update 3

I've spent the last week and will spend next week's three days of work at the Low-Cost Effective Care Unit (LCECU).  It is a primary care office/small hospital run by family medicine doctors who are committed to serve the poor people of Vellore who could not afford to go to the main hospital of Christian Medical College (CMC).  They do some minor procedures as well - toe amputations, pleurocentesis, wound debridement, lymph node biopsy, etc.

I spoke with one of the attendings early in the week about my desire to do medical mission work, and he explained that working here was much like that for him since he speaks another primary language (he's from a neighboring state) and in many ways this is cross-cultural for him.  He said that there are many benefits to working with the poor, however: you never feel like you have to up your standard of living to match that of your patients.  They are generally very grateful for help.  You have the personal satisfaction of doing something good. But we agreed together that it would be difficult to do cross-cultural service on a long-term basis without some sense of calling from and sustenance by God.

Specialists also come into LCECU once a week or so (orthopedics, gastroenterology, psychiatry, etc.) to offer their service to patients at a lower cost than at the main hospital.  I got to work with the psychiatrist on Friday and saw in the space of a few hours two psychotic patients, three bipolar patients, one woman with panic attacks, two wives of alcoholics who beat them when they are drunk and spend all the money the family has, leaving them starving, a very depressed woman who cried and cried, a schizophrenic, a person with obsessive-compulsive disorder and hypochondriac, anxiety disorder, depression with temporal lobe epilepsy, depression and anxiety with somatization.  It was very interesting (imipramine is very common for depression here since it's cheap, and risperidone for agitation or as an antipsychotic) as well as a bit emotionally wearing.

The psychiatrist explained to me that the alcoholics can take a very small dose of an antipsychotic to curb aggressive behavior when they are drunk.  One of the wives cannot afford even the subsidized prescription, which costs Rs. 20 (about 45 cents) for a week, so her husband has been beating up everyone in the house.  The psychiatrist explained that social services for domestic violence are nearly non-existent here and "Wives are considered part of their husband's household when they marry.  Therefore, their families often tell them to live with or die with their husband if they try to return home.  And they do," she said.  For want of 20 rupees a week to curb aggression when drunk.  My heart both cries for justice and mercy and feels unable to grasp these women's circumstances and their lives.  "I don't know how these women go on," the psychiatrist commented several times in the afternoon.  I don't either.