Karigiri

Yesterday we took a trip about 20km from CMC hospital to Karigiri, where the leprosy hospital is located. It was established in 1955 to care for the leprosy patients in and around Vellore and as a center for leprosy research. Due to advances in the treatment of leprosy, it has evolved into a hospital with multiple departments for that particular area near Vellore. It is now called the Schieffelin Institute of Health Research & Training Centre, named in honor of Mr. William J Schieffelin, the then president of American Leprosy Missions.
We took a tour of the hospital grounds and learned about the lastest research in leprosy that is currently being performed at the institute. We also toured the building where they make prosthetics for the diabetic and leprosy patients.
Afterwards, we stopped by the outpatient center for another tour of the facilities. One of the physical therapists showed us how he performs a diabetic foot exam and explained the different instruments he uses to assess neuropathy in a diabetic foot. It was an interesting trip and I felt honored to visit the place where Dr. Paul Brand performed many miracles for the leprosy patients during his time at the institute.
Tonight we had a going away dinner at Darling Hotel to talk about our experiences over the last three weeks and to wish everyone good luck in their future medical careers. I feel lucky to have met so many wonderful medical students from different parts of the world and learn from their perspectives on medicine. It was a fun night yet a little sad because we were all going our separate ways. I hope to keep in touch with some of the cool people I met during my time at CMC.

CHAD is awesome!

So my last two days have made this whole trip worthwhile. Going to the villages and meeting the people is reason enough. They are so friendly and so grateful, it's just amazing.

Yesterday I went on what the Community and Health Development Department calls "Nursing Rounds." Basically, one nurse and a community health aide who usually lives in the village, design a plan to make home visits to particular patients within that same village. The village we visited is called Palavansathukuppam! There are about 5,000 people who live in that village, and the health aide who lives and works there for CHAD named Janasee, coordinates the visits for all these people.

During the day, the main objectives are to do well baby checks, antenatal checks and chronic illness checks for things like blood pressure and blood glucose. This particular village was located fairly close to CHAD hospital, which is a different hospital located near campus. According to the nurse I worked with, even though the hospital is close, home visits are still necessary because the village patients would not go to the hospital otherwise.

We saw a variety of patients from pregnant moms to preterm babies to geriatric patients. At one home we checked a pregnant mother for fundal height and blood pressure and her friend whose house we were in showed us her tongue. Because it was so pale, it was obvious that she was anemic, so because of the home visit we were able to refer her to CHAD and get her some help as well.

In another home we visited a baby who was born at 34 weeks gestation. The baby was still underweight, yet he was growing appropriately. One interesting thing was while we were there the baby got hiccups, so the mom put a leaf on top of his head as a remedy to make the hiccups stop. I don't know if it worked because we left soon after that, but it cool to learn a remedy that the villagers believe in.

Today was a great experience. I went on "Doctor's Rounds," which is similar to nursing rounds except the patients in the village come to a certain location at a designated time and in the van physical exams are performed and outside patients are seen for acute and chronic conditions and get prescriptions which are filled instantly since the medications are taken to the villages.
The day started out with health education by one of the residents. Today's talk was about hypertension and its effects on the body. It was great to see the people so interested in their health. One interesting case in this village was about a family of 5 siblings whose father had a history of progressive spinal cerebellar degeneration. Currently three of the siblings, two females and one male, have different severities of the same disease and a group of researchers from Chennai are studying their family's pedigree and looking to see if there is a relationship between the severity of the degeneration and number of tandem repeats in the gene known to cause this debilitating disease.
We then travelled to a different village and used the same system of seeing patients. In the third village we visited, named Arcottankudisai, we started with a visit to a 17yo female's home with a history of a cobra snake bite about 2 years ago and subsequently her muscles became paralyzed and she became blind. Over the last two years though, with physical therapy and treatment of anti-venom, she can now stand and walk a few steps on her own and she has progressively regained her vision. It was sad knowing that if she had transportation to the hospital that day two years ago, she may have never suffered these losses because the anti-venom could have prevented it if given soon after the bite.

Here the women were very kind and grateful. As I was helping the intern tally the patient population, I felt someone putting something in my hair and realized it was flowers. Whenever I see the older women from the village, I think about how much they possibly endured living in this village their whole lives and what interesting stories they might have for younger women such as myself.

I also saw a 6yo girl with tetralogy of fallot who never had surgery to correct the problem and now lives with heart failure at such a young age. We wrote her prescriptions for Lasix, Digoxin and potassium. I also noticed the clubbing of her thumbs and great toes, which is a sign of chronic heart failure. One other woman was seen for her elephantiasis, which is when there is swelling and thickening of the skin usually in the legs and genitals due to a parasitic nematode worm.

At the end of the day, all the children from the village were returning from school. The tallest girl in the middle of the picture started talking to me and asked me my name and if I was from CMC. Once the other children saw her, they all wanted to gather around. They were all so cute and when I wanted to take pictures of them, literally 40 children surrounded me! It was cool interacting with them and seeing their smiling faces.

At the end of the day as we drove away from the villages back to CHAD, I realized all the positive aspects of this community health program and how many lives were impacted in just one day.

Off to Bangalore

The reminder of my medicine week was interesting. We did some more ward rounding and outpatient clinic work. I did see a 34yo female patient with somatization, which to a doctor means she may be using her physical complaints to mask emotional problems because her chart was filled with notes from many different departments, yet all her tests were negative. It was difficult to explain to her that we couldn't find anything wrong, so Dr. George gave her a psychiatry referral.
I also saw a 46yo male with 9% eosinophils on his CBC differential (which by the way is a sign that the patient may have a parasitic infection because the normal count is around 1%). Come to find out he has strongyloides, which is a roundworm that lives in the mucosa of the intestine. Don't worry though, we gave him a prescription for albendazole which should cure it. Speaking of prescriptions, I like how I can walk down almost any street and find a pharmacy with a sign that reads, "Dr. So and so, Druggist and Chemist." (Whatever that means.) Because of all the pollution and dust, I've had to buy the Indian version of Zytrec and Flonase. The good thing is that they work pretty well and they are definitely cheaper than in the states!
This weekend Bimpe and I went to Bangalore, which is described as the "IT" (information and technology) city of India. Surprisingly at one point I felt like we weren't in India anymore because the city has some developed areas and there are huge malls and great restaurants. We decided to go by train, which wasn't as bad as I thought. We even ate the Indian version of McDonald's!
Touring the city was nice. We went to the Iskcon Temple, which is similar to the golden temple in Vellore, but definitely not as captivating. In the temple people were chanting, "Hare Krishna, Hare Krishna, Krishna Krishna, Hare Hare, Hare Rama, Hare Rama, Rama Rama, Hare Hare." I read that you are asked to chant these words a minimum of 108 times daily! We also went to a palace where Tipu Sultan (I think he was a king) lived in 1790 AD. It was interesting and if you are not from India you have to pay 100Rs to see it!
The best part of the tour was visiting the botanical gardens. There are beautiful flowers everywhere, ancient trees and monkeys playing on the sidewalks. It was refreshing to get away from the busy city streets and enjoy the nature around me.

I can't believe my trip is already half-way done. The time has flown by and there is still so much for me to see and learn. It is fun to meet people from different places as I travel and ask me if I'm from any country you can think of. Everyday I'm from a different part of the world! So far I've been asked if I'm from North India, Nepal, Australia (I don't know where that one came from), South Africa, Malaysia and Indonesia!!! I guess these people haven't see to many people from Mexico. :) Tomorrow I start my Community and Health Development Week which should be exciting. I am looking forward to meeting the people who live in the villages and I hope to see and learn some new things!

Harrison's Textbook in Person!

Yesterday we went to the Golden Temple called Mahalakshmi. It is located on 100 acres of land at Sripuram, near Vellore, and is headed by the spiritual leader Sri Sakthi Amma. He is said to be the reincarination of three sisters, so his physical appearance is male yet his soul is female. The temple, covering 55,000 sq ft, has intricate carvings and sculptures in gold. Except for the star-shaped pathway, the entire structure is composed of gold and copper and has quotes from the Bible and the Quran displayed on either side. I read that it is worth 160 million USD, which is ridiculous considering all the poverty that surrounds it.
We went around sunset and it was an amazing sight. You walk up to the temple on the pathway for what seems like forever and finally when you get there it's a huge temple made out of pure gold and the crowds are endless. At the end we all got a red dot on our forehead which represents a third, inner eye that everyone receives after leaving the temple. It is a Hindu tradition to have three eyes, two for seeing the outside world and the third to focus inward towards God. Here's a picture of us with our third eye!
Yesterday I started medicine with Team II in the outpatient clinic. It was cool seeing some of the same diseases that people in the states have, like the average hypertension and diabetes. There wasn't anything too different or exciting and Dr. George was a good teacher.
Today though was a completely different story. Team II had what they call, "Grand Rounds," in which we round on all the Team II patients in the MICU and Ward C. It's about 50 patients total so it took a good 41/2 hours, but it was really cool and Dr. T. David is an awesome teacher.
Here is a list of some of the patients I saw....
1. 35yo F with pneumococcal meninigitis
2. 32yo F with Rickettsial infection, scrub typhus type with eschars on her abdomen
3. 27yo F with middle cerebral artery stroke with history of pre-eclampsia during here first pregnancy
4. 60yo M with organophosphate poisoning on a ventilator
5. 28yo F with another Rickettsial infection, Rocky Mountain Spotted Fever (one of the classic diseases we learn about to cause a rash on the palms and soles)


6. 23yo F with oleander flower poisoning causing complete heart block because of the cardiotoxicity of the substance in the seeds (supposedly there's a lot on campus so I'll be staying away from those!)
I can't even imagine a ward like the one I was on today. It was like each patient was from a different chapter in Harrison's textbook, except rather than reading it, I was learning about it in person! There were many more patients with classic medical problems, but the above were a few of the ones that I might not ever see again in my medical career. I am so excited that I was able to see only a sample of what the medical students from CMC see on a daily basis.

My Weekend Away...

The rest of my OG I week was cool. I went to clinic and saw some new things. First of all, samples for pap smears are collected with a huge tongue blade and then smeared on a slide and placed in a jar with what I assume is some type of fixative. Again there are no stir-ups, so as the examiner you have to just stand and turn your head to see what you are doing. In the gyn clinic, I felt a 16-week size uterus from a huge fibroid and a cervical cancer tumor which was invading the side wall. The next day we went to the OR and saw a few specimens of fibroids after a couple of hysterectomies.
For the weekend, a bunch of us from San Antonio and two of the medical students from Australia went to Pondicherry, which is about 3 hours away from Vellore. It is a French colony established back in the 1800s, so it has some French articheture and cobblestone roads. It was a lot cleaner than Vellore, but way more humid because it is next to the Bengal Bay. We had dinner on a rooftop Friday night and then shopped on Saturday. The French food unfortunately was not as good as I expected and the shopping was mediocre.
We went to one of the ashrams located in the city where some of the locals and tourists go to meditate and do yoga. There were beautiful flowers inside and everyone has to go in barefoot and no pictures are allowed. Also, two of my friends and I received a massage called, Abhyanga, which is an Indian type of massage with fragranced oils. It was an experience that I rather not discuss on my blog, but I don't know if I'll ever get that type of massage again!
Here is a picture of a stand where we got some fruit drinks. At the time we weren't sure if it was safe, but the drinks were good even though the guy working there yelled at me because he didn't understand that I wanted some water too.
Overall it was an interesting weekend with many new experiences. I am looking forward to seeing some different things on internal medicine starting tomorrow.

OG I

The international evening a couple nights ago was fun. Some women performed a traditional south Indian dance for us and it was cool. I met some of the other students and we ate some really good vanilla ice cream. :)
The next day I went to the labor room. The CMC hospital has about 10,000-12,000 deliveries per year and is basically two large rooms, connected by a nursery in the middle, labelled "low risk" and "high risk."
Women are laboring and giving birth merely a few feet away from each other behind green sheets for "privacy." This place is nothing like the states. Epidurals are only given if you can afford them and routine pain medications are not given unless absolutely necessary.
I met more of the residents and the intern rotating on labor room. Here the students receive a M.B B.S (Bachelor of Medicine and Bachelor of Surgery), which is equivalent to an M.D. for us. They go straight from high school into medical school which is 41/2 years. After graduation they do a one year internship where they rotate through all the specialities, (kind-of like third year for us but with a lot more responsibility) and then do a residency in the speciality of their choice for three years. Even general surgery is three years!
The first thing I saw was a C-section. We had to wear these shoe covers called, "over shoes" and a blue cap similar to the one we wear back home. I was surprised that the OR was very similar to the UH OR. The only difference was it was a lot hotter under my face mask and the surgerons don't protect their eyes with face shields. Also, the skin closure was a mattress vs. a subcuticular. It was cool to compare the differences.
Later on in the day we went back to the labor room and during a delivery all you hear from the nurses is, "Muku Ma!" (Which means push lady!) There are no stir-ups, so the women literally have their baby right on the bed. I also saw two mediolateral episotomies vs. the midline ones we do more in the states. The intern said they prefer the latter here because of the risk of fourth degree tears with midline ones.
Today I was able to meet the rest of my OG (what they call OB/GYN here) team, which is OG I. They were all very nice. We met with Dr. Verghese and before rounding we sang Christian songs and did a daily reading out of a scripture book. I had never done that before at work, so it was a cool experience. We also talked about ITP in pregnancy and then did teaching rounds on three different floors to visit the OG I patients, but that was of course after our coffee break. I noticed here that around 10am everyone goes and drinks coffee or lime juice and they even have a team coffee fund! I think I'm starting to like this place. :)
On rounds I saw anything from women with pre-eclampsia to hypothyroidism to a post-op myomectomy. They do not have separate obstetrical and gyn teams like in the states. Each team has both types of patients and we round on everyone at the same time. It was interesting that during every presentation the speaker states the patients name, age and martial status. Dr. Verghese told me it is very important here to know martial status because no pelvic exam can be performed on a woman unless she is married, the family gives specific instructions to do so or if she is never going to get married.
I am definitely enjoying my OG experience here. I have noticed many differences yet many similarities as well. Dr. Verghese is a great teacher and she definitely explains things in a way that integrates the clinical and basic sciences aspects of a particular disease.

After work we visited our friend the tailor who sews sleeves on shirts and puts strings in the waist of pants. I guess for simplicity of mass production, the sleeves are not added on shirts when you buy them and you have to add string to pants to act as a knot so they don't fall off.
I'm thinking I might change my schedule to do internal medicine the second week instead of OG again. I really am enjoying my time here and I have OG clinic tomorrow so I should see some interesting things.
Here is a picture of me in one of my salwar kameez outfits!

First Official Day!

So today was the first official day of my rotation. I made my schedule and as of today I will be doing two weeks of OB/GYN and one week of Community Health and Development. I might change my second week to something different, but this is my schedule so far.
Before we headed out I was able to eat some breakfast and tried the Dosa which was good, but greasy. It comes with different sauces that you dip the dosa in. The one on the left was the best.

We toured the CMC campus a little more today, since Bimpe and I checked it out yesterday afternoon with Aruna and Nicolette. There are a lot of cool trails you can walk on and we even saw some monkeys in the trees yesterday. Were able to check out this beautiful garden located in the courtyard of the female medical students' hostel and it was amazing!

After visiting the "Principal's Office" where we registered, we headed over to the hospital. We paid our fees and saw a video about the Christian Medical College and learned more about it's purpose to bring healthcare to India. Then one of the students from our school named Kathryn, who is doing a second month here because she loved it so much, showed us around the hospital. We toured the OB/GYN labor rooms and she showed us where the "theatre" was located, which is actually the OR. I met my OB/GYN attending, Dr. L. Verghese and one of the residents who were both very nice and ready for us to join them tomorrow.
We did go shopping and I was able to find more clothes since all the shops were open today. Tonight there is an international student welcome evening, which happens every first Monday of each month so that should be fun because I heard there are other students rotating here from places like Germany and Australia.
Tomorrow I will report at 8am to the labor room and hope to have many exciting stories to share with everyone. Stay tuned...

P.S. Here is a picture of the rickshaw I told you about in an earlier blog. These things are cool!!!

On to Vellore...

Yesterday morning I woke up around 5am, which would be perfect for an OB/GYN intern to do automatically, but since I haven't reached that part of my life yet (thank god!) I thought it was weird. I guess the jet-lag is still in effect.
My friend Aruna and her family picked Bimpe (my partner in India) and me up in the morning and it was off to Vellore, which is 70km away from Chennai. The traffic was crazy as we drove away from the city, but once we reached the outskirts it was smooth sailing, or I guess I sound say smooth driving. :) We stopped at a restaurant on the way and afterwards I experienced what Aruna called, "My first India bathroom."


The rest of the way there I watched the side of the roads and saw things like rice patties, Motorola factories and huts. It was cool to watch the people live their everyday lives as I catch only a glimpse of what they do on a daily basis.
We finally reached Vellore. Bimpe and I are staying in the Avanna Inn and costs us a whole 30USD a day! It is located across the street from the CMC hospital, which for me is a plus because walking to work is always nice. The rest of the group is staying at the International Hostel on the CMC College campus which is about a 15 minute rickshaw ride away. Bimpe and I will make that trip in the morning to register and pay 100USD to the main office.
The hotel is definitely not like the Comfort Inn in Chennai. The sheets were stained and the shower curtain was dingy, but hey at least we have HBO! :) Three weeks at the inn won't be to bad and Bimpe was smart enough to bring sheets from home.
Again I woke too early (6am) and we ate breakfast in the hotel restaurant. I opted for an American breakfast and we saw a lot of people around us eating Dosa (which looks like a crepe), a traditional South Indian breakfast. I hope to try that tomorrow morning before heading to campus.
Afterwards, we met up with Aruna and Nicolette and walked around the open market on Ghandi Street. We were looking for saris and salwar kameez, which are clothing for Indian women, but since today is Sunday many of the shops were closed. Walking up and down the streets we again had to be careful for the guys on motorcycles and bikes. I love the colors of the fruit and clothing and the hustle and bustle of the people. Even the cattle love the market!
Tomorrow I start my rotation and I am looking forward to everything I will see and learn in the near future...

I have arrived!

Three planes and a car drive later, I finally arrived in Chennai/Madras, India. The 14 hours from Houston to Dubai wasn't as bad as I expected, yet the leg room on Emirates was slim considering I'm only 5'5". Our luggage arrived along with us, which was a relief after hearing stories of luggage not arriving until two days later.
I slept from about 5am to 7am and ate a huge breakfast in the Comfort Inn Marina Towers and it was free! I had an omelet, watery oatmeal, pancake-like things, fruit and some other different foods. I slept until about 3pm and it was time to go explore Chennai!
Since this is my first time in a different country, the sights and sounds are very different from what I'm accustomed to. No traffic lights, motorcycles everywhere and the natives walking the streets with no shoes. It was unbelievable! As we rode in a rickshaw, (motorcycles with a roof I guess is how I can describe it) I was scared that we would hit other rickshaws, motorcycles or for that matter people walking, yet for some reason no one wrecked and that was amazing.
We ended up at Spencer Plaza, which is a huge mall with good shopping. We ate spring rolls, mushroom fried rice and Kaptur Shipud (potatoes and tomatoes in spicy gravy sauce). The food was delicious and I think the bus boy was laughing at me because my nose sweated from the spice. We were also given complimentary sweet pudding of some sort which was good even though it didn't appear very appetizing.
As we walked about Spencer, I bought three shirts (300Rs each) and two cute bags (140Rs each). The conversion rate is about 36-38Rs for every 1 USD. I love the shopping even though everyone wants you to be their costumer.
I returned to the hotel excited about my first day in India. A man working in the lobby drew a picture of me wearing one of my new hand-embroidered shirts. Tomorrow the plan is to travel to Vellore, India which is about 2 hours away by car. I am looking forward to seeing CMC and learning more about the Indian culture. I'll be sure to keep everyone updated!