Kolam in the morning

There is a custom in Southern India, of women drawing figured on the ground to bless the home. They start by sweeping and cleaning the doorstep and then draw a figure. I was able to watch this a couple times. It was amazing! The shapes and creativity that they did was wonderful. Someone would come every morning and draw one on our doorstep as well. It is called Kolam. Check out the wiki article, it’s short.

Whirl wind adventure on the other side of India

Here is the first Installment of the “Weekend Adventure India 2012.”  I haven’t had time to sort through the pics and stuff, but I’ll start sending them out.

So first, we left from Thenkarai, where we were at and drove through the mountains of Tamil Nadu and Kerela to the other side of the sub-continent.

We stopped first at a wildlife reserve and took a boat tour for an hour and a half of the area.  It was awesome.  Periyar National Park was the place, and the boats were very cool!  We were top deck, wearing our life preservers and taking shots.  There was collection of Monkeys hanging out near the dining arrangements, but we were fenced in by gates, so they just watched.

The shores had barking dear, some king of warthog/pig, and water buffalo.  Sometimes they have elephants and of course tigers, but not for us.  I have included the picts here.  It was awesome.

Oh yea, the medicine…

As Dr. Speicher pointed out, I haven’t written about the medicine. So there are 3 of us here, 1 in surgery, 1 in neurology, and me in OB/Gyn. Unfortunately for me, there is a residency here, and I’m lower than the interns in scale, and since I don’t speak Tamil, I just get to watch. The most interaction I’ve done is help the Intern with his H&Ps. Which is fun, because the intern I was working with is a great guy(and the only guy) in the department at the moment. He’s doing his rotating intern year. His name is Mohamed, and he has taken really good care of me. He’ll translate things for me, and work with me directly, and explain what is going on. All the doctors speak English, but to varying degrees. The first day we showed up, the Department head just kept saying, we’re very busy, and when she tries to talk to me, her accent is VERY thick, and it’s hard to understand her. There is another woman, who is a director who is much more interactive, Dr. Padma, who will actually ask what we do for this or that. She is there’s go-to Doctor for Surgery and issues.

During the day, there is a consultant service going on, where the interns and lower residents to the History(and just the history) in the chart, and then hand it to a consultant who reviews it, and makes the Assessment and plan. I’ve had some opportunities to figure out what’s going on with a few patients, and follow up with watching their surgery or procedure. That was interesting. One lady came in with post-menopausal bleeding starting the day before, and I pretty much said cancer…and it was, large necrotic mass on her right ovary. They did a curettage to get the staging I guess? I thought they’d just take it out. They seem to do hysterectomies pretty freely(when indicated, since they don’t have novasure or things like that).

I’ve seen 2 c-sections and picked up a couple tricks I thought were interesting in the OR. They have a lot of pre eclampsia, near 10% prevalence. They also have a difficult time getting people to come in for prenatal visits, probably why they have a higher rate of pre eclampsia. The C-Sections I saw were both related to Pre-eclampsia. The goal the OB department has is to see the patient 3 times a trimester, they are lucky if they get 1 per trimester, and they live with that because of the social issues around it. Tamil Nadu is actually very good at lowering their mortality rate for both babies and mothers. One of the lowest in the country, but it took them about 30 years of advances in public health to do that.

The OB department has a about 6 attendings(I think), and a consultation room, with 2 desks and 10 chairs for patient interviews. No private rooms for interviewing patients. You all gather around the table and get the histories. Then the Pap smears/pelvic exams are behind a curtain in the same room. Next is a general ward, with 18 beds 1 foot apart and in 2 rows. This is the general ward where most things come to, deliveries, 2 days post op, normal care. Then in the back is 4 small cubicles which are more private, but at the end of the general ward.

Next is 3 private rooms, right off the hallway for paying clients with cash(rupees) and then a clean room for sterilization/fabrics, etc. Then a dressing/storage room for the men. Across from that is the Doctors room for the on call doctor and a lunch/meeting room. Then behind a set of doors is a small 6 bed, 1 room Post op room. Here is all the critical cases/post op care which is staffed by an attending and an upper year.

Next is the next set of double doors and then the 2 ORs with a wash room in between to scrub. Both are set up for surgery, but one has nicer equipment for laparoscopic and more technical anesthesia equipment.

Okay, what I am about to explain may seem unreal to the common American doctor, but it’s true. So, first off, you wear flip flops in the OR. I kid you not. Some of the attendings have a pair of crocks, but I only counted 2. Some of the Techs where nothing at all on their feet, walking in bear feet. Next, when they scrub, they wear a plastic apron and then a cloth covering over them—a large green apron that ties on. They assumed their hands are sterile when they scrub in and they use them to tie their wrists and then glove up. Usually double gloving. They usually have 4 docs scrubbed in, an attending, an upper year or 2 and an intern.

Unfortunately they are so busy that I haven’t been able to scrub, but that’s life. The anesthesia cart in one room has a picture of Jesus stuck right under the nitro valve. It was the first picture of Christ I’d seen on my trip here.

The anesthesiologists are pretty nice, there is a trainee and an attending. There is a scrub nurse who is handing things to the field from silver canisters with long sterile pronged grabbers. They keep counts like we do and they waste almost nothing. Laparoscopic surgeries are 5 times more expensive because of the cost of what is wasted, the sheaths, the equipment, etc. If you can afford it you can have it. Money plays into everything here. There is some charity care, but it’s not as easily obtained. Only about 20% of the population has any kind of insurance. There are some government issued cards that have a cash amount that they can use.

The OB suite is small, 2 normal beds and 2 birthing beds.  They do NOT give epidurals.  They don’t use any anesthesia unless you’re doing a C-Section.  Most notably, I never heard a word or scream, or peep out of ANY of the women doing labor.  I was amazed!

It’s amazing to see the differences in medical care. They don’t waste ANYTHING. They re-use sterile gloves by autoclaving and use them on the floor. In a normal surgery, like a hysterectomy, they use cloth, metal tools and nothing except old sutures, and blades get tossed. They are very efficient. It made me think a lot about what I use in medicine.

The People of India

This gallery contains 15 photos.

Here are some shots of people in India.  Notice the color/fabric schemes of the women, and the multiple riders on the motorcycles.  It’s amazing.  I always told my Julie that you could take the whole family on the motorcycle.  She never believed me.

My first international incident….

So we went out to see the attraction of a statue being placed in a dedicated temple. The people were pulling it on a large wagon, with lights, and a procession of women with potted plants on their head with beautiful flowers and designs. Well, as we approached, everyone was watching us, and then they came….hordes of them out of no where…children coming from every place. Some of them were trying out their English, asking us our names and our parent’s names. They were even trying out swear words and phrases they’d picked up on TV. Some tried to trick us into using bad words on them. They were pretty funny.
There were a couple girls who were following us as well. Most of the horde was boys. Once they saw me taking pictures, they asked me over and over to take their picture and show it to them. Some adults would also come up and gently asked if they could have their picture taken.

It was truly an international “incident” as it was the first up close an personal look I had of the Tamuli people, other than walking around them.
It was fun.

Arrival in India

As I was traveling my last leg, I left Frankfurt and flew SE towards the Persian Gulf. We actually flew over Bagdad, Dubai. I saw the Black Sea, and portions of Qatar…over the India Ocean. I have seen Iraq from above. That was just cool. I grew up knowing about these places, but now I have sen them, traveled over them, pretty cool.

As soon as you get off the plane, you feel the hea=t and smel a mix of sage and jasmine in the air. Lots and lots of people with a myriad of languages, and ethnicities. The trafic is insane, dropping off people and trying to get out of it can nearly kill you.

We got a taxi from the airport to the home we are staying in. I am so glad I don’t drive. There was so much honking and lights flashing. Which is considered polite here.

The air has a distinctive smell in the van we are riding in. Stronger jasmine sent with some flowers are draped on the rear view mirror. The city is a mix of new and old buildings. The roads are like spigetti, I thought I was going to die…just kidding sweet wife… the driver was very skilled…and there was a lot of honking.

We got to the home safely, tok off our shoes, got our room with large fans and a cooler. I slept like a rock.

On my way to India, reading Indian History

I was reading about the Indus river civilization, and it’s amazing to think that they created fabrics! They were industrious, lots of trading, and had huge cities for that time. Apparently they were the largest old civilization of their time.
Pretty Cool.
Can you imagine an ancient civilization that we have NO idea how to read their writing? Or to even understand it?


On my way…

plane Wing

And that is the semingly small plane for the puddle hoppin plane I boarde to start me trip.  I’m heading from pittsburgh to washington DC, there to meet up with my group to head first to Germany..too bad my sister won’t be able to see me…and then to Chenai(Madras) India for day 1.

I kissed Julie and the boys goodbye, walked Gracie to her bus with the family this morning…she was sad…and now I’m off.   I’ve never flown over and ocean before.  Never left the continent.  I already mis my family.

The plain is particularly loud…prop planes, go figure.

Blog ya later.


Boy do I have a fat face..

I’m Going to India!

So, this is my first trip abroad. I’ve always wanted to go. And with the grace of my Sweetheart, Julie, I am going to India for 2weeks(2.5 counting the travel. I’ve never left the continent.
I will be flying Thursday to Germany, and then to Chenia, then taking a train to Madurai to work in the hospital there. I’m excited and nervous. It’s like a new rotation, with people I don’t know, in a place where customs are completely different. I’m taking our camera and my laptop, as I’m staying in my host doctor’s house, and can leave them safely there. I hope to post daily, while I’m there and tell my stories.
Here goes nothing!