Sojourn With Claire

San Antonio befriends Santorini

2008-05-09T11:08:00.000-07:00

We arrived in Santorini safely after an eight hour ferry ride. With occasional bouts of nausea and it being incredibly cold the first half of the journey it was fairly uneventful. We got into town by a bus that meandered its way back and forth basically up the side of a cliff and eventually found our way to our hotel. Jami and I were both a little worn out and cranky which called for the immediate solution of gelato or mentos, whichever came first. We found an excellent gelato stand and upon our first bite we immediately began feeling better,once again sweets work their magic!! We then proceeded to wander through the streets aimlessly with no particular destination in mind, the usual for our trip to Greece.

Our hotel, our room is in the bottom right corner. The view above is the view from the terrace over our room.

Santorini is very much a tourist destination. With streets lined by souvenir shops, jewelry stores and restaurants I am not sure where the locals hang out. We were, as usual, drawn to gazing at the jewelry in the windows. We eventually stopped going into the shops because we were so flabbergasted at the prices and nothing could really match up to the diamonds we got in Istanbul. I do have to say there were some very beautiful pieces, unlike anything I had seen before, but still way too expensive.

The start of our hike.

The best day was yesterday. In the morning we managed to meet up with the folks from San Antonio (all 17 of them) and figure out plans for the rest of the day. Most of them were venturing off to wineries but Jami and I, in the interest of being outside and not spending money, went on a hike. We kidnapped Megan and hiked from Fira to Imerovigli down to some castle ruins at Skaros then over the hills and around the caldera to Oia. It was a beautiful walk and the pictures do not do it justice. It took us about two hours to go from Skaros to Oia over lava rocks and cobblestone pathways. I thankfully had on my tennis shoes but Megan and Jami had on flip-flops, I was personally impressed with their perseverence (not a single complaint from either of them, shows you what kind of great people I am fortunate enough to travel with!). we made it to Oia and had a delicious feta cheese pizza, a greek salad and a fanta before taking the bus back to Fira.

Done with our hike and still they have smiles on their faces!!!

Jami's grandmother really wanted her to ride a donkey and there are donkey rides from the old port up the side of the cliff (also on back and forth cobblestone pathways). We walked our way down the mountain and paid an old man to use his donkeys to carry us backup. The ride itself was fun although my donkey would make wide turns on the curves and come dangerously close to the edge. I, being slightly afraid of heights, would hunker down and grab ahold of my donkey hoping he would not suddenly decide to buck me off his back and down the hill. With an occasional stop to rest, eat some grass, and once to poop (not me, the donkey) my donkey and I successfully made it to the top! We met up with the other 16 from San Antonio for a delicious meal and caught up on news from back home. It was really nice to see everyone but it would be really difficulty trying to travel with that many people.

The city of Oia (pronounced eye-ya, we are pretty sure)

This morning we had a breakfast of crepes before missing our bus down to the port and having to take a taxi (my fault). Now we are about to head to Mykonos for the final leg of our journey. As the trip winds down we are planning on doing a lot of sitting on the beach the next two days, maybe trying to figure out if there are surfboards for rent and whether I can muster up the courage to get into the freezing cold water. This has been a great trip but I thinkI am ready to come home and begin tackling my to do list in preparation of starting residency. I probably won't post much else until I get home but I hope all is well.

The castle ruins at Skaros and the view from the church at the base of the Skaros castle overlooking the Aegian and a cruise liner.

As a side note Mykonos is beautiful and Jami got to go scuba diving. If you want to surf you have to bring your own board but I did get in the water and go swimming, a personal victory for myself!! Hope all is well, see many ofyou soon!

Just my style!

2008-05-06T10:55:00.000-07:00

We woke up incredibly early to navigate the Athens seaport and catch our ferry to Hydra. We took a "flying dolphin" to the island,a high speed ferry boat. Known for its whitewashed walls, blue doors and blue water juxtaposed against rocky crags Hydra held up and exceeded all expectations. The island does not allow cars or mopeds so you have to get around on foot or by donkey. This was a very welcome and peaceful retreat frm Athens' bustling streets and chaotic drivers.

Jami and I booked our hotel on a hostel website so we were not so sure what to expect but we were very pleased to find a beautiful old mansion that had recently been restored and turned into guest rooms. Our room had its own private terrace with beach chairs and a little table. We spent most of the day sunning ourselves on the terrace,wandering around the island and napping. We then ate appetizers of fresh shrimp and Kalamari as we watched the sunset and sailboats come in. By the time we were done it was freezing cold, my fingers were blue and I could not feel my toes so we ran home to change into warmer clothes and warm up before going back out to find crepes.

I told Jami that we should have goals for our trip and it just so happens that most of these goals revolve around food.The goal for Greece was to eat fresh seafood and find delicious dessert crepes.We had seafood as part of our dinner: check! and in the evening we found a little cafe that made fresh crepes: check,check!! Mine was a delicious combo of bananas, nutella, chocolate sauce, and nuts with chocolate ice cream and Jami had apple, cinnamon and honey with vanilla ice cream. Afterwards we waddled back home and passed out. Eating and site-seeing is tiring!!

Where we spent our last afternoon.

We had a great, leisurely breakfast and finally got to sleep in. The plan for the day is we to sit by the water and read the rest of the afternoon until our ferry departs. When we get back we are going to head to the local market in Athens as I am in search of olives,cheese and Baklava for mom and dad, hopefully I won't eat all that I find before coming home!! Tomorrow morning we catch another early ferry for a seven hour ride to Santorini to meet up with other folks from San Antonio.

Croissants, chocolate and fresh fruit?...Why not?!?

2008-05-04T22:25:00.000-07:00

First impression of Greece? This sucks I want to go back to Istanbul!! We arrived in the early afternoon, checked into our hotel (which happens to be next to an erotica store and a corner where a good number of prostitutes hang out) and headed straight for the Parthenon. We quickly discovered that Athens is impossible to figure out if you have a map, know any street names or have a set destination in mind. The streets seem to change names at each block, most of the signs are written in the Greek alphabet and nothing runs parallel to anything else, or so it seemed.

Caryatids!!

At any rate, we made it to the tram stop and found our way to the Parthenon. We hiked up the marble steps to the acropolis and photographed some of the spectacular views of the countryside. I have to admit, the Parthenon was cool but my favorite part, as in art history class, were the Caryatids on the Erechtheion, or Temple of Poseidon. The story goes that Poseidon competed with Athena to see who the city of Athens would be named and they did so by each giving a gift to the city. Poseidon gave the gift of a well of water with a continuous supply and Athena gave the gift of an olive tree. Being called Athens Athena obviously won. So now Athens has plenty of olives, they may run out of water but they will always have olives!! Just to be on the safe side though they made the Parthenon the Temple to Athena and the Erychetheion the Temple to Poseidon as they so intelligently realized they still needed the ocean for business and angering or offending Poseidon was not a good idea. Once we got kicked out at closing time and navigated our way back to our neighborhood we partook of our first Greek Salad, complete with tomatoes, olives, feta cheese and cucumbers. I was so excited to have vegetables I actually ate the tomatoes!! It was something about the combination of the feta cheese, fresh tomato, onions and dressing that masks the taste of the tomato and makes them tolerable. The feta cheese here is absolutely delicious, it is creamier than in the US and not as bitter as what we get at home, it’s sneaking it’s way up there with goat cheese as an all time favorite!

We spent the next day seeing a number of other sites: the Roman Agora, Temple of Zeus, the Olympic Stadium, the National Gardens and the National Archaeology Museum. By the end of the day we were both tired and Athens had still not warmed up to us yet. We were told by an American college student studying in Athens that the city exploded in the 90s,rgowing faster than it could handle thus they built numerous square or rectangular buildings for apartments and offices and really gave no thought to the architectural design or creativity of the city. Compared to Istanbul Athens appeared kind of charmless. We also thought maybe the prostitutes on the street corner near our hotel was a sign that we were staying in a bad neighborhood but then found out that our neighborhood was not much different from any other one in the city. I also still could not get a good sense of where I was and really did not like that feeling.

At the National Archaeology Museum, Dad this is what a Philosopher is suppsed to look like.

But then things started to turn around. As we were walking home we passed by a Patisserrie which had tons of pastries, deserts, gelato, and the nicest girl was working there, one of the first nice people we met in Athens. We decided we would find a supermarket and buy various things we had been craving and further supplement that with sausage filled croissants, feta cheese filled croissants, strawberries we picked up at the market and for desert mini fruit tart and éclairs!!

Therefore our meal consisted of :
Croissants-savory and sweet
A carrot
Strawberry yoghurt with fresh cut strawberries
Chocolate milk for me, regular for Jami
Dried Apricots from Istanbul
It was one of the best meals I have ever had!!

The view from Delphi

The next morning we went to the main square and jumped on our day tour to Delphi, a.k.a the belly button of the world (Zeus called it a navel). The story goes Zeus let two Eagles go in opposite directions and where they met up again was the center of the world, this happened to be Delphi. In Delphi lives the Temple of Apollo and where the Oracle foretold the prophecies for the Greeks. Along the way there our tour guide told some Greek mythology stories and the story of Oedipus Rex which all reminded me of Don, my Montessorri school teacher who took special delight in teaching us Greek mythology and history rather than American history, truth be told the Greek myths are far more enchanting for an 8 year old!!The tour to Delphi was just what we needed, as we drove into the mountains and climbed Mt. Parnassus the dirtiness of Athens melted away into beautiful countryside, plains of olive trees and random archaeological ruins. We spent the day trotting around the mountain, seeing the temple, the theater and the original olympic stadium, ate lunch in Delphi (ate Moussaka—a cleverly disguised eggplant dish) then headed back to Athens. We stopped in a small town along the way for people to shop but seeing as Jami and I do not have a lot of money and the dollar is abysmal against the euro we snuck off. My main goal was to find cheese and olives to bring home but instead we found a coffee shop and hot coacoa. Also, we stopped by a bakery to sample a couple of different kinds of Baklava. Both types we tried were incredibly delicious. Melting in your mouth as you take a bite, one was quite syrupy and had whole nuts at the bottom of it and the other one had a number of different spices in it making it taste a bit like pumpkin pie, must have been nutmeg or cloves… but both amazing!! We made it back to the hotel, stopped off for another Greek salad and now we have to pack up to get ready to take a ferry to Hydra, one of the Greek islands, tomorrow morning!! Things are looking up!!

Istanbul: My Turkish Delight!!

2008-05-01T21:07:00.000-07:00

Me getting my prayers answered by sticking
my finger in a special hole in the wall
Jami and I successfully navigated our way out of India, a feat in and of itself, and flew to Istanbul. We arrived as the sun was going down and wandered about our little neighborhood to grab a bite to eat. We ended up eating at a little cafe around the corner where they gave us a great huge piece of puffy bread that you tear off a piece and dip into a yoghurt sauce. It was delicious, can not tell you what the sauce was... As I may have mentioned before any bread product that can be dipped in a sauce or combined with a dairy product is fine by me!

The goal after dinner was to go to bed early so we could be well rested the next day for our rapid tour of Istanbul and visit a Turkish bath. Due to staying in a hostel we were rooming with three other girls, all college students, who operate on a very different schedule than what we were used to. At any rate, we stayed up a bit late and still got up early the next morning. We then found out that the turkish bath was actually closed so we ended up checking email and performing some much needed logistics before going to breakfast. We ended up not going to a Turkish bath because Jami had a weird rash on her leg (turned out to be a reaction to the sun) that we didn't want to expose her to anything that would cause an infection. Since Turkish baths are not as sterile as a surgical field we decided we would have to come back another time.

Breakfast was great! The bread is incredibly fresh and there was strawberry jam that tasted like actual strawberries, in India it tastes like a jolly rancher (not in a good way). And we had apple tea, something specifically from Turkey that tastes like real apples, better than apple juice and it has caffeine! The best part about breakfast was it was served on the roof of our hostel and in one direction you could see minarettes of the blue mosque and the other direction was a sweeping view of the Bosphorous strait and the Golden Horn.

As our tour started we quickly discovered we were in an optimal location. Litterally 100 feet from the Four Seasons hotel (i.e. nice neighborhood) and just around the corner from Hagia Sophia, the Blue Mosque and Sultanamet station. Using Rick Steves' guide to Istanbul (a book I happened to find at Borders before leaving home and I would recommend to anyone who ever went anywhere Rick Steve has ever been!) we started at Hagia Sophia. Rick Steve literally takes you step by step through the main tourist sites and tells you what to see and what to skip and provides historical information on walking tours around the city. It was really all we needed! At any rate, Hagia Sophia was spectacular, probably one of my favorite spots. As another architectural masterpiece I studied in art history class it was awe-inspiring to be standing in front and inside such a magnificent building. The building of the Hagia was a remarkable feat itself. Built under the watchful and gregarious eye of the emperor Justinian the central dome is tall enough to fit Paris' Notre Dame Cathedral under or the Statue of Liberty sans torch.

I think the best part about the building is its integration of religion and cultures. When Constantinople built it, it was the primary Christian church of the region. In 1453 the Ottomans conquered Constantinople and turned it into a mosque. Now we mostly see the elements of the mosque but some frescoes and mosaics have been uncovered reminding us of earlier history. We wandered through Hagia before going onto the Blue Mosque. The Blue Mosque had spectacular stained glass windows and geometric artistry on the ceilings but it paled in comparison to Hagia. We also went to the Underground Cistern where they stored water for Istanbul in case of a shortage, also during Justinian's time. Now used as a tourist destination and a performance venue it is an underground network of columns and arches. We were going to try and see a concert here but there was only going to be a dance performance so we passed on that. We stopped off after at the archaeological museum, Topkapi Palace, and the Hippodrome before heading to Taksim Square to see the New District.

The New District is where a lot of locals go to hang out and shop. After being in India for four weeks and doing my best to wear dull, inconspicuous clothing the hip euro trash trends were quite enticing. I do not think I will ever go back to the skinny leg jeans with zippers at the bottom or start spiking my hair but it was great fun to go into the stores and walk the streets while people watching.

We ate a dinner of lentil soup and split a chicken dish and then the best part of the evening, we went to a place called Mado Cafe and had Baklava served with Kesme (I think that's what is it called but there is also a distinct possibility I made this up). Kesme is Turkish ice cream made with goats milk and wild orchid pollen, it is incredibly dense and requires a knife and fork to eat. This may sound a bit odd but it is delicious, so much so that Jami and I stopped at Mado for this treat once a day while in Turkey.

Our next day we planned to dedicate to shopping at the Grand Bazaar and Spice Market. Rick Steves provided another great tour through both of these. We took the aproach of going through the tour first then we go back and look at anything we remembered we liked and wanted enough to trek back to the sale site. The Grand Bazaar can be exceptionally overwhelming. They have everything and a whole lot of nothing. Salesmen try to get you to stop and "just have a look," once they get you inside they really don't want to let you go. We simply started shaking our heads no as soon as anyone started to talk to us and focused on what lay ahead or around the corner. We eventually happened upon a little courtyard with cobblestone paths leading up to the shops. The area is called Zincirli Han, is far less touristy and the sales guys are all a bunch of old men sitting out in lawn chairs in the courtyard smoking. Here we found our own personal treasures. The first is a jewelry store called Merim Kuyumeuluk that sells mostly diamonds and at wholesale prices with a workshop right above the store. We sat and spoke with one of the owners who said five generations of his family had worked in this jewelry shop and he had worked here for 53 years. When we told him we were medical students and from Texas he got really excited and told us he had gone to Houston about 30 years ago and had heart surgery done on him by Debakey! After hearing horror stories from mom about Debakey at Baylor and the way he ran the OR and his residents I asked him if he liked him. He replied with, "He was wonderful, a fantastic surgeon, very kind and look, I am still here!!" That was a good enough reason for someone to like another person as far as I am concerned.

We eventually got to talking about apple tea and asked who made the best kind and which should we buy. He then sent some guy out into the bazaar to go buy us some tea. (I guess a small token of appreciation for us buying his diamonds... ) After chatting with him and visiting his workshop we went nextdoor to Osman's Carpet Shop. The carpet shop had a similar history to the jeweler with the shop owners spanning for generations. The only difference is they do not make the carpets, they collect carpets from around the coutnry, know all about the history and styles and now sell them. He showed us a number of rugs that were greater than 30-35 years old that were hand-made with lambs wool. Carpets used to be made by women as offerings to their future husbands as a dowry of sorts. Unfortunately, this art is becoming obsolete, as are newly made carpets. At any rate Jami and I each bought a small rug then decided after spending a large sum of money in a small amount of time in a small area it was time to head to the spice market and focus on food.

The Spice Market was great!! With heaping bags full of spices, coacoa, nuts and dried fruits you could have anything you could imagine! Here we partook of turkish delight: a gooey candy that is kind of jelly in consistency and comes in all different kinds of fruit and nut flavors. The best thing was the huge blocks of nougat that had pistachios in it and the guy shaved off slices to give us free samples. I was going to bring some back for mom but I, um... ate it... If I find some more I will be sure to buy the whole block of it! We also stocked up on tea and a few little souvenirs before walking across Galata bridge and watching the sunset over the city. We then ate grilled fish sandwiches off a boat, not the best tasting thing but still worth a try, before heading back to the hostel and our last stop at Mado Cafe for ice cream and Baklava.

I can not say exactly what is so wonderful about Istanbul except to say that it just is!The people are incredibly friendly, the city itself retains its old world charm in its architecture and cobblestone streets, the food is delicious and it's Istanbul! Jami and I head to Greece in the morning to continue our adventure. We have found we make excellent travel companions. We both are pretty laid back and go with the flow, want to see the sights when it seems important but sit back and enjoy ice cream and pastries every once in awhile as well. Hope all is well at home! Much love!

End of the whirlwind tour...

2008-04-29T11:28:00.000-07:00

Bangalore, Goa and Bombay:

We separated from reality for a bit on these excursions. All three of these locations have the resources to make you feel like you are far away from India, in denial about the severity of poverty in some places and in others magnify the divide between the rich and the poor.
We started off with a short drive to Bangalore with an incredibly reasonable driver who even slowed down for pedestrian crosswalks and STOPPED at red lights (Another point learned in India, red lights are merely a suggestion).

We met up with a friend who lives in Bangalore and has a number of different capitalist ventures going on around the world and lives quite a different lifestyle than what we were used to in Vellore. We needed to do some last minute souvenir shopping so did that for most of the day. I think I was a bit tired so I kind of wandered aimlessly although I did go to a store called FabIndia which does a lot of free trade with local artisans and I fell in love with some curtains. However, as I said I was tired so I actually did not purchase anything. After shopping we went out to a posh hotel called the Taj (a chain of super expensive luxury hotels, nicer than any four seasons, ever) for drinks and appetizers. After we went to another bar for more Kingfisher and dancing. The best part about Bangalore is the city has a curfew of 11:30pm so you have to do all your partying by 11:30. This is actually perfect for me because I can go out then go home, go to sleep and still get eight hours of sleep! The next best thing about Bangalore was our hotel had a treadmill! This was the first time in three weeks I got to run. For anyone who knows me this is a huge amount of time for me not to run but I have actually been ok. However, all of our hotels the next three days had treadmills and there were a fantastic treat!

The next morning we sent Vida off to Thailand to meet up with Dustin and we went on to Goa to sit on the beach and do some serious relaxing. The first night we were there we walked down to the beach by our hotel just to check things out. There was trash all over the place, cow dung mixed with sand, lots of men in their underwear (including a group of men playing cricket on the beach in their undies) and sea water that kind of made your skin itch. The cool part about our beach is there is a tanker that ran aground and then was abandoned because no one knew what to do with it. Apparently some groups want it removed but the Indian government does not want to allocate funds to take it apart and therefore it shall remain! The next day we took a taxi with a driver anmed Francis (huge portuguese influence in Goa) to a more quiet beach. We were going to go to Morjim but Francis informed us that it was vacation time for the country and it was not going to be quiet so he would take us to Aswin instead. The beach was perfect! With little straw thatched coverings and beach chairs for rent for $1.25 for the whole day, a restaurant nearby and a clean beach we could not go wrong. We spent most of the day reading, swimming and sleeping and ate some of the most delicious garlic prawns ever (they literally melted in my mouth). We went back to the hotel and then went shopping again! We found another FabIndia and seeing as I was more rested I bought some curtains. I really do not know what I am decorating seeing as I do not have a place to live yet next year but darn it I have curtains! (It's the little things in life).

After Goa we flew to Bombay and stayed at an apartment owned by a friend of a friend that was in a building where a lot of Bollywood stars live ( I told you we saw the other side of India). Bombay had everything your heart could desire. Setup kind of like Manhattan it is congested, dirty, overpopulated, overpriced, and smells a bit like fish. However, it is still India and still has a certain charm about it and I still enjoyed myself. We partook of our last true Indian dishes and also treated ourselves to some gelato (definitely not available in Vellore) before flying to Istanbul. After the India portion of the trip I have to say I had a fantastic time. Each town we visited really has its own unique character, the people are incredibly kind and there is really something for everyone as long as you are willing to find it. It is imperative that you take each day at a time, do not be in a rush because inevitably things will run behind schedule and be willing to try new things.

These are memories that all of us will cherish as we head into residency and for the rest of our lives as we may never have this opportunity or time to allow this kind of trip. All I can say is when you travel to another country rememebr that it is a privelege to be in a foreign country and you should respect that. All too many times I have been in another country and seen tourists take a holier than though attitude with the locals , and usually they are from the US, and it's really embarrassing. When you are traveling you are a representation of your country and because you look and act differently people will take particular notiece of you. So, I just ask you treat everyone with the utmost respect and not be afraid to try new things, practices that are "weird" to us may be daily occurrences for them. I am not saying you need to drink the tap water or bathe in the water drain on the side of the road just be smart and enjoy yourself. Figure out all that such a rich country has to offer through culture, food, tradition and even day to day life!

Mycobacterium leprae

2008-04-26T11:14:00.000-07:00

Seeing as I was reading about leprosy and this was Paul Brand’s particular interest I wanted to read a bit more about it and use the topic as my paper for my final requirement of this elective.
Leprosy, a.k.a. Hansen’s disease, is caused by the bacteria Mycobacterium leprae, an acid-fast, rod-shaped organism that affects the skin, mucous membranes, eyes and peripheral nerves. There are two main types of leprosy: turberculoid and leprematous. We saw mostly leprematous form in the hospital so that is what I will focus my paper. The leprematous form is the more severe version, invading multiple organ systems along with the areas mentioned previously. The exact mechanism of transmission remains unknown although it is believed to involve respiratory secretions from infected individuals, human-to-human contact and vertical transmission (from mother to child). The incubation period is about five years, making it more difficult to pinpoint an exact source.

Leprematous leprosy presents with the pathognomonic sign of multiple hypo-pigmented skin lesions lacking sensation. Severe cases can involve the eyes or nasal septum and hand contractures. Multiple methods for testing for leprosy have been tried but the only reliable and standardized method is a skin biopsy, a simple procedure that is easy to do even in India! In leprematous leprosy one can see giant cells accompanied with epithelioid-lymphocyte granulomas along with bacilli surrounding blood vessels and within nerves. The disease begins first affecting thermal sensation followed by pain and touch while proprioception and vibratory senses are often preserved. In addition, deep tendon reflexes remain intact due to bacilli sparing muscle spindles and large nerve fibers. This denervation eventually leads to compression ulcers of the feet or damage to the fingers, often times becoming infected.

From the time of diagnosis patients are then treated with a multiple drug regimen, in the clinic they largely used rifampin, dapsone, clofazamine and sulfa medications. All these meds were tested in the laboratories housed in the center. These meds were determined to be the most effective and required a shorter duration of use, increasing compliance and improving outcomes.
Knowing the treatment for leprosy the medication regimen is simple. What remains difficult is the education of patients to prevent further damage. Education involves significant effort on the part of doctors, nurses, physical therapists and many others. One thing that Ms. Koshi (the public relations woman) pointed out that was interesting, and something to take home, was the effectiveness of patients teaching patients. The clinic organized sessions of previously diagnosed leprosy patients to come and talk to newly diagnosed patients to educate each other on what works and what does not. Patients do not want to hear orders from another doctor or nurse who has never experienced the disease first hand and does not know about the day to day struggles.
In addition, India has the large task of finding those yet to be diagnosed as 70% of leprosy cases are found in India, Myanmar, and Nepal. With 12 million diagnosed worldwide it remains quite prevalent and with it endemic to Florida, Louisiana, and Texas (one reservoir being our very own nine-banded armadillo) it is something we may see at home.

We are asked to research a topic for our elective on a “tropical disease” but the bottom line is the leading cause of death in India, just as in the US, is cardiovascular disease. This along with cancer, traffic accidents and diabetes, amongst many others, are what plague our patients and stress India’s and our healthcare system. What is the solution? I’m not sure yet Going into Ob/Gyn I have a pipe dream of improving the world and quality of life by making women more healthy and thereby their children, even if it is just one person at a time.

I had the pleasure of reading Atul Gawande’s Better: A surgeons notes on performance which definitely got me thinking about what I as an individual and in turn as an individual adding to the medical community can do to make the system “work.” One thing that he stresses and I must remember is to be open to change. Each person has something they can teach someone else and we all have a lot more to learn, no matter who you are. Being humble and putting aside ones ego could dramatically improve how we deliver care. Because of this we have discovered new methods for delivering babies, laparoscopic surgery, vaccines, new medications, etc. and have turned this information into common practice.

After being in India I have learned that we have excellent healthcare in the US (especially after being a patient myself in an Indian hospital), if one has access to it. However, where India falls short of resources and supplies they excel at physical diagnosis and ingenuity, skills that are somewhat fleeting in the American healthcare system.

You may disagree with me and that is ok as long as this makes you start thinking about how you can improve the world around you. Yes, you might be one person but one person can make a huge difference, especially when working with others.

Going to other countries has always inspired me to continue to make a difference, in my local community and abroad. I have traveled and worked in hospitals in other countries before but never with the knowledge and expectations of the medical system that I now have. India was unforgettable, challenging and inspiring, something completely unique and magnificent all at once. So, thank you to the donors who contributed to the scholarship fund that sent me here, nothing compares to this opportunity and for that I am forever grateful.

Tips for Vellore

2008-04-26T11:08:00.000-07:00

Places to stay:

If it is hot get air-conditioning, it costs more but it makes all the difference! There are three main hotels in town that are safe and reliable:

Aavana Inn is directly across the street from the hospital so this will save you money on rickshaws but the rooms are fairly small and you will have to share a bed.

Hotel Surabi (where I stayed) is halfway between CMC hospital and CMC campus (about a 25-30 rupee rickshaw ride in either direction, that's less than a dollar). It is clean, has a good restaurant with incredibly slow service, and the laundry guy is one of the nicest people you will ever meet. There is a party place next door that sometimes plays loud music and sets off fireworks, particularly for weddings, but all parties stop around 10 so it's not much of a problem. There is an internet cafe right next door to Surabi for 15 rupees an hour.

Hotel Darling is the most expensive but also the nicest. It is basically across the street from Surabi and has free internet access for its guests. (It also has excellent food, just a warning though anything that you think is an american treat will have some type of indian flavor thrown in, i.e. pizza with a dash of curry...) Otherwise internet is down the street at iWay or other internet cafes around town. You can also get internet access through the campus library. You pay for the whole month and get a username and password. It allows you to use internet on campus or in the library by the hospital.

As for food all three hotels have good food, all have veg and non-veg restaurants, we usually went with non-veg and ate our share of meat, just don't touch the beef! The other places to eat are at baby residency down the street from Surabi, Chinatown across the street from the hospital or another restaurant with good food that is across the street from the hospital is in the basement of a building. The entrance usually has a guy selling samoses or cheap toys out front and there is a drawing of four cats all holding guns with the letters K-I-L-L written on their backs (promise it's good food though). There is also food at the campus and hospital cantinas and everything at all these places is only a few bucks.

There are two grocery stores near Surabi and Darling one called Harish Zone and the other is called Nilgiris, both on the way to iWay and within walking distance of Surabi and Darling. I personally love grocery stores so these were two of my favorite places. Try out new snacks, the Milki Biiks (cookies with vanilla cream in the middle) are delicious and there are some special spiced peanuts which we referred to as "fart nuts" which taste delicious but smell like... well, like the name we gave them. This is also a good place to get big bottles of water and an occasional ice cream treat. Nilgiri's has a better toiletry section if you forgot something or just want to buy stuff when you get over there.

The Gift of Pain

2008-04-23T22:20:00.000-07:00

After our rude awakening with the accident our last week in Vellore was a little disturbed. We took about a day to recover from our bumps and bruises before returning to work. I ended up visiting the Paul Brand Leprosy Clinic this week seeing as that is the namesake of the scholarship I received and what originally made this area well known in the medical field. Dr. Brand was an English surgeon working at CMC in Vellore in the 50s and 60s. He would research patients with leprosy at the end of each day to try and piece together the reason the patients had such severe deformities. What they discovered was that even in mangled extremities there remained normal, healthy tissue. Because of this discovery Dr. Brand was able to perform highly successful reconstructive surgery and subsequently also revolutionized the way the world thought about healing ulcers. We now use a number of similar techniques for our diabetes patients in the US, believing that tissue can, in fact, heal if given enough time and if the insult to the tissue is stopped.

With the discoveryabout the tissue Dr. Brand had a huge influx of patients coming for reconstructive surgery and treatment, flooding the CMC hospital and causing problems with the other patients. Leprosy was a highly misunderstood disease with most people believing it occurred due to a curse from God for unpardonable and unmentionable sins. To make matters worse the disfigurement that ensued from the damage was horrific. With necrotic ulcers, missing appendages, and a hole in the middle of the face after losing a nose no one wanted to come close to a leprosy patient. So in conjunction with the help of Dr. Robert Cochrane CMC was given a large piece of land, about 250 acres, near Karigiri Village (30-45 minutes from Vellore by rickshaw and many bumpy roads, not so much fun when you have to go to the bathroom).
The men's ward.
At the time of the purchase, the property was a vast wasteland, something the government found to be suitable for leprosy patients (sarcasm) and figured no one would want to live in that area thereby completely avoiding the social stigma attached to the disease. What developed after obtaining the property and what one see today is absolutely incredbile. As we arrived on our autorickshaw we drove up to a lush paradise with green trees, flowers blooming and an overall peacefulness, rarely found elsewhere in India. We met up with Ms. Koshi, the public relations person, who kindly took time out of her day to give us a private tour aorund the facilities. The design of the center was to fully treat leprosy patients, perform research to further improve care and provide support for the patients and families (physicially and spiritually).

The disease is caused by bacilli that infiltrate nerves causing severe damage causing patients to lose sensation. The bacilli preferred cooler climates and would thus migrate to the coolest areas of the body: the hands, feet, nose, ears, etc, making these locations the site of the most injuries. In turn, individuals would develop deformities from repetitive damage followed by healing or ulcerations, all due to a lack of sensation. To give an example, in Paul Brand's book The Gift of Pain he describes what happens when someone twists their ankle. A healthy person, like you and me, has a signaling mechanism for when you step on the edge of a sidewalk. In the split second you lose your balance a message goes to your brain telling you that you are about to fall on your face or break a tendon or bone. Your brain sends a signal to the appropriate part of the body telling it to compensate for the fall and therefore not injure yourself. A leprosy patient has none of this. Upon stepping on the edge of a curb a leprosy patient will continue to put his or her entire weight on the foot providing enough force to snap a tendon then continue walking as if nothing happened.

You may wonder why this clinic is still around seeing as we have treatment for leprosy now but Ms Koshi informed us that the definition of an eradiacted disease is 1:10,000 (something I have to check is correct but you will see my point in a sec) therefore by definition leprosy is eradicated but due to India's population being so humongous that comes down to about 20-25 new leprosy diagnoses per month (yes I said month)! In addition, the clinic has turned into a large treatment center for diabetes, particularly the treatment of ulceration with the use of casts, new shoes, antibiotic treatment, education and proper dressing changes.

One other interesting note is that we met a beautiful young girl who completely lacked any sensation of pain. She was being treated for a recent foot ulcer and was scooting herself around the hospital in her little wheelchair behind our group. Dr. Brand talks about a similar case in his book where the little girl would bite the tips off of her fingers and use her blood to paint on the walls, fingerpainting quite literally!

The young girl is in the wheelchair.
Now the medical staff knows so much more about these diseases they focus largely on prevention and protection. There is a shoe factory on site that makes the soles of the shoes with special rubber and each pair is specifically made for each patient. They also designed gadgets to assist with everyday activities: fastening a button, combing hair, brushing teeth, writing, etc. All of these things we take for granted, do not even think about having to do each day but each task is a challenge for each of these patients. Another wonderful aspect of the center is they taught weaving techniques and designed tools so that even those patients missing fingers could still participate in the design and creation of something. This reminded me a lot of the women's prison in Nicaragua; the simple act of believing an individual can do something and contribute to society makes such a huge difference in peoples lives. They currently make wavings and do block printing, a very popular Indian art. The blocks are made out of wood and carved into different shapes then dipped in ink and stamped onto fabric. They can then leave the fabric in its natural creme color or they dip it into a liquid (what that liquid is I don't know, we will call is magic liquid) that changes the colors, the fabric and the ink prints. All in all this is quite impressive because they do all this without any fingers.
Making protheses.
We also got to visit the wards to talk with the leprosy patients currently being treated. I often times feel bad being an observer of sick indivuals and especially felt this way with the leprosy patients. Yes, I enjoyed meeting them and talking to them and yes, I learned a great deal from them but I can not help but feel I was invading their privacy in some way or making them feel like they were on display. However, I must say the patients did not seem to mind and actually seemed thankful to have us around after we told them we were medical students from the US. They were willing to talk about their treatment and their ulcers and let us take some photos. The patients on the male ward actually reminded me of VA patients, talking about how long their ulcers have been around and their various ailments, but I also have to say that the patients in India were quite a bit cheerier than those at the VA in San Antonio. At any rate, I wish I could come back and work here but there does not seem to be much demand for OBs. They are in need of dermatologist, ophthalmologists, orthopedeists, general surgeons and ancillary staff. Ms Koshi said we were welcome back any time and that there was lodging there if students wished to do a week long rotation in the future.

We head to Goa, Bangalore and Bombay this weekend to complete our whirlwind tour of India before flying to Istanbul. Hope everyone at home is doing well!! (as usual, pictures to come when I get to a computer that has all parts working properly!)

The crash

2008-04-22T06:19:00.000-07:00

"He jests at scars who never felt a wound" ~Shakespeare

2008-04-21T22:19:00.000-07:00

I woke up this morning to screams. I thought I was having a bad dream. After a weekend of having our driver drive around like a maniac I thought that I dreamed we finally crashed, but when I woke up it took a couple of seconds to realize it had, in fact, come true. I looked up and directly above me was the roof that was supposed to be above the front dashboard, cold water was dripping on my legs from the air conditioning unit that was pushed up over the passenger side seat. As I slowly got my bearings and stood up to look around the car seats were scattered haphazardly. The immediate action by all was to make sure everyone was OK. We moved some of the chairs to free Anne from her seat and found Chris, unconscious, lying in the center aisle with blood on his face. I have to admit the terror surged through my body as I yelled "Chris" and he did not respond. Dinesh, being trained as an EMT and having seen accidents like this went into triage mode. He attended to Chris as my thoughts turned to "get the hell out of this car and find help."

The driver who had fallen asleep at the wheel had already climbed out of the front door and as I tried to squeeze behind the front seat he closed the door in my face. I yelled at him to open the door but I think he was in a daze too and did not turn around. (He was also very young, and a tad reckless and more than likely had no idea what to do in a situation like this). I was able to reach the door handle and squeeze behind the chair. Once out I felt like I could not catch my breath and started feeling light headed. A villager was directing traffic and told me to get in the median and out of the way. I sat in the grass for a few seconds trying to catch my breath and wrap my head around what had happened before I stood up to go behind the van. Vida was sitting on the ground and saw me stumbling around and yelled at me to come and sit. Vida and I both began yelling to call an ambulance and one villager who understood English stopped a jeep and told them to call the hospital. We began extricating people out the back door of the van and by this time Chris had come to and was answering questions appropriately, even joking sometimes like his usual self, as Jami held c-spine. We got all our stuff and all the people out of the van except Chris, Jami, and one of the guys from OSU traveling with us who was having vision problems, in retrospect due to vasovagal reasons but we held c-spine for him as a precaution.

The ambulance arrived and short of having c-collars were fairly efficient. They took the OSU guy out on a stretcher as we made make-shift c-collars with towels for Chris and him. Chris was hand carried by the two ambulance drivers to the back of the ambulance. Cristina, who was sitting opposite to me in the vehicle, had gotten hit in the chest with the front passenger seat and the TV above the front windshield had been pushed down and hit her head. She was having difficulty taking a deep breath so we decided to pile everyone, plus luggage, into the ambulance and drive the 120 kilometers home to Vellore. The van driver had a good head lac above his right eye but was completely coherent so we left him with the van and to wait for the next ambulance to take him to a closer hospital.

We spent the rest of the day in the hospital as Chris and Cristina got pan scanned and the OSU guy got x-rays taken of his legs. The rest of us were fairly banged up with scratches and bruises but all walking and talking. No one was hospitalized overnight and all scans, x-rays, echos, etc. checked out just fine.

This seems to be another lesson in India. I have been talking about the chaotic driving that occurs here and how I don't know where the car accident victims end up, I have come to the conclusion that they rarely make it to the hospital. The ambulance consists of two guys who own a van and a cloth stretcher similar to those used in WWII. Without a backboard, c-collar, any type of medical supplies it is a wonder that anyone makes it to the hospital. When things like this happen you begin to wonder what could I have done differently, what if we had left our initial departure site five minutes earlier or later, what if we had forced the driver to stop and get coffee after he refused, what if he had napped two minutes longer or slept during the day as we asked him to do. Bottom line is when you have a sense of doubt or danger or impending doom lingering n your gut listen to it. We were all uncomfortable with the drivers erratic driving and Chris had remarked on the way to Kerala that his driving was like rolling the dice and at some point you have to lose. We made it to Kerala safely and we should have found another mode of transportation home whether it had meant more money or being late for work Monday morning. But hindsight is 20/20.

We don't know who it was but we all decided someone was looking out for us. Being in India we thought maybe Ganesh, the god of luck, or perhaps Shiva, the destroyer. Shiva destroys in order to rebuild, maybe destroying our car to remind us we are mortal and not take for granted the people we have in our lives, the privileges we are given by being in the medical field or in the position in society that we function. Whomever or whatever it was we figured we would cover all of our bases tomorrow and visit the Hindu temple, the Christian church and the mosque down the road and be thankful for all having each other and thankful that we were all able to walk away.

I also say this because for some reason we all seemed to be in exactly the right position to not get seriously injured. Also being asleep probably helped. They say drunk drivers survive car accidents because their bodies go limp and they do not sustain as serious injuries, we figured sleeping was pretty similar. Jami, who had gotten car sick on the way to Kerala and was sitting in the front passenger seat was asleep in one of the chairs in the back, leaving the passenger seat empty (the site of primary impact). Because she was in the backseat Vida was then not lying across the row and was not hurt as badly when the seats were shifted all over the place. I was sitting in the front seat, behind the driver with a clear view of the road in front of me (due to my own motion sickness)and nothing between me and the front windshield. At the time of the accident I was thankfully lying down and the front of the car was pushed down above me and I barely rolled anywhere. Anne was sitting behind me and as we crashed she hit the back of my seat, stopping her from going anywhere and again because I was lying down the seat bent over me rather than pushing me forward.

We all made it safely to the hospital and got to experience the trauma bay from the inside (one rotation med students are not allowed to do). Once to the hospital we were treated very well. We were taken care of by the head nurse who had trained at the Mayo clinic in the US. Dinesh got his facial abrasion cleaned by a very friendly guy who later turned out to be the janitor, but that's India for you, using all your resources! India is also smarter than the US making you pay up front for everything (procedures, supplies, lab tests) before anything is done. Everything is obviously considerably cheaper than in the US but it still makes you think about all you are spending and what is absolutely necessary.

We stayed there most of the day then went back to the hotel to relax. After no breakfast or lunch and being incredibly dehydrated I ate like I had never eaten before and I was never going to eat again. I devoured my paneer naan, anything that is a fresh baked bread product with additional cheese is ALWAYS good. A few of us ate dinner together for somewhat of a debriefing meeting and treated ourselves to some much deserved ice cream sundaes.

As I said before everyone is doing alright. I have a few scrapes and bruises on my legs as do the others but we are all thankful that we walked away. This is just a clear message to never travel at night, make sure you tell your friends and family you love them as often as possible and live life with no regrets! There are too many things that are left to chance in this world, things that can happen in a split second, that could be irreversible. We see it happen to our patients and begin to think "this could never happen to me," only to wake up one morning to your worst nightmare. We have to remember we may be physicians but we will forever remain mortal.

much love to all! Pictures to come...

Houseboats and Relaxation

2008-04-19T15:56:00.000-07:00

Sunset

After a painfully long overnight drive from Vellore we arrived in Alleppey, found in the south-western state of Kerala. Known for houseboats, the peaceful serenity of its backwaters and its 100% literacy rate. We met up with a friend from the US who is originally from Kerala who was kind enough to treat us to a houseboat and introduce us to various local customs.

Our boat.

We traveled all around the canals and got to see the little towns that are along the jetties. It was great seeing how people lived but was a little uncomfortable as were basically in their backyard where they do the dishes, take baths, etc. The boat was fantastic. We ate (which I have been doing a lot of), got to sit down and read books, oh and I finally got some fruit and vegetables, one thing that seems to be lacking in Vellore as mangoes are not in season on the east coast. We drive back the fourteen hour distance tomorrow after seeing some temples and a palace today and an ayurvedic massage before leaving in the morning. I am just going to post a bunch of pictures because it's hard to explain, that and mostly what we did was relax...

This looks like a lobster but it is actually the biggest shrimp I have ever seen in my life!

Amazingly I am about to start my third week of India, the time is going by so quickly and I am doing my best to take it all in. If you have never been to India it should be put on your to do list. The culture and way of life, although overwhelming at times, is so incredibly rich and unique you will never find anything like it anywhere else!

Below is Captain Chris Patton at the helm and Queen Anne Cioletti enjoying her siesta.

See! We're in someone's backyard!

Things I learned in India

2008-04-17T18:42:00.000-07:00

1) The cows that wander aimlessly through the streets are owned by people but they are allowed to roam free during the day. They then know to return home at 4pm each day (so says one of the locals). Cow hanging out outside the hospital.

2)A vespa is the new minivan: a family of four can comfortably ride to whatever destination desired. The new and ultimate soccer mom vehicle! In general more people can fit on a vehicle than I would ever think possible.
This is a jeep. Our driver said it normally seats four but in India it seats 35.

3) It is absolutely ok to relieve yourself on the side of the road if you are male, pooping is optional.

4) There is no such thing as a lane or a one way road. The rules of driving are "every man for himself" or the bigger vehicle always wins.*

*No doubt this list will be added to.

C.H.A.D.

2008-04-15T17:01:00.000-07:00

Community Health and Development is what CHAD stands for. This is the rotation that everyone seems to love. It gives us the opportunity to go around to the surrounding villages and see patients to determine whether they need to go to the hospital or if they can be given meds out of the supply carried in the truck. There are doctors rounds, nurses rounds, and clinic held at or for CHAD which is next to the CMC campus. The doctors rounds are in a large van/bus that goes around to the villages to see patients. I will tell you about nurses rounds because I thought they were more interesting.

On nurses rounds we went out into the villages in a four-wheel drive SUV so we could maneuver over the potholes and dirt roads. Luckily it has been dry and hot so I did not have to push any trucks out of the mud like I did in Kenya! Nurses rounds are done either before or after the doctors rounds to work up a patient or follow-up with a patient. There was one nurse, three medical students, the driver and we picked up a local health aid worker in each village who was supposed to know where all the patients lived and if they were home. All of this works beautifully in theory but when it comes to reality things start to fall apart. Without the modern luxuries of cell phones, landlines to the huts or email it's difficult to communicate with the patients and remind them the health workers are coming. I don't know about you but if I could go to work in the fields to make money and feed my family or sit around and wait for medical care at home I would probably go to work too! We wonder why it takes so long for people to come and seek help for their ailments but when you break it down to a matter of life and death I would pick life and tolerate the pain then deal with the consequences when the time comes.

The truck.

The people we did find and take care of seemed like a social visit more than anything. We would go to the home to seek out the patient, would subsequently hear about the rest of the family then the neighbors would come over and talk for a bit then everyone would leave feeling like something was accomplished, just continues to prove the power behind a good listening ear. We saw mostly foot ulcers secondary to diabetes. The nurses also collected death certificates of the recently deceased, checked on any pregos and newborns, which I was excited about. However, the two pregnant ladies we went to check on had left that morning to go to the hospital and deliver (Both had healthy baby boys, fyi) so we didn't get to see any of them.

Little girl in the school with nutritional supplement in her hand.

I have to say the best part of the day was visiting a little school house that had kiddos from ages 1-5 and they were all busily writing on chalkboards when we first entered. We went to deliver some nutritional supplements which was some sort of peanut butter based block of stuff (highly technical term, I know, but I don't know how else to describe it) with additional glucose and vitamins. We tried some and it was a little too sweet for my liking, needed more peanut butter, but it was definitely filling and the kids liked it. Before leaving the kids all got up and sang a song and jumped around dancing, imagine twenty screaming kids in a small concrete building jumping up and down, it was awesome!

Little girl at one patient's home that was terrifed of me, blue eyes are not very common in India, but she really wanted to eat the peanuts.

All in all it was a lot of fun wandering through these little towns and seeing where people lived and not feel like we were there as tourists but as people providing a service and something they were appreciative of having. It was definitely hot, once again, but we lived through the day and ended at a health clinic and shared a cup of tea and friend plantains with another nurse and her family.

So far everyone seems to be doing okay. Vida's bag finally arrived completely intact and there have been minimal GI issues along the way. This weekend we are going to Kerala to get on a houseboat and relax for a few days. Next week is Ob/Gyn, woohoo!

The Taj

2008-04-13T22:36:00.000-07:00

Over the weekend we had a fantastic trip to Jaipur, Agra and Delhi. We started by flying on Spice Jet from Chennai to Jaipur and were picked up from the airport by Colonel Singh. He served for the Indian army for 23 years and fought in the Pakistan-India War in 1971. His wife and the colonel own a kind of bed and breakfast called Shahar Palace, kindly recommended by Colin and Nicolette when they came to Jaipur. It was fully equipped with AC (our one requirement) and good food. The best aspect of the place was how peaceful it was. We slept without honking cars, yelling and loud music and were awoken by the rooster crowing in the main courtyard as opposed to the marching band that seems to play at sunrise every morning in Vellore (why? I don't know but I do mean real marching band complete with drums and horns).

The monkey that ate breakfast with us at Shahar.

We started early the next morning by touring Jaipur, "the pink city" and capital of Rajasthan, which has its own unique charm. The buildings on the main street of the old city are all painted pink (the color of hospitality) and the city has maintained a majority of the old architecture. The streets remain chaotic, true to Indian culture, but included in the chaos are camels, horse drawn carts and elephants waiting at stop lights and hauling cargo.

Our first stop was at Amber Fort. Erected in 1592 by Maharaja Man Singh this was a huge palace on the top of a hill that used to house the maharaja, his numerous wives, concubines, eunichs and children. The steep incline to the top was made a bit easier by taking an elephant ride to the front entrance. This being my first time to ever ride an elephant I was quite excited. These are huge animals! They are each beautifully painted and you sit on top of a platform on their back as they lumber up the hill. Once on the top we were hounded by people selling various items and telling us they "have the best price for you!!" We quickly ducked through the entrance into the main courtyard where our tour began. Each millimeter of the place is ornately decorated and I can not even imagine what it looked like when it was in use. The walls used to be painted with real gold and with gems inlaid into the stone. Paintings and carvings of the gods were placed in every possible location and the views from the front door were breathtaking. The main meeting area once housed the largest carpet ever to exist and above it hung a 15 foot chandelier sent from Czechoslovakia (thought Lizzy would appreciate that). Since the fort is no longer in use most of these items were moved to the City Palace museum, or stolen. The design of the palace, however, is in and of itself impressive. The maharaja had separated the palace into summer and winter sections. The summer part is made of white marble that has small canals where water was pumped out from under the ground and circulated throughout the main rooms to provide a home made air-conditioning system. The winter portion relied on good old fashioned fire! Using curtains to hang along the outside of the buildings the inside of the rooms were carved then painted with a silver finish that would reflect whatever small amount of light was present in the room and retain all the heat.

The elephants waiting to carry us to the top.

After the fort we went to City Palace which was where a later maharaja moved after he got bored with his fort (it's really not surprising there are so many poor people here when they spend all this money on their palaces). We did a bit more sight-seeing, visited some tombs, did some shopping and got henna done on our hands then called it a night. The next day we drove to Agra and stopped at Fatehpur Sikri. Fatehpur Sikri was built by emperor Akbar between 1571 and 1585. This too had the ornate decorations, which I am sure used to be incredible. The interesting notes about Akbar was that he wanted everyone to be accepting of all religions. In turn he had a Hindu wife, a Muslim wife and a Christian wife (along with 233 concubines). He has a separate house built for each wife but throughout the fort the resounding theme is the intermingling of these religions existing within the same space and melting together peacefully into one entity.

The other note about Akbar was with all these women in his life he was unable to father a child. He visited the Sufi saint Shaikh Salim Chisti in Fatehpur who predicted the birth of an heir to the throne and when the prophecy came true Akbar built this city at the home site of Shaikh. Now, being medical students and witnessing our own share of gossip at university hospital, we are not sure how he was suddenly able to have a son at this time and never father a child again, but that's history now! At any rate, the Hindu wife had the son and she coincidentally got the largest house.

From here we headed to Agra, a dismal and disgusting town with the perpetual stench of sewage in the air, to see the Taj Mahal. As one of the wonders of the world I do have to admit it was breathtakingly beautiful. After studying about the construction and the story behind it in high school art history class it was amazing and humbling to actually be standing in front of the actual structure. For those who do not know the story behind it I will tell you, as Ms. Russell told us in high school. It was built by the Emperor Shah Jahan in 1631 as a memorial for his wife, Mumtaz Mahal, after she died during childbirth. The building and designing of the structure was a fantastic feat. Individuals from India to Europe helped in the process and the final product is a perfectly symmetrical structure of white marble stone inlaid with gems and carvings set before a reflecting pool. It is a rumor that when the emperor died he was going to build an identical building in black marble directly across from the Taj Mahal, also perfectly symmetrical, for his own tomb. However, the emperor was overthrown by his son and sent to jail for the rest of his life. When the emperor died his son buried him in a tomb next to his wife completely throwing off the symmetry of the Taj, I think it was to spite his father.

The grand and glorious Taj!!

We saw a few more sites in Agra then left as quickly as possible. I really have to say the pictures of the Taj do not do it justice. The two dimensions presented in the photos can not capture the reflection of light or the vibrant colors and intricate detail of the marble inlay work but you can probably close your eyes and imagine!

We made it back safely to Vellore again after a stop at McDonald's in Delhi (moment of weakness) and a quick plane ride. Tomorrow I start CHAD and get to go see some of the villages and where all the patients live!

PICU and SICU

2008-04-10T05:30:00.000-07:00

We made it safely to Vellore after spending a comfortable night in Chennai. I started my rotation this week on pediatrics, following a team around the PICU. Vida and I started on rounds with the attending and three residents. Past visitors to CMC mentioned the whispering rounds and they were not kidding! With the kids crying, the sound of overhead fans, honking cars outside and everyone else on the ward talking I could not hear very much. The attending seemed a little better than the residents and actually explained some of what they were talking about and pimped me a few times but I ended up taking the liberty of going around and looking at dignoses and talking to the patients and their families. There seems to be an uncanny number of kiddos with congenital heart defects and I also met a little guy with rheumatic heart disease, something that I would never see in the USA. It seemed we spent most of our time on rounds discussing fluid management for varying degrees of dehydration, something I am guessing is a larger problem here where the hospitals are not air-conditioned and patients probably lose considerably more fluids during their hospital stay than they would in a nice AC room in the US. I know I lost a lot more fluids on rounds in the morning than I would usually at University Hospital in San Antonio!

Changing dressings in the SICU. This was the first obese person I saw in India and the docs were trying to figure out why.

This is the everyday scene in San Antonio but 300 pound men are VERY rare here.

We met up with some of our other classmates a bit later who were on the SICU rotation who said they got to see quite a bit and had somewhat meaningful interactions with the residents and attending. So I went to the SICU today. The SICU takes care of any surgical patients that are not neuro or cardiac care patients. It runs very similarly to SICU rounds in the US with looking at xrays first of all the patients for the day then going around to each patient. Anesthesiologists run the show in the SICU. They do all the dressing changes on top of pain and medication management. The general surgeons come in for brief periods of time, eye ball their patients and maybe put their two cents in before going back to wherever they emerged from. The SICU rounds felt a lot more beneficial to the American students than the PICU rounds were. The attending and residents were more excited about explaining what was going on with the patients and what were current methods of treatment in India and how those compared to treatment in the US. There were a huge variety of patients in the SICU, from transplant patients to those with septic complications from amputations. Surprisingly there are not very many people from car accidents, we are not sure where all those people go but if I figure that out I will let you know because I am sure they are being sent somewhere!

This is the crash cart, but like most things in India nicely colored, i.e. makes for a good photo.

I will have to write more later when I get a bit more free time. India is fast paced and I feel like my senses are just totally overwhelmed as I adapt to the culture. From all that I see, hear, smell, feel and taste it seems there is so much thrown at you at once it is hard to take it all in. The country is beautiful yet harsh, peaceful yet chaotic. I have rare moments to sit and think and contemplate all that is around me. Currently I am just taking each day at a time, getting accustomed to the heat and getting over the jet lag. We are looking forward to a great trip to the Taj Mahal this weekend and an elephant ride at some point along the way! Hope everyone is well at home!

Made It!!!

2008-04-06T21:27:00.000-07:00

Just a quick update and more to follow later when we get to Vellore. So far 6 out of 7 have arrived in India and 5 of our bags made it all the way. We were welcomed in London by snow flurries and freezing temperatures. Jami and I had a leisurely layover in Heathrow and partook in a delightful boiled English breakfast. Vida, on the other hand, sat on the runway waiting to get to a gate only to have thirty minutes to run from one end of the terminal, catch a bus and get on the flight to India with us. She, thankfully, made it but her backpack sadly did not...
We are spending the night in Chennai tonight and will head to Vellore tomorrow morning to start work at the Christian Medical College. First impressions of India: bordering on chaos, and apparently today is a holiday so I am guessing this is calmer than normal (?). The driving is probably the scariest part, there are no lanes, I don't think checking one's blindspot was part of the drivers ed teaching and driving on the left hand side of the road and obeying one way streets is optional. We decided to go exploring this morning and found walking and crossing streets on foot brings you face to face with death every two minutes. I suggested we start taking an autorickshaw to cross the street, currently still being debated as to whether this is the safer option. This afternoon we are on a mission to find clothes, a travel agency and a much needed nap! Hope everyone is doing well, more to come soon!

Here is a picture of the street we had to cross which in retrospect is a quiet, calm road. Add forty more motorcycles, a bus, and three bicycles and you might get a better idea...