The Backwaters and Cochin

We started off from Kovalam with a hired taxi (the Ambassador... the cars name is so much nicer than the car itself) that drove us 2.5 hours to Allepey where we boarded our houseboat. These boats are amazing, and when I figure out how to load pictures up I swear I will. They look like they are made completely from bamboo and are just so airy. We hired one with a roof deck, which I would highly recommend. It was the only place to get a strong breeze when the boat is cruising at its maximum speed (4 miles an hour). We spent our afternoon watching small villages and farms pass us by. We watched fishermen and "mud collectors". No joke. These men spent at least an hour collecting mud off of the bottom of the river. All I kept think was that that was the mud I was given to wash off my oil after the massage in Kovalam. Pretty gross. The food was terrific on the boat. All three meals were served on banana leaves with fresh pineapple as dessert. In the evening they lit oil lanterns around the boat, and every insect possible hovered around the light, including quite a few geckos that would open their mouth and dine on the bugs. I swear, I was so grateful for the geckos. We couldn't open our mouths to speak without a tiny bug flying in, but the lizards handled that pretty quickly. Sleeping on the boat was another story. The three of us shared a bed (somewhere between a king and queen size). So it wasn't overly comfortable and we didn't have AC. So I ended up popping a Dramamine and that got me through the night. In the morning the guide of the boat told us a Keralan folk tale (more like a story you would read a 3 year old) over breakfast. It was a strange experience. He spoke perfect English, but his words were so deliberate that it took him 30 minutes to tell a 3 minute story. It was an experience I will never forget.

We have spent the last few days in Cochin. Shopping, visiting the Dutch Palace, the Jewish Synagogue, seeing the Chinese fishing nets, going to a Kathekali dance show, taking a Keralan cooking course, and listening to a sitar concert. We have eaten some of the best breakfasts here. The Kashi Art Gallery has the perfect setting for an artsy western breakfast. There isn't a menu, you just get whatever they are making that day. And I haven't been disappointed yet. We also tried "toddy" which I truly recommend. It is the sap of a coconut tree that is fermented for a day to become an alcoholic drink. I can't really describe the flavor...a bit coconutty with Sprite mixed in....that's the best I can do. But I'm pretty sure I won't find that anywhere else but in Kerala.

We leave today for our journey home, which although I'm really happy to return, I can't say I'm all that happy to travel. But, I can't wait to get all of my clothes into a real washer and dryer, and to be back in the comforts of America.

I promise I will post pictures as soon as I can.

Kerala - God's own country

We (Colin, Nicolette, and I) left Vellore on Friday and arrived into Trivandrum on Friday early evening. We took a taxi to The Swagath Beach Resort in Kovalam Beach. How can I describe Kerala...absolutely beautiful!. Just imagine a forest of palm trees is what greets you from the airport. I understand why they call it God's own country. We immediately changed into our swim gear and headed for the beach. We rented some cots for the beach and sipped on coconut water while eating the smallest bananas ever. We spent the evening at a restaurant, where the food was good but the service was incredibly slow. But this is pretty much the way beach life is. Then this morning we woke up, had a great breakfast at a German cafe and headed off for our Ayurvedic massage. I had been forewarned that the massages required you to be completely naked on the table, without any sort of draping. So at least this wasn't a shock. But no one can quite prepare you for the amount of oil that is slathered on your body. I realize why the oil is necessary, the movement are so fluid. One stroke reaches from the ankle all the way to shoulder and then back down again. This wouldn't really be possible with a towel covering your "private" areas. I have to say I mush prefer a deep tissue to my "oil rub down", but it was nonetheless an experience. We spent the rest of the day reading at the beach, strolling the shops and eating at Spice Garden for dinner. Which is really hidden but totally worth finding. It is a small bungalow with colorful lights and lanterns hung everywhere, and a trance-like music in the background. Tomorrow we leave to spend the night on a houseboat in the backwaters of Kerala. If it is anything like the past two days, I think I pretty much have reached heaven.

Karigiri

There were 8 of us who decided to hire a van for the 40 minute drive out to Karigiri (the leprosy hospital started by Paul Brand). The drive out there, was like all of out other drives in Tamil Nadu, just gorgeous. I mean once you get beyond the endless trash on the road, the stray mutts everywhere, and the never ending stream of random smells that seem to merge together. The hospital itself is built on acres and acres of lush land. I really think you could jsut throw seeds into the ground here and a plant would grow without any nurturing, it is just that rich. We were all excited to go to leprosy clinic and we had heard so much about the prosthetics and PT at the hospital. We were greeted and made to sign in (something we seem to do often in vellore, everyone wants out passport and visa numbers, it is beginning to freak me out), then taken on a 1 hour tour of the grounds. The hospital itself looks much like CHAD, with scores of patients just sitting in the central courtyard, surrounded by examination rooms. We also got to see where they make "special sandals", from rubber with micropores in them. Apparently this helps provide extra cushioning. We also got some great teaching on the care of a diabetic foot...dealing with thickened nails, treating/preventing ulcer formation, and using a pumice stone to remove dry skin. Oh, and their pumice stones, are real stones cut in half. They seem much better than the grocery store variety in the US. We also took a look at the labs where they study drug treatment on M. Leprae on the footpads of mice. They made us take our shoes off while we were in the lab, which I have to say is a bit concerning. Why would we want to step on leprosy infested flooring with bare feet? Gross.

I was a little disappointed, once again, that we basically had a 5 hour tour. I would have loved to actually be in clinic and learn from the doctors. So my advice would be to really have this arranged with the Karigiri hospital to find out when the leprosy clinic is held, otherwise you might just bee in Diabetic foot clinic for the day. As if we don't see this enough in San Antonio. Also I would not go with more than 3 people.

I head off with Colin and Nicolette for the next week to Kerala for some amazing sights and relaxation. I absolutely can't wait. So hopefully I'll get some pictures up soon...

Urology

I have spent the past few days with the Urology team at CMC. What doesn't cease to amaze me is that I just feel so at home with urologists. The past few weeks I was with generalist, mostly family practitioners, and was interested but bored at the same time. I was beginning to think that it was just Vellore, and our status as observers. That is literally all I did, observe. That was really fine when I was a first year, but after almost 4 years of medical school and finally getting my "hands dirty" in the hospital it is really hard not to be challenged. And I know there is ton of stuff to learn here, I just don't believe it is presented in the most appropriate way. For example, unless I'm with a CMC student or with a junior resident, the attending or upper level resident will never really look at me when they speak. Plus, they speak so quietly I really just can't hear anything they are saying. But then, I finally made my way over to urology. And it has been tremendous. I find the rapport between the staff to be just like I remember it in the States. Everyone is making fun of each other, from the OR nurses to the attending, and even to me. I just feel like I fit, which is really why I picked urology in the first place. I love to see how they use a real ultrasound machine to get a PVR, when we have handy bladder scans. And they don't throw anything away, from the draping to the tubing, everything is reusable. And they use plastic aprons instead of gowns in the cysto suite. Everything just makes me feel like I have been transported back 100 years, yet their outcomes are just as great as our back home. Plus for the first time in Vellore I have A/C...which may sound silly, but it gets hot in a cysto suite with 7 people in such a small space. I have to admit I had huge misconceptions about urology. I knew all the faculty and all the residents they have ever trained have been male, so I thought the patients may be weirded out to have a female in the room. But far from it, no one even gives me any strange looks.

So it is overall looking great, and I am excited to go to the leprosy hospital tomorrow...

Mamallapuram/Pondicherry ... and sickness

This weekend Jen, Colin, and I decided to take a 2.5hr car ride to a coastal town called Mamallapuram. We stayed at the Sea Breeze hotel (it was decent) and ate at a restaurant on the beach. The next morning we hired a tour guide to visit the shore temple and Arjuna's Penance. Apparently Mamallapuram (which also has 4 other names) has five different types of stone architecture: cave type, flat-faced type, temple type and two others??? The guide was great and taught us a lot of the history, but I just couldn't get over how hot I was. I swear I was sweating from sweat glands I didn't even know that I had. Absolutely brutal. We came back, showered, ate lunch, and took a 2 hour ride to Pondicherry. Pondicherry is also a beach town, with French influence. There were a ton of foreigners there. And they all seemed to be...well I can only describe them as hippies on drugs. The town was crazy crowded and the beach was not nice. The hotel we stayed in was totally mediocre. And the restaurant we went to for dinner was awful, even though it is the most I have paid for a meal since being in India. All in all, as you can probably tell, the weekend was a bust, and totally not relaxing.

Not to mention that everyone just seems to want to cheat us out of money. The car service which is set up through the school, is clean and air conditioned. However, the driver asked for extra money and asked me not to tell his boss. I'm still trying to figure out what I would have gained from this transaction? Then wen we got back his boss (Mr. Paul) was waiting for us and asked to be paid more than what was agreed on. Here is the conversation:

Mr.P : uhhh, Seema it would be 6,000
Me: no, we agreed on 5,600
Mr.P: oh, no, it was 5,600 + or - 5%
Me: 5% for what? I only agreed to pay more if we went above 600 Km. and we only went 400Km so if anything it should be -5%
Mr.P: no 6,000
Me: NO, I really don't like this back and forth I'm only paying what we agreed before...

I mean come on...yes it is only and extra $10, but I really hate being cheated. And I swear there is no logic to it all they just ask for whatever they want. Crazy. The best way to deal with it all is to just hand them whatever you want to pay them and walk away.

But the topper to the entire weekend was getting sick on Sunday night... I will spare you the details.

I have been so careful...I drank only water that I bought from the canteen on campus, brushed and gargled with that bottled water, never used the drinking glasses anywhere, and never ate anything raw. But yet, still afflicted with some stupid GI bug...maybe and most likely bugS. Well the doctors here did not take any chances and placed me on a crazy cephalosporin (cephalexin). So I'm feeling a bit better, but I'm basically room bound and so I haven't been able to go to work for the past two days.

Hopefully this won't be a trend.

CHAD and the blind orphange

The past two days have been amazing! We (Nicolette, Jen, Colin, and I) delivered the four boxes of clothing that we brought with us to the orphanage for the blind. The clothing was all stuff that we collected from our own closets and from friends. We tried to weed out the stuff we thought they couldn't wear, like tank-tops. Even then we ended up with tons of donations to GoodWill and four suitcases/boxes for India. The Hotel Baby Residence suggested the donation go to this school for the blind, and for blind orphans. We thought it was a terrific idea and took two rickshaws filled with us and the clothes over. The kids were so excited. Especially for shoes. Which I really wish we had smaller sizes of...thank goodness I wear a 6.5! But they were so delighted with everything we brought, so I'm so grateful for all those who contribute. Wouldn't it be wonderful if we could make this something every one of us does as part of the Paul Brand scholarship? Plus now we all have empty suitcases to bring back whatever we buy here!

I also have done a few days of CHAD (community health and development). This is my dream program. It combine so much of what I learned in public health school with what I learned in medical school. CHAD combines two tracks: mobile and stationary. The hospital (stationary) itself is extremely well run. Patients are able to come and get full primary medical care, and also give birth and get tubectomies. The is a TB ward, as well as maternity and general medicine wards. The ward are more like long hallways with a bunch of beds. I saw several mothers who receive great antenatal check ups. But most importantly I got to sit in on a prenatal counseling session where women and there husbands can participate for free. They spoke of AIDS/HIV, Hep B and C, caring for the baby after birth, vaccination prophylaxis, extramarital affairs, ways to keep up the nutritional needs of pregnancy, cord care, and much more. I found it really interesting that they had to tell the mothers to bring a set of clothing for the child to wear when they come to give birth at the hospital. Apparently is is considered a bad omen to buy or make clothing for an unborn child, and the mothers would give birth and have nothing to take the child home in. Then of course the talked about ways to get iron into there system. This wasn't a huge problem until the government began subsidizing rice and it is now cheaper to buy rice than millet (which is very high in iron). Also mothers have beliefs that taking pyrantal pamoate (a drug to kill intestinal worms that contribute to iron deficiency) will cause there child to have a darker complection. So most mothers won't take the medication offered by the clinic. So, basically myths are dispelled and they have seen a dramatic improvement in maternal morbidity due to anemia.

The mobile part of CHAD is where health care workers take a jeep and visit individual villages. It is a pyramid system, where the villages each have a member that keeps track of health, death, and birth of that village. Then there is the next level up where someone is in charge of a few villages. Then there is a trained nurse that is in charge of even more villages. And finally the Doctor who is in charge of 30,000 village residents! The health care visits they receive are free, the medications are even further discounted, and the patients don't have to travel to the hospital. I saw a great case of Hurler's syndrome. Where everyone just thought this young boy had achondroplasia. However, the CHAD team noticed the boy had corneal clouding and appropriately diagnosed him. He also has a ventricular septal defect and is now in the process of surgical evaluation for repair. Interestingly enough his older brother died of heart failure, yet no one had previously investigated this. We saw many almost term patients, that will deliver in their villages. I also got to visit a gypsy camp, that has been there for 25 years. So can they really be called gypsies? I don't know. The houses were made of mud, and dried banana leaves. Yet, interestingly enough, they all had color flat-screen TVs playing in the huts! Priorities become very obvious.

We traveled to so many different farming villages, and every so often people would be waiting by the Jeep when we would come out with their health cards (mini-medical records here) in their hands. The wanted refills on medications, and we were able to provide these for them. We also did some grief counseling with a wife who lost here husband to a tragic burn accident, and visited the daycare that CHAD sets up so that both parents can go to work. The kids in the daycare would all sleep in these hanging pieces of fabric made into a hammock. It was absolutely adorable to see 10 of these things hanging from the ceiling with a small child sleeping within.

I really can't say it enough...this is an amazing public health model that actually works!

I'm truly enjoying my time so far, despite the heat and major mosquito bite on my legs even though I wear pants throughout the day. This weekend I'll be traveling to the east coast to be on the beach, relax, and site-see.

Arrival to Vellore

What a journey!!! Where to even begin. We (Colin, Jen, and I) left San Antonio on Saturday Feb. 2nd. We flew to Houston and there our flight was delayed for 3 hours. The flight was boarded as usually except for the fact that Jen and I both had small roll-on luggage (with extra clothing just in case our suitcases were lost) and these were basically confiscated on the loading ramp. They gave us some excuses that all roll-ons were too heavy and too big for the flight so everyone would have to check the luggage to their final destinations. So we explained that we needed the stuff inside the bags in the Dubai airport. They ended up giving us some plastic bags to place our important stuff in. When we got onto the flight, every overhead bin was filled with suitcases! Great. Needless to say we were mad, but we made the best of it. I watched three movies on my personal touch-tv screen. At some really great plane food, and before I knew it we were landing in Dubai.

At the Dubai airport we had a 4 hour layover and had a shower for $13. It felt great after a 14ish hour flight to be fresh again. We hoped for the best as the luggage came off the plane at the Chennai airport. And I would say we did pretty well. Jen's carry on never made it (we are still crossing our fingers), but we got everything else. We then took a 2 hour car ride to Vellore. Stopping twice: once to drink some fresh coconut water, and once to pour water over the radiator of the car. I haven't been back to India since 9th grade, and I have never been to the South. I am surprised at how different the countryside looks from the north., with palm trees lining the road side. But, of course, much of it looks as I have always remembered it. Skinny cows digging through trash, roadside stalls with piles of fresh fruit, and just people everywhere.

When we got to Vellore we tried to check into the Darling hotel (apparently the best hotel in Vellore). But the stated that they didn't have a reservation for us! So we moved to the Baby resdience and checked in. Thankfully my mom had made us two reservations, and one of them pulled through. But honestly the rooms made me a bit uncomfortable and there were no drawers to place our stuff in. Plus it was not really all that close to the hospital or the college campus.

Then we went to visit the college campus to check in. The college campus is beautiful. With manicured gardens and wild forest everywhere. The canteen and the entire campus apparently have "clean" water. You can actually brush your teeth without having to use bottled water! This is a first for me in India. We then went to visit the international hostel on campus, and found it to be without A/C, but very clean and furnished just right. So the choice was obvious and we moved all of our furniture out of the hotel and into our hostel rooms. I can't believe we are paying only $3/day to stay here.

There is also a canteen on campus, the food is great. Not a whole lot of variety, but all my meals cost less than a dollar. Best of all you don't get sick, which I would pay any amount for that luxury. And they have great fresh fruit and smoothies.

I am extremely excited for what the week holds. We are starting on CHAD. Which is a community outreach health program. I can't wait...so there will be more to come.