Last day in India- Steph

Dear friends…sadly today is our last full day in India.  The month seems to have flown by, but it has definitely been a month of my life that I will never forget.  This past week we were in a very rural village called Patti.  It is a farming community tucked up in the mountains near the Himalayas.  The people there are amazing, and in my opinion very beautiful.  We lived in the lower level of a free clinic in modest, but sufficient rooms.  We had three meals (and of course my favorite, afternoon tea) provided.  Rinko, our cook, was awesome.  He looked like he was about 15, he sang at the top of his lungs while cooking and prepared what is probably the best Indian food I have ever had.  Sadly, the GI bug did come back to haunt me…but don’t worry I’ve decided to load myself with antibiotics until I leave the country tomorrow, hahaha.

On Monday and Wednesday we held clinic at our site and people would come to see us from 9-1pm and then from 4-6pm.  We had yoga twice a day, 6 AM and 6PM, which was well…intense.  I do a fair amount of yoga at home, but this man had a military like style that I usually don’t associate with the practice of yoga.  I was in pain, but no pain no gain I guess.

On Tuesday and Thursday we hiked to nearby villages and set up a little clinic there.  We saw lots of coughs, colds, allergies, high blood pressure, and a few wounds.  Luckily  no real emergencies because our most advanced intervention was an IV.  There is no pathology lab there so we can’t even check a blood count.  We simply look at the eyes and the skin to see how pale they are and start iron treatment if needed.  It was refreshing to see how much medicine can be practiced without ordering a million tests.  All the medicine was provided for free to the villagers as was the doctor visit.

In our down time we explored a bit and even had a medicinal herb hike with our preceptor, who turned out to be a very hilarious man.  He loved to scare me with the stories of the leopards and snakes that live out there.  I of course was very easily frightened, especially of the GIANT spiders that lived in our bathrooms and hallway, gross.  

Today I am hopefully meeting up with my dad who has been exploring India on his own for the past three weeks and we are taking a train together to Delhi.  Tomorrow morning we are flying to Munich and then to Dusseldorf to see my family.  I seriously can’t wait to hug my family, have a cold beer, a big pretzel, and a chocolate bar.

I of course am going to miss many things about India.  How colorful everything is here, saying Namaste to the adorable school kids, and most of all the little cups of chai J  Thanks so much for reading this!!  I can’t wait to see you all!    (Also a great big HAPPY BIRTHDAY to my wonderful sister Pam who I miss very much!)

"Madam, snap please" Amritsar and Wagah border - Steph

Hello!  I know I said I was going to write more posts over the last week but my GI and I got into another fight so I was feeling a bit sluggish.  Things are much better now and Joe and I actually just got back from an amazing trip to the India-Pakistan border.  On Friday night we left around 7:40 on a sleeper train from Dehradun.  The train was quite an experience.  There are three little bunk beds that are stacked so tightly together that you can't sit straight up in bed.  Luckily, the middle one folds down so you can use the bottom bunk to sit before you are ready to snooze.  The entire car is just stacks of beds so you are very close with your bunk neighbors (which makes me super nervous about the person who was hacking up a lung all night and probably gave me TB).  The ride was about 12 hours and I slept ok...although my sleep was frequently interrupted by people turning the lights on, talking, singing, snoring, begging for money, and selling chai. 

We got to Amritsar which is the holy city for the Sikh religion.  After a quick breakfast we visited Jaillanwahal Bagh which is site of a masacre which took place in 1919.  The story goes that 1500 Indian civilians were peacefully protesting and otherwise enjoying what was a communal park area when the British soldiers arrived, demanded that the Indians clear the area (which by the way was physically walled off on three sides and the British were thus blocking the only exit).  They waited about thirty seconds and started firing.  The monument now is a wonderfully peaceful place with a beautifully manicured garden, which in some ways is kind of eerie, but a nice place to visit and remember those who lost their lives. 

On a side note, at this garden I had my first (and definitely not last) experience of the day with "Madam, snap please."  People would come up to me, say this line and then hand me their child, hoping I would take a picture (snap) with them.  I complied, because really what is it to me but a chance to hold a cute little baby.  But, I just would love to know what they tell people about the picture.  Am I just a random tourist, or do they claim that I am famous or what?

Then we were off to the Golden Temple, which is the holiest temple for the Sikh religion.  We had to wear head coverings and take our shoes off and wash our feet in accordance with their practices before we entered.  The entire compound itself is an unbelieveable sight.  Huge buildings entirely made of white marble, a beautiful reflection pond filled with koi and "nectar water" which is holy.  In the center there is the Golden Temple which is just as it sounds, a temple completely covered in gold.  Amazing.  There were people bowing down and kissing the ground and bathing in the holy water.  Although I certainly am not Sikh, it was beautiful to see how happy and grateful people were to be there. 

We then went to buy an offering...which was interesting.  It was a very greasy sweetened porridge that was given to us in leaf bowls.  Joe and I bought one for a dear friend's family and then one each for our families.  I was so excited to have this offering blessed and see the temple...until I saw the line, holy moly.  We stood in a line literally shoulder to shoulder for two hours in what felt like million degree heat.  There was a tent shading us and some fans blowing but somehow it just wasn't enough to overcome the Indian sun.  We finally made it to the temple, and our offering was taken by a Sikh man who reduced it to a more manageable amount (as we were supposed to eat it) and then we went inside.  We were able to give our offering to some men who were seated in the middle of the temple and in exchange we received a bright orange cloth with two sugar discs to share with those for whom we prayed.  (Get ready family, I'm bringing it home).

Finally, we went to the Wagah border which is a very peaceful part of the India-Pakistan border where everynight there is a border closing ceremony.  This was awesome.  It was a little difficult to figure out how to get in but once we discovered that we could flash our passport and get basically VIP treatment, we were set.  We got to sit very close to the actual border and watch and listen as the Indians and Pakistanis tried to sing and cheer louder than the other side.  Both countries completely filled their stands and at least on the Indian side there were plenty of people who were still hoping for a seat.  The soldiers then did this crazy ceremony where they would bark out a loud command, slap their feet vigoursly on the ground, and march at lightning speed to the border gate.  They all also frequently kicked their legs straight up so that their knee literally almost touched their nose.  I have no idea how they were this flexible, it was amazing.  All in all it was just awesome to see two countries have so much pride and excitement and meet on good terms.  I went home a very happy camper.

We took the sleeper train back again last night and today have been preparing for our week in a rural village.  Today, in an effort to pack a bit for this adventure I took some things out of my backpack and to my delight a GIANT cockroach climbed out.  Awesome.  My host mom came and after partially fumagating the room with some Indian bug potion the monster came back out and she killed him.  I since have unpacked and shook out my entire bag and then sprayed it with DEET, hahaha. Yes, I know this can cause cancer but you should have seen this bug, it could have killed me.

I know this is super long so I promise I'm almost done...but just to let you know where we'll be for the next week...we are going to a rural village Patti.  There we will do yoga twice a day (hoooooray!) and seeing locals at health camps.  We will be hiking on Tuesday and Thursday to other villages to hold camps there.  I'm pretty pumped.  After that Friday we are off to Delhi and then Saturday to Germany so Joe can finally meet my family!

I hope you are all well!  I think of you often and can't wait to see you again!!

OBGYN - Joe

It's been a while since I've done OBGYN -- in fact, I haven't delivered a baby since January of 2010.  So it is refreshing to have a chance to be in the ob clinic and hone in on my pregnancy knowledge (even though I won't really use it in the future too often, I think).   The preceptor that Steph, Anjoli, and I have for OB is great; she's a very competent, straight-forward, and medically open-minded physician that has been very pleasant to work with.

I asked her, on our second night there, how her billing system works.  Surprised I was to learn that she was going to answer that question quite literally, quite exactly.  For example, it costs 200 rupees for a consultation (5 dollars) and any repeat consultation within a 10-day span is free.  This does not apply to any emergency consultations at the middle of the night, which are totally acceptable by her perspective, as she lives in her clinic and she is virtually available 247 for emergencies.  Then when she told us about the cost of deliveries (birthing, babies, ... not pizza) I was stupefied.   Assistance in a spontaneous vaginal delivery is 15000 rupees (300 dollars).  Cesarean section is 25000 rupees (500 dollars).  That is the total cost for each of those events -- her patients aren't going to get a separate bill for the hospital fees or for the anesthesiologist (patients at her clinic don't get epidurals as the additional financial burden would become too much).  I'm not sure what type of anesthesia she does for the c-section, but I will ask tonight.   Her patients are expected to pay at the time of their consultation, or, in the event of a delivery, at the time of discharge.    How radically different is this from the US model of health-care??   I understand that the operating costs and overhead between the two models are not comparable -- however, I find it remarkably less stress-provoking to think of a model where the physician dictates the price of his/her services, not some middle-man insurance company who has no concern about the patient or the physician's well-being.

In non-medical news, we went out for lunch today -- and it was delicious.  Biryani, hot and sour soup, and vegetable kofta in manchurian sauce.  Only to be completed later in the day with some Baskin Robbins; it tastes as good here as it does at home, and probably even better due to the fact that it was scorching hot today.

Making a rebound - Steph :)

Well...the last few days have been rough.  I have spent a fair number of hours in the fetal position, in the bathroom, and at times with tears in my eyes and curse words flying out of my mouth...but now, I am feeling much better and ready to rebound back into my Indian Adventure.

I'm not sure what it was that set off the gastrointestinal disaster that ensued over the past few days.  I have been super cautious about the water I drink, the food I eat, and I regularly use hand sanitizer after I touch anything questionable.  Either way, some stomach bug got to the best of me and brought out the worst in me.

That aside, let's catch you up on the happenings since my last post...this weekend we went to Rishikesh, which was absolutely beautiful.  The Ganges river, a holy river, flows through the center of the city and it is an amazing green color like nothing you've ever seen before.  There are mountains in the backdrop and to the excitement of my yogi (yes, this is the correct word for one who does yoga) heart, many many ashrams where visitors can come to train in yoga.  Sadly it was only a day trip so I didn't get the chance to partake in a class, but I see a trip to an Ashram in my future, I'll probably need it after residency.

We did a little shopping, ate and drank a ton (likely the culprit was in here somewhere) and then took an evening bus back to Dehradun to our new homestay.  The bus situation is what I've come to think of as "typical Indian."  Although the bus leaves from the station every 15 minutes and is sitting there waiting for passengers for at least ten minutes before departure, the overwhelming majority of people get on anywhere along the road during the trip.  In fact, when we left the station there were maybe 5 people in total on the bus, but within the first 30 min of the trip we had stopped I don't know how many times to pick up people on the side of the road.  It came to the point that every seat was full as well as the aisles and space around the driver.  Everyone happily crams together and no one seems disturbed that we are wasting insane amounts of time stopping every 5 feet to pick up more people.  For someone who gets easily stressed about efficiency I have found these situations remarkably refreshing.  I could never live my whole life like this, but it is nice to step out of the non-stop attitude of America and realize as my mom used to say "we will get there when we get there."

This week we are in Dehradun as I have mentioned.  We are staying with a new homestay, she is a bit much for me but she is incredibly sweet and means well.  She just has to know where we are and what we are doing every second and continuously wants to shove food and tea down our throats.

Clinic wise we are working with a cardiologist and an Ob/Gyn doctor.  The Cardiologist works in a government hospital while the Ob/gyn has her own practice/mini hospital which is known here as a "nursing home" (it saddens my heart that nursing home in this context does not refer to old people at all because i can assure you that the older adults here are just about the most amazing people ever).  In cardiology clinic we get the chance to see amazing things like severe murmurs in small children from rheumatic heart disease, and a guy who has had his mechanical valve in much longer than would ever be recommended in the US because of the risk of surgery/cost of the procedure.  It is incredibly sad sometimes when I think about the care they would receive in the US and Joe and I recently had a conversation about whether or not the general population here would be upset if they knew what care the COULD receive.   Would they fight for the same care or would they just think we are absolutely insane for keeping people in the ICU on ventilators and dialysis and balloon pumps?  Sounds like a good topic for my paper, so I won't bore you :)

Well friends, it is time to go to ob/gyn clinic.  I hope you are looking forward to maybe one or two more posts this week because next week I am apparently living in a very rural village and so internet will not be a part of my life.

Hooray for feeling better!!

Rishikesh

We went to Rishikesh on Saturday for the day.  It was a pretty low-key trip in all; we took a bus there and back from Dehradun.  Rishikesh is located on the Ganges, which is extremely beautiful.  I was actually supremely surprised to see that the Ganges was not as polluted as I would have originally thought (the rest of India is a giant, unorganized landfill).  They say that the water of the Ganges has the power to cleanse you of your sins, so Steph and I took our shoes off and stepped into the water for a bit.  It felt great, as it was easily in the 90's in Rishikesh. 

I'm going to keep this pretty short, because I'm not feeling too hot.  I woke up at least 10 times last night and had to exercise a bacterial bowel cleanse, so to speak.  I think I actually have Montezuma's Revenge -- so I started taking cipro last night.  For some reason, our homestay cannot understand that I don't want to eat anything right now -- she seems completely offended by my lack of appetite. 

Almost halfway- Steph

So I can't believe that I have been here almost two weeks now.  In some ways it feels like forever since I saw a bathroom with toilet paper and in others it feels that this place is just as foreign as it was when I walked out of the airport.  I try to remind myself everyday to try to be present in the moment and not count down the days, but I will be the first to admit, that I have caught myself counting down the days until I see my friends and family again.  Now, don't get me wrong I am still enjoying myself here 100%, but the so called "honeymoon" period has definitely come to a close.

Today we got to go to a Tibetan village in a valley very appropriately called "Happy Valley."  It was a beautiful little oasis filled with prayer flags and centered around an amazing temple.  We saw the most lovely Tibetan monks (and yes, the future geriatrician in me forced me to take a picture) and many children coming to clinic in their cute little school uniforms.  For the most part we didn't see anything too exciting medically speaking, just some coughs and colds and a few rashes.  The Tibetan people were just so grateful for the care they were receiving, it was wonderful to be there.

Otherwise we have just been hanging around Mussoorie.  I am becoming more and more aware of the nuances of Indian culture.  As I mentioned in my previous post, there is definitely a gender separation issue here in the clinics.  Today I worked with the American woman I mentioned last time (she is originally from India and now came back with her 4 children and husband).  She runs an ob/gyn and women's clinic.  We had one patient come in with some pretty vague complaints of rib pain and shortness of breath.  Of course there are emergent issues like a blood clot to the lung that would need to be ruled out, but really her story wasn't very worrisome and I know in the US she would be told to take some Ibuprofen and go on her way.  The physician sent the patient to get a few quick tests and once the patient left the room turned to us to say that she didn't really think that there was anything wrong with this patient but that Indian women are very oppressed and often abused, so it was important not only to rule out potential organic problems but also give the woman some much needed attention because a doctor's visit may be the only time really spent focusing on her.

I have learned recently that women here are less desirable children (which has led the government to make it illegal for a physician to determine the sex of a child by ultrasound).  When a woman is old enough, she gets married and then becomes a part of her husband's family, meaning her biological family invested in her for the first however many years of her life and then don't get to reap any benefit when she is older.  Concurrently, when she enters her husband's family her mother-in-law often abuses the new bride because she is "another mouth to feed."  It certainly is hard being a woman around here. I find myself wishing desperately that there was something I could do to help these women when I hear these things, but I know that this is something so ingrained in their culture that it will take years to dissolve.

Sorry for such a downer post, I really am having a lovely time, I guess it just wouldn't be fair to portray India as all sunshine and happiness because life here for many is far from it.

I do however hope that you have sunshine and happiness wherever you are!  I miss you all!!

Pictures of Mussoorie -- Joe

Just wanted to share some photos of Mussoorie.  They were taken from my I-Phone -- so not the best quality, but you'll get a picture for the area we are currently in.

We leave here tomorrow, sadly.  Luckily, we have an awesome weekend trip setup in Rishikesh, which promises great excitement.  I really hope that they have a place where I can get a nice brew -- I miss my beer.

Mussoorie Mountain Magic- steph

So as I mentioned in our last post we are in Mussoorie, which is up in the foothills of the Himalayas.  Although I am a girl from the Midwest who is used to flat land, I wouldn't let the term "foothill" fool you, these are mountains.

The views here are breathtaking and the culture is with a little less hustle and bustle than Dehradun which I really enjoy.  The only problem I have with the area is the weather...it is cold.  As India has no central heating and the hospital is made of stone, I literally wear every layer I own basically all the time.  I am hopeful it will be warmer tomorrow, power of positive thinking.

The hospital is a christian missionary hospital and is really quite nice.  We work in clinics in the mornings and then usually have the afternoons free which is great.  The interesting thing about the clinics here is that female patients see female physicians and males see male physicians.  This was not the case in dehradun, which is only 20 km away.  I have no idea why.  We are staying in the hospital, in rooms on the second floor, which at times makes me miss the coziness of my homestay last week, but our room really is nice (although cold).  The good news is there are other med students from the UK there and they are just delightful.

The highlight of my day today (as we were feeling a bit down as it was cold and we were imprisoned by the rain) was visiting an American couple's home.  They are both family med physicians and she is originally from India which inspired them to come back and do some work here.  They have four beautiful children who they home school.  They plan on living here until there oldest (now about 9) is a teen and will want a more structured social group.  There we had a lecture by a woman from New Zealand who talked about her work trying to improve nutrition for children in India.  Again, I began to somewhat idolize this woman.  I certainly do not feel that international health is something that I could do long term although I wish deeply that I was the kind of person who could suck it up and do it.  I just find these people absolutely inspiring, and they gave us fresh baked chocolate chip cake and hot cocoa :)  oh how I miss chocolate.

I had a bit more written, and for better or worse it is gone now.  There hasn't really been much exciting happening here and now I am off to dinner!  Miss you all!  Thank you so much for all the comments, you have no idea how much they brighten my day!!!

Mussoorie -- Joe's take

6000 feet above sea level.  I'm not sure if it's the low oxygen tension or the steep roads that we have to traverse, but it's giving me angina.

Not really, of course.  But it is simply astounding how the human body can adapt to such conditions.  There's not an obese person here; there are 60-70 year old men carrying 80 pound sacks of whatnot on their backs up these crazy mountains.  I'm pretty sure they could kick my tail.

Mussoorie is beautiful.  It is one of the most picturesque places that I have ever seen in my life.  There are mountains all around us, and the village twists and turns, totally entwined in the tortuous curves of the slopes.  It is what I have always thought that Nepal would look like, a civilization tucked away from the rest of the world in the unmoving folds of the mountains.  The bad thing is -- it is freezing here.  This would be alright, but I packed for warm weather.  Needless to say, I've shivered off at least 80% of my excess body fat.  Sweet.

The clinic here is alright.  We go in from 10-1 and then we're essentially done -- we are given the option to do more, but Steph and I would rather read or enjoy walking among the village.  For example, after clinic I was told that there was a hernia surgery that I could go scrub in on.  After half feigning a moment's interest, I said that I would rather pass.

There are other people from the UK and Ireland (3 girls total) here with us for this week.  They are great.  I especially love the Irish accent, and I continually find myself laughing aloud when she says something particularly authentic.  We are actually going to meet them for dinner now -- so I am going to bid the screen adieu.  

Weekend of the Taj -- Steph/Joe Combo

Steph and I decided that we were going to blog about our weekend at Agra, the city where the Taj Mahal is, together.  I'll be in normal font, and Steph will spice hers up with italics.

We were ready to set off on our first Indian adventure on Friday night.  At 8pm as scheduled, our cab arrived to pick us up.  Our program coordinator graciously agreed to set it all up for us, but then unfortunately happened to mention that he was a little worried about our cab driver.  For those of you who don't know, Joe is the ultimate back seat driver.  He trusts NO ONE'S driving but his own, and maybe his father's...No, actually, I don't trust my father's.  Ok, fine, he only trusts himself.  So for whatever reason we both get incredibly nervous, Joe throws around the idea of not going which well...makes me pretty peeved.  We walk out to the cab and see our driver, he looks just over 14 years old with the worlds tiniest car. 

This is when I first start to get that uneasy, impending sense of doom feeling.  But Steph says in classic fashion, "well what do you propose we do now"?  Great.  So we end up getting in the car anyway.  Then I quickly find out -- there are NO seatbelts.  Steph gets this deer-in-headlights look on her face, and I was pretty confident that we would have a high probability of dying on the road.  I'm not going to lie, at this point I am freaking out too, but I am absolutely dead set on making it to Agra.  Joe throws a fit, I try to pull it together and we finally decide to get another cab (a larger one with seatbelts). 

Our new cab shows up, and I already am feeling like a ridiculous demanding American.  I try to assure myself that it's really just because I value my life.  We set off, but only after an hour of stopping to buy chew (the driver that is, not us) and picking up his "assistant."  At first things are ok, just the usual near head-on collisions that we have come to expect, but then it gets a little dicey as we head into the mountains.  There is one lane at times and a steep cliff with no sign of a guard rail anywhere.  I eventually decide that I would do a lot better if I just closed my eyes.  So I do, and I fall asleep. 

I, however, do not.  It gets to be 1 or 2 in the morning and my eyes are fixed on the driver and on the road.  Steph tried to reason with me that I should just go to sleep; I told her that it frankly was not possible.  Moreover, I explained to her, the driver's "assistant" (his friend in the front seat), had already fallen asleep and thus could not be depended upon to keep the driver awake.  Someone had to do it, right?  Steph did not seem so sure -- but I knew that I was right (in classic Joe fashion). 

Yes, actually, and I quote from Joe "Someone has to stay awake with the driver, DIDN'T ANYONE EVER TEACH YOU THAT?!"  I stop feeling bad for him and just close my eyes again, haha.  Minutes or maybe an hour or so later he wakes me up, concerned again about the driving.  At first I am just annoyed, but then I realize that our driver has his eyes closed and is swerving out of the lane.  I panic and say "Um, excuse me, do you need to stop and take a rest?"  He wakes up, insists that he's ok and within minutes swerves again, nearly killing us.  I again demand that he needs to stop.  He ignores me and eventually stops to get more chew, for once making me thankful for nicotine.  The rest of the ride is relatively uneventful, just about 100 more near death experiences and a massive traffic jam where I had to wake the driver up to let him know that the traffic cleared and he could drive again, AWESOME.

Sorry for expanding so heavily on all this up to now -- but we felt it was necessary to give everyone a sense of the panic we both had.  ANYWHO -- now we're in Agra.  We had wanted to go to the Taj and then go to Fatehpur Sikri and stay the night there in a hotel we had made reservations for.  But no, this is where the grafting and grafters take over and determine our destinies and how best to exploit the dumb Americans.  We try to tell our driver our plans... he says, "we go to a friend's hotel of mine, it nice".  There was a major language barrier so we just went with it.  The place charges us way more than they should have for a tiny, musty, awfully-decorated room.  They tell us that we'll have to wait for the next morning for Taj and that we should go to Fatehpur at noon, giving us a few hours to rest and get lunch.  When we meet in the hotel lobby at noon, we suddenly have a "guide".  Did we ask for a guide?  No.  Did we want a guide? No.  Were we stuck with him? Yes. 

Luckily, he ends up being wonderful and I am so glad we had him.  He was very nice and knowledgable and even called us a "friend."  I bought it, for a while, but I will get back to that.  Fatephur was ridiculously beautiful.  Seriously one of the most awe-inspiring things I have ever seen.  It was the emperor's palace.  He had three wives (one for each religion- christian, hindu, and muslim) and had a palace for each.  Absolutely amazing.  We got to tie a string (for a price of course) to a beautiful ornate gate which brings you luck and one free wish.  It was really a wonderful experience.  Later that afternoon, we went to Agra Fort, again beautiful.  It had great views of the Taj and was where Saison was sent to be inprisoned when his son wanted to be king.  After all this, we suddenly are taken to gift shop after gift shop where we see some hokey demonstration and then are offered stuff that was probably made in China. 

I told Steph that our driver and guide probably have a deal with the local merchants in order to bring us over to their shops.  Turns out, they do.  By the end of this trip, I realized that my paranoia isn't completely unfounded.  We don't buy anything in the shops and then we are taken back to our hotel.  We had wanted to go and walk around and find a nice restaurant; when we asked our guide for a suggested restaurant, he told us that our driver would take us to a place that foreigners' usually like.  And that was it -- we didn't really get a chance to dispute his supposed suggestion.  The food at Indiana (weird, right?) was pretty awful.  Steph and I both had dishes with meat in it, and the meat was utterly inedible (we've since decided to stick to all vegetarian dishes while in India -- they simply don't know how to prepare meat here).  BUT, we did have one magical item... BEER!  We both only had one, and it was marvelous; it only took the one beer to completely knock us out.  I had been up since 7 AM on the day before, so I was dead to the world in seconds of hitting the bed.

We slept like rocks and got up the next morning for the TAJ!!!  It was amazing (I know I've used this word a lot, but really it is beautiful).  We took about a million pictures and learned a lot more about Indian history (which I won't bore you with right now).  We also saw a wild peacock and monkeys!  Which was a fabulous bonus.  After a few hours of taking it in, we got some street food for breakfast.  It was a deep fried spices biscuit like thing with green chile and potato sauce in a LEAF bowl!!  Awesome, but I was a little nervous about potential GI backlash.  We survived, were taken to about a million more gift shops until we threw a fit and hit the road to go back "home" to Dehradun.  After another incredibly frightening 10 hours in the car we arrived safe and sound to our homestay.  We again slept like rocks and woke up this morning to be driven to our new location for the next week Mussorie (pronounced is Missouri).  It is up in the mountains and it is ridiculously beautiful.

Thanks for reading friends, we will keep you updated this week with more adventures!!

Indian food and other random thoughts: Joe

I thought today would be a good opportunity to talk about food.  Apparently that's what people want to hear about -- go figure, gluttonous Americans back home only want to hear about the food-- JK.

The first morning we were at our homestay was quite a shock.  Imagine, if you will, a grilled cheese for breakfast.  Except, it's not cheese, but  flattened potato slices that have been spiced with various Indian flavors (curry and heat).  I hovered between disgust and bewilderment for a few moments, then said screw it and popped it in my mouth.  It was wonderful.  Every breakfast is served with tea, which is nice -- it's basically a combination of tea leaves, water, and milk that gets boiled together and then sweetened.  It's not coffee, but it's quite tasty.

Most meals that we have at our homestay are delicious variations on a theme.  The theme itself is simple:  a vegetable medley that gets curried, basmati rice (love this stuff), and some pita-like bread called roti.  Usually there are more than one type of curried dish for dinner that mixes two or three veggies (cauliflower, peas, carrots, potatoes, green beans, and chickpeas are favorites in our homestay).

It is quite impossible to find coffee in this place.  I started to get awful withdrawal headaches yesterday, so I found a vendor that had mountain dew.  Two things about the elixir of life: (1) it only cost 20 rupees for a 20 oz bottle (40 cents or so), (2) they use glucose and not high-fructose corn syrup for their sweetener (it's ... different).  We went early to clinic today so we could stop at Cafe Coffee Day.  It is, without exception, the dumbest name for a coffee shop that I've ever witnessed.  The managers/owners must have anticipated this type of condemnation in regards to their branding, so they cleverly stocked the store with the most delicious coffee that I've had in a long time.  No joke -- it kills Starbucks and Hubbards and (etc... every other big coffee chain in America).

With great humility I will let you all in on the experience I had while eating out at an Indian restaurant for the first time.  There were 8 of us in total, all students and one site coordinator.  The food looked delicious on the menu, and I was super excited to try some authentic food.  I started off with a chili paneer, and it was delicious.  Paneer has the look and texture of tofu, but is actually a form of low-density cheese that has incredible flavor.  They make a lot of it and combine it with various vegetables and spices/sauces.  After the chili paneer appetizer, I took my coordinator's advice and got a larger paneer item for my actual meal.  Even after the first appetizer, my stomach started to cramp and feel a bit off, but in classic form I shrugged it off and continued on.  I finished most of my dish, and Steph's, and Anjoli's... me --> fatass.  We paid and left (Steph, Anjoli, and myself).  Walking down the road, I started having pretty intense gas cramps, but I kept going with the girls because they wanted to shop.  I thought it was going to go away -- wrong --  it just continued to get worse.  I started to sweat and get light-headed and it felt like a 3-year old was playing Operation on my abdomen.  Steph could see it on my face and encouraged me to turn back towards the coffee shop so I could use the bathroom.  I almost didn't make it.  Long story short (to skip the gruesome tale of how an innocent Indian restroom was forever scarred), I found out that I have a form of lactose-intolerance or something.  The way that they prepare their dairy here is much different than we do, and my intestines weren't fooled.

Finally, on a non-food note.  I admire the way that the people here are so straightforward -- their innate ability to call a spade a spade, so to speak.  They don't have Plan B here, as we found out today.  They have Unwanted 72.

Indian food and other random thoughts

One of the most exciting things about going somewhere new is the food.  Indian food has not let me down yet.  It is just as colorful and spicy as its culture.  While everything seems to be more a less a variation of every other dish they are satisfyingly different.  Lunch and dinner are vegetables or beans in a red spicy curry broth, seasoned sauteed vegetables, served with basmati rice and a delicious bread that looks like a tortilla called roti (I am obsessed).  People here eat very little or no meat because animals are regarded highly.  Although they are not vegan many also don't eat eggs because they could potentially be fertilized.  Milk and dairy however are completely acceptable.  For those who eat meat, most avoid red meat as the cow is sacred because it provides milk, like a mother would; therefore, eating a cow would be like eating your mother.  Because of this high regard for the cow, cattle literally rule the roads.  Cows and oxen which are used to haul carts are allowed to roam around which sometimes ends in a nap in the middle of the road.  I find these situations absolutely hilarious because with everything else that gets honked at here, people carefully and quietly go around the cattle.

Another amazing thing I have fallen in love with again is rice pudding.  When I was younger my mom would occasionally make rice pudding and I had a very close friend Georgeanne who was Greek and her mother too would make us rice pudding.  While my mother (and Georgeanne's mother for that matter) are excellent cooks, the Indian rice pudding puts every other rice pudding in the world to shame.  It has all the usual ingredients (being rice, milk, sugar, cinnamon, vanilla) but then there are slivered almonds, a magical combination of other spices, and sometimes what tastes like soggy corn flakes (I know, that sounds gross but trust me, don't knock it until you try it).

Being a sweet person and a tea lover I am also obsessed with the chai.  Starbucks has nothing on this stuff that you can buy on the side of the road for cents.  Of course people here still have a concept of portion size, so you get "one cup" which is 8 oz.  Starbucks smallest is 12 oz.

For those of you who are curious, obesity is not nearly as big a problem here as it is at home.  There are obese people and according to the people we've been working with they are increasing in number as people eat more processed foods and exercise less.  Although I have yet to experience it, the fast food companies that have come here (McDonalds, KFC, Pizza Hut) have "indianized" their menus.  KFC apparently puts indian spices in its breading and it has a separate grill for vegetarian food.  I just may have to venture into one of these chains to see for myself especially because ice cream is very popular here (and somehow more delicious as well) and as my dear friends Anna and Karyn know, in every new country, the McFlurry has to be sampled as they usually have very different toppings to add in (ie- cadberry creme eggs in England).

Tonight Joe and I leave for the Taj.  We rented a taxi for the whole weekend so if you are the praying type, go ahead and say one for our safety otherwise just cross your fingers or something.

Joe the "less verbose one" all the days since day 1

We started doing clinical "work" on Monday of this week.  The overall schedule goes something like this: breakfast, take the vikrem to Doon hospital, spend a few hours in the ophtho clinic, go back to our homestay for lunch, chill for a few hours, then take an auto to City Heart Centre from 6-8:30 for some ER/cardiology time.

The ophtho clinic is pretty unreal.  We usually spend about 3 hours there a day, and our preceptor is a really awesome guy who loves to teach.  Patients stream in and out of his obscenely small office, which is directly open to the waiting room. Essentially, it seems that whoever is able to shove their way to the front  of the line gets the next facetime.  That being said, even with one patient in the room, others will just come in and start talking to the doctor (and that's totally appropriate).  HIPAA is non-existant in India -- and it's slightly refreshing.  We've seen some pretty ridiculous cases come through:

(1) A type-1 diabetic girl, looks 8 yo but is actually 14, with a cataract in her left eye.  Her other eye had already been operated on. We got to see her operation on Wednesday.  The doctor thought her diminutive and cachectic appearance was secondary to underlying nephropathy.  SAD.

(2) An extremely pleasant older lady that had recently been operated on for cataracts.  She had a hypopyon (pus in the anterior chamber of the eye), which is something I've never seen before.  Also, when looking at her hands, we were completely taken aback.  They were mangled and deformed with digits fused together and auto-amputated (it looked like a plastic hand that had been melted together).  The three of us (steph, anjoli, and me) tried to guess what it was.  Bad rheumatoid arthritis?  Burn injury?  When she left the doctor turned to us and said, "she has Hansen's..."  That sparked a very rusty lightbulb in my brain, but it took a few seconds for it to register...  Hansen's = Leprosy.  Holy cow.  I will not see this again in my lifetime.

(3) The "operation theater" is sweet. The doctor did 24 cataract cases in one day.  While we were physically there, he did 7 in one hour -- puts us in America to shame.  Moreover, the operation only costs 750 rupees.  Less than 20 dollars.    Everyone pays out of pocket.  We really got fix shit in the US.

I have mixed feelings about our time with Dr. Gandhi in the ER.  He's an amazing man; he single-handedly runs 24 beds, including an ICU, while keeping his door open for walk-in appointments.  By ICU, I don't mean pressors and vents -- that doesn't exist here, but there are somewhat sick patients.  On the first day there, (after taking off my shoes to walk into the ICU ... WTF?), I looked at a few of the cardiac monitors for some of the patients there.  Active ST depressions in leads II/III/AVF for the patient in bed 3; afib with RVR for the patient in bed 12; a man with massive ST depression on his rhythm strip in bed 5.  Is cardiac cath in their future? Nope, try again.  Dr. Gandhi would promptly tell us that all these patients are doing better than when they came in. Really? Because I was pretty sure that their hearts' were bleeding in disagreement.

If that didn't make me somewhat skeptical of Dr. Gandhi's management, the story I heard from steph about how he handled a patient with R upper lobe infiltrate and ipsilateral hilar adenopathy pretty much sealed the deal.  After putting the patient on a cephalosporin, a beta-lactamase inhibitor, and clarithromycin, the fact that the lesions didn't get bigger signified that there wasn't TB.  Right.

Time outside of the clinics is pretty swell.  Our homestay lady is a fantastic cook and we get fed 2-3 of our meals by her.  Initially, I was quite concerned, since everything was vegetarian and we don't have access to alcohol.  I wondered to myself, if I go through delirium tremens, will it be meat-DTs or alcohol-DTs?   I bet most people would place their money on the latter, knowing the affection I have for the 'occasional' drink.  But they would be wrong.  I don't want to go into too much detail about the pseudo wet-dreams I've been having about St. Elmos ... but yeah.

I finished reading Survivor by Chuck Palahniuk -- freaking awesome book.  I recommend it to everyone.  Unfortunately, I finished that book in under 3 days, so I knew I would need a more substantial book to bide my time.  So I picked up Atlas Shrugged yesterday.  I'm only 75 pages into it so far, but I can tell that this is going to be a mindbending read.

Last of all -- I wanted to throw a shout-out to my man, Merv.  He's the loyal friend who sits on the wall of our room, a silent guardian 247 -- or at least he would be if he wasn't a 6-inch lizard.  Honestly though, I look forward to seeing him every day.  And yes, I'm an expert at figuring the sex of lizards.

All the days since day 1: Steph

Luckily things are still going well for Joe and I in India.  We have been busy working in two different clinics since we've been here.  In the mornings we work with an ophthalmologist (Dr. Ramola) at a government hospital.  No offense to all you future eye docs out there but I wasn't really too jazzed about spending hours of my morning looking at eyes.  To be honest, eyeballs gross me out.  However, much to my surprise, it has been an amazing experience.  We see a lot of crazy pathology that you would never see in the US where most people have easy access to doctors.  We've seen leprosy, tons and tons of cataracts (even in children), and some crazy injuries and infections. 

The clinic experience in general is unreal.  Much like the traffic, it is loud, unorganized and  every man for himself.  There are no appointments, in fact for cataract surgery everyone is given the same appointment.  That day, everyone shows up and then they just go down a list.  When it's your turn you gratefully accept and go to the OT (operation theater).  In the OT they do a nerve block with lidocaine to paralyze the eye for the operation.  There are no other sedatives given, just a quick warning and a syringe to the eye.  Amazingly, hardly anyone even flinches.  There are always three patients in the OT at a time, two waiting and one being operated on.  The conditions are clearly less than what we know as sterile and there is no semblance of privacy.  However, the cost and time are greatly reduced and the complication rate doesn't seem to be any higher when we see his post-op patients from the days and weeks previously.  The patients graciously thank the physician who seems to be placed on a pedestal in the minds of most Indians (even though they get no pain medication after the procedure and when they complain about pain their comment is not even acknowledged).  The power to deny pain medication someone is something physicians in the US don't seem to have as we have now all been taught that pain should be regarded as the fifth vital sign, something that needs to be addressed just as a fever or high blood pressure. 

Outside of the clinics we have an absolutely wonderful homestay, Ms. Mehta.  She's just awesome.  The food she cooks is delicious and she is a very sweet lady.  We come home after ophtho, eat some amazing lunch walk around town and then head over to Dr. Gandi's.  He is an emergency physician, but the emergencies are much different here since there is no "911" to dial and ambulances are a rarity; most people who are seriously ill die at home.  The patients he ends up seeing are more like family medicine cases- people with a cough or cold, although he gets a fair amount of chest pain patients.  When the patients come in, since I don't speak Hindi I often don't know who the patient is at first.  There is usually an entourage of people who speak for the patient, but the patient himself remains pretty quiet and a physcial exam may or may not be done.  The family usually brings in the medical record, as hospitals do not keep records for you, it is your responsibility.  The doctor looks everything over, writes some suggestions and you go to the pharmacy (no prescription needed) and buy what he suggests.  Later on, you could just go to the pharmacy and ask for the same thing if you felt the same symptoms again, but most people here amazingly don't self treat.  Crazy, I know.

All in all, I am incredibly grateful to have been born in America where my access to healthcare is so great.  As much as I complain about the inefficiencies of Wishard and the VA, Americans really are so lucky.

For those of you who don't like medicine, I am so sorry that this has been nothing but a long blog about how different medical treatment is here.  This weekend Joe and I are planning on going to the Taj Mahal so look forward to an exciting post about our adventures there!!

Arrival and Day 1: Joe

Steph and I are simultaneously blogging about our India experience.  She's much more verbose than I am, so I'm going to try to keep it nice and brief.  Here it goes:

So, we leave on Friday at 9 PM, and we don't end up getting there until Sunday at 7 AM -- this boils down to a whole lot of time up in the air, and losing a whole bunch of time by changing time zones.  If you didn't already know this about me, I'm deathly afraid of flying.  It's irrational, I know, but I can't stop thinking that I'm going to die at every next second.  LUCKILY, there's a cure for that.  Alcohol.  I was pretty buzzed by the time I got on the first plane to Munich, and that helped a deal.  Unfortunately, I didn't sleep at all.  Nor was I able to get much sleep during the layover.  I felt like a post-call zombie. LUCKILY, there's a cure for that too.  Yup, you guessed it.  The second flight was pretty uneventful, needless to say we got to India eventually.

So now we get there and past customs, and then some nice Indian man spots us and directs us to his car.  As we pulled out onto the street and into traffic, I could only think of one thing -- shit just got real -- and it kept going on repeat.  And to think that I thought that flying was scary?  I could actually die on the streets here.
We made it, by some stroke of good fortune, to our first destination: some beat up hostel next to an eye clinic.  We were given a room and a few hours to rest before we had to eat and get to the train for Dehradun.  Holy cow, I passed out.  I'm also really glad that we brought sheet-sacks to sleep in -- the upkeep for the beds here is not stellar.

The train ride was awesome, except that I didn't get to ride with Steph (she was in a different cabin).  The sites were beautiful and breath-taking, and yet, they were filled with a poverty that I had previously never seen.  Occassionally there would be the equivalent of a septic sewage river that would run parallel to the train -- brimstone doesn't have shit on the smell of that.  It took about 6 hours and then we got to our homestay. I had about 4 hours of sleep in the last 48 hours, so after a brief introduction to the family, I passed the hell out.

I could say a lot more, but I won't.  Stay tuned for info about the homestay and clinics.

Arrival and Day 1: Steph

It's almost impossible to put into words all that we have experienced since leaving Indy on Friday, but, we are going to try anyway. :)  Joe and I are going to blog together because in most things we experience together we have very hilariously different interpretations and perceptions of things so we sincerely hope that you enjoy reading about our crazy Indian adventure. 

xoxo
Steph and Joe

Steph's day 1:

We left on Friday from Chicago O'Hare and flew into Munich.  The flight was wonderful for me, I drank wine and then slept the rest of the way (I am my mother's daughter).  In Munich I had a pretzel, sausage, and beer, took a nap and then jumped on another plane to Delhi. 

In the Dehli airport you wouldn't even know you were in a different country, but as soon as you stepped out...oh my.  There were so many sounds, sights, and smells to take in all at once it was absolutely insane.  I would love to bottle it all up to take home and share with you but I am absolutely convinced that such a bottle would burst.  There is poverty right next to incredible wealth, beautiful countryside but litter strewn about everywhere, and most of all there was traffic.  At first I thought that Indians had a lot of road rage the way everyone was honking, but I've come to realize it's just a form of echo location.  You honk and that means here I come, move.  Despite the numerous close calls (one involving me as a pedestrian and a motorcyclist speeding right at me, take a deep breath mom and dad I'm ok) I haven't seen any major disasters (hopefully it stays that way). 

In Delhi, we were greeted by a program coordinator who later took us to a train to our first week's location, Dehradun.  The train station was my first experience being in a large Indian crowd, and I quickly realized that I stood out like a sore thumb with my pasty skin and long blonde hair.  I apparently also wasn't the only one who realized this because it seemed that everyone was just staring at me.  It made me feel awkward and out of place and really just terrible.  Although I want everyone to be happy and healthy I wish that we all had the chance to feel that way at least once in our lives.  It quickly makes you reflect on how you treat minorities in your own home country.

On the train my stigmatized status turned to celebrity status as the woman and little girl next to me began intensely quizzing me about everything American and offered me biscuits and tea.  Also, a somewhat uncomfortable experience, but much preferred to endless gawking.

We finally made it to Dehradun and had our first dinner at our homestay.  Spicy and delicious, I was in heaven.  The next day we ventured into the clinics but I will save that for another blog for now I am just happy and in love with India.