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)

First Day on Peds!

Hi everyone!

It's been a while since I've posted, and I'm LONG overdue for a post about what I've been doing at the hospital. Lucky for you, I'm planning on writing two posts today...one about the weekend and my day at the hospital today, and one about the week I spent with the Gynecology Dept. The notes I took last week are currently in our hotel room, which I am currently locked out of (Thanks Alexis and Jen! JK), so look for that one a little bit later tonight :-)

So we all had an very exciting Friday night of watching a Twilight double feature on TV and ordering room service! Like Alexis mentioned, we get pretty geeked up when American movies are playing on the TV...even though they tend to censor a lot of the best parts of every movie...

On Saturday, Rasika headed to Chennai to visit her uncle, Alexis spent the day in bed rewatching Twilight (she's feeling under the weather), and the rest of us went on shopping sprees across Vellore. Jen, Sarah, Shivani and I headed to the fabric/sari store to check out the South Indian style saris for sale. The fabrics were AMAZING! While we were looking for a bookstore, we stumbled across a super cool local market where lots of people were selling fruit (mangos and jackfruit) and veggies and assorted household items. One alleyway off the main strip was home to an amazing flower market with lots of locals buying jasmine and lilys to give as offerings when they went to the temple on Sunday. The flower sellers loved the "American girls" and gifted us with some flowers to wear in our hair. Yinan got the best deals of the day with two pairs of shoes and a boxful of bangle bracelets. She is totally the queen of bargaining, but we already knew this from watching her do her thing at the Jan Path market in Delhi.

I was asked yesterday by my wonderful boyfriend Eoghan what the nightlife in Vellore is like. Well, there really isn't much! Besides, when the temperature low for the day is 83 F, staying in the A/C hotel sounds wayyyy better. Which explains why we all spent Saturday night in Vellore camped in front of the TV watching "He's Just Not That Into You", gossiping, and ordering room service again! Had some issues ordering Sweet and Sour Chicken (just ask Jen!), but it was really delish.

On Sunday, Jen, Yinan, Sarah and I headed to Vellore Fort in the center of town to check it out. Really sticky and humid weather, so we didn't last long there. Lots of cricket matches going on inside the fort, and we checked out a temple that was on site too (can't spell the name haha). Shivani headed over to the Vellore Institute of Technology to meet up with some old family friends. At night we started trying to plan our upcoming weekend, which we hope will include visits to a backpacker beach town called Mamallapuram and the somewhat big city Chennai. :-)

Today, all of us started new postings at the hospital. I am posted in Child's Health II, a pediatric unit with a special focus on rheumatology and nephrology. The first part of the day included a case discussion with one of the residents (they call them post-grads in India) about a little boy with LCH, which stands for Langerhan's Cell Histiocytosis. It's basically an immunosuppressive disease, with a characteristic three symptom triad of diabetes insipidus, exopthalmos (protruding eyeballs), and lytic (holey) bone lesions. It sounds like its really rare, and when I just Wikipedia-ed it, I found out it was featured on an episode of House!

After that we had rounds on the Pediatric unit with all of the attendings, residents, and interns. After lunch, we followed up all of the cases we saw on rounds with a radiology conference, which totally tied it all together for me! I was kind of lost up until that point, no matter how many questions I asked. It was cool because a lot of the cases related well to the stuff we just covered at the end of our first year of med school (Genetics and Neuroscience).

One case was a 7 year old little girl who had been experiencing a lot of back pain (she won't sit up or walk any more)and had high blood calcium levels. Turns out she had hyperparathyroidism. On X-Ray you could see very obvious bone loss in many bones, and there was characteristic "scalloping" of her distalmost finger bone that gave it away for the radiologist. One of the attendings told me that the treatment is to remove 2 or 3 of the 4 parathyroid glands in the body.

The second case was a little 3 year old boy with severe hydrocephalus ("water on the brain"). For our med school friends reading this, the ventricles were HUGE in horizontal cross sections (you know you miss Rafols' Atlas!). The neurosurgeons had put in a shunt previously to relieve the pressure and drain cerebrospinal fluid (CSF), but it didn't work. The radiologists found a malformation in one of the veins in the brain that collects and drains CSF (Galen's vein) and believe that to be the cause. Alternatively, the pediatricians think it may be a complication of tuberculosis, even though the patient's parents said he hadn't been exposed to TB. On the MRI you could see that his brain had begun to atrophy and there were mineralized regions, so he will never be able to fully recover from the disease. The doctors had to have the difficult discussion of whether or not to consult the neurosurgeons, since very often in India, the financial aspect of medicine must be balanced with potential outcomes.

We also talked about a severe case of encephalitis (inflammation of the brain) with an accompanying hematoma, as well as a child with hypophosphatasia. I don't know what that means (yet), but maybe I will next year when I'm a second year.

All in all, it was a really good day at the CMC :-)

Thanks for reading this super long post, and look for another from me later tonight!

Shoes, crickets and of course...babies!

So I have had quite an interesting week, inside and outside of CMC! On Tuesday after a day spent in the MICU (mentioned by Yinan below, I attached a pic of a typical bed here), Yinan, Sarah and I ventured to CMC Main campus. We had a few errands to run, met up with our new Canadian friend and discovered the very well-stocked Campus Store! They have EVERYTHING- monkeys (outside, and they do NOT like to have their pictures taken!), oreos, shampoo, noodles, and lucky for me, a way to finally re-fill my cell phone!

On our way out, we decided to catch the bus back to our place (only 3 rps, a steal!). Unfortunately for the three of us, my shoes were not ready to leave. When I stepped on the bus, one of my shoes stayed behind and the bus took off!!!! After a bit of arguing with the bus driver, they finally stopped for us to get off. Then the hobbling began. As Yinan ran back to try and find my shoe, I walked back (at this point, only wearing one shoe!) with Sarah to the bus stand where we had to wait and catch the bus once again. Luckily the CMC Security guard saved my shoe behind the guard booth and Yinan got it for me and all was well. Embarrassing moment #1.

On Wednesday night after another day in the MICU (where we saw a person who was bitten by a poisonous snake causing paralysis), we met with other CMC International students at the rooftop restaurant at our hotel (the other students claim it has the best food in the whole city). It was a great time minus the moment when a cricket landed on my shoulder. Sarah casually mentioned to Jen (sitting next to me) that there was something on my shoulder. Jen reacted, and ran away from me! Which of course, startled me and I ran screaming the other way looking frantically around for the bug since no one would tell me exactly where it was! Finally, Norman (one of the students from Singapore) yelled that it was on my bag strap and I threw it on the ground. It landed with the cricket still sitting on it. Embarrassing moment #2!

Yesterday (thursday) and today I moved from the MICU to OB-Gyn/Labor and delivery. I was assigned with a great team, which was actually expecting me! Everyone knew I was the elective student and they all showed me where to go! I was lucky and in addition to Dr. Kishore in the MICU (ultrasound guru), I met Dr. Santosh who is another great teacher (and quizzer! I guess I should get used to being put on the spot!). After watching 2 surgeries (laproscopic tubal ligation and a vault prolapse repair) I ventured over to labor and delivery and found alexis. Babies... everywhere! Dr. Krupa was great, asking us questions and explaining so much about why things are done they way they are in their ward.

Today I was assigned with Dr. Santosh again and was in the out-patient clinic, after first making fun of me for taking notes (so I could share stories with all of the girls later, of course), he taught me so much about the health system in India, barriers to care, how they have to diagnose and treat completely depending on the funds and resources available... not a common thought in the US. It was exactly the type of information I have been waiting to hear all week, the public health side of medicine in India. Hopefully I can find out more next week while at the rural clinics.

Enjoy the pics attached: a shopping area called Gandhi Rd, view from the rooftop restaurant, a typical "to-go" canteen lunch (sambhar rice and chips), the MICU and a map of the hospital campus.

Shivani

FRIDAY!

Hello all,

So it's finally the end of our first week, and I think I speak for all of us when I say I am absolutely exhausted. We are not used to being on our feet all day, nor are we used to being on our feet all day in the heat. This is definitely a good taste of what rotations will be like in our third and fourth year of med school, and it makes me grateful that we still have one more year of classroom-style learning (I'll probably want to take that statement back once second year starts....).

I am blogging on my lunch break...I was on OB/GYN all morning (again). Today is my last day of SCHEDULED OB/GYN, but I have a feeling I will go back everyday I am here for at least a couple of hours every afternoon. I have learned SO much already about life in labor and delivery, and I don't want to leave my friends there! I have become close with a couple of the interns as well as one of the attendings, Dr. Kruipa. She is 26 but already at the top of the food chain! This is because they do not go to undergrad and get a bachelors degree, students just go immediately into medical school which lasts 5.5 years, with the last year being their "intern" year. For us, our intern year comes AFTER we get our M.D., so it's slightly different. The interns here, however, do EVERYTHING - they deliver most of the babies and stitch up all of the episiotomies and just take care of checking on all the patients. The attendings oversee everything, but they don't have to get their hands too dirty unless there is an emergency. Speaking of getting your hands dirty, let me just say I have never seen so much blood in all my life...after the delivery, women lose SO much blood! And it keeps coming well after the delivery. I can't remember the exact amount, but I know pregnant women have a very large blood volume, I just had no clue it was THAT much additional blood to the point where they lose over a liter during childbirth and are still fine after! Sorry if that's TMI....

This weekend we are opting to stick around Vellore and see what there is to do in this area. We are planning to watch Twilight (1 AND 2) tonight because they said last night on TV that they would be showing them back to back tonight...we are also planning on ordering in ice cream from room service....HOW EXCITING! It's really funny because whenever an American show is on we get super excited. Yinan and Rasika have become faithful Dexter watchers every night at 10 p.m., and Sarah, Shivani and Caitlyn have been loving watching American movies on HBO. Jen and I only recently plugged in our TV, and we prefer watching Indian MTV - Indian music videos are, in a word, hilarious. We just lay there and crack up the entire song, none of which we can understand, but their costumes and dances are definitely very different from American-style music videos. Tomorrow, some of our Singapore friends are going to what is called a "hill station" - it is basically an area higher up in the mountains where it is cooler, and super pretty! I am going to email one of the girls about it, but we may also choose to do something a little bit closer (they are going to a hill station two hours away). I would love to find a hiking trail and go up in the mountains, so I am going to ask around today aobut that. And on Sunday, as Jen said, we are going to try and see the new Pirates movie....should be interesting to see what movie theaters are like in India!

Time to get back to my babies! Hope the weather is nice back home....

Alexis

CMC Vellore = Crazitown!

Hello all,

And by crazitown I mean CRAZY but in good way! With in the first 3 days we have all experienced and seen aspects of health care that are not witnessed in the U.S. So far the trip has been so rewarding and we aren't even half way done.

Along with Sarah and Alexis I have also been on the obstetrics delivery and labor ward. In a half hour 3 babies can be born in one room! It is absolutely nuts. The second day, I scrubbed into my first surgery, a c-section, the high risk ward (scrubbed and washed 3x). The O.R. was NOT air conditioned so on top of my scrubs I had a plastic apron and a long sleeve sterile green floor length jacket, let me tell you, it was hot. But I got to participate in my first surgery and "get my hands dirty" literally. It was awesome. Here is the picture of Alexis and I in our very large scrubs going into our second c-section.

Yesterday, I was in the low risk ward and with in the morning at least 10-15 babies were born, if not more. The ward is crazy busy but very interesting. The new borns are adorable, we learned about the vaccines given in India and how the neonatologist looks for fetal anomalies.

Today, I followed a doctor in the MICU (medical intensive care unit) and this ward is very similar the the U.S. Yet, the patient diseases are not. I saw a severe case of malaria and cellulitis to name a few. Dr. Kishore is the attending in the MICU and I'm thinking about contacting Wayne State to hire him as a teacher. He's awesome.

Alright now for more of the fun stuff:

Last night was international night at the roof top restaurant of our hotel. There was about 20 of us from all over world: Singapore, U.S., and Canada. The restaurant was BEAUTIFUL and we could oversee almost all of Vellore. When it got dark we could see a gold dust cloud in the distance coming from the Golden Temple! All of us students shared the food, our different stories from volunteering, similarities and differences between our cultures and educations.

Today I did some research and found the new pirates movie is playing in a nearby theater and I am so excited to see it! I hope it is playing in english....

Ok thats all for now, talk to you all later!!

Jennife/Jen

p.s. the MICU is air conditioned and thats where I will be again tomorrow, CLUTCH

I love OB/GYN!

Hello faithful blog followers,

Our third day at the hospital is complete, and I cannot begin to express how much I have already learned!! I have been in the O.G. (obstetrics and gynecology) portion of the hospital for the last three days and I absolutely LOVE it. I knew I was interested in OB/GYN before coming to India, but this experience has confirmed that feeling times a million! Since Monday, I have seen multiple C-sections, vaginal deliveries, ante-natal checkups, and I have gone on rounds in the wards with high-risk pregnant or post-labor patients.

My first day (Monday), I was on the high-risk labor and delivery ward and immediately scrubbed in to watch a C-section. It's amazing how quickly the doctors and nurses can access the uterus and pull the baby out. While watching, I realized I haven't actually forgotten EVERYTHING from anatomy - you see the doctors cut through Scarpa's fascia, pull apart the rectus abdominus (no cutting of the abdominal muscles, entirely manual in nature...literally just stick their fingers in the linea alba and tear the two sides apart!), then the uterus is sitting right there! It's a very simple, concise procedure. I held the babies after both C-sections (my mom and Bridge know how happy that made me!) and made sure to tell them both happy birthday and welcome to this world!

The multiple vaginal deliveries I saw were wild - I cannot get over how amazing the miracle of human life is. I also can't get over how quickly the baby is delivered once the woman starts pushing, or how crude the episiotomies are here! Babies are born by the second - I left to watch a C-section and missed 4 vaginal deliveries! Only the women who can afford their own room get privacy, while the rest of the women are lined up in beds along the wall, separated during their delivery by only a curtain from the woman next to them. Additionally, there is no AC in the labor and delivery rooms!!

Outside of work, people still stare at us like we are aliens, but I am used to it! I love how bustling everything is here (Caitlyn hates crossing the street, but I think it's fun...I feel like I am in the game Frogger) and we are loving the rickshaw rides we take to and from the hospital. Today, Shivani, Sarah, Jen and I rode on a rickshaw to the bus station, and I don't think I have ever or ever will be anywhere dirtier. There were homeless people sleeping on the ground, goats eating trash, TONS of flies, people trying to sell us street food, probably about 50 buses and new buses arriving/leaving every 2 minutes. We were there investigating how to acquire tickets to visit Bangalore this weekend, but the Bangalore ticket station was closed and supposedly opened at 3:30 according to a random boy. So we waited 15 minutes and then asked another man who told us it closed at noon. Hours of operation in this country are ridiculous - we had to go to the bank multiple times to cash travelers checks because the only man who does it is there from only 10-2! What kind of hours are those?!

All in all we are getting the hang of things in Vellore and have started to venture out. We ate at a restaurant down the street, got ice cream at another place, walked and picked up some pizza (which was awful - nothing like American pizza!), and basically just explored the surrounding area a little. This trip is opening my eyes and helping me to realize how small America is in the grand scheme of things - there are so many places to see and so many adventures to go on and so many people to meet in the world! Hopefully my next trip will be to Macedonia with my Baba to visit relatives and see the village where my dad's side of the family lives/lived!

Talk to ya'll laterrrrrr!
Alexis

P.S. For those who this pertains to, I have wireless so feel free to email me and I will respond when I can!

Day 3 in the Hospital

Well, I think we can all say how much we appreciate A/C after this trip. If standing all day at work wasn't exhausting enough (my parents still wonder how i'll work a fulltime job let alone residency), the heat definitely adds a whole other element of exhaustion. Not sure if I can speak for everyone else, but I do have to say its liberating not wearing any makeup, not doing my hair and becoming content just sweating in every single outfit by 9am.

Both Rasika and I started on surgery rotations but were on different units. As far as my first day, I showed up at Surgery 4 (liver, gallbladder and pancreas unit) and was told to go to lunch, come back at 1, and when I did, no one was there. I think we've all gotten good at asking every single person directions (aka pointing to our sheet of paper repeating "Surgery 4!") I was told to go to the outpatient rooms and find a doctor, well that's easier said than done. I stood around, asking every person in formal clothes and they kept telling me to go somewhere else. I sat for while in one room alone and then a nurse finally came in and laughed and told me I should go to the next room with Dr. Joseph. I'm not sure anyone knows where we're supposed to be or with who, they just say go wherever.

The outpatient clinic was very interesting. There are about 12 cubicle cement rooms, each with a wooden bed, a desk and computer. The doctor stays in the room and over a microphone, announces for the next patient to come to this room. In the 2.5 hours i was with him, we saw well over 20 patients, not including the patients that just pushed themselves into the room between switches to just get 1 min with the doctor. He was a wonderful teacher, he reviewed every patient with me before and then after they left, summarized what they had to say. The whole process was nothing like i had every seen (same goes for the operating rooms). The door was constantly opening, residents coming in to discuss other patients with the attending while he was with another patient, other patients trying to get their way in the door, never a dull moment.

My 2nd day in surgery was a little more unorganized. Hoping to Dr. Joseph again, it took me about45 min and 15 security guards asking directions to to find OR 19, where he told me to show up. Unfortunately he wasn't doing surgery this week, so I just watched the other guys working, who weren't as willing to teach so when they went on break (and i was left alone in an OR with the patient on the table and a nurse), the nurse just said I could walk into any OR and just watch. So I did! And found a surgeon doing McKeowns procedure ( an esophagogastrecomy) and he was teaching other med students as well which worked out well!

Today, Jen and I saw 6 vaginal births in labor and delivery (5/6 had episiotomies done which was a bit traumatizing for us both). The OB ward was fascinating. I will get to do OB again next week and am very excited! We all are having very different experiences so hopefully we can all share our different stories!

Melting like ice cream

I finally got internet today at the library by the CMC hospitals and so here begins my first blog. The heat is almost unbearable, I'm sweatier than a "non-legacy applying to Yale". If you got that quote then you automatically earn 20 cool points. This heat reminds me of the summers I spent in Beijing where I would take up to 8 showers a day. Beijing is actually more humid than this but I think that is because I used to visit in late July-August. All this sweating has to be good for de-toxing. The rounds were pretty slow today, our attending has mad skillz with the ultrasound machine! I think he should come to WSU and teach us our ultrasound training because this man I swear can find anything wrong via ultrasound. It was a little bit different from what I had expected because it doesn't feel like the medical staff is used to having us students around. The ICU is pretty much the same here in India than back home, everyone is on a ventiliator and hanging on by a thread. I'm hoping that Medicine will be a little more hands on! A lot of the clinical presentations I have had mutliple times in the ED and in Rehabilitation. Most of the new things I've learned are mainly from the Ultrasound Guru!
Last night I was so hungry that I ran up to the rooftop and had some chicken tiki masala. There are only 3 things that I always order from Indian resturants back in CA - aloo gobi, gosht curry, and chicken tiki masala....and I've finally had all three here in India! Chicken tiki masala reminds me of Berkeley where my friend who was the captain of the Indian dance team and I would share a plate between classes. We would practically lick the plate clean since it was so good! The one I got last night was slightly different, the sauce was spicier and redder and less creamier, but it was still HELLA good! I think I ate it so fast I practically inhaled it...
Alright we are all about to head onto campus to run some errands! Will be posting later :-)

What a day!

So today we experienced our first day in a hospital in India, CMC- Vellore! Our day started out as an adventure as all 7 of us packed into 2 rickshaws to head to the Bank, only to find out the Bank did not have anyone to cash our travelers checks, apparently a common occurrence in Vellore. We then walked across the street to the Main CMC Campus. One word to describe it- beautiful! Set between mountains amongst lots of green trees, plants and flowers we found the Principal's Office (and no, we were not in trouble!). Mrs. Sheila was there to greet us warmly and welcome us to Vellore. After filling out a little paperwork and receiving our ID badges, we ventured outside to catch our bus to the hospital, about 7km away.

What a ride it was! I have never taken a city bus, and today was an experience. It was like a big Blue bus on Michigan's campus times 5. There were so many people! We had to ask the money collector where to get off while we were shouting to find each other on the crowded bus.

Upon arriving at the hospital, we had to part ways. I can only explain my first day, though everyone has plenty of stories to share, and we still have 2 weeks to go! I was assigned to the MICU- Medical Intensive Care Unit along with Yinan. We did not end up meeting with the doctors until 2:30pm so in the meantime we checkout the hospital library, met a new friend in the computer lab, and ate lunch at the canteen. The experience was great but made me realize how much I have forgotten from this year! They were throwing out acronyms, diseases, tests and treatments and my brain was working double time just to catch up. I wrote down so many things to look up so when I return tomorrow, I can understand the patients cases better!

I'm off to meet with the others for dinner, we will try and post pictures of Vellore later tonight!

Shivani

The Golden Temple!

Hi everyone!
Greetings from Vellore again on a hot and humid night! Shout out to the Klaska, Bowman, and Jump families :-)

Today, after our exciting first Indian grocery store experience, we decided to join Rasika and her grandparents (they rode in on the train to Vellore from Bangalore to drop her off at the Darling Residency) at the Golden Temple. The Golden Temple is a relatively new temple (about 6 years old) about 7 or 8 km from where we are staying. It's a Hindu temple dedicated to the goddess Lakshmi, and the temple itself is made from plated gold.

We took our first trip on autorickshaws (if you've never seen a picture of an autorickshaw, definitely look it up on Google!) to the temple....Shivani and Yinan were in the same autorickshaw as me, and while they were playing it cool, I was fearing for my life. These city streets are CRAZY. Can't really explain how chaotic the roads here are, but there are buses, cabs, autorickshaws, bicycles, and motorbikes all weaving in and out of lanes competing for space on the correct side of the road (which is opposite side compared to U.S. driving). Definitely gonna take some getting used to!

We arrived at the Golden Temple to the largest crowd that we've seen yet. Most were locals there to visit the temple and worship on a Sunday, especially because the kids are out of school and will be returning after vacation soon. This was the one time we didn't mind paying the entrance fee for a monument, because this ticket allowed us to skip the more than 3 hour line and enter the temple directly.

The gold plated temple was surrounded by gardens, waterfalls, statues of other Hindu gods, as well as covered walkways where we waited in line, which Rasika said were in the shape of an "ohm".

We got to take a quick walk through the temple itself, where they were performing a ceremony. There was music, lots of jasmine flowers (especially in womens' hair), and TONS of people On our way out of the temple, we were presented with prasad, a blessed sweet. Near the exit we saw a painted elephant walking through the gates towards the temple.

Compared to the crowds in Delhi and Agra, we definitely stood out more and attracted lots more attention towards ourselves. We'll see how things go tomorrow at the hospital, though as we have heard (even in our travel books), Vellore is known to attract many international medical students, so we might not be such an unusual sight after all!

Caitlyn and Shivani

down south!

Hello sports fans,

We flew into Chennai last night and drove to Vellore in the state of Tamil Nadu. We arrived at our hotel, the Darling Residency, at around 11 p.m. We were all exhausted - we are adjusted to the time change for the most part, but traveling is tiring no matter what!

Delhi was AWESOME - I will never forget some of the things we saw there, such as the morning bazaar and our walk along the narrow streets with all of the shops set up, the Taj Mahal, and just the overall bustling city with bikes riding alongside cars, constant honking, TONS of people and dogs walking along every street, etc. I am glad though that we are going to be in one place for the next 2.5 weeks and grateful we can kind of call Vellore home as opposed to moving hotel to hotel.

We explored a little bit this morning in the area around our hotel and found a supermarket just across the street (2L of bottled water cost only 28 rupees! What a steal! It cost 50 rupees for 1L in Delhi at certain restaurants!) We also found some boys playing cricket down the street. I have been asking everybody since we arrived about cricket because I am very curious about it and want to learn the rules. I have also been wanting to actually play, but the opportunity didn't present itself ....until today! I, being the SUPER shy one in the group (NOT), went up to the boys playing and started asking about the rules, then I asked if I could play and they thought it was hilarious that I wanted to, so they let me "bat" (I know it's called being the striker, I don't know if they call it "batting"). I am pretty sure they just laughed at me the whole time because I didn't have the correct form - I would just swing as hard as I could and send the ball flying baseball-style, but I think you're supposed to kind of block the pitch and just redirect the ball as opposed to whaling on it...I have a lot to learn. Needless to say, I plan on finding those boys either during the week at some point or next weekend and asking them if I can play again. My friend who I worked with all of last year, Rajiv, would be proud! P.s. Rajiv, we flew over Hyderabad last night and I thought of you!

The food, dress, and weather are all different in the South from what I have seen so far. I believe the dress code is more conservative, and the men wear skirts (I am pretty sure they aren't called skirts, but they are a skirt equivalent) instead of pants, and I have noticed a lot of the children have white lines on their forehead that is different colors - Rasika tells me this is ash and it is related to what God you worship, among other things. It is definitely more humid here - you step outside and immediately feel like there is a blanket of moisture on your face/body, but it is similar in temperature to Delhi. This morning at breakfast we discovered they serve very concentrated black coffee (we weren't sure if it was espresso) with hot water and hot milk, so we kind of just had to add our own amount of each element. Perhaps when we start working 8 hour days I will start adding more of the strong black coffee and less water/milk...Jen makes fun of Sarah, Shivani and I for always wanting coffee - what can I say, med school has opened the flood gates for caffeine/coffee addiction! I remember during high school my friend's (Natalie) dad, who is a neonatologist, asked me if I wanted coffee one day while shadowing him. I told him I didn't drink coffee and he chuckled and said ....you will soon. At the time, my thoughts were that I wasn't planning on starting to avoid getting hooked on it....oh, how wrong I was, and oh, how right you were, Dr. Relich!

We being working in the hospital tomorrow and we are all very excited to see what it will be like and to see how health care is delivered in another country, especially one so different from our own. I am interested to see what sort of patients will be at the hospital. Before we left, Dr. Chandrasekar said we should expect to see a lot of people from the rural areas who cannot even afford to pay, but the physicians will often still treat these patients (very unlike the states...). I will let you know what sorts of things we get to see later this week!

I'm not homesick yet, but I'll say this....I miss all of my American TV shows! My dad is probably uber frustrated at the 700 shows I DVR that are accumulating - sorry Dad! And Nick - if you delete Real World or Grey's, we will have beef when I get back! I also miss some American foods, but we got our fix of McDonalds in Delhi yesterday - no beef, but they have a really good spicy chicken sandwich on the menu!

Talk to you all soon! I hope the weather is nice and that those who are still in school are enjoying their summer vacation, and those who are working are enjoying the nice weather on the weekends!

Much love to all,
Alexis

P.s. I think all of our bags now weigh 10 pounds more after all of the shopping we did in Delhi...it is going to be like Christmas for everybody's families when we get home! We got some REALLY cool stuff and did a lot of bargaining while shopping in a market (called Janpath)...Yinan was a pro at getting the shopkeepers to lower their prices, I was awful! But in the end, if I could get somebody to bring their price down from 500 to 350 rupees, I was happy (after all, 350 rupees is only about $4...I forget this sometimes when I am hesitant to spend 50 rupees on water then realize it's only one U.S. dollar haha).

recent pictures

Last few hours in Delhi at Janpath - great shopping!
Here is the Lotus Temple in Delhi - obviously shaped like a lotus flower. It is a temple for the B'hai religion.

Here we are at the Qubut Manar - the oldest monument we saw. It was built in the 13th century. The British had to restore the upper portion of the minaret twice because it was struck by lightning.

Here we are at the largest mosque in Delhi! 20,000 people pray here every day. While we were here they were setting up tarps to protect the people praying from the heat. It was hottest day on our trip to date!

Taj Mahal

What a cool and beautiful morning! After our 5:15am wake-up call, we visited the Taj Mahal just after sunrise. Our short walk up to the gate turned into a fast sprint as our tour guide suggested we walk faster to get ahead of a tourist group of 50! Once inside, everyone was in awe of the Taj Mahal, the gardens and the weather! We now have new standards for our future husbands, as the Taj Mahal is the epitome of love ever lasting!

We are going to try and post pictures of tonight, talk to you when we get back to Delhi tonight!

Jen and Shivani

India is HOT.

And I don't mean hot like "oh that dress is HOT!" I mean hot as in I feel like my face is melting when I step outside. Never have I been so glad for the sun to set....

Negativity aside, INDIA IS WILD! I have never truly traveled (besides Mexico and the Bahamas...) so this is definitely a lot to take in...let's just say I haven't been speaking much, more just gazing out the window at the thousands of other people on the road (half of which are on motor bikes, the other half a combination of buses and rickshaws).

Today we went to Agra Fort...it was HUGE and there were a lot of tourists as well as native Indians...also a lot of beggars and naturally people trying to sell you everything under the sun. It was super pretty and ornate...the king had it built hundreds of years ago and it just amazes me what people accomplished without any sort of machinery, just their bare hands and sweat!

Tomorrow is the Taj Mahal...WOO! Very excited to see it. We have to walk a kilometer to reach it because no cars are allowed within a kilometer to preserve the monument. OH and they are SUPER eco-friendly here, it's great!

Alright that's all for now...talk to ya'll soon!
Alexis

Greetings from Delhi!

We have arrived! Very late last night we landed and were picked up by our tour company to go to our hotel, Hotel Star Rocks. So far so good! We went to bed last night, for a grand total of 4 hours, woke up this morning to car horns and birds chirping and a bright sun. We just finished breakfast and are waiting for everyone to meet in the lobby to head off to Agra! We're going to try and stay awake for as much of the 4 hour car ride as possible... but we will have to see how it goes.

Ok, someone else's turn to use the computer. Hopefully we can start posting pictures soon!
Shivani

Months of Preparation!

From way back in January when we filled out our applications to just this past week when we booked our final hotel, all the preparations needed to spend a month (or more for Shivani!) in India has consumed a large portion of our 2nd semester of Year 1 in medical school.

Shivani spent SO much time organizing our tour for the first week of the trip and taking care of all the plans to finalize that. Our itinerary for the first week includes:

-arrive in Delhi Tuesday evening

-drive to Agra Wednesday to see The Tomb of Itmad-ud-Duala, Agra Fort, and stay overnight at the Hotel Clarks Shiraj.

-wake up SUPER early Thursday to go see the Taj Mahal at sunrise!! Later, sightseeing of Fatehpur Sikri

-drive back to Delhi for Thursday night, spend the day in Delhi Friday seeing Old Delhi, Jama Masjid (the largest mosque in India) and the Raj Ghat (cremation site of Mahatama Gandhi)

-stay overnight in Delhi and fly out on Saturday for Chennai

-from Chennai, we get picked up to go to Vellore where we will be working at CMC Vellore for 2.5 weeks

Hotel is booked in Vellore where we will stay for those 2.5 weeks and hopefully make some weekend trips to neighboring cities. Our last 5 days will be spent relaxing in beautiful Goa, where we will be staying at the Taj Fort Aguada.

Amongst all the tour planning, hotel searching and booking, flight booking, tour book reading (Caitlyn probably checked out every India travel book from the library!) and plenty of reads on trip advisor, we also managed to squeeze in applying for our Visas, getting all our vaccinations/preventative meds (Hep A, anti-malarial, typhoid, cipro, might as well add Pepto-bismol on there), trips to Target and of course shopping! Caitlyn found the best deal for linen pants which we all bought. Nothing says prepared American tourists than a group of 5 girls with matching pants!

There have been many more minor details along the way and amongst all of this, still having to be medical students (oh yea, minor detail). But we've managed and crossing fingers, will all be done with our first year of medical school and on our way to India within 4 days of finishing.

I think we can all agree that this trip will change all of our lives and really help shape our future careers in medicine. We all look forward to chronicling this once in a lifetime trip for all of our friends and family at home and hope you all enjoy it!