Monday, February 23, 2009

The CHAD rotation

Hello. To my friends and family just a warning, this is a medical post about my first rotation here in Vellore.

So my first rotation was at the CHAD. The CHAD stands for Community Health and Development. It is basically the secondary referral hospital of the CMC Hospital. I am really glad that I did this rotation first as it gave me a good overview of medicine in India as well as how their health system works.

First of all there is what they refer to as the Community Health Aide. Each health aide is responsible for one village, which is generally the village that she lives in. She is responsible for knowing the census of the village (any births or deaths) and basically everything that is going on in the village. If someone just got married, if someone is pregnant, if someone has become ill or how someone with a chronic medical condition is doing. She keeps track of all this information and reports to one of the CHAD nurses. Each CHAD nurse is responsible for several villages (30,000 people). She goes to each village once a week and sees any prenatal visits, postnatal visits, chronic illnesses and new illnesses. She sees these patients and dispenses chronic medications as well as decides if they need to be taken to the CHAD hospital. A doctor will come to the village once a month and see any new illnesses and examen chronic patients. I have been very impressed with how this whole system works. They really seem to cover the entire area and make sure to know everyone that needs their help.

There were so many areas you can work in the CHAD, it was a bit over whelming. You could go to labor and delivery (i avoided that one), the ER (which they call casualty which i think is pretty funny), the outpatient clinics, TB clinic (I am crossing my fingers that I do not have TB now), the ICU, the medicine wards (where I spent a lot of time), the pediatric wards and the villages. I just wanted to share with all of you a few of my observations and some of the patients that touched me or that I found medically interesting.

- The Hospital: its kind of what I expected. I have worked in a hospital in Nicaragua and it was a lot like this. Open air, lots of beds in a room, no A/C, bugs and animals in the wards but the patients are very well cared for and don't seem to mind all these things that stand out to me and that you would never see in the US.
- The patients: they are so grateful for your attention. They really respect the doctors and listen to what they say. Funnily, they are a lot like American patients, and do not feel like they have been treated unless they are given an antibiotic or some kind of medication. They all receive care for free if they cannot afford it. The intern I worked with a lot could not tell me exactly how this is all funded except there are lots of donors to the CMC. If the doctors feel that a patient will not take care of themselves when they leave the hospital they will keep them in the hospital as long as the patient is willing to stay, free of cost. The Indian villagers are the most welcoming people. On the days that I went into the villages I was amazed. Here I am a stranger walking into their home and I cannot even explain to them why I am there and that I may even be qualified to be there. But it doesn't matter, they welcome me into their home, insist that I sit down in the one chair they have in their home (one lady didn't have a chair so she brought a mat for me to sit on), hand me their children and allow me to see any ailment they may have. Many of the homes even offered little gifts of candy and flowers. Incredible, so trusting and friendly.
- Apparently Diabetes isn't unique to America: I had always kind of felt that diabetes (I am referring to type 2) was such a huge problem in the US because we don't eat well and we eat too much (especially of fast food). I always thought it was a problem of developed countries where food and money is plentiful but apparently I was wrong. I was so surprised by how many patients are diabetic. You walk down the streets here in India and you see that the majority of people are painfully skinny, you can see their bones and yet Diabetes is a major problem here. Even worse is that a lot of people can't afford shoes and so they live their lives barefoot and develop severe foot infections that never heal because they are diabetic and have no shoes to keep their feed clean. Amazing. But I guess its kind of the same scenario that we have in the US: the cheaper foods are the ones that are less healthy. Here rice is a major part of one's meal and one of the cheapest things you can buy so I guess I understand why diabetes continues to be a problem here.
- Being in an outreach type of hospital I expected to see lots of bizarre illnesses that I do not see in the US but instead I saw lots of seizures, HTN, diabetes, etc. However, these 'typical' diseases pose a whole other set of problems in this country. For example, one patient that really struck a cord with me was this young woman who was admitted for burns. It turns out she has a seizure disorder and during one of her seizures she fell into the fire where she continued seizing until someone was able to pull her out. Horrifying! I cannot even imagine the everyday things that are such hazards to her.
- My very first day I walked in on a code blue. A patient had been found unresponsive and CPR was started. They regained a heart beat and breathing but she was brain dead. I asked the doctor about what the family wanted and he said they just wanted her to die. He said that it is very common here that once you are considered "elderly" you are not really valued anymore. That they feed you and take care of you but that it is viewed that you will die at some point and therefore there is no need for medicine. Quite the eye opener on your first day.

It is impossible for me to relay to you everything that I experienced in such a short time. I believe is was the perfect way to start my work here in Vellore: I was able to get an understanding of the health system, refresh my memory on areas of medicine I have not seen in a while, and see some basic differences in the way that medicine is approached here versus in the US. It was a really great experience and I am excited about my next rotation: Ophthalmology

Tuesday, February 17, 2009

Update

Hello. I am so sorry it has been so long but no worries I am alive and well. First I will update you on the last few days of our travel and our arrival in Vellore and then about my first week on the CHAD rotation later.

So Saturday morning we set out for a safari. We went to this massive forest that covers 3 of the states. We had been told there were tons of elephants and some tigers and a leopard if you were lucky. Well, we were not so lucky. We saw nothing. We saw deer, pigs, peacocks and monkeys but no elephants, no tigers, nothing fun. Quite sad. Well Gowri was having none of that and went to argue with the company to get our money back. Meanwhile we were all busy trying to clean all the dirt off of us. Since we were a little distracted we did not see the monkey that jumped into the car and grabbed a bag of snacks from the car. We saw him as he was jumping out of the car with the food and climbing up the pole. But karma got the monkey because as he was climbing a rope away from us the bag ripped and dropped all the snacks. So all the other monkeys came running to eat all the food off the ground. Sill monkey didn't get any food. The animals here are hilarious. There are cows just roaming the streets (both in the villages and in the middle of major cities), its crazy. One cow that was up near a temple we went to decided it really did not like Jenna and myself so it decided to start charging us and followed us around for a good 3min. All the locals had a good laugh about that. Another monkey tried to steal Jenna's purse. Sneaky monkeys

After the Safari we drove up to a Tibetian Monastery which is the second largest in the world and the only one outside of Tibet. It was fascinating. I knew nothing about this before coming so I was full of questions. Apparently you are entered into this "school" at birth or shortly after if you think your child might be the next dalai lama. Here they are taught about Buddhism and math and science and medicine. Apparently most of them will not make it to become a monk because they will not be able to learn all the information required of them. Those that do not make it will reenter society. I was kind of expecting these extremely religious and obedient monks who were very serious and straight faced. However, there were tons of kids running around playing and guys joking around with each other. One guy reached under his robe and pulled out a cell phone. I thought that was pretty hilarious. We happened to be there during meal time so we were able to enter the temple and listen to their chants before dinner was served. It was really pretty cool. Definitely a once in a lifetime experience.

For dinner that night we went to this tiny local restaurant which is supposed to have the best Dosas (a kind of pancake like dish served with spicey chutneys). This place have 4 tables and the only thing on the menu was dosa. we were the only white people in the place and they found it hilarious that we were in such a local eatery. it was a really good dosa.

Sunday we headed out to Vellore. On the way we happened upon this festival (I cannot remember the name of it) where there were nearly 30 weddings occurring that day. Apparently, if you are from a poor village/family and cannot afford a wedding on your own you can go to these festivals where the temple lumps a bunch of weddings together. I have decided there is a reason for arranged marriages, it is impossible to get married in this country without someone finding a husband/wife for you because you would never find the person that meets all the right criteria by chance. So no only do you have to marry someone of the same caste, you have to marry someone of the same subdivision of the caste. You also are born under a certain star and zodiac. For the marriage to be successful you have to marry someone with a complementary star and zodiac. Not only that but you have to marry on a day that is considered a "good star day". It is all way too complicated for me. So apparently Sunday was a "good star day" so all these families gathered at the temple to basically share the cost of the weddings. We puled off the road to go wander and see what this was all about. I felt so terrible because as soon as we walked into the area we caused a huge commotion. People stopped paying attention to the bride and groom and were staring and pointing at us. EVERYONE wanted their picture taken. One group wanted us to come stand right up front and watch the bride and groom get married. It was all so nice and so incredible to experience but I felt terrible that we were taking away from the couple.

We finally arrived in Vellore Sunday night. It was quite difficult finding the place but we finally did. The hostel that was recommended to us was a bit more rustic than we had anticipated but apparently this is in fact the best place to stay in vellore (I am scared to know what the other places are like).

Alright, well I am tired of typing for the day. I will write later about my first week in the hospital. I already have so much to tell after just 2 days.

Jacq

Friday, February 13, 2009

Things I Have Learned Today

Hello! So today was full of information about Indian life. An absolutely amazing day!

1. Driving is a dangerous sport: Driving here is crazy. There are absolutely no traffic laws, or at least there doesn't seem to be. First of all they drive one the left. There are lines drawn denoting lanes but apparently they do not mean anything. Everyone honks constantly. It basically is a free for all on the roads, everyone trying to pass each other. If traffic is going to slow for you, no worries, just drive on the other side of the road to pass traffic and honk so the on coming cars hopefully avoid you. Jenna and I have found ourselves gripping the car many times thinking we are about to hit another car, but amazingly we don't. The drivers here are very skilled and just whip around each other like its nothing. However, its not always incident free. Today we passed by a bus that had fallen off the road and tipped over. We stopped to help pull people out and amazingly no one was hurt. A few scrapes and that was it. Incredible

2. No one should travel around India without Mrs. Gowri: Mrs. Gowri is one of the wonderful travel agents who helped us to plan our trip. She is traveling with us through Mysore (the city we are currently in) and we are learning so much more about India than we would ever learn otherwise. Today we drove out to an ancient temple and on the way stopped on the side of the road probably 5 or 6 times for her to point out various things to us such as: we stopped in the rice fields to see how they were sowing the ground after to harvest, we tasted tamarin straight from the tree and learned that it not only is used as seasoning but is also what the women use to make the dot on their head (see below for more), we saw banana plants, we stopped at a school (see below), and so many more incredible things. She has taught us about all the different foods and took us to a temple dedicated to a certain goddess and it happened to be "her holy or worship day" so we were able to see and partake in some of their rituals. Seriously, if anyone ever comes to India they must contact Mrs. Gowri

3. There are 3 main gods: Today we drove out to an ancient temple build around the 1200s. There we learned all about the hindu gods. There are three main gods: the creator, the preserver and the destroyer. Each god has his own wife. You recognize each male and female god by the objects they hold in their hands (also, they can have anywhere from 4-36hands) and the animal which they ride. This ancient temple was made of soapstone. The entire thing was intricately carved into various statues of the gods. When this was built they did not have cement so they created holes and pegs to put the pieces of stone together. This particular temple was dedicated to the god that is the preserver, Vishnu, so the temple was mainly covered in statues depicting him and his wife. I learned from Gowri that much like Catholics have a patron saint the Hindus have a family God. Each family has a specific god that they worship and they will carry this god into their families when they marry to pass on to their children. We also went to the temple of the god of the royal family. Today is Friday so it was her worship day so the temple was full of priests. We entered very confused and simply followed Gowri and received a blessing from the priest in which he dabs tamarin on your forehead and gives you bangle bracelets (not sure what the meaning of those are). Today was such an interesting day to learn all about the religious (mainly Hindu) side of Indian life.

4. India still has some Kings: So, long ago each Indian state was ruled by a different King but once India became a democracy these kings lost all their power. However, here in Karantagar (I am totally butchering the spelling of this state) the king still lives in his palace and is respected by all in his state. We were able to tour his palace today. It was absolutely beautiful. It had some of the most amazing stained glass windows that I have ever seen.

5. People here, especially children, are amazed by white people, especially blond ones: Jenna and I have become quite accustomed to the stares we get from people but still some of the big reactions are hilarious. Today, on your drive to the ancient temple, we saw a bunch of children playing at a school. Gowri told the driver to pull over and said "come, we will go make these children's lives, many have never seen a foreigner". She was not kidding. As soon as we had been spotted we were swarmed by the school children. They all came running out of the classrooms and wanted their picture taken. Each one had to ask us our names and then tell us theirs. Every single one wanted their picture taken but they didn't quite understand the concept of the camera and that if you all back up more of you can be in the picture. They thought that they had to get right up in the lens of the camera in order for it to see them. So cute. Very peculiar but they associate foreigners with pens. Every child we have seen and even lots of adults have all asked us for pens. Had I known this I would have brought boxes of pens to to hand out. Pens, who knew?! So one of the funniest reactions I have received was this tiny little boy maybe 3yrs old. We were walking into the royal temple and he just stopped and stared at us in absolute confusion/amazement/shock/etc. you could tell he had never seen a white person before and just could not believe what he was seeing. it was hilarious. Needless to say, I stand out here

6. the third eye: I was always taught in school that Indians where a dot on their forehead to signify they are married. However, I have seen women, men and children with paintings on their foreheads. So I asked the oh so knowledgeable Gowri what it all meant. According to their culture the spot between the eyes is your vulnerable spot. They believe it is where evil can get you and that if you get hit there you will die instantly. So many children and men will paint a small flower, eye or symbol there to represent the "third eye" which will protect you from evil.

It is impossible to convey everything I have learned to you all but I will try my best. Today was a full day and tomorrow we are getting up early to go on a sunrise safari and ride elephants as well as visit a Tibetian monastery. After that we will head to Vellore on Sunday where we will begin our work in the hospital. I will try my best to find internet as frequently as I can to keep you all informed on what all is going on. It is truly a once in a lifetime experience

Jacq

Thursday, February 12, 2009

Update

Hello All, Sorry I have not had the time to find internet since my arrival in India but I did make it here safely. Briefly, here is what I have been up to and some things I have observed

Tuesday: Arrived in Delhi at 5am. Basically slept all day because our clocks were all messed up and we were exhausted from the flight. First impressions of Delhi, nasty. Seriously, I choked when I took a breath leaving the airport. There is so much pollution that there is a constant fog in the air except its not fog, it pollution. Pretty gross. Once we woke up the brother-in-law of our travel agent came and picked us up and took us to dinner to have our first taste of Indian food. We went to a buffet so we could try various things and decide what we wanted. I would never have guessed how to eat some of these dishes but it was all delicious. We had this dessert that tasted like a hot krispy kreme but better. After dinner he took us to his house. It was a beautiful home that he was very proud of (not many Indians own there own home, in fact the majority seem to be living in what I would have thought was a condemned building). He showed us pictures of his kids and was generally amazing. He said that if we came back to Delhi he would love for us to stay with him and give us a tour of the city.

Wednesday: We took our favorite hotel driver Ajay and headed to Agra. Agra is a city abour 130km from Delhi best known as being the home of the Taj Mahal. On the drive out there Jenna and I began counting the different animals we encounted on the road: cows (which often block traffic), goats, dogs, elephant, camel, donkey, monkey and i am sure i am forgettign soemthing. so crazy. Once we got to Agra we picked up an amazing tour guide who led us through the Taj Mahal. Because of the damage pollution is having on the Taj you are not allowed to take cars within 500m of it, so we had 3 options: autorickshaw, camel and bus. Obviously we all were hoping for the camel but our tour guide said the camel takes a lot longer than the autorickshaw and smells. ha. The Taj is everything it seems in pictures. It is absolutely beautiful. It is made entirely of Indian Marble and precious gems. The gems are actually carved and inlaid into the marble, we saw some people doing this and it seems so impossible, a simple flower can have up to 50 pieces. The thing I thought was the most amazing was that the marble and one of the stones glows with light, so at sunrise and sunset (or if you have a handy flashlight) the Taj glows and is absolutely beautiful. I could not resist buying a small plate that had this stone in it to show all of you when I get home. The other thing that amazed me at the Taj was the incredible forethought it took to build. Everything is symmetric and every single thing down to the number of gardens and fountains has meaning (symbolizes the year it was completed). After the Taj we went to the Agra fort. Also amazingly beautiful and built in sandstone. Only about 20% of the entire fort is open to the public which is amazing because that 20% took 2hrs to walk through. The fort was so interesting to see how royal life was lived on a daily basis. Our tour guide was excellent at describing the different rulers and their positive influences and downfalls. Each new ruler added on new parts of the fort so you can see the different interests of each king. An interesting tidbit, the builder of the Taj Shah Jahn was overthrown from power by his youngest son who then imprissoned him in the Agra fort, but just to show he isn't totally heartless he imprissoned him in a room that overlooked the Taj, kind of cruel in my opinion. Anyways, after a long day of sighseeing we basically made it back to the hotel and crashed.

Thursday: Today we were basically flying all day. We had a 630am flight but because the pollution/fog was so bad we were delayed and kept on the plane for 4.5hrs. We finally made it to Bangalore and our travel agent's sister picked us up to take us to Mysore. On the way we stopped at the cutest little restaurant where you felt like you were in a jungle. She introduced us to some of the foods that are local to this area. She is such a blessing to have with us as she knows so much history and we get to ask her all our silly social questions such as arranged marriages and such plus she stops the locals from taking advantage of us. We have now arrived in Mysore which is apparently the city of the palace which houses the current king as well as a tibetian monestary. All incredible things I cannot wait to tell you all about.

I have to go since my internet time is running out but i wanted you all to know I was alive and well. I will try to write soon about my general impressions and some of the crazy things we have seen and heard.

love you all

Monday, February 9, 2009

8hr Layover

Hello, So we have safely made it to London and now have an 8hr layover. That is how far it is to India, so far it requires 2 overnight flights....ouch. I also did the math and apparently I will be 11.5 hrs ahead of all of you in the central time zone. How are you half a time zome from someone.Did some country decide to just be difficult and mess up the whole thing? Odd

Thus far the trip has been uneventful. Thanks to a long night of dancing at my soon-to-be-sister in law's wedding I was exhausted on the plane and slept nearly the entire way only interrupted by the periodic screaming of a small child several rows up.

We will board the plane here in london in a few hours to land in New Delhi tomorrow morning. We will have Tuesday to attempt to recover and then we are off to several days crammed with as much sightseeing as possible.

Love you all!

Thursday, February 5, 2009

Hello All! Welcome to my blog. I will be updating this as frequently as I can in India. It will generally be all about my adventures in India and the interesting situations I am sure Jenna and I will get ourselves into. I will also be posting about interesting medical cases I encounter there (required for school).

A little intro into what I will be doing:

I will be arriving in New Delhi on Feb 10th where we wil begin our travels to see the big tourist spots such as the Taj. From there we will make our way to southern India where we will be staying for the rest of the month. I will be working at the Christian Medical College which is a major medical school and hospital in a city called Vellore. I am not sure exactly what I will be doing but will let you all know as it happens.

Enjoy!