Delhi

I'm in Delhi now, the capital of India! Tomorrow I'll finally get to see the infamous Taj Mahal. Although, the bus ride will depart Delhi at 6:30am and arrive back in Delhi at 10:30pm! I hope the ride will be enjoyable....or at least comfortable. It is crazy here! There are so many people here.
This past weekend I stayed in Bangalore and experienced my first banana leaf meal. So I finally caved in and learned to use my fingers and scope up pieces of rice without utensils. First, I had to sit on the floor then wash my banana leaf with some bottled water and then the meal was placed on top of the banana leaf. It's quite a challenge trying to scope up rice and pack it into a ball before bringing the fingers to your mouth! With many eyes on me from the others around me and a pile of rice outside the banana leaf that managed to escape between my fingers....I finished the meal in about 20 minutes! No problems with the GI so far!

Bangalore

CMC was an incredible experience! I saw/experienced things I probably wouldn't have had a chance to see in the U.S. It's amazing how similar and yet different medicine is practiced across the world. Now, I am in Bangalore visiting my medical school roommate and her relatives. It was a 4 hour train ride from Vellore.
Today I got my eyebrows threaded for the first time ever! Quite different and a lot faster than plucking. The coffee in India tastes wonderful! There is an international coffee festival this weekend in Bangalore. On Tuesday, I am traveling to Delhi to see the capital of India. Then hopefully the Taj Mahal in Agra before I leave India for Houston. These past few weeks have flown by! I cannot believe I'm leaving India in less than one week.

Infectious Disease

Wow, I am almost done with my rotation here at CMC. Yesterday was outpatient clinic and it was quite interesting. The doctor had studied in the U.S. and did a fellowship at MD Anderson in Houston. His English was great and it was interesting in how he practices medicine here compared to the other doctors here. He respects his patients very much and treats each one with dignity and will praise every patient that walks into his room. Although, it quickly became chaotic when he had 4 patients in his room at one time! He had one sitting in the room across his room and three other patients in his room. I was suppose to interview one, Codi another, and a medical student from CMC see the 4th patient. In addition, each patient brought along a close family/friend. I interviewed about 4 patients that only spoke Hindi and well...understood a couple of English words here and there. I realized after my first patient that the only way to succeed was to use one word sentences/questions. For example...pill (along with a hand motion imitating taking a pill), hurt (pointing to certain areas of the body), job, etc. Asking "do you take any medications, or does it hurt anywhere" will not get me anywhere! The only response I will receive is either a puzzled look on their faces or they start saying a bunch of stuff I completely don't understand. This epiphany only occurred after I had realized that they spoke to me the same way. For example when I step into a shop, they say "come" and that's it or "bye" and walk away. It's been a quite interesting experience.
Today during ward rounds, I saw gangrenous toes due to SLE, Raynaud's phenomenon at different stages, a great clinical example of rebound tenderness, and numerous cardiac murmurs. I've noticed that many of the patients have rheumatic heart diseases or have been treated with tuberculosis....I just hope I don't end up having positive PPD's once I leave India.

The Pool

This weekend was nice and relaxing. It was almost an escape from reality......the pool by the CMC college campus. With palm trees, a blue swimming pool, western toilets, pizza with cheese, french fries, coke, and grass, real grass, was a nice escape from the dirt roads and the honking of the cars, motorcycles, mopeds, rickshaws, bicycles, and buses! Codi and I spent the entire day at the pool on Sunday along with some other international students we met the previous night at a hotel roof top restaurant. One is a Urologist attending starting up this fall in Baltimore. Another two were doing research here in Vellore, one from Sweden and the other from Denmark. Then there are two girls doing their endocrinology fellowship elective at the CMC hospital. There were a bunch of other international students there too. So this week we start I&D, infectious disease.

Leprosy Clinic

Today was leprosy clinic. Yes, it's a Saturday and we had to show up at 7:30am but it was definitely worth it! I've always seen leprosy on TV or in the books but to see it in person is stunning. I did not realize how debilating it was and I saw all stages of leprosy. I meet a newly diagnosed leprosy female in her late 20s. She had the hypopigmented patches/macules on her face and arms. Then I saw another male with hypothenar atrophy and missing digits. Another patients had ulcerated his entire plantar surface of his right foot and yet he walked around as if nothing was there. Thankfully, there are multiple drugs for this disease and quite curable! This afternoon, there's suppose to be some festival right in front of the CMC hospital. We might even visit the one and only tourist spot in Vellore....the FORT! :)

CHAD

So much has happened since my last blog. I've been at CHAD, a community health and development secondary hospital out in the rurals. That is the reason why I have not had a chance to update my blog. The computer there takes forever to start up. To get to a website would take 2 mins! So, here's a review of what happened this past week.

Monday:
Orientation at CHAD and learned about the history of CMC. It's a great story. So a brief synopsis would be a lady named Ida Scudder, who is a daughter of a medical missionary, was born in India. She is an American who one day witnessed the death of three pregnant women while in labor during one night near Vellore, because no female doctors were available to help with the deliveries. Ida's dad was a doctor but he was not able to assist because he was a male. So she went back to the U.S. and studied to become a doctor. She came back to Vellore and started a one room clinic at her house that eventually expanded into CMC hospital. She was a huge advocate of community health and traveling to villages to help people. So now CMC sees over 5,000 outpatients and 3,000 inpatients a day! This is a very brief discription of CMC's history but there's a more complete story online.

Tuesday:
Checked out the L&D, pediatrics, geriatrics, ICU, ER, and general wards at the CHAD hospital. I saw leprechaunism, a congenital syndrome, which I have not ever seen/heard of before. I have a great picture but until I figure out how to upload pictures onto this blog.....maybe later. So apparently there is a lot of consanguineous marriages within the villages and many autosomal recessive traits show up.

Wednesday:
Nurse's Run, where we do home visits. This was exhausting! We visited a total of about 16 homes and 6 villages. We walked to each house and did mostly prenatal and postnatal checkups. We saw some hypertensive individuals and a handful of well baby exams. Unfortunately, most of the babies were malnourished and one was a 2 months old term baby girl, but only weighed about 5 pounds! The mom was feeding her cow milk and the baby had diarrhea and just looked aweful! The nurse referred the baby to the hospital and supposedly there will be a van to pick the patient up the next day. Some of the houses were made out of sticks/cow dung and some were made out of concrete and bricks. There was a huge variety of living quarters. Some villages had a well!

Thursday:
Doctor's Run, where we travel in a mobile clinic and go to 4 different posts. The patients would arrive at the post and we would see patients either in the van or outside the van at a table set up. I loved this experience! So two doctors would run this. One doctor is outside at the table taking blood pressures and doing baby exams, hypertensive/diabetes checkups and some geriatrics/psychiatric conditions. Another doctor would be in the van doing prenatal checkups. The back part of the van were two nurses giving immunizations to the babies and dispensing medications. We left at 8:30am and didn't get back until 6pm!

Friday:
Today, was our day to recuperate! Wow, what an exhausting week! We went to a traveling agent to help us organize our trip for our last week in India. So far we have a train ticket to get to Bangalore and a plane ticket from Delhi back to Chennai on March 2nd to catch our flight back to Houston, home! Ro, my roommate back in San Antonio, is in Bangalore with her relatives so I'll get to see her finally!! Now, off to the ER at CMC hospital to explore some more.

Mamallapuram

This weekend Codi, Becky, Joel, and I went to explore a city nearby called Mamallapuram and on the way stopped by a silk place, Kanchipuram. The culture here is quite different. I'm slowly adapting to the custom, but I have not yet mastered the skill of eating with your hands. I'll use my hands for Naan but as far as rice goes...still sticking to the utensils. So the city we visited is on the east coast of India, south of Chennai. It was definitely a tourist town. The beach was nice. We mostly spent our time visiting the different temples nearby. The drive was 3 hours and I didn't really see any traffic lights along the way. People use the horn an aweful lot and well there are toll roads just like the U.S. So I think I know why there's trash everywhere! I tried looking for a trashcan to dispose my empty bottle and I couldn't find any! Although in the morning on our way to see sunrise at the beach, I did see a guy sweep the grounds. However, he swept the trash to separate little piles along the walls.....so I guess it just accumulates. At least they try!
Last night, we attended the evening chapel service offered at the CMC hospital. It was packed! People were even standing at the doorways listening in. The sermon was about healing and as a doctor our job is not just to heal our patients but to feel and experience our patients' lives.
So far my stomach has been pretty good, no heartburns, no diarrhea.....hopefully it'll stay this way. The first week flew by and now I'm on CHAD, community health and development. This is a secondary care center for the more rural areas.

Pediatric Surgery

I saw really awesome cases today at the OR. I guess in India the pediatric surgeons do peds urology too. I was able to observe an orchipexy, hypospadia, bifid ureter, TE fistula/diverticula/stricture, TB lymphoma, and rhabdomyosarcoma at the parotids. I got to scrub into the TB lymphoma case....quite different. The gowns are cloth and you do the same thing to scurb in so not too tricky. Well and as a medical student....my job was to retract. However, I did get to feel the golf ball size lymphoma at the ileocecal junction on a 14 yr old girl. It did feel like a golf ball too, so firm! Then I peaked into a C-section, vaginal delivery, and laparoscopic exploration of the uterus for a possible cancerous polyp. They're pretty advanced here in India. They have the tools - fluoroscopy, CT scan, MRI, laparoscopy, X-rays, ventilators, and more. Wow and for vaginal deliveries of course no anesthesia used! Their scrubs are cute too. Long shirts that go down to the knees and huge wide legged pants.

Pimping

I guess pimping isn't much different compared to how we get pimped in the U.S. I felt so bad watching the attending make the student try to answer tricky/impossible/read-my-mind type of questions. Thank goodness I'm done with that...for now that is. Once again I witnessed another procedure without the use of lidocaine! The resident did an LP on a 14 yr old boy with possible manic posturing and they wanted to rule out organic causes. I think the boy was poked 7 times with no localization. Ouch! The idea of possible malingering was definitely ruled out. The patient didn't even flinch or cry with pain. There were tears streaming down his cheeks...brave one. I really feel for these children. They really do go through quite a lot.

On a brighter note, tonight all the UTHSCSA students in India are meeting up for the first time for dinner at the roof top of a hotel.

Peds Wards

Oh wow and ouch are the two words that came into my mind as I stepped into the pediatrics wards. It's so different from our hospital back in the states. The beds are rusty with green sheets and there's some privacy with a curtain. The nurses are all so cute and dressed in white saris with a plastic nurse's type cap on. Very cute. I'm going to have to get a picture of them. The procedure room....let's just say that would never fly by JACHO! They do sterilize the equipments used but everything is cloth and is laid out in the room with the windows open. Today there was a little girl with pleural effusion. First, the resident did a thoracentesis and found empyema and then decided a chest tube was necessary. The way they went about doing these procedures was quite a surprise. First, they do not use anesthesia and will only use localization to numb the skin on a child! The little girl was in so much pain and her eyes were wide-eyed the entire 15 mins with screams in between. Pushing the hemostat with the tube for the chest tube placement into the chest wall while the child was fully awake and had only some localization was quite painful to watch. I can't imagine what can be as painful as feeling a scapel cut into your chest wall and then a metal type probe with a plastic tubing shoved into your chest. OUCH! But brave girl she did it and all that nasty pus is nicely draining out. Oh and the chest tube water/air set up...completely like the original set up back when it was first invented! Very neat!

First day in Peds

So today was my first official day at CMC, Christian Medical College in Vellore. I signed up for pediatrics since I plan on doing this as my future occupation and I wanted to see how different or similar it would be to the way I have been used to practicing/observing in the U.S. To start off, each doctor will see around 60-70 patients a day! There did not seem to be much security around the hospital. The peds wards were locked but the clinic was a "mad house." Those are the exact words my attending used the entire day while I followed him. The etiquette is also quite different. To my surprise, I did see quite a few patients come in with their fathers instead of their mothers. If the dad was not present then the grandmother and mom would be present. The children were cute, as always! Today I saw parvovirus/rubella, status elipticus, gastroenteritis, failure to thrive babies, hypertonic babies, dystonia, and many viral syndromes.
Patients would just wander into the doctors offices and there did not seem to be much organization going on. The physicians would use the PA system to call patients into their rooms and each rooms held two doctors seeing patients at the same time. One bed was used between the two doctors and the sheet on the bed remained the same the entire day. Hands were seldomly washed between patients and equipments were also shared freely between the children....

Arrival to India

It was about a 17 hour flight broken into two to arrive into Chennai, India. The flights were okay, but once we landed into India....things at first seemed so surreal. Am I actually here?! All the way across the world, a 12 hour difference between where I am now and where I was once standing only 24 hours ago....

The hotel by the airport was pretty decent...at least there was running hot water. :) The ride to Vellore...well that's a different story. Codi, my traveling buddy, and I took a taxi ride from Chennai to Vellore. A taxi with A/C because well we heard about not having A/C and having dust blown in your face for 3 hours. Plus it was only $7 dollars more. So, I've concluded that there are no rules when it comes to driving here in India! I'm so greatful to be alive right now. It was almost as if we were playing chicken! Who would steer their car out of the way first....didn't matter the size cuz we would be heading straight towards a huge truck with logs loaded as its cargo or straight into a guy on his moped. It was fun and thrilling, I guess.

After finally arriving into Vellore safe and sound after having to stop every 5 mins to ask for directions, we successfully arrived at a hotel with some rooms available! I was so afraid we would be homeless because the two hotels that were recommended to us were booked until next week.