On my last day in clinic, I feel a little strange... maybe out of place. I know i'm leaving and that this is the last time i'll see this clinic - somehow i've already distanced myself. Yesterday I asked Dr. Sunil if the clinic could use some Doxycycline because some previous students have literally left bottles of the antibiotic behind trying to save space in their suitcases. Nobody here at the hostel has claimed it and i'd rather see it go to someone who needs it than sit around and go bad. So I waited out side the wards and dropped off the containers; Dr. Sunil was a gracious mentor and good ambassador to the students who have gone through there. In the back of my mind I feel like there is some sort of professional relationship that could be fostered between KU and CMC to develop new ideas and growth in the area of implimenting primary care with Dr. Sunil... but I can't quite solidify what that is yet, so I say nothing other than thank you for a wonderful experience. For a couple of hours I sat near the treatment room for patients coming in to get their penicillin prophylaxis shot for their rheumatic heart disease. They would first get a test patch on their skin to see if they had a reaction to the penicillin. In the half hour they had to wait to see if they reacted, I got to listen to their hearts. They ranged from barely audible murmurs to murmurs so loud I wondered if they could hear them the way you can hear your own heart pounding in your head sometimes. I was able to distinguish systolic vs diastolic, grade, and location but I realized that I had a hard time picking up the regurge on the murmurs... I need to buff up on my cardiology. It was a brief morning for my last day, but it was a good day. Now i'm back at the hostel packing and washing clothes before I head out on my night train this evening after one last dinner at the Darling Residency (great food ;-> ). Again, it's a weird sensation packing... I feel some nostalgia for leaving but I also realize i've only been here for 3 & 1/2 wks. Should I have nostalgia? Is it nostalgia, or just another wonderbug woking on my gut? I guess i'll find out soon enough. One thing I can say that i'm not going to miss is the ever increasing heat that is here to stay... it's hot now, probably 15-20 degrees hotter than when I arrived.
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Tuesday, February 24, 2009
Mahabalipuram
This weekend I ventured down to Mahabalipuram (Mamalapuram) with David Lee. Another med student that I met on the interview trail. His medical training is somewhat unique though in that he applied to a US program that is based in Isreal. We headed out early on saturday morning and got to our first bus transfer in Kanchipuram. From there we managed to get onto a direct bus that went through Chengleput, but didn't require us to get another bus from their to Mahabalipuram. Overall it took us about 3.5 hrs by bus, not bad. On arrival into town were landed next to a public demonstration against the violence between the Sri Lankans and the Tamil Tigers (Tamils in Sri Lanka who want their independence, if I understand correctly). It was a very vivid image for someone who doesn't speak tamil and can only derive information from facial expressions and other visual clues like demonstrators dressed in black and waving black flags... I thought about taking a picture, but my better judgement won the arguement so I have no visual aid to offer. Next we headed towards the beach to try and find a place fairly close to the shore. By about 1 pm. we were checked in and looking for lunch and we found it by wandering to the beach. After a feast of masala fried fish (deep fried spicey fish), french fries, and fresh lime soda (a wonderful drink i'm only now discovering that involves fresh squeezed lime that you mix carbonated water with sparring amounts of sugar... otherwise you create a momentary volcano, which is kinda fun too), we wondered down the beach in the direction of the only temple we could see. After coming to a fence that surrounds the complex and discovering we had to walk all the way around the fence to get in, we finally got to see the temple up close about a half hour after originally being within 100 ft of it. Instead of plagerizing Lonely Planet, i'll just include a link to a website that explains the temples ( http://www.mahabalipuram.co.in/shore_temple_at_mahabalipuram.php ). An interesting and understandable note, foreigners are required to pay 250 Rs. for entrance to the Shore Temple and the Five Rathas, citizens only have to pay 10 Rs. I was a little confused by the spectacle that I saw throughout the day as we visited the sights... it's my understanding that the temple and the structures like the Five Rathas are somewhat sacred, yet the entire day children and adults alike climbed around these ancient structures like they were a jungle gym. There were hordes of school children on field trips Saturday, so we're not talking one or two kids acting a little unruly. Combining this with locals hawking their goods more zealously than places i've previously visited before, I found my patience and basic trust in my fellow man wearing thin by the end of the day. Along the way toward the end of the afternoon we came across a man trying to sell rock carved pendents. Mahabalipuram is world renowned for their trade of rock sculpting and are still commisioned world wide to work on temples and statues. Almost everyshop in town sells ridiculously ornate rock carvings, so this man selling small pendents while we were trying to sight see didn't have a chance at a sale. In our moment of weakness, as the man sat down in the shade almost as if in resignation, accepting that he was done selling for the day - the man struck up a friendly conversation about where we were from and what we were doing in India and even offered a few tid bits about the history around us. Eventually he somehow became our un-official tour guide for the remaining bits. At the end of which, he invited us to see his rock carving shop... conveniently located at the end of the tour. At which point he confirmed his previous story of being a teacher of rock carving to students that worked at his shop - we saw them in action. We even got to talk to one named Dilip (Indian for Phillip) age 19. The nail in the coffin was accepting the tea and cookies... we felt obligated to buy something, even though we swore off buying anything made of rock as the truly beautiful carvings had no chance of making it on a backpacking trip and the more robust pieces were too heavy. I opted for two small pendents and David chose a simple elephant... only after choosing all the pieces we wanted were we given a price ;-> Ah, I wish there was a way we could have just made a donation... I'd feel better about donating something to a good cause than walking away with our trinkets feeling hosed. After confirming the outragous prices we paid, even after bargaining for a good 15 min., with other street vendors - we chose to BELIEVE that everything we were told was true and that we were in fact helping support kids learning the trade at the local colleges! Later that day, as we were watching the sunset in the park we ran across Dilip once again. This time he and some other boys were flying kites and engaging in the occaisional battle... he stuck to his story and we got to see a spectacle not unlike the magnificent flying scenes from the Kite Runner. Other than the fact that it seemed like 19 was a little old to still be flying kites... I felt much better about my purchase earlier in the day- although I remained a shrewd bargainer for the rest of the weekend.
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L.C.E.C.U. Round 2/23/09
In my final week here in Vellore, I opted to go back to LCECU as I enjoyed my first week there... and partly because I originally had designed my time here to be split up into 2 one weeks rotations and 1 two week rotation. This morning was kinda of slow to get going, as monday mornings usually can be - those in charge not showing up till 8 am. I had a nice chat with a OB/Gyn physician origonally from Detroit who once tried some tropical medicine courses in the Amazon where she met a group of people who were headed to Vellore, she accepted an invitation to travel with them and decided to stay for a while once she got here. She had just returned from a trip to Mysore this weekend and so we chatted about what I should see while i'm there during my travels. She was also the second person to discourage me from going to a wild life park as they aren't designed to allow people to see any wild life. Instead she recommended I visit a nearby town with some old ruins of a fort that she particularly liked. It was a nice chat!
One chore I wasn't looking forward to was asking whether or not in the week that I've been gone, with a friendly reminder this last thursday, if they had managed to get my required evaluation form filled out. I know KU needs some tangeble way to evaluate the month, but it truly is a pain and inconvenience to everyone involved to make it happen. It's hard enough to get evals filled out by our attendings back in the states, let alone a physician over seas that we've only worked with for a week. So, I did ask, and of course nothing had happened. I didn't make a big deal out of it, but it did seem like I had put them at an inconvenience for bringing it up again. Oh well, it finally got done today and what's done is done... I've got my required eval.
On a brighter note, I got to see some interesting pathology with the most classic case of Molluscum Contagiosum that i've ever seen. We also had an interesting talk about how patients manage to keep their insulin useable at home after a lady presented in possible DKA or lactic acidosis from being on Metformin while in renal failure. With insulin it's important to keep it refrigerated or cool, otherwise it starts to breakdown and does not work. So with the lack of refrigeration available to the typical LCECU patient, I wondered how the insulin did any good at all. Apparently by storing the insulin in a small clay pot that is set into a larger clay pot with water and out of the sun... it stays cool enough to have some activity, and they learn to adjust the amount accordingly. It's not the best medicine model, but it is the most effective model for these patients.
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One chore I wasn't looking forward to was asking whether or not in the week that I've been gone, with a friendly reminder this last thursday, if they had managed to get my required evaluation form filled out. I know KU needs some tangeble way to evaluate the month, but it truly is a pain and inconvenience to everyone involved to make it happen. It's hard enough to get evals filled out by our attendings back in the states, let alone a physician over seas that we've only worked with for a week. So, I did ask, and of course nothing had happened. I didn't make a big deal out of it, but it did seem like I had put them at an inconvenience for bringing it up again. Oh well, it finally got done today and what's done is done... I've got my required eval.
On a brighter note, I got to see some interesting pathology with the most classic case of Molluscum Contagiosum that i've ever seen. We also had an interesting talk about how patients manage to keep their insulin useable at home after a lady presented in possible DKA or lactic acidosis from being on Metformin while in renal failure. With insulin it's important to keep it refrigerated or cool, otherwise it starts to breakdown and does not work. So with the lack of refrigeration available to the typical LCECU patient, I wondered how the insulin did any good at all. Apparently by storing the insulin in a small clay pot that is set into a larger clay pot with water and out of the sun... it stays cool enough to have some activity, and they learn to adjust the amount accordingly. It's not the best medicine model, but it is the most effective model for these patients.
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Karigiri: Day 4 Mobile Clinic and Orthotic Workshop
Today we went on a mobile clinic to a local village and got to see various dermatological pathology such as tinea corporus. We got a patient with chronic cough for a couple months, so we asked them for a sputum sample to check for TB. One of the most memorable patients was a lady that had a BTK (Below The Knee) amputation because while having a seizure one of her legs flailed into an open fire... we just did a quick check for ulcer's on the stump and managed her seizure meds. All in all a pretty relaxed morning that was mostly consumed by making casual medical conversation with the Dr. for the day.
One of our biggest frustrations at Karigiri has been the very structured schedule that doesn't start on time, but has three to four hr periods of down time between morning clinics and afternoon clinics that hold us hostage. If we could just have a half hour for lunch and knock out the afternoon session right after, we could get a head start on the hour commute back to our hostels and get some other stuff done with the day. As it is now, we get back closer to six in the evening. I know, I know - IST (Indian Standard Time) rules the land ;->
So this afternon when we got back from the mobile clinic we went over to the location for the afternoon session and asked if we could start a little bit early... which i'm glad we did because it turned out to be a really unique experience! Karigiri manufactures it's own microcellular rubber from raw rubber stock produced in Kerala, and then uses it in make custom orthotic shoes as well as prosthetic devices. We got to tour the workshop, rubber mill, and even had the opportunity to purchase a custom fit pair of orthotic chappals (sandals) - for a whopping, wait for it, 450 Rs. ($9)... custom, and they did it in under an hour for four of us! I had read in Dr. Paul Brand's book, The Gift of Pain, about the research that went into finding pressure points of leprosy patients extremities and the long process of creating new ways and devices for combating their ulcers. After wearing my new chappals home from Karigiri, i'm a firm believer that the microcellular rubber disperses the pressure on the bottom of your foot more evenly and thus reduces pressure on the pressure points... you ask how, because the sandals I had been wearing had given me a blister in exactly one of these pressure points that has had me limping for the last couple days. With the new microcellular rubber insole sandals on, I walked without a limp and could barely notice the discomfort. It was amazing to see them work, fast and efficient and doing it for literally pennies on the dollar... yet another example of a low cost efficient system. They could even recycle the scraps of rubber into new batches. The icing on the cake was to see that the hard sole put on the bottom of the sandal was made from used tires! After nearly a month of seeing mountains of trash lining streets and a total disregard for throwing trash into trash cans, these guys are recycling! It was a neat afternoon, and we're glad we started early cause we ended up staying the entire afternoon.
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One of our biggest frustrations at Karigiri has been the very structured schedule that doesn't start on time, but has three to four hr periods of down time between morning clinics and afternoon clinics that hold us hostage. If we could just have a half hour for lunch and knock out the afternoon session right after, we could get a head start on the hour commute back to our hostels and get some other stuff done with the day. As it is now, we get back closer to six in the evening. I know, I know - IST (Indian Standard Time) rules the land ;->
So this afternon when we got back from the mobile clinic we went over to the location for the afternoon session and asked if we could start a little bit early... which i'm glad we did because it turned out to be a really unique experience! Karigiri manufactures it's own microcellular rubber from raw rubber stock produced in Kerala, and then uses it in make custom orthotic shoes as well as prosthetic devices. We got to tour the workshop, rubber mill, and even had the opportunity to purchase a custom fit pair of orthotic chappals (sandals) - for a whopping, wait for it, 450 Rs. ($9)... custom, and they did it in under an hour for four of us! I had read in Dr. Paul Brand's book, The Gift of Pain, about the research that went into finding pressure points of leprosy patients extremities and the long process of creating new ways and devices for combating their ulcers. After wearing my new chappals home from Karigiri, i'm a firm believer that the microcellular rubber disperses the pressure on the bottom of your foot more evenly and thus reduces pressure on the pressure points... you ask how, because the sandals I had been wearing had given me a blister in exactly one of these pressure points that has had me limping for the last couple days. With the new microcellular rubber insole sandals on, I walked without a limp and could barely notice the discomfort. It was amazing to see them work, fast and efficient and doing it for literally pennies on the dollar... yet another example of a low cost efficient system. They could even recycle the scraps of rubber into new batches. The icing on the cake was to see that the hard sole put on the bottom of the sandal was made from used tires! After nearly a month of seeing mountains of trash lining streets and a total disregard for throwing trash into trash cans, these guys are recycling! It was a neat afternoon, and we're glad we started early cause we ended up staying the entire afternoon.
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Karigiri: PBIHC - Day 3
In my attempts to catch up on my entries, arranging travel, and uploading pictures I find myself staying up later and getting up earlier. This morning I was rewarded for my efforts! After spending over two hours last night trying to purchase a flight from Dehli to London without success due to something the website didn't like about how I entered my credit card information, this morning on my first attempt with a different credit card - victory was mine ;-> I even was able to blog successfuly this morning before leaving by 7 a.m. to make it to Karigiri by 8 a.m. I've come to appreciate the small victories even more during my time here!
On to the PBIHC, which stands for the Paul Brand Integrated Health Center. This morning we were designated to attend a diabetes workshop there and I had high hopes due to the fact that this center was named after Dr. Brand. Unfortunately, the clinic was somewhat of a let down and no one offered to explain exactly what the mission of the PBIHC is. After again arriving on time, the clinic began on IST. The Dr.'s in the clinic we began the morning with weren't interested in teaching or translating so I quickly moved on to another station at the clinic that examined the patient's feet, tested and measured sensation, and calculated ABIs to evaluate for peripheral vascular disease that quickly complicates the life of a diabetic. Fortunately these stations, run by the Occupational Therapists and Physiotherapists, were much more interested in explaining their work and translating conversations... I stayed for the rest of the morning. Also at one of these stations, I ran into a Dr. from Bolivia who is here at Karigiri for a 3wk course on diabetic ulcer care. The pioneering research and techniques perfected at Karigiri for caring for and preventing wounds caused by the insenstivity to pain that leprosy patients suffer from, directly translates to diabetic foot ulcers.
Haggling with the auto drivers is a constant chore and a delight rarely, at least for me. They seem to enjoy the sport quite a bit. On the way from the PBIHC to Karigiri Hospital we need an auto and as we were debating rates I swear that I heard the man say "60" to which I said ok. When we arrived I handed the man a 100 Rs. bill to which he gave me 35 Rs. change. After about a minute of debating the 5 Rs. in change and being robbed of my only leverage (money) I decided to wage a sit in. At this point my classmates began to laugh as they informed me that he really did say 65 Rs. I had to swallow my pride and exit the vehicle ;-> It's not the amount that mattered it was the principal of the thing. Yesterday they agreed for a whole trip to be 90 and when we got there we handed the driver a 100... meaning we only needed 10 Rs. in change, an amount any auto driver readily has. Seeing an opportunity to get 10 Rs. more he feigned that he had no change. We promptly pooled our change to exactly 90. After discussing this incident with other students they've had similar experiences, but I like their reaction to the "no change" scam- "so free ride then"... apparently drivers suddenly remember they have change at that point.
The afternoon was rather unproductive as we sat and watched a group occupational therapy session take place in Tamil. It was great to see the hospital addressing the social rehabilitation aspects of leprosy (Socail ostracism leaves scars just as handicapping as any physical deformity). However, the same OT that was so gracious and energetic about explaining his station's role in the diabetic clinic that very morning, let us sit for an hour and a half without explaining what was taking place or translating for us. The language barrier has proved to be a bigger issue than I thought it would.
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On to the PBIHC, which stands for the Paul Brand Integrated Health Center. This morning we were designated to attend a diabetes workshop there and I had high hopes due to the fact that this center was named after Dr. Brand. Unfortunately, the clinic was somewhat of a let down and no one offered to explain exactly what the mission of the PBIHC is. After again arriving on time, the clinic began on IST. The Dr.'s in the clinic we began the morning with weren't interested in teaching or translating so I quickly moved on to another station at the clinic that examined the patient's feet, tested and measured sensation, and calculated ABIs to evaluate for peripheral vascular disease that quickly complicates the life of a diabetic. Fortunately these stations, run by the Occupational Therapists and Physiotherapists, were much more interested in explaining their work and translating conversations... I stayed for the rest of the morning. Also at one of these stations, I ran into a Dr. from Bolivia who is here at Karigiri for a 3wk course on diabetic ulcer care. The pioneering research and techniques perfected at Karigiri for caring for and preventing wounds caused by the insenstivity to pain that leprosy patients suffer from, directly translates to diabetic foot ulcers.
Haggling with the auto drivers is a constant chore and a delight rarely, at least for me. They seem to enjoy the sport quite a bit. On the way from the PBIHC to Karigiri Hospital we need an auto and as we were debating rates I swear that I heard the man say "60" to which I said ok. When we arrived I handed the man a 100 Rs. bill to which he gave me 35 Rs. change. After about a minute of debating the 5 Rs. in change and being robbed of my only leverage (money) I decided to wage a sit in. At this point my classmates began to laugh as they informed me that he really did say 65 Rs. I had to swallow my pride and exit the vehicle ;-> It's not the amount that mattered it was the principal of the thing. Yesterday they agreed for a whole trip to be 90 and when we got there we handed the driver a 100... meaning we only needed 10 Rs. in change, an amount any auto driver readily has. Seeing an opportunity to get 10 Rs. more he feigned that he had no change. We promptly pooled our change to exactly 90. After discussing this incident with other students they've had similar experiences, but I like their reaction to the "no change" scam- "so free ride then"... apparently drivers suddenly remember they have change at that point.
The afternoon was rather unproductive as we sat and watched a group occupational therapy session take place in Tamil. It was great to see the hospital addressing the social rehabilitation aspects of leprosy (Socail ostracism leaves scars just as handicapping as any physical deformity). However, the same OT that was so gracious and energetic about explaining his station's role in the diabetic clinic that very morning, let us sit for an hour and a half without explaining what was taking place or translating for us. The language barrier has proved to be a bigger issue than I thought it would.
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Karigiri - Surgical Rounds and IST
Rush to get there by 8, then IST strikes again. But amazing surgical rounds and got to see surgery! Again, a quick summary of the day. Yesterday we vowed to be on time, which is no easy task because it takes about an hour of public transportation to get there. There is a CMC bus that goes there every day, but for some reason this bus is strictly for staff and no students are allowed to ride... so instead we foreigners stumble our way through a new bus route that takes about 45 min and then take an autorickshaw from there about 12 km to the Karigiri Hospital. Fun times. The afternoon bus ride back is especially awful as the heat boils a metal bus packed full of people as it bounces back and forth down the road. But that's besides the point. So we busted it this morning and made it to Karigiri by 8:00 a.m. on the dot, cause that's when our printed schedule said that surgical rounds began. When we walked in to ask where we should go for rounds, we got a puzzled look and the reply that rounds don't start til 9:00 a.m. Ah, kharma ;-> Despite the frustration, surgical rounds were well worth the wait. We got to see more chronic wound pathology, abcesses, and writhing maggots in one morning than I had seen in my whole pathology course! The message in Dr. Paul Brand's book was really driven home for me to see, both leprosy patients and advanced diabetics, suffering from complications of painlessness. Of course, not all of the wounds we saw were from painlessness. No, Karigiri has adapted it's services as Leprosy has declined. What they learned from their pioneering work with leprosy, applies to chronic wound care regardless of the etiology. We saw a patient with frost bite from Nepal. We saw a local gentlemen who had fallen over with his motorcycle and suffered a severe 3rd degree burn to his calf muscle. We saw about as many non-healing diabetic ulcers as we did ulcers from complications of leprosy. I believe Karigiri will continue to provide a great service to patients in the years to come... diabetes is becoming quite an issue here in India, and posed to be every bit the epidemic that it is in the U.S. The morning of gruesome sights as bandages were removed reminded me how far I've come from my first anatomy labs... instead of being repulsed, I was intrigued by the science, anatomy, and care of each wound. We finished by around 11:30, which was a good thing - once we got back outside in the fresh air we all realized we didn't have much of an appetite just yet ;-> But by the time 12:30 rolled around and the canteen opened up, we welcomed the meal.
The afternoon gave us the opportunity to watch the surgical debridement of a foot wound that had begun tracking along the synovial sheaths that line the tendons of the foot... again the anatomy and science intrigued me, although I was still caught off guard by the way some things were done. For example, we all wore open toed flip flops into the OR. We didn't handle any instruments so I wasn't worried about my own safety, but it still made me uncomfortable after being conditioned to a specific model of surgery in the US. Pain control was given after the fact if the patient was able to feel it, and then it was only a local anesthetic. But they get the job done, they do it well, and they do it for a population of patients that 50 years ago wouldn't have dreamed of such care. An attitude I have discovered to be a good way to experience another culture - it's not wrong or right, it's just different. Regardless, it was an amazing opportunity and made the morning wait worth the trouble!
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The afternoon gave us the opportunity to watch the surgical debridement of a foot wound that had begun tracking along the synovial sheaths that line the tendons of the foot... again the anatomy and science intrigued me, although I was still caught off guard by the way some things were done. For example, we all wore open toed flip flops into the OR. We didn't handle any instruments so I wasn't worried about my own safety, but it still made me uncomfortable after being conditioned to a specific model of surgery in the US. Pain control was given after the fact if the patient was able to feel it, and then it was only a local anesthetic. But they get the job done, they do it well, and they do it for a population of patients that 50 years ago wouldn't have dreamed of such care. An attitude I have discovered to be a good way to experience another culture - it's not wrong or right, it's just different. Regardless, it was an amazing opportunity and made the morning wait worth the trouble!
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Karigiri - The Gift of Pain
The mad rush back to Karigiri on day 1, then hurry up and wait. Brisk welcome. This pretty much sums up what was left of our day by the time we made it to Karigiri at 11:00 a.m. When we got there we were promptly asked why we were late and we replied in part truth, we got lost... cause we actually did, but it didn't account for 3 hours. After sitting down and filling out paperwork for 20 min. or so we got an olive branch in the form of chai tea. Then we waited for another half hour or so until the head Dr., Dr. Solomon, briskly asked one of the girls who, had just momentarily risen from her chair to look at a calaneder on the wall, to sit down. After that, he actually had a fairly warm welcome speech to deliver. After the formalities had been taken care of we wandered over to the canteen for lunch and to await the 2:00 p.m. afternoon start time for our tour of the Dept. of Laboratories. The tour was actually quite interesting. Mycobacterium leprae is actually quite hard to grow in a labratory setting. The only medium that has been found that can grow cultures, is made from the footpads of mice. Karigiri has it own mice factory and research center where they follow the resistant strains they find in patients. It was interesting to see this kind of research going on in the middle of the very arid, rural, countryside. With the tour completed we headed back to Vellore making plans for tomorrow and vowing not to be late two days in a row!
As a side note, Karigiri is of special interest to me even more now that I am reading a book by Dr. Paul Brand "The Gift of Pain". It chronicles his life experience of dealing with and treating pain. It takes a unique view point that without pain, we would destroy our bodies because we would have no warning system... and therefor pain should be looked at, to a degree, as a blessing and not a curse. He then expounds on this concept and how it applies to today. He actually worked at CMC in Vellore and then helped start Karigiri. So this week is of special interest, to see in person what i'm reading about in the book! This book came highly recommended to me, and I would highly recommend it as well! The link for it at amazon.com is below.
http://www.amazon.com/gp/offer-listing/0310221447/ref=dp_olp_used?ie=UTF8&condition=used
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As a side note, Karigiri is of special interest to me even more now that I am reading a book by Dr. Paul Brand "The Gift of Pain". It chronicles his life experience of dealing with and treating pain. It takes a unique view point that without pain, we would destroy our bodies because we would have no warning system... and therefor pain should be looked at, to a degree, as a blessing and not a curse. He then expounds on this concept and how it applies to today. He actually worked at CMC in Vellore and then helped start Karigiri. So this week is of special interest, to see in person what i'm reading about in the book! This book came highly recommended to me, and I would highly recommend it as well! The link for it at amazon.com is below.
http://www.amazon.com/gp/offer-listing/0310221447/ref=dp_olp_used?ie=UTF8&condition=used
Windows Live™ Hotmail®…more than just e-mail. See how it works.
Kerala: Beaches, Socialism, & Toddy
In a last minute decision I decided to join my roommate and his Malaysian friends on a weekend trip to Kerala. It was an interesting experience from the get go. Because it was a last minute decision I didn't have a confirmed seat on the train... I was wait listed. Which really all that means is that I can get on the train, I just don't necessarily have a place to sit/sleep ;-> On a 12 hr overnight train that could be a problem. We hoped that people would no show and I could get a bed as we were in the sleeper class (lowest class with the option of laying down to sleep). As it turned out, Kerala is a popular weekend destination - it was packed, and so were we. My roommate Eric and I ended up head to feet for the ride. It was as bad as I thought it was going to be however. The night cooled down considerably and the cool air allowed for a few hours of sleep. Arriving tired but energized to start the weekend, we got an auto to take us to the beach front ASAP from the Varkala trian station. On arrival we snapped a few quick shots of the majestic cliffs with the beach below, and then set off to find rooms. As it happened, there were a group of Oklahoma girls that also ended going on the same trip as us... they reserved their rooms in advance... we were of the mindset to find something when we got there. Considering how our sponteneity had rewarded me so far, I was preparing myself for the worst, but I ended up being pleasantly surprised with a decent room and a reasonable price. Since we only had the afternoon and evening in Varkala, we headed to the beach for the afternoon and had a great time swimming and splashing around in the waves. The beach was ok, but it was a very windy day which made it to feel like you were getting sand blasted instead of tan. After a day of fun in the sun, we had a delicious dinner of fresh sea food that night... things were looking up in Varkala! The only interesting thing of note that night was that the power went out... we later learned it was planned outage that happens every night as part of Kerala's effort to conserve electricity usage - a product of it being a socialist state.
Apparently it is a Socialist state in the sense that the state takes care of all the people - education, health care, etc. Kerala is also a much cleaner state than the rest of Tamil Nadu.
The next morning we got up and headed for Aleepy to see the Backwater's of Kerala which are a major attraction in south India. Again the first order of business was finding rooms. This time, we told the rickshaw driver that we wanted cheap places... he obliged. He turned down an alley going about a block or two down it off the main road... we were a little hesitant/skeptical/scared and understandingly so. However, the rooms weren't too bad and the prices were cheap... we stayed ;-> After a quick lunch we negotiated a boat tour and off we went. Having been to the florida swamps, I was expecting this experience to be somewhat similar. I hardly saw any wild life. There were a few birds here and there, and I did get to see several King Fishers, but that was about it. The Backwaters are getting fairly polluted from the boom in motorized tours and boats used for transport; and i'm ashamed to say we didn't make the effort to find a motorless tour that afternoon. The scenery was still quite beautiful though, a network of canals that sit higher than the expansive irrigated rice fields below. Lined with palm, mango, and flowering trees and with many locals going about their daily business it was still quite an experience. Later in the day we convinced our boat captain to lead us to the local watering hole to try the official alcohol of Kerala - Toddy, a fermented beverage made from the sap of palm trees. I'll just say I was there and I and I tried it, but warm fermented palm sap isn't the tastiest beverage I've ever had! As we headed back to town we got to see the sunset over the Keralal Backwaters.
Sunday, we headed to Cochin (Kochi). An island fort with a long history of many cultures co-existing. I believe the oldest church in India is located here. There is also a historical synagogue there as well as a mosque. Because we had been travelling all weekend and it was quite hot that afternoon, our sight seeing enthusian was starting to wayne... especially considering we still had to ride the night train back. A welcome break, for lunch we decided to buy fresh fish from the local fish mongers by the Chinese fishing nets that lined the shore on part of the island. Quite tasty and feeling a little better after getting out of the sun fo a while, the group headed out to do some shopping and then have an afternoon of a desert recommended to us by other students - Death by Chocalate cake. It was quite good and the shake I had along with it was the best shake I've had so far! We stuck around for yet another sunset over water... which we've discovered are beautiful and frustrating all at the same time. They start out looking like as they descend to the horizon that they'll be magnificent, but then there is so much humidity in the air that the clouds that inevitably line the horizon quickly obscure the best part of the sunset.
A quick dinner back on the mainland and a bumpy autorickshaw ride to the train station, and we were headed back to Vellore. To my surprise, my wait list # had come up and I had a confirmed seat... but as fate would have it the conductor wouldn't switch our seats around so that we could all stay together - my roomate and I shared again. I wasn't looking forward to the morning... we got back around seven and my new rotation in Karigiri (Leprosy Hospital) started at 8 a.m. Needless to say I wasn't on time. Luckily though, the other students (OK girls) that were starting at Karigiri the next morning were also with us on the night train going home ;->
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Apparently it is a Socialist state in the sense that the state takes care of all the people - education, health care, etc. Kerala is also a much cleaner state than the rest of Tamil Nadu.
The next morning we got up and headed for Aleepy to see the Backwater's of Kerala which are a major attraction in south India. Again the first order of business was finding rooms. This time, we told the rickshaw driver that we wanted cheap places... he obliged. He turned down an alley going about a block or two down it off the main road... we were a little hesitant/skeptical/scared and understandingly so. However, the rooms weren't too bad and the prices were cheap... we stayed ;-> After a quick lunch we negotiated a boat tour and off we went. Having been to the florida swamps, I was expecting this experience to be somewhat similar. I hardly saw any wild life. There were a few birds here and there, and I did get to see several King Fishers, but that was about it. The Backwaters are getting fairly polluted from the boom in motorized tours and boats used for transport; and i'm ashamed to say we didn't make the effort to find a motorless tour that afternoon. The scenery was still quite beautiful though, a network of canals that sit higher than the expansive irrigated rice fields below. Lined with palm, mango, and flowering trees and with many locals going about their daily business it was still quite an experience. Later in the day we convinced our boat captain to lead us to the local watering hole to try the official alcohol of Kerala - Toddy, a fermented beverage made from the sap of palm trees. I'll just say I was there and I and I tried it, but warm fermented palm sap isn't the tastiest beverage I've ever had! As we headed back to town we got to see the sunset over the Keralal Backwaters.
Sunday, we headed to Cochin (Kochi). An island fort with a long history of many cultures co-existing. I believe the oldest church in India is located here. There is also a historical synagogue there as well as a mosque. Because we had been travelling all weekend and it was quite hot that afternoon, our sight seeing enthusian was starting to wayne... especially considering we still had to ride the night train back. A welcome break, for lunch we decided to buy fresh fish from the local fish mongers by the Chinese fishing nets that lined the shore on part of the island. Quite tasty and feeling a little better after getting out of the sun fo a while, the group headed out to do some shopping and then have an afternoon of a desert recommended to us by other students - Death by Chocalate cake. It was quite good and the shake I had along with it was the best shake I've had so far! We stuck around for yet another sunset over water... which we've discovered are beautiful and frustrating all at the same time. They start out looking like as they descend to the horizon that they'll be magnificent, but then there is so much humidity in the air that the clouds that inevitably line the horizon quickly obscure the best part of the sunset.
A quick dinner back on the mainland and a bumpy autorickshaw ride to the train station, and we were headed back to Vellore. To my surprise, my wait list # had come up and I had a confirmed seat... but as fate would have it the conductor wouldn't switch our seats around so that we could all stay together - my roomate and I shared again. I wasn't looking forward to the morning... we got back around seven and my new rotation in Karigiri (Leprosy Hospital) started at 8 a.m. Needless to say I wasn't on time. Luckily though, the other students (OK girls) that were starting at Karigiri the next morning were also with us on the night train going home ;->
Windows Live™: Discover 10 secrets about the new Windows Live. View post.
Wednesday, February 18, 2009
L.C.E.C.U. - Days 3 & 4
Wednesday and thursday proved to pass quite quickly. On wednesday there was an ENT clinic which would have been quite interesting and educational had I observed someone who was more interested in teaching. I took for granted that Dr. Sunil and Dr. Sushil (village visit on tuesday) were the norm at LCECU and that everyone there were as interested in teaching... Observing conversations and examinations in another language already puts me at a disadvantage and I had forgoten what it's like not to be able to communicate or simply listen since my year in Barcelona. I shouldn't be so harsh, I did get to see some interesting pathology, such as a cholesteatoma, and they did explain what a tympanoplasty was. I just really enjoyed Dr. Sunil's and Sushil's enthusiasm, so the contrast appeared quite stark to me.
I had been told that I would be able to observe the tympanoplasty later that morning, but then when I showed up at the alloted time I was told that they had already started and that I should take my lunch break.
Thursday morning was somewhat unique as well. They had a Psychiatrist give a talk on the importance of and growing need for primary health care professionals to identify and either address the psychological issues or refer them for care. A good majority of the lecture was lost on me because demonstrations on how to interview patients efficiently were conducted in Tamil, however the discussions afterwards were in English and I did walk away with at least one pearl. It doesn't seem to matter what culture you come from, every human being has a need to be wanted and valued. Apparently it isn't uncommon for many women in India to come to GP's complaining of vague pains and ailments, yielding no physical findings and chasing procedure after procedure with more labs and prescriptions, without an impromvment of symptoms. My classmates here have seen similar cases of fibromyalgia in their rotations. The psychiatrist proposed that these women were actually just seeking some form of attention, no matter how small or insignificant. For them, coming back to the Dr. for more procedures or lab tests was the high light of the month. He suggested that in his experience all these patients really need is a friendly ear to listen, to acknowledge that they exist. He encouraged the lecture room to stop and truly listen when a new patient presents with such symptoms, it will save both parties involved much time and expense and produce improvements quicker then briskly ordering a lab test and dismissing them, much like these women are probably dismissed at home. This insight reinforced why on Tuesday afternoons, LCECU goes out to villages for "mother's meetings". I don't believe that all women here are treated like this or that all men in India are this inhuman... i'm positive this isn't the case. However, just like in the US, we must watch for signs of abuse, both physical and mental.
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I had been told that I would be able to observe the tympanoplasty later that morning, but then when I showed up at the alloted time I was told that they had already started and that I should take my lunch break.
Thursday morning was somewhat unique as well. They had a Psychiatrist give a talk on the importance of and growing need for primary health care professionals to identify and either address the psychological issues or refer them for care. A good majority of the lecture was lost on me because demonstrations on how to interview patients efficiently were conducted in Tamil, however the discussions afterwards were in English and I did walk away with at least one pearl. It doesn't seem to matter what culture you come from, every human being has a need to be wanted and valued. Apparently it isn't uncommon for many women in India to come to GP's complaining of vague pains and ailments, yielding no physical findings and chasing procedure after procedure with more labs and prescriptions, without an impromvment of symptoms. My classmates here have seen similar cases of fibromyalgia in their rotations. The psychiatrist proposed that these women were actually just seeking some form of attention, no matter how small or insignificant. For them, coming back to the Dr. for more procedures or lab tests was the high light of the month. He suggested that in his experience all these patients really need is a friendly ear to listen, to acknowledge that they exist. He encouraged the lecture room to stop and truly listen when a new patient presents with such symptoms, it will save both parties involved much time and expense and produce improvements quicker then briskly ordering a lab test and dismissing them, much like these women are probably dismissed at home. This insight reinforced why on Tuesday afternoons, LCECU goes out to villages for "mother's meetings". I don't believe that all women here are treated like this or that all men in India are this inhuman... i'm positive this isn't the case. However, just like in the US, we must watch for signs of abuse, both physical and mental.
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Tuesday, February 17, 2009
L.C.E.C.U. Day #2
I forgot to mention yesterday that I have finally caught up with David Lee, another applicant that I met at the Via Christi call back weekend... actually I didn't meet him, but had several people tell me that we were both going to be in Vellore, India at the same time. At which point I got his email address from them and introduced myself via e-mail. We finally caught up the first week for a day and then it turns out that he and another student, Song, are both at LCECU for two days this week. Today we got to tag along on a trip into the surrounding towns and villages with a WHO representative making a report on the rehabilitative programs that CMC has pioneered. The day was filled with 2 examples of local needs for rehabilitation that were not being met by formal organizations and therefor a few locals had begun rehabilitation programs on their own. At that point CMC found out about it and decided to pilot a program that assisted in training the locals and then turning the programs over to them to run.
The first example was the nicknamed the "professor of rehabilitation" because he ended up teaching the CMC staff so much about what's possible with a motivated patient in rehabilitation. The man once had climbed coconut trees to harvest cocunuts for a living, that is before he fell and suffered a complete transection of his spinal cord at T12... leaving him a paraplegic from the waist down. As the professor had grown up in rural farming area he didn't adjust well to city life as a cripple and the countryside didn't accomodate to a wheel chair. For a year or two he tried several odd jobs to support his wife but just wasn't able to do them and wasn't content with them. He finally decided to get the help of CMC and pioneer new rehabilitation techniques that would allow him to functionally farm in the country side again. The answer they came up with is reminescent of gear used by victims of polio patients - forearm supported crutches with leg braces attached to shoes. They had to adapt a special pair of crutches without the rubber end for walking in the fields because the rubber would get stuck in the mud when he pulled the crutch up. Together with the un-ending support of his wife and the CMC rehabilitation support the professor has been able to return to his original farm and prosper. I don't recall what land is measured in, but I do remember him saying he started out with one unit and today along with his son he has 50 units of land. Quite an impressive story.
The second example came from parents of MR children in a neighboring town of Alcot that had nowhere to send their children to school . One such mom decided to start a school specially for MR children due to the fact that the only schools that existed at the time for MR children were in Vellore and Chennai, both of which were exhausting day trips for anyone from the region. Additional parents joined the effort and CMC came in to assist in training the parents. Now six parents are full time teachers at the school, each specializing in a specific area of rehabilitation with MR children. The rest of the parents of the 45 children support those six who work at the school full time. The youngest child there is 3, the oldest student is 32. Again quite an amazing story of what regular people can organize and sustain with a little help and training.
For the afternoon we departed from our WHO delegate and went to a "mother's meeting" in a low income area on the outskirts of Vellore. It was better living conditions than the slums, but still quite poor. Basically this meeting was a time of discussion where females could talk about and even encouraged to discuss gender and it's discrimination in Indian society. It was quite interesting to see women in this setting as they are usually quite and reserved in public, inside this meeting they were loud, boisterous, and joking. It was a joy to see this side of the equation. It was also interesting to see that for as much gender discrimination as they endure they are still skeptical of all the freedom women have in the US. They turned the discussion on us and asked about divorce rates and the importance of family, acceptable dating practices, etc. At the end of the meeting there was a positive attitude as women are gaining more rights and are being empowered with education. I was surprised to learn that they already new that the male is responsible for the sex of their offspring, just one weapon in their arsenal for combating men in this area. I was glad I got to see this meeting and felt priveledged to be accepted into the discussion.
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The first example was the nicknamed the "professor of rehabilitation" because he ended up teaching the CMC staff so much about what's possible with a motivated patient in rehabilitation. The man once had climbed coconut trees to harvest cocunuts for a living, that is before he fell and suffered a complete transection of his spinal cord at T12... leaving him a paraplegic from the waist down. As the professor had grown up in rural farming area he didn't adjust well to city life as a cripple and the countryside didn't accomodate to a wheel chair. For a year or two he tried several odd jobs to support his wife but just wasn't able to do them and wasn't content with them. He finally decided to get the help of CMC and pioneer new rehabilitation techniques that would allow him to functionally farm in the country side again. The answer they came up with is reminescent of gear used by victims of polio patients - forearm supported crutches with leg braces attached to shoes. They had to adapt a special pair of crutches without the rubber end for walking in the fields because the rubber would get stuck in the mud when he pulled the crutch up. Together with the un-ending support of his wife and the CMC rehabilitation support the professor has been able to return to his original farm and prosper. I don't recall what land is measured in, but I do remember him saying he started out with one unit and today along with his son he has 50 units of land. Quite an impressive story.
The second example came from parents of MR children in a neighboring town of Alcot that had nowhere to send their children to school . One such mom decided to start a school specially for MR children due to the fact that the only schools that existed at the time for MR children were in Vellore and Chennai, both of which were exhausting day trips for anyone from the region. Additional parents joined the effort and CMC came in to assist in training the parents. Now six parents are full time teachers at the school, each specializing in a specific area of rehabilitation with MR children. The rest of the parents of the 45 children support those six who work at the school full time. The youngest child there is 3, the oldest student is 32. Again quite an amazing story of what regular people can organize and sustain with a little help and training.
For the afternoon we departed from our WHO delegate and went to a "mother's meeting" in a low income area on the outskirts of Vellore. It was better living conditions than the slums, but still quite poor. Basically this meeting was a time of discussion where females could talk about and even encouraged to discuss gender and it's discrimination in Indian society. It was quite interesting to see women in this setting as they are usually quite and reserved in public, inside this meeting they were loud, boisterous, and joking. It was a joy to see this side of the equation. It was also interesting to see that for as much gender discrimination as they endure they are still skeptical of all the freedom women have in the US. They turned the discussion on us and asked about divorce rates and the importance of family, acceptable dating practices, etc. At the end of the meeting there was a positive attitude as women are gaining more rights and are being empowered with education. I was surprised to learn that they already new that the male is responsible for the sex of their offspring, just one weapon in their arsenal for combating men in this area. I was glad I got to see this meeting and felt priveledged to be accepted into the discussion.
Windows Live™: E-mail. Chat. Share. Get more ways to connect. Check it out.
Week #2 - L.C.E.C.U day 1
As trips exhaust the weekend, and rotations & preparations for the former exhaust the days leading up, I am exhausted and have fallen behind on documenting daily my experiences. This has been a frustration for me as I found during the first week the reflection at the end of the day to be a helpful tool for a more meaningful experience. It allowed me time to think about my initial reaction, and thereby let me look at both my reaction and the day's experience from a distance - an average of the two if you will.
Since I wrote last, much has taken place. My gut finally fell prey to India's robust micro-organisms. I experienced my first Indian train ride, an overnight one no less! I travelled through the beautiful socialist state of Kerala. And I have picked up a common cold on the overnight train that has left me drained. I'll try to chronicle in the order I left off, and hope I can catch up.
The week started off stumbling my way through a new route in Vellore in grand CMC style... tell the bus driver where I want to go and jump off when he says so. Then ask random people nearby where to go. Fairly quickly I found where I supposed to go and after a brief introduction to the concept behind LCECU I was talking with a pleasant Dr. Sunil. I ended up shadowing him for the morning as he first saw staff members with medical complaints and then started seeing the growing line of patients. In between examing patients he also explained LCECU and his drive to be there. LCECU stands for Low Cost Efficient Care Unit, and aims to do just that. This branch of CMC is subsidized by the main hospital but the patients must pay some amount, however small. They feel this gives the patient ownership in their care, more responsibility for taking care of themselves, and feeds into the funds for the unit. A patient has a one time registration fee of 25 Rs. (~$0.50), after that the only thing patients pay for towards their care is for lab costs and medication; they pay no consultation fees for as long as they are patients at LCECU.
At first I was confused about LCECU role... it seemed quite similar to CHAD that I had rotated through the previous week. I soon discovered that the difference lies in the specialty operating the clinics. CHAD is community medicine (Public Health to us) and is the closest thing to a Family Medicine post graduate MD recognized specialty in India... or at least it used to be. Two months ago, CMC started a MD post graduate Family Medicine program with 200 participants. I believe this to be congruent with a larger movement in India to begin focusing unprecedented focus and monetary support towards primary care. LCECU is run by "Family Physicians" (as they call themselves, but I guess it's not a recognized post grad MD certification). They both do surgical procedures and deliveries, although LCECU doesn't do c-sections. In essence, they serve many of the same functions but their "missions" differ in scope - public health to the masses v.s. individualized primary care to the masses. LCECU provides basic services and coordinates with specialists to take care of anything they cannot. Tests are only allowed to be ordered if it will has the potential to change the diagnosis. Medication prescribed on effectiviness and affordability to the patient, not because it's the best drug medicine has to offer.
Interested in the large support going towards primary care, I asked Dr. Sunil what systems are in place or will be in place to encourage medical students to go into primary care... his response shocked me both in substance and in attitude. He said, nothing really. Sometimes students are sponsored by their local towns and therefor they return to work in repayment. Pushing the issue I asked about pay level, will there be any sort of pay incentive to go into family medicine? "No, were paid just the same as any other specialty... we all make the same amount." I thought, wow - that sure would make a difference in the states. But here in India, or at least CMC, it would be unheard of for one specialty to get paid less than another. To me that seems like it would leave medical students with the pure choice of what area truly called them, not how much will I make so I can pay off my massive debt. I wonder though, if more people would really go into family medicine under a similar system, or if i'm just seeing an oasis of greener grass from a distance. I'm scheduled to work with Dr. Sunil again, and hope to discuss this topic more.
I'll finish with an example of the kind of treatment a patient can get at LCECU, albeit probably an extreme one. A forty somethig female was diagnosed with breast cancer. She was referred to CMC main hospital and received a unilateral mastectomy with lymph node excision; cost 23,000 Rs. Her combined FAMILY income is 5,000 Rs. per month or 166 Rs. per day. She paid a nominal fee for what she could afford and received life saving treatment without furthering their financial hardship. I don't know how many days I can say that i've spent less than 150 Rs. while I've been here in India. Obviously, I don't know how or where the funding comes from - but with the system they have in place, the patients are getting pretty big bang for the Rs.
Windows Live™: Keep your life in sync. Check it out.
Since I wrote last, much has taken place. My gut finally fell prey to India's robust micro-organisms. I experienced my first Indian train ride, an overnight one no less! I travelled through the beautiful socialist state of Kerala. And I have picked up a common cold on the overnight train that has left me drained. I'll try to chronicle in the order I left off, and hope I can catch up.
The week started off stumbling my way through a new route in Vellore in grand CMC style... tell the bus driver where I want to go and jump off when he says so. Then ask random people nearby where to go. Fairly quickly I found where I supposed to go and after a brief introduction to the concept behind LCECU I was talking with a pleasant Dr. Sunil. I ended up shadowing him for the morning as he first saw staff members with medical complaints and then started seeing the growing line of patients. In between examing patients he also explained LCECU and his drive to be there. LCECU stands for Low Cost Efficient Care Unit, and aims to do just that. This branch of CMC is subsidized by the main hospital but the patients must pay some amount, however small. They feel this gives the patient ownership in their care, more responsibility for taking care of themselves, and feeds into the funds for the unit. A patient has a one time registration fee of 25 Rs. (~$0.50), after that the only thing patients pay for towards their care is for lab costs and medication; they pay no consultation fees for as long as they are patients at LCECU.
At first I was confused about LCECU role... it seemed quite similar to CHAD that I had rotated through the previous week. I soon discovered that the difference lies in the specialty operating the clinics. CHAD is community medicine (Public Health to us) and is the closest thing to a Family Medicine post graduate MD recognized specialty in India... or at least it used to be. Two months ago, CMC started a MD post graduate Family Medicine program with 200 participants. I believe this to be congruent with a larger movement in India to begin focusing unprecedented focus and monetary support towards primary care. LCECU is run by "Family Physicians" (as they call themselves, but I guess it's not a recognized post grad MD certification). They both do surgical procedures and deliveries, although LCECU doesn't do c-sections. In essence, they serve many of the same functions but their "missions" differ in scope - public health to the masses v.s. individualized primary care to the masses. LCECU provides basic services and coordinates with specialists to take care of anything they cannot. Tests are only allowed to be ordered if it will has the potential to change the diagnosis. Medication prescribed on effectiviness and affordability to the patient, not because it's the best drug medicine has to offer.
Interested in the large support going towards primary care, I asked Dr. Sunil what systems are in place or will be in place to encourage medical students to go into primary care... his response shocked me both in substance and in attitude. He said, nothing really. Sometimes students are sponsored by their local towns and therefor they return to work in repayment. Pushing the issue I asked about pay level, will there be any sort of pay incentive to go into family medicine? "No, were paid just the same as any other specialty... we all make the same amount." I thought, wow - that sure would make a difference in the states. But here in India, or at least CMC, it would be unheard of for one specialty to get paid less than another. To me that seems like it would leave medical students with the pure choice of what area truly called them, not how much will I make so I can pay off my massive debt. I wonder though, if more people would really go into family medicine under a similar system, or if i'm just seeing an oasis of greener grass from a distance. I'm scheduled to work with Dr. Sunil again, and hope to discuss this topic more.
I'll finish with an example of the kind of treatment a patient can get at LCECU, albeit probably an extreme one. A forty somethig female was diagnosed with breast cancer. She was referred to CMC main hospital and received a unilateral mastectomy with lymph node excision; cost 23,000 Rs. Her combined FAMILY income is 5,000 Rs. per month or 166 Rs. per day. She paid a nominal fee for what she could afford and received life saving treatment without furthering their financial hardship. I don't know how many days I can say that i've spent less than 150 Rs. while I've been here in India. Obviously, I don't know how or where the funding comes from - but with the system they have in place, the patients are getting pretty big bang for the Rs.
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Monday, February 16, 2009
CMC Info
It's come to my attention by loving family members ;-> that I haven't given much info about CMC itself (background, history, etc.). So, please follow the link below for the CMC website and peruse to your hearts content!
http://www.cmch-vellore.edu/t_main.asp
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http://www.cmch-vellore.edu/t_main.asp
Windows Live™: Keep your life in sync. See how it works.
Tuesday, February 10, 2009
1st Weekend
For my first official weekend here in India I decided to travel with the herd and the herd went to Pondicherry. The town used to be a french sea port before the British took over and still retains many influences from their rule. Most of the town is actually laid out in a grid pattern with street names and signs being relatively common (a welcome change)! Pondicherry is known mostly as a tourist attraction for it's western food and wine along the sea even though the beach is all boulders. It being only a week since I arrived I wasn't that desperate for comfort food, but I agreed to a compromise by stopping at Senji (Gingee) on the way back to see the old ruins there. I felt like I needed to at least partially do something Indian for my first weekend. So, as is common practice here we took off on Friday for a long weekend riding a bus for a little over 3 hours. We were lucky enough to finally get someone to tell us which bus to take to a town part way there and then even more lucky to get seats for the long ride. It seems that here in India the limits of how many people can actually fit onto a single bus is open to interpretation. The ride out wasn't too bad, we did have people standing next to us for most of the way, but it was still doable. At one point one of the girls offered her seat to an elderly woman... I feeling ashamed of myself tried unsuccessfully for the next half hour to switch with my classmate. Once I did convince her, more seats opened up literally within 5 minutes. I do feel that it was very much a fact that only we were uncomfortable with the old woman standing because no one else on the bus attempted to offer their seat. I don't understand which times Indians choose to respect their elders; I'm wondering if sometimes gender and marital status play a role. Upon our arrival we got a taste of what was to behold our trip back to Vellore, but unbeknownst to us at the time. As we pulled into the bus station in Pondicherry people began running along side the bus as it slowed down and started jumping on to the bus and forcefully pushing there way against the flow of people trying to get off the bus. We got almost all 7 of us off, but then the bus moved forward another couple meters to try and alleviate the cluster that had formed slowing the exit process. Eventually we got eveyone off the bus, a little flustard, but no blood no foul. If i've stated before that this aspect of Indian culture is something I just don't understand, agree with, or plan on getting used - i apologize for belaboring the point. It just is so foreign to every sense of organization that's been beaten into me since pre-school... you wait your turn in line and you don't cut ;-> And it seems so out of touch with the rest of the relaxed laidback lifestyle that karma dictates. Anyways, so we've made it to our 1st destination. We finally get to our hostel, which will infact not be our final hostel for the night because they didn't have room for our whole group. So with our luggage unloaded temporarily, we set out in search of food as most of us had not planned ahead far enough to bring lunch for the long bus ride, and now being the better part of 5 pm, were fairly hungry. With a knee jerk reflex we opened our Lonely Planet guide and found " Rendevouz", a restaraunt serving mostly foreigners... surprise, surprise. It was good food that soothed most of the longings for pasta, fresh salads and vegatables, pizza, and steak (which I still think was a chicken fried type steak). We ate quickly and laughed when we realized how fast we had consumed our meal. Appetites satisfied we set off to finalize our sleeping arrangements for the evening, which really was nothing more than a house that someone owns and rents out rooms to travelers when a friend of his at the hostel we originally booked didn't have enough room... a little sketchy yes, but it was clean and spacious and a good location, so we didn't complain. But as so many things can and often do go wrong when traveling with large groups, the number of rooms soon became an issue. We had reserved several rooms and then found out after the fact that some people weren't coming the first night, so we agreed to pay for a room we didn't need the first night in hopes of keeping it for our companions now arriving the following day. This proved to be a mistake later on. However, with our luggage stored in it's final location for the evening we set out for a couple of drinks and to catch up with a few stragglers from our group that trickled in later that day. We didn't last long though as it had been quite an exhausting experience to travel so few kilometers. But sleep was not in the cards for us just yet, as we were having drinks one of the girls realized that a pendent that belonged to her grandmother that passed away early in the year was missing. After scouring the floor of the restaraunt we went back to the hostel, no luck. Under the guise of having to got get water for the evening anyways we all set out on a hopeless walk back tracking our steps earlier in the evening. Unbelievably, one of the other girls spotted this small pendent that still laid in the street that we walked down hours previously... amazing luck!
The next morning we continued our binge on comfort western foods with a quite relaxing restaraunt that served whole wheat pancakes and black coffee with milk on the side (coffee here is made with boiled milk). After again satiating our western appetite we set off for a day of exploring markets, shops, and the stretch of rocky beachfront. My main goal for the day was to find a more reputable sandals shop and get a new pair of sandals because the ones I'd gotten in Vellore proved to be quite cheap and had begun to hurt my feet and had even rubbed an open sore on the top of my left foot. I ended up buying two pairs of sangals ;-> A pair of flip flops that wouldn't rub on the top of my foot and a better pair of leather sangals to break in at a later date. With my one goal accomplished for the day, I was contempt to be drug around to various markets and shops in search of different gifts, cloths, and tapestries. The hot day peaked when we argued with our "hostel" owner that the other people in our group had "not come" and that we couldn't afford to pay for the un-needed room again that nigh... I think he just saw an easy meal cause there is no formal reservation system in place and if we had not shown up in the first place, he wouldn't have had any compensation. Long story short we only paid for the rooms we needed and were frustrated with our friends who apparently had made their own bookings.
For the evening activities, we went to a wonderful little coffe house / restaraunt and stayed there from nearly 7:00 - 11:30 p.m. Drinks and good food all around with a cool breeze coming off the water - hard to beat.
The next day we set off for a local grociery store stocking up on food for the day, tea for gifts, and drinks for the ride to Senji. This time we weren't so lucky to get seats and stood for the 2 hour ride. Once there, it was worth the effort with the ruins giving me some of the most beautiful sights so far. With the ruins closing we headed for town and were confused as 3 consecutive buses headed for Vellore didn't show... then the next 3 buses that were headed in the right direction were literally packed to the gills with people again forcefully pushing and hanging off the handles by the doors. About an hour after dark and several full buses later, beginning to feel a little uncomfortable with our situation, we completed our weekend of western habits and hired two taxies back to Vellore... a price tag few locals could even dream of affording. Eye opening, would be an understatement.
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The next morning we continued our binge on comfort western foods with a quite relaxing restaraunt that served whole wheat pancakes and black coffee with milk on the side (coffee here is made with boiled milk). After again satiating our western appetite we set off for a day of exploring markets, shops, and the stretch of rocky beachfront. My main goal for the day was to find a more reputable sandals shop and get a new pair of sandals because the ones I'd gotten in Vellore proved to be quite cheap and had begun to hurt my feet and had even rubbed an open sore on the top of my left foot. I ended up buying two pairs of sangals ;-> A pair of flip flops that wouldn't rub on the top of my foot and a better pair of leather sangals to break in at a later date. With my one goal accomplished for the day, I was contempt to be drug around to various markets and shops in search of different gifts, cloths, and tapestries. The hot day peaked when we argued with our "hostel" owner that the other people in our group had "not come" and that we couldn't afford to pay for the un-needed room again that nigh... I think he just saw an easy meal cause there is no formal reservation system in place and if we had not shown up in the first place, he wouldn't have had any compensation. Long story short we only paid for the rooms we needed and were frustrated with our friends who apparently had made their own bookings.
For the evening activities, we went to a wonderful little coffe house / restaraunt and stayed there from nearly 7:00 - 11:30 p.m. Drinks and good food all around with a cool breeze coming off the water - hard to beat.
The next day we set off for a local grociery store stocking up on food for the day, tea for gifts, and drinks for the ride to Senji. This time we weren't so lucky to get seats and stood for the 2 hour ride. Once there, it was worth the effort with the ruins giving me some of the most beautiful sights so far. With the ruins closing we headed for town and were confused as 3 consecutive buses headed for Vellore didn't show... then the next 3 buses that were headed in the right direction were literally packed to the gills with people again forcefully pushing and hanging off the handles by the doors. About an hour after dark and several full buses later, beginning to feel a little uncomfortable with our situation, we completed our weekend of western habits and hired two taxies back to Vellore... a price tag few locals could even dream of affording. Eye opening, would be an understatement.
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Monday, February 9, 2009
Bizarre
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C.H.A.D.
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I.N.D.I.A. - "I'll Never Do It Again"
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Weekend of Westernization... kinda
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India - Arrival
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Thursday, February 5, 2009
Day 4
Today I went went out to the village Munjiput just a few km outside
Vellore with a nurse and some other students. India has made a huge
investment into primary care and one of the systems they have in place
is having a filter down type that tries to promote prevention. Each
village has a "health aide" which is more or less a liaison for the
village that is intimately knowledgeable of the villagers and their
health issues. When the nurse or sometimes doctors come to the village
they first meet with the health aide to triage. Then the nurse/Dr.
filters out the chaff from the wheat, so to speak, of whom needs to be
seen at CHAD/ CMC Hospital and refers them on. In this method they cut
down on traffic to the hospitals that don't need to be there, they
provide service to patients who can't travel or afford to travel into
Vellore, and hopefully they prevent illness. It was good to see the
theory in action, however it was hard to actually see it in action.
Women who come into the hospital accept the fact that they might be
treated by a man, but if you come to their home they require the men to
exit the room before ANY type of exam is done. So that was a little
frustrating to be of the male persuasion today. I'm glad I got the
experience but I got about as much as I could in the first hour or so...
I was glad we only did a half day. The second half of my day consisted
of traveling into Vellore to once again try to buy some sandals as shoes
are proving quite hot here. I managed to find some, but I still haven't
got the hang of barganing... i'm too used to paying the listed price and
agreed 3x today to just that today before I realized. Once for sandals,
once for a shirt, and then once for the auto ride back to CHAD in a rush
because I realized that I had left my camera in the van that we took to
Munjiput... I honestly didn't think I would ever see my camera again. I
searched the vans in the parking lot at CHAD the one we took wasn't
there... after finding an intern that could speak English so as to
provide advice on how to pursue my lost item, I was directed to the
equivalent of the lost & found where to my chagrin, my camera awaited!
My 3 megapixel camera is 4 years old and wouldn't have been a huge
financial loss, but the loss of a camera for the whole trip would have
been discouraging. The evening activities should consist of dinner at
the canteen, yet again, and then making plans and reservations for the
weekend trip to Pondicherry.
Vellore with a nurse and some other students. India has made a huge
investment into primary care and one of the systems they have in place
is having a filter down type that tries to promote prevention. Each
village has a "health aide" which is more or less a liaison for the
village that is intimately knowledgeable of the villagers and their
health issues. When the nurse or sometimes doctors come to the village
they first meet with the health aide to triage. Then the nurse/Dr.
filters out the chaff from the wheat, so to speak, of whom needs to be
seen at CHAD/ CMC Hospital and refers them on. In this method they cut
down on traffic to the hospitals that don't need to be there, they
provide service to patients who can't travel or afford to travel into
Vellore, and hopefully they prevent illness. It was good to see the
theory in action, however it was hard to actually see it in action.
Women who come into the hospital accept the fact that they might be
treated by a man, but if you come to their home they require the men to
exit the room before ANY type of exam is done. So that was a little
frustrating to be of the male persuasion today. I'm glad I got the
experience but I got about as much as I could in the first hour or so...
I was glad we only did a half day. The second half of my day consisted
of traveling into Vellore to once again try to buy some sandals as shoes
are proving quite hot here. I managed to find some, but I still haven't
got the hang of barganing... i'm too used to paying the listed price and
agreed 3x today to just that today before I realized. Once for sandals,
once for a shirt, and then once for the auto ride back to CHAD in a rush
because I realized that I had left my camera in the van that we took to
Munjiput... I honestly didn't think I would ever see my camera again. I
searched the vans in the parking lot at CHAD the one we took wasn't
there... after finding an intern that could speak English so as to
provide advice on how to pursue my lost item, I was directed to the
equivalent of the lost & found where to my chagrin, my camera awaited!
My 3 megapixel camera is 4 years old and wouldn't have been a huge
financial loss, but the loss of a camera for the whole trip would have
been discouraging. The evening activities should consist of dinner at
the canteen, yet again, and then making plans and reservations for the
weekend trip to Pondicherry.
*Our background and circumstances may have influenced who we are, but we
are responsible for who we become.*
-Unknown
Wednesday, February 4, 2009
Day 3
Today again experiencing CHAD I started off the day with a brief lecture
on Diabetes management. Then after that we went and rounded on the
pediatrics ward... i'm afraid between the days starting to get much
hotter, sick babies not feeling well and letting us hear it, and a thick
Indian accent on the English explanation of each patient I wasn't able
to hear much. It was odd that probably 75% of the kids we saw though had
nephrotic syndrome though, which is a name given to a disease process
when your kidney is spilling too much protein into the urine. We
foreigners weren't quite sure why such a high prevelance was present in
the population and never quite got a definitive answer as to why. The
best we came up with was that it was due to Minimum Change Disease (I
apologize for medical jargon), but again no reason for why it was so
prevalent. After ped's rounds we went down to observe the maternal and
child clinic... by far the busiest we've seen CHAD. Patients lined up
into the streets quite early in the day to "get their appointment" (they
got a number in line) and then waited until they were seen. The section
of the clinic that I was in saw mostly pediatric and adult medicine
cases, apparently the maternal pregnancy checkups were in another part
of CHAD. We got to see some vitamin A and most likely B12 deficiency in
a woman with Pica (eats non-nutritious material e.g. dirt, gravel,
etc.), a 8 yr old girl with a goiter but no signs of developmental delay
or cretinism, and take lots of pictures of cute children who were bored
in line when we had a small break. This was all before lunch. After
lunch a group of students decided to set in search of clothing shops...
a group of girls from Oklahoma apparently bought the one tour guide book
that didn't talk about the modest clothing appreciated here - so we got
more than a few looks, honks, and side comments as I traipsed around
town with several white girls with bare ankles. Still not quite sure why
ankles and shoulder's are found to be so provocative, but I guess if you
never see them because everyone covers up then it probably would be
provocative. Anyways, to our dismay once we arrived at our destination
we found all the shops to be closed til 6 p.m. in protest of the
genocide and persecution of Tamil Sri Lankans in Sri Lanka (were in the
state of Tamil Nadu). I need to do some research into the history of the
conflict because I don't know much. With our schedule chopping up parts
of our day we only had about an hour and a half to get back to campus to
"register" with the police, which I guess has become a big deal since
the Mombai attacks. So we decided to walk a ways back towards home
seeing more trash lined streets stuccoed with cow patties and a starving
forlorn puppy. After that, we sought refuge for an hour or so in the
pool near our campus until the appropriate time to go see the police.
After leaving the pool and walking to the place we were meeting we found
out that our appointment had been moved til tomorrow due to the city
wide strike/protest... not sure if the police participated in this as
well or not, we'll hope they didn't just take the day off.
on Diabetes management. Then after that we went and rounded on the
pediatrics ward... i'm afraid between the days starting to get much
hotter, sick babies not feeling well and letting us hear it, and a thick
Indian accent on the English explanation of each patient I wasn't able
to hear much. It was odd that probably 75% of the kids we saw though had
nephrotic syndrome though, which is a name given to a disease process
when your kidney is spilling too much protein into the urine. We
foreigners weren't quite sure why such a high prevelance was present in
the population and never quite got a definitive answer as to why. The
best we came up with was that it was due to Minimum Change Disease (I
apologize for medical jargon), but again no reason for why it was so
prevalent. After ped's rounds we went down to observe the maternal and
child clinic... by far the busiest we've seen CHAD. Patients lined up
into the streets quite early in the day to "get their appointment" (they
got a number in line) and then waited until they were seen. The section
of the clinic that I was in saw mostly pediatric and adult medicine
cases, apparently the maternal pregnancy checkups were in another part
of CHAD. We got to see some vitamin A and most likely B12 deficiency in
a woman with Pica (eats non-nutritious material e.g. dirt, gravel,
etc.), a 8 yr old girl with a goiter but no signs of developmental delay
or cretinism, and take lots of pictures of cute children who were bored
in line when we had a small break. This was all before lunch. After
lunch a group of students decided to set in search of clothing shops...
a group of girls from Oklahoma apparently bought the one tour guide book
that didn't talk about the modest clothing appreciated here - so we got
more than a few looks, honks, and side comments as I traipsed around
town with several white girls with bare ankles. Still not quite sure why
ankles and shoulder's are found to be so provocative, but I guess if you
never see them because everyone covers up then it probably would be
provocative. Anyways, to our dismay once we arrived at our destination
we found all the shops to be closed til 6 p.m. in protest of the
genocide and persecution of Tamil Sri Lankans in Sri Lanka (were in the
state of Tamil Nadu). I need to do some research into the history of the
conflict because I don't know much. With our schedule chopping up parts
of our day we only had about an hour and a half to get back to campus to
"register" with the police, which I guess has become a big deal since
the Mombai attacks. So we decided to walk a ways back towards home
seeing more trash lined streets stuccoed with cow patties and a starving
forlorn puppy. After that, we sought refuge for an hour or so in the
pool near our campus until the appropriate time to go see the police.
After leaving the pool and walking to the place we were meeting we found
out that our appointment had been moved til tomorrow due to the city
wide strike/protest... not sure if the police participated in this as
well or not, we'll hope they didn't just take the day off.
*Our background and circumstances may have influenced who we are, but we
are responsible for who we become.*
-Unknown
Tuesday, February 3, 2009
Day 2
Windows Live™: E-mail. Chat. Share. Get more ways to connect. Check it out.
Day One
With no instructions from either our KU contact or the school here in
Vellore we stumbled our way through a morning of filling out forms,
taking passport photos for ID's, and waiting the appropriate amount of
time inbetween each activity that has been explained to me as... "it's
India." Tonight i'm headed to the welcome party for new international
students and then maybe watching a little bit of the superbowl that
someone has recorded... although it's been tough trying to avoid finding
out what the outcome was ;-> So today has been pretty relaxed. After
lunch I've been reading The Gift of Pain which has been a great read
right now, especially since the surgeon in the book actually worked here
in Vellore and describes his experiences here. It's starting to get hot
now, today was a good taste. Luckily this area is somewhat arid, so the
heat isn't quite as suffocating as it could be.
Vellore we stumbled our way through a morning of filling out forms,
taking passport photos for ID's, and waiting the appropriate amount of
time inbetween each activity that has been explained to me as... "it's
India." Tonight i'm headed to the welcome party for new international
students and then maybe watching a little bit of the superbowl that
someone has recorded... although it's been tough trying to avoid finding
out what the outcome was ;-> So today has been pretty relaxed. After
lunch I've been reading The Gift of Pain which has been a great read
right now, especially since the surgeon in the book actually worked here
in Vellore and describes his experiences here. It's starting to get hot
now, today was a good taste. Luckily this area is somewhat arid, so the
heat isn't quite as suffocating as it could be.
*Our background and circumstances may have influenced who we are, but we
are responsible for who we become.*
-Unknown
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