CHAD

For my last rotation at CMC, i was able to do CHAD. I can't remember what is stands for, but basically its a team the consists of either doctors or nurses with a healthcare aid. These groups travel to different towns or villages and go home to home to check up on patients. It is a wonderful cultural experience! I loved it! We walked into families homes, went up into the mountains to small villages, and walked through rice patties to get to them. It's exactly why I came to CMC. What's funny, is that nobody believes that I am not Indian. They all started to speak to me in Tamil, and when I couldnt understand, the nurse would translate to them that I am in fact, not India, not even northern Indian, to their disbelief. It's become a joke between my classmates. It was wonderful but shocking to see how people live. Some homes are made of cow dung walls and dried leaves as a cieling. The people were so friendly, even though they have barely enough money to live, they constantly offered us food or something to drink. Little kids are just running around the fields as their other family members tended to the crops or livestock. A lot of what these groups are trying to accomplish are minor checkups, prenatal care, and assesment for further care. It helps to bring healthcare to those who would most likely not be able to make the journey into town on their own. The healthcare workers are basically the connection between the villages and the hospital. From what I could gather, their is a designated healthcare worker for each village or a groups of villages, and she is responsible for documenting the births, deaths, and marriages. So because of this, she knows about all the families illnesses as well, so she is the one that take us to the homes and remembers their complaints. It was definitely a great expereince, something that I am glad I was able to have.

Our weekend trip to Kerala

So for the weekend, our whole group of classmates plus 2 others from Oklahoma went to Kerala. It is on the other side of India from Vellore, and we have all heard it is beautiful. When we made theses plans we were supposed to take a night train there, but there were no spots because one of the schools here in Vellore just had a graduation so apparently they wanted a trip too. After a lot of researching, Dinesh and our travel agent, Joseph, found a travelors van that seated 14 people. So we hired a driver and made the drive from Vellore to Kerala. The drive was only supposed to be about 12-13hrs but it took and additonal 3-4 hrs because the driver was terrible. When we finally did arrive in Kerala, it was breathtaking. So beautiful and serene. One of Dinesh's friends, Manish, had provided a houseboat for all of us to float down the backwaters and just have a fun, relaxing time. It was amazing. The food was delicious as was the scenary Apparently, it is one of the top 50 things you should do in your life! I have now done 2, this and the Taj Mahal! We enoyed each others company talking and eating and playing car games. The next morning we had breakfast and then left the house boat to go to Manish's house which was in the city. There we toured a little bit and saw some areas that had been damaged by the Tsunami a few years ago. The next morning we were treated to a new experience, an ayurvedic massage. It is definitely not what you get in the states. what happens is that they give you just a loin cloth to wear and then you lay down on a wood table. A lady came in with a bucket of some herbal oil and just started to rub me with it. By the end, you are oily and in pain because she uses a lot of force. But it was definitely a good experience, but i do prefer my depp tissue massages back home! We were sad to leave our getaway but got on the road because we had a long journey. As I have mentioned before, driving in India scares me. It really does, and the driver who had been hired for our trip was awful. Unfortunately, about 80 km outside of Vellore, we awoke to to screaming and crunchind noises. We were is a massive accident. We believe our driver fel asleep. I had been sleeping along two chairs so when the accident occured, I fell down between two rows. I was freightened. I had no idea what was going on. The next thing I saw was my friends Swamy's face flying over me. Thankfully, he didnt go far. He was alright and heled me out from beneath the two rows of seats. Everything was a mess and the front of our van was replaced by the back of a truck. The whole front row was obliterated, but thankfully no one had sat there as Jami previously had. It is a miracle. Cristina was sitting in the second row on the side of the accident and awoke to find the truck mere inches from her face. She experienced chest pain and shorness of breath. Chris, who was sitting directly behind her, could not initially be seen. We removed the chair that Anne had been ejected from to find him unconscious and unresponsive. This is where I almost freaked out. After a few minutes he awok but disoriented. Swamy was starting to lose vision and began passing out. There were villagers observing what was going on, but no one came to help us. I started to yell for them to open the back door but they didnt understand. I tried to gesture but nothing. Claire was able to get out of the driver door somehow, and I think it was her that opened the back door. Kevin then bent back one of the chairs so that we could get out, but the front windshield was on the ground surrounded by shattered glass. Chris and Swamy's head were being supported by Anne and Jami, repectively, to ensure no C-spine injuries and Dinesh was examining them. The rest of us sat along the road side. We were so scared. Things are different here. No one called the police or a doctor for us. Drivers just honked as tehy came along so that they could get by. Thankfuly, 10 min late, a passerby stopped and called an ambulance. It was about 30-45 min until we got an ambulance, but it wasn't an ambulance equipped to do anything. We all piled in and told them to take us to CMC Vellore. The three serious students were seen in the emergency department, and that is a different entry, and in the end everyone is okay. We all have some sort of bruise, scrap, pain, and whatever else, but we are just so grateful for the way it happened because we are all safe and alive.

Kerala Pictures

For a weekend trip, all of the UTHSCSA students along with two of our friends from Oklahoma went to Kerala. We were able to have a house boat to float down the backwaters. It was absolutely amazing.

CMC L&D

This is the only picture I took during my OBGYN rotation. For some reason, I dont feel comfortable asking these women to pose for a picture at such a personal and vulnerable moment. This is the portion of the ward that I mentioned in my blog posting.

Taj Mahal Pics

These pictures are of the Taj Mahal. It is so beautiful! Some where taken from our hotel rooftop.

Jaipur Pics

Here are some pictures from Jaipur. They are of the Amber Fort.

CMC Pics

These are some pictures I took at CMC. It has taken me days to upload them. For some reason, I have failed so many times in putting pics on my blog. I do not know why!

Luggage Update

I just thought I would let everyone know that I finally got my luggage. It was a week late and went to Australia, but I have it now! It was waiting for me at my hotel one night. It was the most beautiful piece of luggage I have ever seen! Everything was still there and my backpack was not damaged. Yeah!

L&D

I am so excited about going into OBGYN. It is definitely what I want to do with my medical career. Seeing it at CMC has been so interesting! First, there are only a few single rooms, other than that, L&D is just one big room with curtains for the patient when she is eing checked or delivering. In fact, there is one area distinguished at the Low Cost Effective Care Unit. Now these ladies are strong. I was talking to a resident who was telling me that women hardley ever get epidureal or any pain meds besides local. That is insane! She started to laugh when I told her that almost everyone gets an epidural. Some women were labouring themselves without the help of physicians or nurses. I couldn't believe it! The resident said that Inidan women are strong, and after seeing everything, I think she's right.
I have seen many, many deliveries, but the biggest difference is the administration of the episiotomy. In the states, it is given only when indicated and along the midline. Here, it is given mediolateral, so basically towards the thigh. Remeber, these women don't have an epidural. The resident just quickly injects local at that site and then cuts. Oh my goodness, that was definitely an experience. That area is so thick. I inquired into why they were using that method, and the resident said that they use it only when indicated but that Indian women tend to have smaller perinieums, so that method is more effective. It was definitely a learning an expereince.
The sound of the fetal heart monitors are in the background along with laboring women. The same things are still of concern. HIV and AIDS is quite common here, and according to the resident, if a woman is positive, she is labored in the Biohazard Area. I found that quite interesting. I asked about a woman with no prenatal care arriving in labor, and she said that it was done and the results are given in 20 minutes. Interesting. Also, India has outlawed determing the sex of the fetus because so many female fetuses were being aborted. There is actually a sign in front of CMC that states that fact.

The other side of CMC

Up until yesterday, we had been exposed to only one side of CMC. We were part of the Staff, Physicians, and Students, but yesterday Jami and I learned was it was like to be a patient. Jami needed a checkup, and luckily the friend that I ran into from Baylor knew some people at CMC that could help us out. First we had to find the Physician, his name is Dr. Mathai. It took us quie some time and multiple buildings to do that. Once we found him, we spent less than 5 minutes with him, but he gave us our next mission... to make a chart for Jami. Now in the states, staff takes care of that, but here the patient must. We were absolutely lost! We had no idea what to do or where to go or who to talk to. At one point, Jami tried asking a security gaurd where we needed to go, he had no idea what we were saying, but someone who did overheard us. His name is Joseph, and he was so very, very helpful. In fact, he did everything for us! Even then it was a difficult and time consuming process. There were so many long lines with multiple payments and so many forms to fill out. Finally, we got what we needed to proceed, her chart number. From there we had to find Dr. Mathai once again, but this time in clinic so that he could give us a lab slip. Then, we had to wait in line again. One thing that is quite interesting here is that people as a whole do not stand in line. There is not waiting for your turn. People see an opening and take it, even if you have been waiting. This happened multiplte times throughout our day's adventure. We learned, though. We started to make sure there was no way someone could cut in front, and when someone was hovering as if waiting for that opportunity, we were ready! In the end, we got everything done that we needed, but it was quite and adventure finding out the other side even though we were helped so much. It makes me so thankful for our system back home even with all of its own flaws.

The Golden Triangle

It's official, I have seen the Taj Mahal. I am so happy. I feel that my list of things I want to do or see in my lifetime has now been shortened. In the interest of time, we had to be very efficient. Typically, people do what is known as the Golden Triangle in 5-6 days. It consists of Jaipur, Agra, and Delhi. We did it in a lot less. We decided what was important and used our classmates' advice. Jaipur is a wonderful city. It is known as the Pink City because it the buildings and walls are pink. Our first experience In Jaipur was on our way to our lodging, Shahar Palace. The owner picked us up from the airport and on our way, we saw a camel in the street! I shrieked out in excitement. I love camels! Not too long after, we saw an elephant. I love elephants!!! The Shahar Palace was so peaceful and beautiful. Animals like wild monkeys and peacocks roam. For dinner, Jami and I walked down the street to a restraunt called Spice World. It was adorable. There were white lights everywhere and ethnic dancers. The highlight of my Jaipur trip was most definitely both the elephant ride up to the Amber Fort and the camel ride later that night at Chakra Dani... in the rain. I think that overall, Jaipur has been my favorite city in India. It is beautiful with so much culture and the people were so friendly. We headed to Agra to see the Taj Mahal but stopped off to see Fahtepur Sikri which is also known as the City of Victory. Unfortunately, this is where we all became quite irritated. There were so many beggars and people just out to get your money that it was taking away from our expereince. They weren't just waiting for you outside of the complex, they were everywhere inside as well. At one point, we were completely surrounded. But oh well. Agra, the city of the Taj Mahal, was definitely an eye opener. It was incredibly dirty, busy, and most importantly smelly! It's sad that such a dirty place is associated with such an amazing structure. We got to eat dinner on the rooftop of our hotel with a moonlight view of the Taj. It just made me more excited to see it. In fact, automobiles are not allowed with 1.5 km of the Taj to prevent damage from the pollution. And then, there was the Taj Mahal. It is so amazingly beautiful. There are honestly no words to describe it. I had been told by some people that they didnt know what the big deal was, but I found it to be beautiful. It's so hard to imagine this being man made. It's incredible.

Driving in India

Oh my goodness!!! Driving in India is almost like a death wish. There is no way I could possibly even dream of being comfortable driving. It is definitely a talent. The drivers are constantly honking at each other as if they are actually communicating. I have tried to catch some sort of pattern. like what does the long, constant honk mean versus the multiplte, short honks one after another. In the end, I think it all means the same thing... watch out for my car. Honestly, I think I am going to die everyday. There is no obedience of the lines painted on the road indicating the distinct lanes. Haha, but it definetely makes us laugh. It is almost better not to watch. Taxis, buses, motorcycles always seem to just barely miss you! Driving at night is even worse. Somehow the roads become even more chaotic. Instead of using the horn, they now only use their lights. It was probably the sacariest experience driving from Jaipur to Agra and night as well as Chennai to Vellore at night. But, I am alive still!!!

I am a tourist

Yesterday was my first official adventure as a tourist. A few of us went and visited Vellore Fort yesterday after work. It was absolutely amazing! Inside of the fort walls was a Hindu temple. First, we were asked to remove our shoes and leave them with some attendants, which was actually hard for me to accept because I have read stories of people getting their shoes stolen at temples. This would have been most inconvenient because I still have not received my luggage. As we entered I think we were all in awe. There was such detail engraved on the temple. Absolutely amazing! We heard drums and a prayer in progress, so we began to walk around the temple, but we were stopped by a temple attendant. Apparently, we were walking the wrong way. We felt to bad, but then continued in the correct direction. I am not Hindu, but have incredible respect for all religions. As a prayer continued, I was watching the people. There was such passion that as an observer I couldn't help but feel it as well. It was then that it finally sunk in... I am in India!!!

CMC

CMC is definitely an incredible facility. There are multiple buildings that remind you of any medical center. People are still waiting to be admitted, there are waiting rooms for family members, and people needing healthcare. As similar as it is to the US, it is still so different. I began on Peds this week. After going to the wrong place multiple times, I finally found my destination.. the PICU. There are multiple areas similar to the bays of our PICU but there are about 6 cribs to a bay. There is no central monitoring or beeping machines. When it is time to get vitals, the parents carry their children into the procedure room one at a time. Instead of beds, there are old cribs that are rusting and peeling and mostly broken. The floors are cleaned with a substance that smells incredibly similar to formaldehyde thus I am constantly reminded of anatomy lab. Even with all this, there is still the universal feeling of hope. The mothers smile as I approach the cribs to interact with them. They are so happy to try to converse and pose for a picture. As a listen to the residents and nurses speaking to the patients mostly in Tamil, I try to understand myself but of course do not, yet I still love listening to the language and trying to guess what is being said. There is still the nervous shuffle of the interns and residents rounding and praying not to be pimped. As a walk through the ward, I am able to read the different names along with their diagnoses. There is such a wide variety, 9 yr old with viral cardiomyopathy to a 3month old with brain abscess to a 2yr old with complex congenital heart disease. The 2 year old with the complex congenital heart disease struck me the most. Although she was not on our specific service, I attempted to talk to the family. She was sitting in her mother's lap with an oxygen mask covering most of her face. Her frail body demonstrated the definition of cachectic. Her extremities had absolutely no fat nor muscle. Her joints were protuding and twice the size of her long bones. Her grandmother showed me her surgery scare on her chest from heart surgery at 1 yr of age. I took a picture of this family, but for some reason the computer will not read my camera, so I will try at another location.

It's a small world

Our first day in Vellore, we met up with our fellow classmates for dinner on the rooftop of Hotel Darling. The food was amazing, and even better than the states. As we were leaving the restaurant and waiting for the elevator, I turned and looked down the hall. I saw two guys, who were obviously travelers, but one looked familiar. I couldn't place it, but I knew I had to know this guy. I asked them where they were from and once they answered, we both realized that we knew each other from undergraduate. What a small world when you run into someone you know randomly in another country!

Getting to India

So, getting to India has been full obstacles. My trip began quite smoothly, my flight left on time. When I arrived in London-Heathrow there was a snow storm that had delayed many planes by over 3 hrs, so when my plane arrived on time, we first had to circle in the air for over 30 min to be allowed to land. Once we landed, there were no places for my plane to dock, so we stayed on the run way. My layover was only 2 hrs, which at first was amazing because I hate layovers, but by the time my plane was allowed to dock, I only had 10 min to get across the entire Terminal 4 of Heathrow. Needless to say, I ran. I thankfully made it, but my luggage did not. When we arrived at the Chennai airport, we had to wait for over an hour and a half before they would accept that my luggage was not coming. After filling out paper work, we finally left the airport and entered India. I had been warned about India. People have told me many times that I will be shocked by what I see, but I honestly was not. As we drove through the streets of Chennai, it was amazing to see the similarities to the US but the vast differences. Drivers do not stay in their own lane, they take over however much of the road they want and all the other drivers are doing this at the same time. We thought we were going to crash at least 20 times. Motorcycles, bicycles, autorickshaws, buses, and pedestrians are all fighting for the road, but some how there seems to be some stability to the chaos. The people have been incredibly friendly, even though we know we have been taken advantage of because we are tourists, but we laugh about it. The drive from Vellore was bittersweet. I was so excited to finally get to Vellore, but I was flustered that I still did not have my luggage.

I am on my way

I am about to leave, and am so excited!