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.