"That's a damn good uterus!"

I love my new clinic posting! It is in Sutika Seva Hospital- which is a private clinic mainly for lower class pregnant woman. The OPD (outpatient department) is general a couple hours in the morning, and last Wednesday we saw 50 patients. It was NUTS. I was taking BP, weight, and FHS (fetal heart sound) with a Doppler like mad (with the help of the resident). the doctor is a character, so knowledgeable, approachable, and funny!
some of my favorite quotes....
-"that's a DAMN good uterus!"
-slapping a woman's postpartum loose abdomen and replying to her complaints of the appearance... "i told her to do abdominal exercises" (sounds harsh but we were all laughing, including the woman!)
-she ends many, many statements that she wants us to be in check with.... "isn't it"
-after nurses showed up to work 2 hours late, "today i came in such a good mood but now im pissed, if i see them i might start fuming again!" (she is so dedicated and loyal to her work that she can't stand people wasting her time, not being efficient, and being LATE!)

Also, the first day while waiting in the OT with a women needing suturing from a medio-lateral episiotomy, the resident comes rushing in and asks- 'which one of you is going to assist me?' I immediately have red flags- out of my scope of practice and voice my concern that we are NOT trained, to which she replies- I'll show you! So nicole steps up, scrubbed in and helped by holding the speculum and cutting the suture thread. Later that day we talking about the ethics of that scenario and decided, she wasn't doing any skill persay and felt like it was safe. The next day, while watching the same resident about to give an intramuscular injection in the gluteus region (bum) that she turned and said 'do you want to give?' I pipped up right away- no we don't know how, so she says 'watch this one, i'll show you, and you can give the next one'. sure enough not more than 5 minutes later, a woman comes in for a tetanus injection and I prepare the syringe and as confidently as i can, slowly inject the fluid into the specific area pointed out from the resident who is holding the skin taunt. it went well! I don't plan on making a habit of preforming the tasks, but it was a pretty cool experience!

So... low of the day yesterday...
There I am using the Indian style toilet before ~2 hours of watching surgeries and while i'm awkwardly balancing, trying to squat and hold my purse from the wet concrete smelly ground at the same time as turning on the facet. Not a good idea. I turn the facet and am immediately shot in the face with a stream of water spraying straight up. I try and turn it off, but it's very clearly malfunctioning and the normal righty tighty is backfiring right into my face. I final twist it every which way to find a position that slows and eventually stops the stream. I managed to keep my mouth closed and stay out of most of the spray. I shake off what water I can and step out of the bathroom half laughing half crying. Later Nicole had a fitting insight... "in India... if you're not laughing you're probably crying!"

Now I'm off to Goa, land of sun, sand, and coconuts! After a 10 hour bus ride, we arrive in the morning and take a bus ~30 minutes north a smaller town, Anjuna, and get a room in one of the many guest houses there. I can't wait for a relaxing weekend on the beach!

More soon on my thanksgiving meal mishap, weekend in mumbai, and daily happenings!

pictures!

Just a couple pictures from the last week- at another Indian wedding in Mumbai; our hands after getting traditional Mehndi!; view of slums from the local railway in Mumbai; enjoying playing doctor with my official white coat and lunch in the "doctors room"; what? no thats not be hanging out of the moving train...

half way !

I am now officially half way through my time in India and also have one week in Pune under my belt The transition from Dehra Dun to Pune was an interesting one. On the train ride to the airport, our train hit and killed 5 men that were working on the track. Apparently they were working at a section with a lot of rail traffic and got off the track they were working on to let a train pass and didn't see ours coming the other direction. I heard that about 16,000 people/year die this way in India. It was gruesome. By the time the train stopped, the men were in pieces and the car we were sitting in happened to unfortunately stop right in front of some of the main body parts. I'll spare the details, but it was horrible. And even more so, the fact that while this effected me for about an hour, the lives of these men families will be forever marked. With that disturbing start to my day, we finally made it to Delhi and had climb the ridiculously long flight of stairs up and back down with 59.5 lbs of luggage. Yes, I know the exact number because I had to pay $20 US for those extra 10 pounds. I guess it's not so bad but when everything else here cost me about $3-4 dollars... it was hard! Because our group was splitting up with one person catching an earlier flight to Mumbai and Nicole and myself to Pune on a later one, we arrived at the airport early. What was suppose to be a 5 hour wait time, turned into an 7 then 8 then 9 hours before finally departing due to... well India. But I did have some nice down time to journal, blog, play cards, eat pizza (!), etc. We arrived in Pune a little after 1 am and were picked up by a CFHI driver and taken straight to our flat where we promptly passed out until the next morning. It was SO nice to know I'd be in ONE place for more than a week. All the moving around and living out of my suitcase for... 8 weeks now, was getting old! I unpacked my clothes and set up camp in the guest house provided by the program. It felt so good to be settled. We spent the first week in an 'upper class' government hospital, Deenanath Mageshkar (don't worry I still don't know how to pronounce it correctly either). Posted in the OBGYN department, I saw 3 births, a vaginal hysterectomy, laproscopic salpingectomy (removal of fallopian tubes), cervical biopsy, and joined a paediatrician and a gynecologist for their daily out patient appointments/walk ins. The most amazing thing was the laproscopy procedure. I was able to see the surgeon scalpel into the abdomen from the inside out! I am feeling really good about where I am; medically I am exposed to so much and I am looking forward to the rest of my time here. The end is in sight- how crazy! We started making weekend plans (this weekend- staying in Pune and seeing the sights around and in the city, next going to Mumbai to meet up with friends and see another wedding!, next going to Goa- beach vacation, yes please!, next going to some famous caves in the area, and next...flying to Malaysia to see my best friend Shannon!!) I have found that sometimes, the time just flies by- like when making plans or realizing I have been gone for 2 months now. And others...it seems like the time is suspended, barely moving- like when I am stuck in between 4 lanes of traffic with cars, rikshaws, and bikes coming at me in every direction. But some how, I manage to take a step forward, weaving between the obstacles, and reach the other side- proud to look at what I have accomplished!
I am excited to see what our next week in a 'lower-middle class' government hospital has for us!

5th week entry... took awhile to get it online!

First of all, Indian weddings are insane. They have on average 4 nights of festivities- often lasting until early in the morning each night. I don't know how they do it- by the actual ceremony on the 4th night I would be half asleep for the millions of pictures and definitely out during the 3 hours of prayer. We were able to attend the last two evenings, which was the brides family (only) party and then the last night was the actual wedding ceremony. Getting dressed was an event in itself. After 9 attempts of trying to correctly tie our Sari's and them still draping awkwardly or slipping off after taking a step, we asked the front desk of our hotel if any women were staying here and if they could possibly help us. 5 minutes later, theres a knock on our door and a very sweet lady walked in and saved the day. The bride's families party was so much fun- lots of music, dancing, food, talking, laughing, etc. The night of the wedding was absolutely unreal. We arrived around 8 pm to a huge party tent elegantly decorated in red, yellow, and lots of white lights. Food surrounded the whole arena- different cuisines, a fruit bar, dessert table, and full bar. There were waiters walking around in uniforms all night with delicious bite size samples that were too hard to say no to. The groom arrived, along with a full band, his whole side of the family and friends, and fireworks marking his arrival. He was wearing a cream colored,, intricately decorated suit, a special hat with white beads and traditional (Aladin) shoes. He (VERY) slowly made his way over to the fully prepared stage upon which he sat for the following ~3 hours attempting to not be blinded by the thousands of photographers capturing the moment. The bride entered absolutely decked out in a beautiful red sparkling Sari. As we are watching the scene unfold, Nicole and I are whisked away with no option of turning down the increasingly hoppin' dance floor. I don't even know how to explain what happened next, but it was probably a once in a lifetime experience and possibly one of the craziest moments in my life. First of all, the dancing is very different than back home- it's not about shaking your behind or turning another person 'on.' It's about feeling the music within yourself (I'm not making this up, a man my dad's age told me this). There were all ages on the floor- a young boy probably about 4 years old with more rhythm and moves than I've ever had, a woman who could have easily been my grandmother, and the older men outnumbered the young ones. So as we are doing our best to really feel the strong, upbeat Punjab music, money, yes money, starts raining down from above. I realize an older man has a stack of money at least 2 inches thick and he is holding his hands up in the air and is flipping through money as if it grows on trees. Everyone is gathering around watching and joining in. Then the DJ turns on the one and only Akon- Right Now which happens to be one of my favorite dancing songs, and I just remember thinking 'no way is this happening right now.' I had to leave the dance floor after that song, it was just too much! Again, I am not explaining this situation to it's fullest and maybe even sounding a little shallow but mix that along with the surroundings and just where I am in general- it was pretty surreal. I won't go into my fairly strong emotions of the extreme gap here- but briefly... one party you have money raining down while the waiters watch more money they probably make in a year get stomped on by the overweight higher class they are serving. It's just not right. The actual wedding ceremony started around 1 am and lasted till ~4 am. It involved at least 3 hours of prayers and other traditional activities. We parted 'early' around 2 am, I felt it was probably time to leave when the Sari was rubbing off layers of skin from the endless supply of food that was now sitting very happily in every nook and cranny of my bulging belly. I definitely got my fill of Indian weddings!

My last week in Northern India was spent in a mountain side town named Mussoorie at a Christian based, well funded hospital. The hour drive up the windy, narrow road in the dark was the most eventful yet. As we are passing another bus on a blind corner (really, why wait...) I look out and see a sign stating “speed thrills but kills” and am thinking I'm really not so thrilled about this! We came the closest to hitting someone yet, but at least if we did hit him we were on our way to the hospital, right? Mussoorie is beautiful; situated at 7,000 ft above sea level and looking out over the night lights of Dehra Dun. It is also very cold. The warmest I felt all week was during my first real surgery- and that wasn't from external heat but more of an overactive mind having systemic effects. While there watched I watched a tubal ligation, the most amazing birth (fast, no tear, no screaming- she was a CHAMP), insertion of a chest tube (crazy case- the man had pockets of air covering his whole face and neck from a punctured lung), a 4 hour bone graph surgery taking marrow from the hip and inserting it into a severely fractured, poorly healing arm. By the last day, while watching the bone graph, all I wanted to do was get in there and scalpel or retract something, anything more involved. What surgeons can do is amazing!
My days went basically like this: wake up at 7:25 am and go down the 2 stories to the cafeteria bundled in as many layers I can manage, eat breakfast at 7:30 and then to chapel at 8:15 am where I tried to follow along the morning teaching but often ended up doing my own reading. Rounds started at 9 am and then at 10 we had tea and sat in with a doctor for a couple hours of appointments. Lunch was at 1 pm and then after that we were free unless there were surgeries scheduled. Thursday ended up being a free afternoon and I hiked up to Landour, the small town at the highest point of the mountain. While I am meandering my way up the (paved!) road, a monkey darted out from the woods on my left and ran straight across the road jumping into a tree down below. I stop in my tracks and watch the monkey in the tree and am thinking how cool it was that I got to see him up close in his natural habitat when I look up and realize they are everywhere! In the trees, along the road to my right and in the hills to my left. One would come towards me, speed up as it passed me and jump into a tree and then settle in. I continued up the road saying 'niceeee monkey' until I passed what was pretty clearly their territory! At the top of the road was a gorgeous view of endless mountains. I sat at a cafe and enjoyed a chocolate 'pancake' that was really more a round cake with syrup! Other than never wearing less than three layers of clothes, it was a really good week and definitely the best one clinically so far!

Mumbai

Hello from Mumbai! We arrived last night and feeling brave decided to take all local transportation to get to our friend's flat. We got off the train from Pune, literally jumped into a packed out local train that was stopped for about 5 seconds and pushed our way into the woman's car and were completely engulfed in a mass of saris, then took a rikshaw to a known mall in the area and found our way to the apartment complex. Today's agenda is to meet up with another participant in a different but similar program here in Mumbai and then make our way to a market and barter our way down the line of stalls. After all we can take of that, we will head back to the flat, freshen up and get dressed up and head to The Palms Resort for a Mehndi function. It is about 15 miles away and it could take up to 2 hours to get to, so I hear. Let the day begin

Chandigarh. Public health rotation + indian wedding

Our fourth week was spent in Punjab, a different state, on a public health rotation. We were the first group from our program to do this rotation and it was... well let me just start with our first day. We meet in the morning and are given a brief presentation of the program we are going to see- Target Intervention (TI). Their overarching goal is to eliminate the spread HIV/AIDS and their objective is get FSM- Female Sex Workers to use condoms 100% of the time. This is a tough population to break into, but starting in 2007, TI has made contact with FSW in the community and have actually developed a trusting relationship with a lot of the local workers. The FSW come at least once a week for support groups and are learning about the importance of condom use. It is hard to get the men to agree, but the women are learning techniques and persuasive ways to get them to comply. We spent the afternoon talking to these women, through a translator. It was pretty shocking- we all sit down and the translator looks at us and says- “okay, what do you want to ask.” It was a completely open forum and we were given free reign to ask these women any questions. Their stories were amazing- most were married but completely unsupported by their husbands and got into the business because they needed to provide for their children. Monday's were the busiest days- seeing that most laborers had the day off. They usually saw between 3-4 clients a day (while their children were at school) and charged ~500 Rs/client (~ $10 US). The program is really making a difference for these women- giving them the power of knowledge and someone to listen to their stories. Change won't happen overnight, but TI is starting somewhere and hopefully can slowly educate and improve the lives of these women and their children.
Tuesday was spent with the NGO Reproductive and Child Health (RCH). Their goal is to reduce maternal and infant mortality rate and their target group are under served areas- rural and urban slums. When we toured the slums, I couldn't believe how many little kids there were. Naked, dark legs sticking out under filthy shirts running through the small alley like streets, playing in the dirt, on the roof tops. We gathered in a small room, chairs of all shapes and sizes were being brought it from what I assume were people's homes. We sat in the room while brightly clothed women flooded in. A newborn is brought in wrapped in a colorful blanket and put in my arms. Whose child is it? I have no idea. All I want to do it give the baby a bath and a clean outfit. I think about this child's future. I ask the program coordinator- if this child does well in the public schooling offered in the slums and has dreams of leaving and lets say becoming a doctor or teacher herself, could she? “Oh no- it's too hard” So I am holding this child, looking out at it's future and it's bleak.
The rest of the week was spent with other NGO's- hearing a presentation and then going out into the field and directly interacting with the people. One was an adolescent group educating youth on the many changes that occur during this time, the importance of utilizing health services and staying healthy. Another was reaching out to urban slum mothers and encouraging them to deliver in an institution opposed to home birth. The whole week was so interesting. India has far to go, but it was incredible to see so openly what is being done.
Currently, I am in Patiala- another city for an Indian wedding! I am so excited to see the event- they are quite different than back at home with four days of celebration and... well soon I'll know what else! We are staying in a hotel- $12/night split between 3 people. I am honestly scared to come home- I am not going to want to spend half of what normal prices are! We ordered lunch and it came out to be 70 Rs each- which is ~$1.50 USD. It's all relative. But I find myself upset and bartering if the price of a shawl is more than $5 US or if a meal is more than $3-4 US. Looks like I'll have a rude awakening when I come home! As for now, I'll enjoy it while I can!

A day at the fair...

Coming back to Dehra Dun for the third week was actually really nice in the sense that it was familiar- I had my same room in the same some stay, the food was what I had first adjusted to, and I knew my way around the town. I decided that the best comparison to explain what Dehra Dun is like is to picture yourself at the county fair. It is hot, crowded, colorful and loud. Smells of food, livestock, and other things you would rather not know are all around. You have to watch your every step or you may end up with a little something extra than you paid for. You enjoy yourself most of the time, but sometimes all you want to do is go home. It's exciting, stimulating, and exhausting.
Here are some highlights of my last week---
While riding to clinic in an auto-rickshaw our driver tries to squeeze past a bus and ends up side scraping it pretty bad (I'm actually shocked this is the first time it has happened). The bus driver gets out and starts yelling at our driver, as us three girls are sitting with wide eyes in the back seat- our driver blows him off and keeps weaving his way through the traffic.
With that same auto driver (you think we would have learned the first time), we are on our way home from clinic and he stops twice, once to say quickly hello to a friend and another time to pick up food- because hey, he was going by it and it looked good, and why wouldn't he... So while he is getting food, we are all sitting there laughing/confused when the auto starts slowly rolling into the on-coming traffic- I guess they don't have parking breaks here?! It slips a little bit, and stalls, slips, stalls... after doing this about three times and us bracing ourselves in the back seat, the driver jumps in with his food and continues along the way.
Another evening (this really was an eventful week), we are riding in a vickram. Vickrams are the main transportation and fit usually 8 people in what would be 4 in the states. I've gotten use to staggering seating and basically sitting on others to accommodate the 4 extra people so when 12 people are packed into this small three-wheeled-go-cart-sounding vehicle, I don't think much of it. But apparently there are some rules in India, because we get 'pulled over' and watch as the driver and his compadres banter back and forth with the policemen. This scene is drawing people in and soon there are groups of people packed around watching. The driver gets out and is walked over to the other side of the road with the policeman and we are left sitting in the vickram. I guess this is as far as we go, so we pile out and try to catch another vickram- which isn't happening because so is everyone else and we end up having to pay for an auto to get to clinic!
So you think you've seen it all, and then as we are riding to clinic one evening, I look up on the rooftops of the markets and monkeys are everywhere! They are climbing all over the buildings- hopping from one to another and looking like they are having a lot of fun, looking down on us. I began to wonder, who was watching who. I'm learning that India has no limits- you never know what you are going to see!
After spending a good chunk of time here, I have begun to see things differently- in snapshots. While driving past the markets, I see a still shot of a grandfather sitting with his legs crossed in fa chair in ront of his tailor shop with his grandson standing with his chin resting in his hands looking out over the commotion, a woman dressed in a beautiful pink sari with 4 quilts tied up and balanced skillfully on her head, the 4 children squatting in front of a water source filling jugs of all sizes and another three young children carrying their already filled water jugs down the road to who know where. It is so picturesque. I have also realized there is a fine balance between exploiting the poverty and showing the story of how these people's lives through a photo. What I have noticed, from looking around and seeing the bright, beautiful colors everywhere, is that these people make the best of what they have. We all could learn a thing or two from each other.