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!!