Andahuaylillas and Cusco

The second half of my trip to Peru was amazing. On Saturday night I attended mass at the local cathedral. It was beautiful with ornate gold and intricate paintings on the walls, along with a huge organ and statues of all sorts of saints. That night we had another delicious dinner complete with soup, main entree and dessert.

The next day we climbed a nearby mountain. The entire group went up to the cross, while Eric, Stephen, Nikki, Beth, Clare, Matt and myself went all the way to the top. It was hard work but well worth the view. I did get a little altitude sickness at the top but improved as we worked our way back toward the base of the mountain.

We ended our time in Andahuaylillas with three more clinic days. I went out with the traveling clinic group for two of the days. One day I saw a peri-rectal abscess and a woman on treatment with parkinsonian medications. The other day we ended up doing physicals on students at a nearby school and teaching them about the importance of washing their hands and brushing their teeth.

All in all the clinics were a great experience. I saw a wide variety of complaints and had the chance to improve my Spanish skills. However, this particular trip was not without its problems. For example, we started the trip with no anti-parasitic medications and were lacking in various other medication categories. We were able to purchase these medications from near-by pharmacies, but not without having to make patients come back to clinic a different day in order to get them. We also began running short of medications towards the end of the trip such as ibuprofen or acetaminophen. Unfortunately this forces us to make a decision of whether to treat a few people adequately or to give less pills to more people. We had the same decision to make about vitamins for the children. Do we give a couple months to a few kids, or a few weeks to all the children?

Another issue that we ran into was the lack of diagnostic equipment. We did not have any laboratory equipment with us and although we were told that we could send people to the posta (the local clinic) for things like urinary dipsticks, pregnancy tests and complete blood counts, we never had anyone come back with results. The problem seems to have stemmed from a couple of things. The first was a lack of communication about the services ordered at the posta. We sent one old man with a concerning history of chest pain for an EKG and he was unable to get it. When I went to visit the posta later that week, I was informed that they do not have an EKG machine. The lab was also not open all of the time. It sounded like there was only one woman running the lab and that she had been sick for at least a couple of our clinic days.

Despite all of that, the people that I had the opportunity to work with were amazing, caring and funny people. There were some local community volunteers that worked as translators for us: two young German girls who were working for the Q'ewar project, Denise and Josephine, a musician/volunteer from Spain, Maria, and four Jesuit volunteers, Sarah, Victoria, Jacqueline and Teresa. We attended a birthday party for Victoria one night at the volunteer house and had a really great time drinking Pisco and singing along to a particularly well-crafted birthday compilation.

On our last night in Andahuaylillas we ate with the mayor and some other important political figures before heading back to Cusco. The next morning half of us went on a day trip to Machu Picchu. It was truly amazing with breathtaking views, and I only wish that I would have had more time to explore the ruins and the nearby mountains. That night we went to a concert that Maria's band put on and went out dancing after getting back to the hotel around 4:30 in the morning.

The next two days we ate some really good food and got tours of Cusco and then Lima before flying back home to the States. Peru is a beautiful country with a lot of offer and I definitely plan on going back soon.

Peru

Saturday morning I woke up early, packed up the rest of my stuff and headed to the streetcar in New Orleans. I arrived at Dr. Seeliger´s house a little bit early and ended up waking him and Tim up. After they had quickly shoved their stuff into bags we got a taxi and headed to the airport. We met up with some of the group in Dallas and more in Lima. We got in around midnight and spent the next few hours at the airport before boarding a regional flight to Cuzco.

Cuzco´s city center was beautiful with cobblestone roads, old cathedrals and stone buildings. I spent the first morning sleeping but ventured out that afternoon with some other group members to explore. We found a nice café, had some empanadas and got a tour of the cathedral. That night we had a really nice dinner before going out to an Irish Pub for a drink or two. The next morning I exchanged some money before we headed to Andahuaylillas, where we would spend the next ten days.

We are staying at a Jesuit-run community center that also functions as a school and playground for the children in the community. We have taken over three buildings located in the back of the compound. The first functions as our pharmacy. The second is being used by the optometrists and the third is our waiting room and clinic. Above the clinic are our romos. Each room has two bunk beds, lots of blankets and a shower. Down the hall are three shared toilets.

Most of our clinic days follow a similar pattern. We wake up between 7 and 8 and have breakfast, which consists of bread, jelly, ham and cheese. Half of the group stays here and sees patients, while the other half goes out to a near-by community to run a clinic there. Clinic runs from 8:30 until 3 or 4 with a break for dinner. In the evenings we have dinner and then sit around the bonfire drinking cervezas and listening to music.

I have mostly been working with a first year medical student named Eric. He translates and we work through the cases together before running it by one of the attendings or residents. He is great to work with and we have been some really interesting cases. Yesterday we saw a little girl with a burn on her foot, a man with otitis externa, and a woman in heart failure with pitting edema, pulmonary edema and a 3rd heart sound. Today we saw a woman with a bleeding stomach ulcer, a victim of child abuse and a man with possible Lamber-Eaton síndrome.

We have three more clinic days left and I hope to keep learning as much as I can. More to come.

Northern India

The last 10 days of my trip to India were interesting to say the least and I would like to take this time to share some of the more curious stories. It took me a while to write this post but I think that the time has allowed me to look back on India with fonder memories and to look at the humorous side of things.

Before I left Manipal I had the chance to play in a volleyball tournament with Sara, a friend of mine from the Netherlands. Volleyball for this tournament took some getting used to. The basic idea was the same but the rules and the way they approached the game was different. We were only allowed to underhand serve and we played on a clay court that was ten feet shorter on either side than normal. In the early rounds smashing (hitting) the ball was not allowed. One-hand tipping was also not allowed. And finally they just had different strategies than we did. We made it to the third round and had a great time playing.

That weekend I said my goodbyes and boarded an overnight bus to the airport in Bangalore. The seats on this bus lean all the way back into the person behind you. Which works great when the person behind you does not have super long legs. I am certain the man in front of me did not understand why I would yell out anytime he leaned back and why I kept kicking his seat every time I moved. The road was windy and I did not get much sleep. Around 3:30 in the morning our bus broke down by the side of the road. After an hour on the side of the road, I boarded another bus that took me to a local bus station. From there, the bus company provided a taxi to take us to the airport.


I had booked a round-trip flight to Delhi with plans on taking a bus to Jaipur to meet up with my friend Crystal and her friend Paulette. The flight went well and upon arrival in Delhi I went to the pre-paid taxi stand (cause they are supposed to take you where you want to go) and got a cab for the bus station. I had a particular bus that I wanted to get on that was recommended by some friends. Instead, the taxi driver waved down a bus in the middle of the highway, put my bag on the bus and said "here's your bus" and demanded 50 rupees. I protested but it was clear he was not going to take me to the bus station. So I climbed through the window into the front of the bus with an Indian girl and the bus driver and prepared myself for the 5 hour ride.

The ride was fairly uneventful besides the bad roads and multiple stops where the fare guy in the back would lean out the door and shout "Jaipur, Jaipur, Jaipur" as we slowly drove past the bus stops. There was one bathroom break. The driver took this opportunity to roll a joint and proceeded to smoke it as we continued down the now dark highway towards Jaipur. When I arrived I headed to the Lemon Tree Inn.

Crystal and Paulette arrived the next day. We spent the next few days exploring the city of Jaipur and taking a day trip to Pushkar to see the temple and ride the camels. Our final day in Jaipur was spent on a day trip out to the village of Rusirani with a quick stop at the Abernathy step-wells. It was arguably the best day of my trip. We spent time talking to the family about topics like farming, the distribution of work, education, marriage and smartphones. Crystal and I took a turn helping in the kitchen while Paulette doted on a cute baby. We had a tour of the area and several cups of tea. At the end they gave us gifts. It was a long day but a good look in life in rural India.

We went to Delhi next. I stayed at a place called Amaxx Inn, while Crystal and Paulette stayed farther from the city center. The first night I went to the sound and light show at the Red Fort that chronicled the history of the Fort and city. The next two days I met up with Crystal and Paulette and toured Delhi and then took a day trip to Agra to see the Taj Mahal. 

The next day I went to the airport and got on a flight back to Bangalore. I stayed at a nice home stay in the heart of the city before heading back to the airport the next morning to fly home. Unfortunately there was a problem with my visa and after being told to sit in the corner for a while, I was told that I could not leave India today. They took my boarding pass, stamped cancel all over it and retrieved my luggage from the airline. Luckily I still had a lot of credit on my phone and began making phone calls and sending text message to the people at Manipal and my boyfriend Warren back in the states.

I ended up spending a lot of money to fly back to Manipal to spend three hours gathering documents and filling out paperwork and another three hours waiting for the gentleman at the police station to sign it. I did get to see some of my friends again and shower (hello Sara, Thjis and Inge) before flying back to Bangalore. I spent the night sleeping at the airport and was thankfully able to return to the United States. Never has it felt so good to be home.

Looking back I am glad that I went to India. I learned a lot about myself and the things that I need to work on. I made some good friends and had some really great days and nights. Thanks again to everyone for the support.

Learning to Love

-->

Over the past four weeks I have come to like, even love, parts of India. There is a unique blend of old and new, rich and poor that defines the country and traditions that unites its over one billion citizens. Things are a lot different here than in the states and it takes some getting used to, even for someone like me, who has traveled before.

To be honest I hated my first two and a half weeks here. The evenings and weekends when we would go out were nice, but overall my thoughts centered on wanting to go home and not come back to India ever again. It wasn’t that I was treated badly or that I couldn’t handle the culture shock, its that I didn’t feel like I had a place, that I just didn’t belong here. I didn’t dress right, I didn’t eat right, I couldn’t connect with people.

I recognized that my attitude could use improving so I spent the second and third weeks trying really hard to like what I was doing and reach out and try to connect with the people around me. Slowly it started to work. I read about India and Hinduism on the Internet. I asked a lot of questions. For lunch one day I attended the Brahmopadesham of a local Hindu boy, a religious coming of age ceremony of sorts. The next day I went to a Hindustani vocal concert. I also started reading a non-fiction book about India called “Behind the Beautiful Forevers: Life, Death, and Hope in a Mumbai Undercity”. That weekend I went back to Goa with my multi-national friends where we enjoyed a night out and a relaxing couple of days on the beach complete with dolphin spotting while kayaking. More recently I signed up for a volleyball tournament with my friend Sara, from the Netherlands. Finally I can say that I do like India despite all of her faults and I hope that my final week and a half here go well.

The original purpose of this post was to tell you all about my experiences with attempting to do research here, so I will try to do so briefly. Attempts to contact the department with which I am working here in India last fall were unsuccessful and I showed up with no idea what I would be doing. Taking Dr. Suma Nair’s suggestion, I decided to look at blood pressure control of hypertensive patients who were being treated in the clinics run by the Community Medicine Department of Kasturba Medical College here at Manipal. 

The problems were multiple and included language barriers, staff shortages, lack of privacy and incomplete medical records. The informed consent that we are taught so much about is largely ignored here. We did manage to get most people’s signatures but they weren’t very informed in my opinion. During my last two days of data collection we had some information sheets about the project available in Kannada but most participants were either illiterate or not interested in taking the sheet with them. I tried to voice my concerns but was largely ignored. We did get data from sixty-four patients and, although we did not have a sufficiently large enough sample size, we did get some significant results. Having a family history of hypertension and being on medications other than those given by the clinic were both associated with decreased blood pressure control. I know this probably doesn’t interest most of you, but if you are I can send you a copy of my paper.

Tomorrow night I leave for North India. I am meeting up with my friend Crystal on Sunday and will be exploring Jaipur, Delhi and Agra (Taj Mahal) before flying home on March 10^th. Hope all is well with everyone reading!

Goa

My first weekend in India included a trip to the province of Goa. It is a small province just North of here known for its beautiful beaches and tourist friendly attitude. My new Dutch friends Sara, Thijs, Inge and I took the 4pm train Friday afternoon. We had a little trouble figuring out what class we were supposed to sit in but ended up in a car near the front. We didn’t have window seats but I enjoyed the view of the countryside and the sunset. Four hours later we arrived at our destination and hired a Rickshaw to take us to the beach. After a delicious dinner we set off to find a place to stay eventually settling on a place called Dylan’s were we rented two rooms for 700 rupees a night each. I was awoken by a phone call at 5 am when Thylbert, who is French and has been in Manipal for many months, joined us after taking the midnight train. The next afternoon Thomas, another Dutch guy who had just finished his rotation, joined as well.

We spent the next day not doing much of anything. I had breakfast at Dylan’s in the morning and spent the rest of the morning either swimming in the Arabian Sea or lying on the beach in the sun reading. There was a sand volleyball court located just in front of our huts. Early in the afternoon some guys started to play and invited me to join them. I did a little bit of shopping that afternoon and got a new bag, some loose breezy black pants and a dress from Desigual. Desigual is one of my favorite designers. They are based of Spain and normally their clothes are very expensive. However, the clothes are made in India and the stores here sell the clothes for about one fifth the cost.

That evening we all had dinner together before heading over to the silent disco. For those of you who have never heard of a silent disco let me explain. Everyone is given a set of headphones when they walk in the door. This particular one had three different DJ’s and you could tune your headphones to whichever one you liked best. Typically when you take the headphones off everyone is dancing but there is no music. It was really fun.

The next morning I again had breakfast and spent the morning on the beach. That afternoon Sara, Inge and I walked over to the small island on the far side of the beach. On the way back I stopped at the Desigual store again and bought another dress and a shirt. Sara (who plays club volleyball in the Netherlands) and I joined the same group of guys for another game of volleyball. We all ate as a group one last time before the five of us got in a taxi and headed to the train station. Thomas was staying in Goa for the next two weeks to relax before heading home.

The train was over 2 hours late but we found our way to the sleeper class. We slept on and off and thankfully did not miss our stop. Since I got in after my midnight curfew, I had to sign in and say the reason why I was late. I guess usually there is a fee but I did not have to pay it this time. The rules at the hostel are pretty strict. No visitors, no cooking in the rooms, no tv or music, midnight curfew and if you will not be there for a night you have to tell them where you are going. The hostel I am in is pretty nice. I have a single room with an attached bathroom and A/C. However there is no common room and almost all of the other foreign girls are in the next dorm over.

The rest of my week was less eventful. I spent Monday, Wednesday and Thursday collecting data for my project. Tuesday I went to a school where they were collecting data on obesity, diabetes and hypertension trends in adolescent and teenaged children. On Friday I had asked to see the emergency room and how it worked here. Instead, in the morning I joined them for ICU and women ward rounds. It was a good experience as I got to see cases of leptospirosis and organophosphate poisoning. However, it was difficult to follow what was going on. Although all rounds are done in English, the Indian residents tend to speak very softly. A group of about 10-15 students joined us halfway through and made it even more difficult to see and hear what was going on. One strange thing about the hospital here is there policy on shoe wearing. If you are going into the ICU or operating room, you must take off your shoes and either put on a pair of provided flip-flops that everyone shares or go barefoot.

That afternoon I did go to the emergency room for a couple of hours. There were a few cases of poisoning that came in. Apparently one of the most common forms of attempted suicide here in India is herbicide poisoning. It is widely available and very fatal. I did not get to see very much and in general they would not let me see what was going on or tell me what the patients were coming in with. I sat in the corner for a while and looked up some things on the computer about the herbicide poisoning. I left after I couldn’t find the resident that I was supposed to be following. I would like to go back and see the whole emergency room as well as their separate trauma bays.

On Saturday I went to an HIV conference in Mangalore. The speakers were very interesting and it was really nice to see how the programs and management in India compared to those in the United States. I will say though, that I felt very out of place. I was the only foreigner in the room. At lunch we had a typical Indian meal. I do like Indian food but I am still unaccustomed to the way they eat. We had our meal standing. Most Indians eat with only their right hand and no utensils. Afterwards you wash your hands.

Today I attempted to go to a waterfall with Inge, Thijs, Sara and our new German friend Eli. It is located in the eastern part of Karnataka province and we got all the way to the national park gate before being told it was closed. We went to a few temples in the area and then drove back. Tonight we will have dinner and tomorrow I will collect more data from the clinic. Thank you all for the words of support and encouragement. This has not been the easiest trip that I have done but I am glad that I am here. You can only grow if you are pushed out of your comfort zone, and I have been very uncomfortable here!

India ~ First steps

As I near the end of medical school and get ready to start residency, I decided to do some traveling. I am currently in India completing a community medicine elective that will count toward my MD/MPH rotation requirement for medical school and my public health degree. I will be staying at Manipal University in the Karnataka province of South India. It is just minutes from the Arabian Sea and has given me a good look at what India is all about.

The journey here was a long one. After spending a month in San Diego with Warren and his family doing a pediatric sub-internship at UCSD, I packed up my bags and got on a twelve-hour flight from LAX to Tokyo. From there I flew to Singapore and then on to Bangalore. I picked up my bag and then checked into a regional flight over to Mangalore where a taxi picked me up and brought me to my hostel. Overall it was an almost 40 hour journey and I was quite exhausted when I arrived.

Unfortunately I got in a little after 5 pm and all of the university offices were closed for the evening. I had received little instructions prior to arriving but made it to my room. The woman working did not speak much English. She showed me how to turn on the air-conditioner and the fan. She showed me how to lock the door and the shower in the bathroom. She pointed multiple times at a bucket in my bathroom and tried to explain something. I still have no idea what the bucket is for.

The room was lacking in some aspects. It had no toilet paper, hand soap, trashcan or shower curtain. I hadn’t thought about bringing these things for my month stay. I ventured out briefly in an attempt to find internet access and some of the above items, but without a university ID card or any idea where to get anything I retreated back to my room frustrated and quite lonely. I decided to just go to bed at 6 pm and hope things were better in the morning.

The next day things weren’t much better. For breakfast I ate some snacks in my room before going to the chief warden’s office since that was the one person who had emailed me with instructions prior to arrival. I talked to a lot of people and got directed to many different offices. I filled out all sorts of paperwork and got sent to different buildings. I eventually met up with Mr. Kini in the Kasturba Medical College office who helped me get an ID card.

 I also paid for my room and internet access for the month. This is not as easy as it sounds. First you have to go to the main building and fill out one form for the room and another form for the internet. You then have to the bank and pay. They will then give you a receipt. Then go to a different office to get the form stamped and signed. Then you take the form to your hostel to complete the process.

 At the end of the morning I met with Dr. Suma Nair who is my preceptor here in Manipal. We discussed my project and what I would be doing for the month. I guess I made her worried when I broke down crying and couldn’t stop. She found me a computer so I could email my family to let them know I arrived safe and sound. She then took me to brunch since I hadn’t had a proper meal for over 24 hours. Afterwards we attended a cancer prevention poster competition put on by the students. I spent the rest of the afternoon completing the rest of my paperwork and purchasing a cheap mobile phone.

 The next day things improved. I attended a pediatric clinic with some students from the Netherlands. They had arrived a couple of days prior and invited me to join them at End Point that night where some other foreign students would be hanging out. End Point is a park at the edge of campus where students can run or play soccer or just hangout. There were students there from all over including, the Netherlands, France, Germany, Scotland, Australia and the United States. It was nice to be around people that were going through the same things I was.

The following day I attended a cancer screening awareness program for the community of Malpe. Several community leaders spoke and a group of medical students put on a play to demonstrate the importance of cancer screening and trying to dispel some of the myths. I understood little of it because it was in the local language but I think they did a good job. That night I went to a place called Fab India and bought some Indian style clothing called salwar kameez since almost none of the clothes that I brought are appropriate either for cultural reasons or because of the extreme heat in the area (mid-90s everyday). After that we went out to eat. I took a rickshaw back early in order to work on the questionnaire, consent forms and proposal for my upcoming project.

 That’s it for now. I will write more later about my project and the difficulties I have run into attempting to do research here. I will also write about my wonderfully relaxing weekend in Goa over the weekend. For now, things are going much better. Thank you all for your support.