A Week in the Life of a Rheumatologist
It was my immense joy to return to Delhi and serve Asha as a medical volunteer for one week in February.
I carried out clinics in 4 different slums and one in the polyclinic at Asha HQ. Most of the cases had musculoskeletal problems and, as a rheumatologist, I was very much on home territory. However, I also offered to see rashes and skin lesions as well because I had spent one year as a junior doctor in dermatology when I was training, in preparation for a career in hospital medicine. On top of that I saw a few general medical cases.
This is not because I feel over confident in any way, but because Asha is desperately short of medical volunteers and I felt that at least I could offer a diagnosis and some help. My experience and observation is that general practitioners and many specialists would be able to positively contribute to the well being of these slum dwellers, and, in particular, dermatologists, paediatricians and gynaecologists are probably a priority. There may be a niche for Hindi speaking psychiatrists even. I would urge anyone to come to Asha for short term medical voluntary work as it is very rewarding.
Two occupational therapists (OTs) accompanied me during the week; one from the UK and the other from Nepal. We saw patients in the clinic together. The OTs came into their own by offering advice about adaptations and aids to improve the patient’s mobility, also solutions to joint problems arising from the work environment and advice about how to protect backs, knees and necks. The OTs used some of the splints and supports which we had brought from the UK and were also able to offer some advice to local suppliers about which were the most useful to stock.
One of the things which I instigated on this recent trip was the idea of conducting “home visits” or ‘house calls’. Volunteers made a list of patients who were too poorly to attend the clinics in the relevant slums and therefore we went to their homes instead. The cases were very mixed, but did highlight problems which might not have been obvious in the clinic setting. In addition, the OT’s were very good at making practical suggestions.
Simple adoptions can transform someones life. This scarf acts as a leg elevator. This lady also required a walking frame and Asha was able to provide her with one which I am sure will improve her mobility no end.
At the end of the week I was able to identify the following: that there is definitely a role for local support groups in each slum; that there is a need for simple and practical devices such as walking sticks, walking frames and splints, supports and leg elevators to improve mobility; and perhaps the need for better awareness of alternative local medical practices. Also, as our slum dwellers begin to have an improved life expectancy, we are now running into the practicalities of monitoring chronic diseases such as hypertension, diabetes and chronic renal impairment. These are challenges indeed to face in the future.
On Friday afternoon, at the end of the week, we carried out a teaching session attended by many of the local health care volunteers. We spoke about signs and symptoms of rheumatological conditions.
The beauty about Asha is that volunteers may stay for only a week to help, but the infrastructure is already set up so that follow up of patients or long term care is continued with the excellent support of the local health care volunteers attached to each of the Asha slums. Thus an acorn is able to grow into a mature and fruitful tree.