could not feel these sores that made me cringe deep within. The most horrific wound was an ulcer on the medial aspect of the ankle on a middle aged man. We unwrapped the gauze to find a terrible odor and saw that they wound appeared to be moving! Upon closer inspection we saw hundreds of maggots crawling inside of the wound. We couldn’t believe it! We spent the afternoon observing wound debridement with the surgeon. One of our patients was a man with osteomyelitis on his foot with infection tracking along the tendon. The surgeon debrided the wound and the anesthesiologist sat back monitoring blood pressure. No anesthetic was administered as the surgeon crunched infected bone out of the open bleeding wound. The patient lay their oblivious to the pain. It was incredible.
Another afternoon was spent touring physiotherapy and occupational therapy and saw countless boots, splints, and devices used to help these patients eat, drink, walk, and brush their teeth despite the loss of their fingers and toes. It all seemed very primitive, but it worked for the patients and it was made affordable to them.
This experience was amazing, only slightly marred by the very questionable conditions of the mess hall they keep sending us to for lunch where we wash our own plates in the sink after eating and where they are continuing foisting papaya upon us.
In the evenings after work I am spending my time washing my clothes in the shower and eating wonderful Chinese food from the rooftop restaurant at the top of our hotel. Two of the Vellore four have finally had India catch up with them and began taking Cipro for intestinal issues yesterday. Hopefully a cure will be near before we embark on our four hour train ride to Bangalore for the weekend!