first real days in peds

Hello again!

Well, now I've completed two full days in pediatrics I thought I'd post another update. Yesterday was "OPD" day (outpatient department) for our team, so morning rounds were very quick and then I went down to the pediatric clinic where I sat with one of the doctors while he saw patients. Clinic is run on a walk-in basis, and patients receive a number when they get registered. Then the doctor sees them in order, and immediately upon finishing with one patient he presses a button for the next patient. He completes his notes during the visit as well, so things move very efficiently -- we saw 23 patients in just over 3 hours. Of course, the downside of this is that little time is spent with patients, and the doctor's manner struck me as quite abrupt. He told one mother that she was essentially starving her baby, since she had stopped breastfeeding at 5 1/2 months and the baby was significantly underweight. Another mother was told she was poisoning her baby by giving it water when it had diarrhea. However, while the style was different than what I'm used to, I think he took excellent care of the children he saw and offered good, thorough advice to families.
Today was my first "normal" day on the wards where I attended regular morning rounds. This was a good experience, and with the schedule being less rushed the doctors kindly took some time to explain things to me and paraphrase cases where discussions were not in English. I saw two cases of dengue hemorrhagic fever, one case of probable mumps, and plenty of things that are also common in the US (respiratory infections, gastroenteritis, etc). Apparently dengue season hasn't started yet (it starts with the rainy season), and the hospital is typically flooded with cases at that time.

Below are a few pictures of the hospital and grounds -- the building itself is old, but the grounds are very nicely landscaped. For unclear reasons, there is a small menagerie with spotted deer, rabbits, guinea pigs, chickens, turkeys, and and aviary. There are also the usual stray dogs wandering around and sleeping in the shade.



-Libby

Picture Time

Our blog is looking a bit bare of pictures. So this post will mostly consist of photos from the past week.

First, I will give a quick update on me. I spent a half day in the ED with 2 med students from NY. We attended ED rounds and saw a few patients with residents/doctors. There were multiple dehydration patients, a 14yo patient with anemia (hemoglobin 4.0!!!) presumably due to nutritional deficiency and severe cellulitis of a large ankle lesion, a younger woman who attempted suicide by hanging who came in with respiratory distress and was intubated by RSI, pneumonia, etc. Overall, I was impressed by the advanced technology they had available including vitals monitors, ultrasound and CT in the radiology department, easily accessible ECG machines, and ventilators in their emergency ICU which was attached to the ED. The conditions were still sub-par according to American standards, although. It as also surprising to me how patient presentations were almost identical to the way patients are presented in the U.S. Even the same order and phrases are used.

Today I was not in the ED as I was the first victim of gastroenteritis in our travel group. Multiple visits were paid to the porcelain gods last night and this AM so I wasn't feeling up to standing in the hot ED all day. I am excited to have more Indian medicine experiences tomorrow and will report back!!

Spice Market in Chandni Chowk market, Old Delhi. These are actually nuts but there were really more spice sellers than nut sellers.

We had been seeing pigeons everywhere in our first few days in Delhi and made a comment that someone was going to be pooped on before we left. Well, it happened at our soda stop just outside the Taj Mahal complex. Right on Sasha's foot. We were so excited it actually happened I had to take a picture.

This is our first tuk-tuk ride in New Delhi. As you can see they are not built for 4 people. That's Jill in the blue shirt, Sasha's nose to the right, and KJ holding on for her life as you can tell by her facial expression.

This is our bedroom in the Annexe III at St. John's Medical College in Bangalore. Bare but very nice and clean. We all brought our own sheets as lice can be a problem.

This is our bathroom at the Annexe. No shower curtains as Indians don't actually use shower heads but rather buckets to bathe with. The water does tend to soak the whole room. Again, bare but very nice and clean.

Namaste!!

-Abby

Day 1 in Pediatrics

Hello everybody!

Well, after a very wonderful week of south India travels with my dad, I am getting settled in at St. John's Hospital in Bangalore. As Sasha's post says, today's activities were almost entirely comprised of getting various documents signed by various administrative staff. However, I did eventually meet my pediatrics team (after a little more than an hour of waiting for them to arrive on the ward). I was just present for quick afternoon rounds, so haven't gotten a great feel for how things run yet. Tomorrow I will be there for the whole day so will hopefully get a bit more familiar with things. The hospital is old but seems well-equipped, although everything is done on paper and x-rays are not electronic. The patients are mostly staying in large wards with 10-20 beds, which makes for a noisy, hectic environment. One patient on our team had a private room in another section of the hospital, presumably because her family paid extra for it. We saw several very malnourished babies, some pneumonia and asthma, congenital heard disease, and a child with respiratory failure from motor neuron disease.

After we finished rounding, I went across the street to get a 3G stick so now I have internet in my room -- so far it seems to be working very well. It's nice to feel more connected!

The photo shows the "glass house" at the botanical gardens in Bangalore -- a very pleasant place to spend an hour or two, with various local and exotic trees and plants.

Rotation day 1

Aka: why don't you have all of these forms signed, aka beaurocracy at its finest How was the hospital today, you may ask? Most of us can't tell you. There were forms to get signed by multiple people, which required trips from one building to another, several long waits, and some only to find out that you actually need that other small piece of paper from the other person in that other office, and only then can the nice man in front of you sign the form you are holding. It was quite funny, until most of us got hungry. Then it was time to explore the hospital canteen, where my meal was 35 rupees (70 cents). Rejuvenated, we attempted to complete many form to get signed. Success. We even got wi-fi access at the medical school. The rotations here can be 1 or 2 week blocks. Jill, Katherine, and I are starting on community medicine. They have an urban undeserved clinic as well as rural clinics. The teams leave each day around 9 and return at 3, so we are all very excited to get started tomorrow. Abby started emergency medicine today, and actually had to go to the department and get started. She will hopefully have some good experiences on her first day! The hospital looks older, but it is a multistory building with every specialty you could think of. Dermatology, all kinds of surgery, pain and palliative medicine, many types of ICUs, and more. We haven't seen what kind of imaging equipment they have here, but there are signs around for GI endoscopy suites, ultrasound, and X-ray. The rooms definitely look different than from home, as was to be expected. More to add hopefully tomorrow!!!!

Home sweet Bangalore

A hearty hello to all our friends back home! We've made it to Bangalore incident free and begin our rotation in 2 days...

First a little bit of filling in. We spent all of yesterday trekking around New Delhi, navigating the metro, and seeing more monuments and historical sites. Our day started with our always delicious free breakfast at Hotel Tara Palace, which has served us well for the past 4 days- it turns out that very few tourists stay in Old Delhi, so hooray for going a teeny bit off the beaten path!

We made our way to the closest metro stop- and were pleasantly surprised to find an extremely clean, modern, and efficient metro system that took us to pretty much anywhere we wanted to go. Between the posted maps, and 2 different tour books, we successfully found a number of great spots. Our first stop was the Qutub Minar, an old Islamic Ruin build in the 1100s- we are continuously impressed by how people are able to build these almost perfect structures with such intricate detail by hand.

Our next stop was another from the "top 10" of Delhi book (thanks, Abby!), Humyan's tomb. It was a little bit of a walk from the metro stop and required a gas station snack/water/coffee/cold beverage visit. Once arriving at the tomb, we were pretty impressed with how similar it appeared to the Taj, minus the astounding white marble. Humayan was buried here after inadvertently falling down a flight of stairs to his death...yikes! Buried with him are approximately 160 of his family members, as well as his barber. (Hopefully the barber lived a long, lovely life prior to his burial with Humyan...) While wandering around the balcony of the tomb, we noticed a number of visitors, locals and tourists alike, being SWARMED by bees, almost reminiscent of a plague of locusts. Despite visitors' efforts to make the bees dispersed, they walked out of the tomb with ~20+ bees completely surrounding them. Needless to say, it looked like something out of the X-files or the Twilight Zone. Eek. We ended our day with a harrowing tuk-tuk ride (Jill has an amazing photo of this) to Connaught Place, the center of New Delhi. What is a tuk-tuk you ask? We theorize that it is a moped, with a body placed over it (open on both sides), with a small bench in the back. It was more than a tight squeeze- we had a death grip on the tuk-tuk and each other to prevent falling out of the sides and/or getting hit by another car/moped/bike/donkey/cow/person....

Our last night in Delhi ended with dinner and a "local" (or rebottled something) at Q'bar, supposedly the 15th best bar in the world. We all felt a little underdressed but it was delicious and refreshing nonetheless.

This morning we awoke bright and early (3:15am!) to get to the airport by 4:30 for a flight to Bangalore. We arrived without a hitch and checked into the annexe III of St. John's Medical College- we each get our own room and our own bathroom. There are med students here from Sweden and England, and quite a few from all over the US. We are really looking forward to meeting some new people and seeing medicine from a few different perspectives. It was wonderful to finally unpack and try to feel a little more at home (I really wish I had some kind of poster to hang on the wall...its a little bare...)

A quick first impression of Bangalore- very modern, and seems to be much more manageable than Delhi. A little calmer (not quite the same as home, but calmer), and LOTS of western influence, and LOTS of huge companies over here...we're 5km away from 3M, and IBM and Dell are even closer.

After unpacking we propmptly realized we were responsible for our own toilet paper. We ventured out into our neighborhood and found TP, some fruit, shampoo, soap, etc. We also found a new favorite hangout, Cafe Coffee Day, which advertises free wi-fi internet. (And air conditioning!!!)...we eagerly packed up our computers and prepared for skype/facebook/photos/etc only to find the internet was down. Sigh. Currently all four of us are sitting in an outdoor internet cafe, paying 10 rupees (20 cents) per each half an hour. The monitor I am looking at appears to be older than me. Hopefully our coffee shop of choice gets its internet up and running and we'll be able to post some photos for you all...

Tomorrow....we're going to see the Hunger Games!!! Its going to be great.

Oofta, that was a novel...

Namaste Friends!

KJ

So we saw the Taj today!! We took a 4 hour car ride to go the 100 miles from Delhi to Agra which was set up by our hotel travel information desk. It was definitely the easiest and safest way to get there. I have to say as well the driver was very thoughtful and probably the best driver we will ever ride with again. You have to be in Delhi. The 4 hour trip was likely this time-consuming because of the constant lane-switching, stops for tourists (us) to buy little souvenirs, and rests for our driver to eat, cough, and possibly visit some friends. Oh, but there was the stops for picture requests by us as well. We had to take pictures of the elephants, come on!

 As you can see the Taj Mahal was absolutely pristine and exactly as it is always described by people. Simply mind-blowing. We mentioned several times how we were actually surprised how well it lived up to peoples' reports and extreme word descriptors. Inside the center of the Taj is the tomb of Mumtaz Mahal, the 'favorite' wife of Emperor Shah Jahan. In this area, photographs were not allowed and was heavily guarded by security, some with ammunition. Eek. The inlayed flowers that are included throughout the outside and inside of the building appear painted but are actually pieces of different types of colored stones shaped to fit perfectly in the carved-out matching marble depressions. How was this done so well in the early 17th century?? Come on?? And speaking of HOW; how was the marble lifted to the very top of the Taj, how were the marble pieces curved so well for the archways (picture below), and how are all of the doorways, windows, etc. so perfectly symmetrical? Amazing, again.

The negatives of seeing the Taj as a U.S. tourist however included the incessant picture-taking of us by Indian people. We couldn't even sit and relax to enjoy viewing the Taj without someone (including children, older women, and mostly young men) asking to take pictures of us, with us, or with their children. It was overwhelming but we maintained patience likely in an effort to extinguish the bad reputation Americans before us have established. Hopefully, it worked but on the inside we were all fuming!

Just outside the Taj Mahal complex we saw a multitude of animals some domesticated, some not. These included Camels (domesticated to pull carts of people), monkeys (non-domesticated), and dogs (non-domesticated.) Wild dogs and wild monkeys in the same area? What?

After our jaws were lifted off of the beautiful marble floors of the Taj, we returned to our driver who brought us to a marble carving training facility/store. We were given a brief overview of how: the marble is carved by hand with practically a kitchen knife held by a man in the squatting position (hopefully not all day), and the flower inlets shaped using a hand-run sander. This was quite enlightening but followed by the ever-present push by the store clerks for us wealthy Americans to buy some of their lovely marble arts. Very tempting, yet on only the 2nd day of our trip we were not willing to relinquish the non-existent extra space in our luggage quite yet. Their strategy was very convincing although. First in the store was a room with the large, heavy marble tabletops which the clerk told us was likely too heavy to be bringing/shipping home which he understood. And, was why the next room we were ushered into was filled with very small marble and flowered turtles, frogs, elephants, and boxes of unknown use. We respectfully declined and spoke at dinner (which was so delicious but I will end that story there) about how it would be difficult for the people here to understand that we fourth-year Medical Students are the poorest Americans they may ever see. -200K is hard to beat as debt goes.

After dinner we started the 4 hour, that turned into a 5 hour, trip back to Delhi and our hotel. The driver was superb in the unbeknownst-to-us 8PM rush hour traffic. Whoops. But seeing the Taj is worth a 57 hour drive so we could deal with a 9 hour/day drive easily.

Tomorrow, another adventure this time involving the metro to see the new part of Delhi, hence, New Delhi!! Ha! Bucket list gets a new item crossed off today: 7 Wonders of the World-Taj Mahal!!!

Namaste!! -Abby

Old Delhi

We are happy to report that we have made it to our hotel in Delhi safe and sound. Here are some of the crazy things that have happened in the past 24 hours:

Cab Ride from Hell, because it really really was: Imagine a green and gold 50s style car, I believe the model was an Admiral Classic, with no functioning speedometer. Pretty sure we were going rather quickly, almost hit many people/vehicles, stopped for gas, and pulled over multiple times so the driver could spit on the road. And when I say spit, I mean copious amounts of something came out of his mouth. Not sure what it was, but there was a lot of it. All of us were gripping the seat for dear life, and finally, after 30 minutes of hairpin turns, close calls, and spit stops, we finally stop at the entrance of an extremely horrifying looking alley. Our cab driver shuffles us out, and informs us our hotel is here. Thankfully, it really was, and even better, we have AC and free breakfast! Win.

Old Delhi:

Went to the Red Fort, built in the 1630s, and where India declared independence. Lots of gorgeous architecture and museums all about Indian history. It pulled of some vague memories of fun history classes in undergrad, before we started cramming our brains full of medicine. Post-Red Fort, we wandered down a main street called Chandni Chowk, hugely busy, people selling things left and right, extremely crowded, and crossing the street means risking a limb. After making it through the street, we found the spice market. Something must have spilled, because we all were coughing/sneezing/tearing up for a stretch.

We braved our way back down Chandni Chowk for a pit stop at the hotel for a western toilet bathroom break, then made our way to a Mosque nearby. We all had to remove our shoes, and were given very, VERY colorful gowns to protect our modesty...we were very bright and voluminous.

Food!

We enjoyed some awesome free breakfast at the hotel, some street samosas, and then ate at a restaurant called Karim's, supposedly listed in Times as one of the best restaurants in Asia. We had Chicken Biryani, Palak Paneer, Chicken Tikka Masala, Daal, and (duh, we all love carbs too much), naan. It was great. Following dinner we stood mesmerized by the men making naan. So efficient, so delicious. Nummy.

Some interesting observations:

People keep trying to take photographs of us, secretly, by walking past us and then snapping their phone/camera or by just asking us. One request came from a reporter from Afghanistan. We have politely declined these requests. I have received one marriage proposal (?!?!) and we stick out like sore thumbs. It will be interesting to see how we are received when we start working in the hospital!

Tomorrow we're getting picked up at 6:30 and headed to....the TAJ MAHAL!! We are all super excited! In the meantime, going to catch up on some sleep and play some bananagrams.

Namaste!

KJ

ps....photos to come, except my computer is on its last dying breath and the upload speeds here are painfully slow...

Hangin in Amsterdam

Hello Friends!

After a relatively uneventful but child-filled flight from MSP, the four of us are in the "comfort chairs" section of the airport, enjoying free wi-fi, and trying to figure out a) when to sleep and b)what the actual time differences are between MN, Delhi, and Bangalore. Its 7am here and our next flight doesn't leave until 11am...another 9 delightful hours before we reach our (first) final destination in Delhi. The plan? Hope that Hotel Tara Palace picks us up as promised, explore Delhi, and, of course, seeing the Taj Mahal.

See you in Delhi!

KJ

Before I go

Before I go I wanted to provide a brief description of where I'm going and what I'm doing!!

March 19-24 New Delhi, India: Taj Mahal, etc.!!!
March 24-April 21 Bangalore, India: Rotating at St. Johns Medical College in Community Medicine, Emergency Medicine (YEAH!!) and Dermatology. Staying at the Annexe III right across the road from the hospital. I hope there's internet so I can continue to blog easily...eek!
April 21-28 Ireland road-tripping with AJ!! This includes Dublin, Galway, Inishmore of the Aran Islands, and Cork. This is AJ and my reward for finishing Medical School before I start residency and move to Morgantown, West Virginia.

I can't wait to experience the Indian Culture and health care system as a poor student!!