The patients who came to the Skin Clinic were a motley crew.
Most of the patients came in after having dabbled at self medication, with OTC s, the over the counter prescriptions. Or they would have gone doctor shopping with old prescriptions from at least 5 Dermatologists in town, at any given point of time. Some came with plastic bags filled to the brim with half squished tubes and ointments. Steroid creams were easily available as a quick fix, masking the morphology of lesions. One Doctor, who will remain nameless, actually asked me in a very condescending manner, What is the big deal about Dermatology, Dr. Susie ? Skin lesions can be divided into 2 groups. Lesions cured by Steroids, and Lesions not cured by Steroids. Simple. Anyway nobody ever gets cured, there are no emergencies and no one dies of a skin disease. Right?
Many thought that Dermatologists were glorified beauticians, as patients became aware of Cosmetology. Aesthetic medicine had come to stay. Bread and Butter Dermatology was pushed to the periphery of the clinic . The Indian subcontinent is completely preoccupied by skin colour. No matter what shade of brown you are , you want to get lighter. If you scanned the Matrimonial column in the Sunday paper, a familiar template would emerge to repeat. Wanted tall, slim, beautiful, fair girl…This wish was unisex. Even men wanted to get fairer, especially when they were getting married. A week before the date , optimistic, heavily pigmented men would enter the clinic, look right and left furtively, perch on the edge of the seat and say Konjam fair aganum. I want to get a little fairer. Most of the patients who came in wanted to go several shades fairer. Some did invasive procedures. Dermabrasion and harsh bleaches with no sun protection post procedure, left them with a dull tell-tale slate grey pigmentation, which was irreversible. The sales of the popular lightening cream Fair & Lovely beat everything else in the market, even the sale of flavoured condoms.
Patients in the West, took their followup visits seriously and they would arrive on time, every time , having followed instructions to the tee. Our patients, on the other hand do not prioritise health. It might be the 7th or 8th on their to do list. The farmer would come after the harvest, or after the sacred cow had calved. The mother would come only after her daughter’s wedding. Parents were free after their school exams. They had more important things on their agenda. Why on earth would they waste their time on a Dermatology follow up ?
Our patients are prisoners of tradition and culture. There are good days to visit hospitals and there are bad days to visit hospitals. Festivals interfere with doctor’s visits and followup. The elements and natural disasters interfere with doctors visits. The ultimate deciding factor is of course, the rising costs of health care and medicines. The hard earned rupee had more urgent uses.
The explosion of new drugs and its abuse on the market and the ease of OTCs, over the counter prescriptions, saw an avalanche of bizarre drug reactions seen especially on the skin. We had a patient who was referred to the Hospital with a diagnosis of a Drug Reaction. He never gave a history of treatment for Leprosy, because no one asked. The suspicion index for Leprosy in a Corporate Hospital setting is extremely low. A skin smear sent on admission showed that he had a Lepra Reaction. Skin diseases are no respecter of class or creed. Infections and infestations are no respecter of social status. An embarrassing diagnosis of scabies and head-lice can appear in a Dermatology clinic in a Corporate Hospital. Travelers by road, rail and air are carriers of culprit vectors of disease.
The mosquito, the bedbug and other vectors of disease often traveled without a visa or a passport, spreading infections globally.