Funny Moments in Vellore

As we are getting ready to leave Vellore tomorrow morning, we've all shared our hospital stories but there have just been some funny moments about staying in the small town of Vellore for 2 weeks that have made this trip unique.

I think we can all agree that the Indian head nod has by far been one of the most complicating things to understand and master. Took us about a week to realize that the Indian head bob is not a definitive yes, or a no, but more of a yes/maybe/we'll try. No one tells you no here (except rickshaw drivers when you ask for too low of a price). The answer is usually yes, but it doesnt mean it will always happen. Accompany the ambiguous yes with the Indian head nod, and its a puzzle that we've all figured out by now (Alexis has even started to use it herself). Its not like our typical forward head nod which =yes, or our typical head shake for no, but in a different plane, more like a bobble head. It was confusing at first, but now we know that when someone shakes their head, its a yes, rather than a no. For example, at breakfast, when telling them our order, "Orange juice please and coffee". Followed by the head bob, which looks like a no and then we continued to repeat orange juice 10 more times thinking they were telling us no.

Rickshaw rides: another favorite part of our trip so far. Theyve become our morning and afternoon transportation to and from the hospital. You cant help but just crack up sometimes at the craziness of the traffic and then the bumpiness of the ride, combined with up to 5 of us crammed into 1 auto rickshaw, hanging on for dear life. A couple rides in particular have been memorable. Some where the driver is blasting indian music as they slam on and off the breaks and we're all sitting in the back with our heads just going back and forth. Today, we took a rickshaw, in the worst traffic, the hottest heat, Alexis hanging out the side bar, and just stop and go traffic. Its so different than anything we will ever experience in the US but is so much fun, such a different way to travel. Definitely one of my favorite parts of the day.

The power outages: a daily occurrence. Not quite sure why, but power outages are very common here. At first, a bit alarming, especially during inopportune moments (i.e. the 3 times Shivani has been mid-shower when everything goes black). Or mid-Twilight movie, all crammed in bed, anticipating the next cheesy line, and then everything goes black and then we all just start cracking up. Dinner on the roof top, and the power goes out 3 times in one dinner, and we now just keep on going with our conversation while not being able to see one another.

We've all learned now to lock our door after asking housekeeping to deliver something to the room as there seems to be no knocking protocol, but more of a general entrance policy. Unfortunately learned while putting on pajamas as housekeeping just starts opening the door to deliver towels as i'm hiding behind the door half dressed. Phone conversations become interesting when ordering things. For example, ordering tea and hot water and they show up with tea and bottled water. Or Jen asking for a floor towel and yelling into the phone "Floor mat! Like on the ground!" Not sure if they actually brought it.

One of my favorite moments was our Reliance Worldwide experience. After finding a high-speed reliance internet, we asked if they had high-speed computers and video cameras. After being told yes, Shivani, Caitlyn and I all bought a package of 15hrs for 100 rupees. Come back later that day (saturday), no cameras set up and the computers are slow as mud. Okay. He promises us to come back on Monday, internet will be fast, cameras will be working. Okay, come back on tuesday. Internet STILL slow, no cameras set up, ask him to help, he doesn't, then tells us we can use the camera in his office. Well at this point, Shivani and I have now gotten mad (which is never good). We decide to ask for our money back and to remove our names from their system. Shivani and I storm to the desk and she just takes it away. "You promised us high-speed internet - its slow. You promised us cameras and microphones - they're still not working. You lied! We want our money back". And I just stand there, nodding in agreeance and reiterating "Yea! We want our money back". Finally terrifying the manager, he just whips out his own wallet, gives us each 100 rupees and we leave defiant and feeling satisfied.

Tomorrow we pack up and leave for Mamallapuram, not sure what to expect seeing as though our hotel said "oh no reservations need, everything is open, just come!" Then we head to Chennai for 2 days before our trip to Goa!

Last night in Vellore

Today seems a bit bittersweet. Although we are all getting a little antsy and ready to start a new adventure, we have finally gotten used to the hospital, campus and the small part of town that we venture into every day.

We have tried almost every good restaurant (recommended by friends, physicians, students) in town, ironically the best one is at the rooftop of our own hotel! We have definitely been spoiled staying at a hotel in town, other visiting students who have been here or will be here for extended periods are all staying in hostels on campus (No air conditioning! We don't know how they do it!). Also, many of us have opted to take rickshaws instead of the bus to get around town. The bus, which has its very crowded moments (people literally hanging out of the door), also has routes that we can't quite seem to get. Even after waiting at the bus stop we will sometimes opt for a rickshaw! The security guard at our hotel has noticed our efforts and gave us a thumbs up the other day for squeezing all 5 of us into one after negotiating a good price!

We met with Dr. Varghese on Thursday for dinner at the rooftop restaurant. He was our main CMC contact since he is an adjunct WSUSOM faculty member. He told us stories about CMC, and even about his time spent in Detroit working in Infectious Disease! He really reminded me of Dr. Chandrasekar, the AAPI faculty sponsor at WSU, in the way that he spoke of his medical work and experiences. We hope to meet Dr. Varghese when he visits MI in the fall!

This week I was working in Endocrinology. I was able to join visiting physicians from all over India who are here taking a 1-wk course in diabetes care. They were so interested to hear about how I thought medical care differed between the two countries. I had to mention that in the US, our system is set up so differently from theirs, that it is almost impossible to compare the task that physicians have to undertake in each country.

I think these past two weeks have really opened my eyes to the financial side of medicine, and how much we take for granted, especially having every form of technology and test available to us. For instance, out of all of the patients that this department sees, only a handful are using an insulin pump to deliver their insulin. The reason is that most patients do not have insurance and each pump costs 10,000 rupees per month (close to $250/month). The department can sometimes sponsor a patient, but even then, the money invested in one pump could potentially sponsor medications for a larger number of patients not using an insulin pump. The fact that the first thought most doctors have when treating a patient is 'what are they able to afford?' and also, 'how long will this patient be in town for' (since many patients travel as far as West Bengal), completely blows me away. I will be taking these experiences with me when I leave and will never forget my time here!

Tomorrow, Yinan will leave to head back to Detroit (Rasika left on Friday to return), and Sarah, Alexis, Jen, Caitlyn and myself will travel to Mammalapuram, Chennai and finally Goa. We are ready to start our next adventure and hopefully I can post pictures soon!


Shivani

Urology!!

Greetings, earthlings!

I'm blogging on my lunch break because I am super pumped about what I discovered this morning....I love urology!!

Jen, Shivani, Sarah, Caitlyn and I all got up pretty early today (before 7 = early for me..) and waited FOREVER for breakfast because it was very busy today in the restaurant. We ended up getting a free continental breakfast even though we were a meal ticket short because they lost track of our tickets....woo to free food! All 5 of us then squeezed into a small rickshaw and made our way to work. I will always remember these morning rides...if you weren't fully awake before boarding the rickshaw, you are definitely awake by the end of the ride. SO much traffic and commotion and honking and just noise in general!

Jen and I were speaking to a doctor yesterday (John) who told us to come back this morning to watch a kidney transplant. We watched the urologist laparoscopically remove the donor kidney, which was coming from the wife of the recipient patient (none of his siblings would consent to donating a kidney :(, so they had to go to another loved one, even though she is only a 3/6 match with her husband). IT WAS SO COOL! Technology is ridiculously cool. The urologist was quizzing Jen and I the entire time about blood vessels, organs, and other structures....I am embarrassed to admit we didn't know all of the answers, but I suppose that's why we are only M2s (!) and not MDs.

We then walked to the adjacent OR to watch a trans-urethral resection of the prostate, which our doctor friend, John, was overseeing. He was an awesome teacher and did a great job explaining everything that was going on to us. Basically, as men age, their prostates hypertrophy due to an increase in growth factors and a decrease in apoptosis. Therefore, the prostatic urethra's lumen is narrowed and urinating becomes painful among other things.

Today was my favorite morning yet - the doctors were so great about teaching us and we got to see some really cool procedures. I feel bad saying this because I did love my OB/GYN rotation, but I really liked urological surgeries! Who knows, maybe I'll join the ranks of the minority of females who become urologists. I surprised myself by enjoying surgery so much! Not general surgery as much, but I enjoyed the focus on the kidney and other urological structures.

Starting to get really excited about Goa...can't believe our time in Vellore is almost over!

Alexis

My Gynecology Posting!

So I spent last week in the OG I department at the hospital. It was an amazing week, and there was so much girl power going on within the department! The Spice Girls would've loved it :-)

On Monday, I spent the day in OPD, which is the outpatient sector of the department. Since I don't understand Tamil or Hindi at all, I sort of had to read the chart notes that the resident and intern were taking to understand at all what was going on with each patient. I did pick up on some body language and nonverbals though, so I wasn't totally lost! The intern I spent the afternoon with, Ludia, was a such a gem. She explained everything to me and was really patient when I asked 50,000 questions. It was interesting that the men came into the room with their wives for their gynecological appointments, and in some cases, they did all of the explaining.

On Tuesday, I spent the day in the "operating theater". I watched the all female crew of attendings, residents, and interns perform multiple hysterectomies and ovarian cyst/tumor removal procedures. One patient had a HUGE ovarian tumor. She was a tiny, probably 90lb woman, but with the tumor, her stomach was protruding as if she was pregnant. She lost 4 liters of fluid between ascites and blood. I also saw a C section that afternoon, so I saw my first baby being born!

On Wednesday, I spent the day in rounds with the OG I crew. The attending was brutal, and the interns were studying hard for the hour before they began because they knew she would ask tons of tough questions. We also had a case discussion with the attending about a patient who had had a previous bilateral mastectomy, and she now had ovarian tumors. Since we just finished our Genetics class at school, I figured that she might have the gene for these cancers, BRCA 1 or 2, and it turns out I was right. So I was super excited about that. In India though, they can't do genetic testing for the gene because there are only two labs that will perform the test. The rest of the day we ran an outpatient menopause clinic.

On Thursday, we had the outpatient clinic again. On Friday, we had surgery again. I saw my first laparoscopic surgery. It was a sterilzation procedure where they clamp the fallopian tubes. SUPER COOL. The woman was only 20 years old! The attending Dr. Alice explained to me that the young age is really common in India. The next surgery was a total abdominal hysterectomy, since the woman had a very large uterine fibroid. I also saw another ovarian tumor removal procedure that was done on a woman with metastatic cancer. The procedure was done to make her remaining time as painless as possible.

I was really inspired by all of these intelligent and motivated females. I ended up really enoying gynecology, even though originally I was hoping to be on labor and delivery. I think when I'm back in the States, I'm gonna try to do some shadowing in gynecology/gynecological surgery!

"Welcome to the Endocrinology Department"

A few days ago, I met the family member of a patient we were seeing in the OB outpatient clinic. She told me that she worked in the endocrinology department and invited my to visit. Well, I was so interested in all of the clinics that the department has, that I changed my last weeks postings to all endocrin. She greeted me so warmly when I saw her this morning, I knew it was going to be a great week!

After meeting with the head doctor, Dr. Thomas, I was rushed to Journal Club that the residents were presenting. I was then added to a group of physicians visiting CMC from all over the country attending a week-long educational session on diabetes care. Along with being added to the group, I was told I could attend their lectures and follow their schedule for visiting patients. The new daily schedule also came with a textbook, powerpoint lecture notes and a very detailed daily schedule! This is going to be a jam-packed week, but I am very much looking forward to it!

More to come later, we are off to dinner (yes, it is 4:30pm but we are so hungry at this time!) and I will write more soon!

Shivani

PS- My parent's have the NICEST friends. On Sunday I was taken under the wing of family friends that I have not seen in 21 years since I was in Hiroshima! They treated me like their own when they showed me their university (Vellore Institute of Technology- on the north side of town), treated me to lunch, traditional sweets, mangos and a day trip to a nearby hill station! I felt like I was at home, it was a great feeling. I hope to meet them again before I leave and hopefully the next time I see them, it will be sooner than 21 years!

CHAD Clinic

Yesterday (Monday) Shivani, Jen and I tried out the CHAD mobile clinic for the day. One of the physicians we were with described CHAD as more of the primary care facilities vs the CMC hospital where all the specialty facilities are located. CHAD has a permanent location and also a mobile unit that travels to local neighborhoods and villages to see patients every week. Most of the patients have chronic diseases as well as a large number of pregnant women for monthly ante-natal check ups. If there is larger problem that the mobile department cannot handle themselves or via ambulance EMT, they are referred to CMC hospital.

The village we went to was only a short bus ride from the CHAD clinic. The van pulls up to a line of waiting people, all bringing their own little medical record card that they bring to the physician each week for their check up. The intern was set up at a little table and took BP and listened to any problems they were having and then wrote new prescriptions for them. The patient then took their slip of paper to the bus where the nurses were administering medicines and vaccines from the back of the bus. In the front of the bus, another doctor saw all the pregnant women. They came in, got weighed, got their BP taken, a quick physical exam, and any referrals if needed.

The whole process was very interesting, to see how a team of 6 people and a van load of meds could take care of about 70 patients. Some complications arise, such as a few patients with similar names who could not recognize their own chart and so received the wrong medications. The doctor told us that has happened before and they get patients back who have been taking someone elses medicine

The clinic lasted till about 2pm and then a whole group of local children started gathering around us out of intrigue while we waited for the doctor to finish up. We goofed around with the kids for about an hour, making faces, taking pictures, letting them play with our cameras. It was fun to finally be able to play with some kids! One of them looked like he was right out of the Little Rascals. Hopefully I can post pictures of them later!

starting to get sad about leaving vellore

Hello friends and family

Although the end is in sight I am trying not to think about leaving. This week has already been incredible - yesterday I participated in the program CHAD and today I was in surgeries all day.


CHAD was awesome - we took the mobile clinic to a village about 15 minutes away. The clinic goes to the same villages every week so the patients are already there waiting for the van. Upon arrival a table and chairs are set up outside to treat patients and the " anti-natal care is taken care of in the bus/mobile clinic. In a short time we saw 80 patients! A lot of patients had hypertension but we also saw anemia, a seizure disorder as well as hypothyroidism. The patients in the village have a strong relationship with the visiting doctor/resident and it was very interesting to see how care is provided in a more rural setting. We were lucky to have a young intern with us to explain everything. He was 23 and already treating patients, where as I am also 23 but I can't do much more than take a blood pressure. We also got to play with some of the kids in the village towards the end of our trip. They were adorable and full of energy! What a cool experience. Completely different than the U.S.

Today I bounced for OR to OR with Alexis and we saw some really cool surgeries. From a hernia repair to a huge tumor resection it was an action packed day. I also jumped in on a left inferior parathyroid excision and lung excision. The Doctor I was following showed us the CT scans before each surgery and explained where the tumors were and how they were going to repairthe damage and take the tumor out. It was intense. We befriended an anesthesiologist and talked about the differences/similarities in our cultures. He was greatly amused by us, and he was also very cute but married. Shucks.

Tons more international students arrived yesterday as well as students from CMC - today I was with 4! I'm getting excited for our second international night.

Alright - that's all for now!

I'm pumped for the rest of the week and dreading the end -

Jennifer (everytime i try to introduce myself as Jen it gets very confusing)