I finished up with Dharampur on Saturday. I am incredibly confused about my experience—it was a wonderful one, but not what I had expected. I think it is going to take me a little bit of distance until I am able to truly appreciate it for what it was. I learned a lot about health care, my perceptions of health care and medicine, and even discovered some of my own demons (health care demons that is). I inadvertently and shockingly realized that I didn’t exactly equally value all human lives (their access to health care) as I want to. At times I found myself thinking “why give them the medicine, they aren’t going to change their behavior anyway,” I also thought some other, more evil things, but I’m as shocked as you will be so I am not going to put it in the blog. Ask me and I will be happy to explain in person.
My last days in Dharampur I spent working on a reproductive health project. Daxa Auntie gave a lecture on reproductive health to Adolescent girls in 7th and 8th grade. I would follow up her lecture by showing them images and clips from The Miracle of Life (all of our favorite, funny how much I appreciate that movie as an Adult) and The Nine Month Miracle. The girls were incredibly responsive and really enjoyed watching real life fertilization and the different stages of the embryo. I asked them if the images were scary and they said no, they were happy to be able to learn so much. It was by far the most fulfilling thing I have done here so far, and I was happy to end on that note.
Achyuta came Saturday night and now we are getting all set for our one month Himalaya adventure. We have all our camping supplies all set to go. I tried out my sleeping bag this morning—it was glorious! Achyuta’s pack is as tall as me (slight exaggeration), I have no idea how he is going to carry it. I practiced cooking…once…hopefully that wont be a problem.
I am both nervous and excited and even scared! Altitude sickness might be a real problem, so I am trying to mentally prepare and tell my body to be good and acclimatize right away. We are flying to Leh, which is in Ladakh (near Tibet). We are going to do a few treks between Leh and Kargil. The plan is to do one 5 day trek and one 10 day trek. The rest of the time will be spent traveling, acclimatizing, and making our way to Srinagar, which is in Kashmir. We will keep Srinagar as our base and do several treks from there. I am a bit disappointed because I am not as physically fit as I would like to be for a trip like this—I have been rotting in the sun here. But, hopefully my youthful legs will serve me well for 30 days. Ok! So! We’re off! Pray that we have a healthy safe trip and that Ach and I don’t kill each other along the way (yes I am worried about that too)!
Sunday, July 15, 2007
Tuesday, July 10, 2007
Surgery!
My dad came on June 23rd and I met him at home in Ahmedabad. I had so much fun with him and my family, I extended my stay for a week. Total I was there for a little over two weeks shopping, hanging out with my cousins, AND shadowing my Uncle (Shrikant Mama) who is a plastic surgeon. This last Saturday he started me out by taking me to the public hospital burn ward. We saw one woman whose throat and neck was completely burnt. He told me that most of his burn patients are female and their burns are a result of attempted suicide. He added that most of the time they are socially driven to such extreme measures. For this case in particular, he agreed with me that it could have been abuse but he wasn't sure what the cause was. The next woman we saw had been completely burnt from head to toe. You couldn't even see her eyes! They had been sunken in (I think), and essentially, she had no face. The resident said that she suffered from Schizophrenia which accounted for her attempted suicide.
After the ward, I congratulated myself on being able to see all the open wounds and I knew I would be fine in the operation room. The first operation was trivial--a young girl who wanted a scar on her hand revised. I stood next to Shrikant Mama and watched as they prepped her hand and injected the local anesthetic. As I watched, I suddenly felt everything in my intestines shuffle about and my face went cold. I felt light headed and knew that I must be on the verge of fainting. I put a piece of candy in my mouth and try to play it cool. I was so embarrassed, how could the sight of an uncut, perfectly normal hand make me woozy when I had JUST seen terrifying sights? Shrikant mama caught me putting the candy in my mouth and ordered the nurse to take my pulse. It was normal but I was sweating. I sat down and luckily I was fine. The wave past and I coulnd't help but laugh at myself, as soon as he started cutting, I was fine. It must have been the anticipation.
Our next patient was a young man who had a severe motorcycle accident. He was in critical condition for months and now that he is more stable he was brought to Shrikant Mama for facial reconstruction--he had several fractures that had healed improperly. His teeth weren't meeting properly and he could not chew. The floor of his eye socket had shattered and Shrikant Mama would have to insert an artificial floor made of synthetic material or a bone graft. I stood for 4 hours of the 7 hour surgery. I was tired and not feeling well so I left for lunch. I missed the bone graft ut he showed me the fractures. Honestly, it was hard to tell. Everything looked like a big bloody mess to me (literally).
The next day our patient was a 16 year old girl who had been born with a uterus but no Vagina. Doctors suggested that the vagina be created when she reached puberty. Shhrikant Mama and a OBGYN performed that surgery a year ago but she was back with immense menstrual pain. They concluded that her cervix was not opening properly and thus holding in all the menstrual fluid. They would have to go in and widen her cervix. Shrikant mama said that the surgery should last no longer than 1 hour. But of course nothing goes as expected. When they opened her up they discovered that she had an odd shaped uterus. The next few hours went on with the doctors just trying to FIND her cervix. In the process the OB nicked her bladder so they had to call in an Urologist (turned out to be fine). We also called in another OB for advice. Seriously this was like watching a movie. Halfway through the surgery the anesthesiologist said that she was in cardiac arrest. Everyone panicked for a moment--cardiac arrest for such a simple surgery?! He then quickly revised his statement and said that she was merely in shock because of one of the drugs. 5 doctors and 4 hours later they decided that she didn't HAVE a cervix. At this point they concluded that she wouldn't be able to conceive and that they should save her the time and effort and just perform a hysterectomy. They went out to ask her family, but her father wasn't present and her mother wouldn't (couldn't) make the decision. Instead they had to create a cervix and they inserted a catheter that she would have to keep there for 6 months to make sure the passage doesn't close. What an experience. Hungry and tired Shrikant mama and I drove back home.
Now I am back in Dharampur and Ach comes on Saturday!! My medical adventures will be over and we will start our trekking adventure in Ladakh/Kashmir! More to come
After the ward, I congratulated myself on being able to see all the open wounds and I knew I would be fine in the operation room. The first operation was trivial--a young girl who wanted a scar on her hand revised. I stood next to Shrikant Mama and watched as they prepped her hand and injected the local anesthetic. As I watched, I suddenly felt everything in my intestines shuffle about and my face went cold. I felt light headed and knew that I must be on the verge of fainting. I put a piece of candy in my mouth and try to play it cool. I was so embarrassed, how could the sight of an uncut, perfectly normal hand make me woozy when I had JUST seen terrifying sights? Shrikant mama caught me putting the candy in my mouth and ordered the nurse to take my pulse. It was normal but I was sweating. I sat down and luckily I was fine. The wave past and I coulnd't help but laugh at myself, as soon as he started cutting, I was fine. It must have been the anticipation.
Our next patient was a young man who had a severe motorcycle accident. He was in critical condition for months and now that he is more stable he was brought to Shrikant Mama for facial reconstruction--he had several fractures that had healed improperly. His teeth weren't meeting properly and he could not chew. The floor of his eye socket had shattered and Shrikant Mama would have to insert an artificial floor made of synthetic material or a bone graft. I stood for 4 hours of the 7 hour surgery. I was tired and not feeling well so I left for lunch. I missed the bone graft ut he showed me the fractures. Honestly, it was hard to tell. Everything looked like a big bloody mess to me (literally).
The next day our patient was a 16 year old girl who had been born with a uterus but no Vagina. Doctors suggested that the vagina be created when she reached puberty. Shhrikant Mama and a OBGYN performed that surgery a year ago but she was back with immense menstrual pain. They concluded that her cervix was not opening properly and thus holding in all the menstrual fluid. They would have to go in and widen her cervix. Shrikant mama said that the surgery should last no longer than 1 hour. But of course nothing goes as expected. When they opened her up they discovered that she had an odd shaped uterus. The next few hours went on with the doctors just trying to FIND her cervix. In the process the OB nicked her bladder so they had to call in an Urologist (turned out to be fine). We also called in another OB for advice. Seriously this was like watching a movie. Halfway through the surgery the anesthesiologist said that she was in cardiac arrest. Everyone panicked for a moment--cardiac arrest for such a simple surgery?! He then quickly revised his statement and said that she was merely in shock because of one of the drugs. 5 doctors and 4 hours later they decided that she didn't HAVE a cervix. At this point they concluded that she wouldn't be able to conceive and that they should save her the time and effort and just perform a hysterectomy. They went out to ask her family, but her father wasn't present and her mother wouldn't (couldn't) make the decision. Instead they had to create a cervix and they inserted a catheter that she would have to keep there for 6 months to make sure the passage doesn't close. What an experience. Hungry and tired Shrikant mama and I drove back home.
Now I am back in Dharampur and Ach comes on Saturday!! My medical adventures will be over and we will start our trekking adventure in Ladakh/Kashmir! More to come
Sunday, July 8, 2007
Trains
Just a quick note on the colorful train system here. I think India is famous for having the most expansive national rail network (thank you Britain). Thus, much more than the US, the railway is heavily utilized by all classes of people. When I went to Baroda, I traveled second class and sat in the Ladies Car ( I figured only women would be less smelly). When I was waiting to get on, the woman who was waiting for me asked "you dont have a handkercheif?" I had no idea what she was talking about until an hour later.
Second class has open windows and no air conditioning. The seats are wooden. One side has single seats and the other side is long benches that can usually squeeze atleast 6 people. Since mine was the first stop, I got a seat easily. I sat on one of the single seats and prided myself on having picked the prime location. The first hour was comfortable and then suddenly the train started to get packed. There were MANY more people than seats and to my surprise, a woman sat down and shared my seat with me. Before I could protest, I realize that everyone was doing the same thing. As we approached Surat, one of the larget cities, people ran along side the train handing in handkercheifs. I just watched, because I had no idea what was going on, but apparently this is a well accepted system of "calling seats." When the train stopped, most of the crowd got off the train. As the car slowly emptied, people who had been given hankersheifs placed them on the benches. Then, when the arriving crowd boarded the train, they looked for their personal hanky and sat down. I was amazed that amidst all the chaos, this system worked flawlessly. Everyone honored the hanky-placements!
I haven't traveled in the 3rd class car yet. I actually should have tested that out, because I won't have a chance to now. 3rd class is reserved for the poorest passangers, whom, as you can imagine, are quite poor. I'll definately blog if I get to have that experience!
Second class has open windows and no air conditioning. The seats are wooden. One side has single seats and the other side is long benches that can usually squeeze atleast 6 people. Since mine was the first stop, I got a seat easily. I sat on one of the single seats and prided myself on having picked the prime location. The first hour was comfortable and then suddenly the train started to get packed. There were MANY more people than seats and to my surprise, a woman sat down and shared my seat with me. Before I could protest, I realize that everyone was doing the same thing. As we approached Surat, one of the larget cities, people ran along side the train handing in handkercheifs. I just watched, because I had no idea what was going on, but apparently this is a well accepted system of "calling seats." When the train stopped, most of the crowd got off the train. As the car slowly emptied, people who had been given hankersheifs placed them on the benches. Then, when the arriving crowd boarded the train, they looked for their personal hanky and sat down. I was amazed that amidst all the chaos, this system worked flawlessly. Everyone honored the hanky-placements!
I haven't traveled in the 3rd class car yet. I actually should have tested that out, because I won't have a chance to now. 3rd class is reserved for the poorest passangers, whom, as you can imagine, are quite poor. I'll definately blog if I get to have that experience!
Sunday, June 24, 2007
Vavar-Health Check Ups
The main point of my stay in Vavar was to conduct school health check-ups. I started with the 7th graders as they are more likely to speak Gujarati. First I checked their vision with an eye chart and then I went through a list of questions to asses their health. "Do you have a fever? Does your tummy hurt? etc." The younger kids were really cute with their responses to "Can you see properly at night?" (we ask this to pinpoint Vitamin A deficiency). Many of them said "no, everything is dark at night" I would have to ask other questions to make sure that they could in fact see.
After the last check-up, we were going to play a slideshow to educate the 5th-7th graders on basic primary diseases that are common in their area. Predictably, th projector wouldn't work, so while they fiddled with the equipment, I decided to be brave and entertain the room full of kids. During the health check ups, I was most disturbed by the number of cavities I had seen so I asked the kids to raise their hands if they had tooth pain. About half of their hands went in the air. I asked them how many brushed their teeth everyday. An honest 3 were raised. I tried to ask them what happens when you don't brush, they were too shy to call out, but I could tell by their murmurs they knew the answer. I then asked them how to brush. They all used their finger to demonstrate. I copied and said "thats it? just the front 4?" They all said "NO!" and very diligently proceeded to properly air-brush their teeth with their finger. They covered every angle possible, they knew to use their finger if they didn't own a brush, and what else do you need? "COLGATE!" If you dont have colgate? "WATER!"
In a way, I was disappointed. They had all the information they needed and yet they still just did not make brushing a priority. Something so painful and yet so preventable and they just don't take action. It goes back to what I was saying in my last entry and even my very first entry. This population of people is so isolated that they have trouble with abstract thinking. Seeing is believing for them. If they can see the cause and effect, they can make the necessary change. But otherwise, the concept of preventative health care is lost on them, most specifically in circumstances like cavities, things that take time to develop.
Before I left I asked how many would brush their teeth everyday. All hands went up, but Vinayak Bhai assured me that they were just trying to make me feel good...they weren't actually going to start. And the truth is, why would they? I taught them nothing new.
After the last check-up, we were going to play a slideshow to educate the 5th-7th graders on basic primary diseases that are common in their area. Predictably, th projector wouldn't work, so while they fiddled with the equipment, I decided to be brave and entertain the room full of kids. During the health check ups, I was most disturbed by the number of cavities I had seen so I asked the kids to raise their hands if they had tooth pain. About half of their hands went in the air. I asked them how many brushed their teeth everyday. An honest 3 were raised. I tried to ask them what happens when you don't brush, they were too shy to call out, but I could tell by their murmurs they knew the answer. I then asked them how to brush. They all used their finger to demonstrate. I copied and said "thats it? just the front 4?" They all said "NO!" and very diligently proceeded to properly air-brush their teeth with their finger. They covered every angle possible, they knew to use their finger if they didn't own a brush, and what else do you need? "COLGATE!" If you dont have colgate? "WATER!"
In a way, I was disappointed. They had all the information they needed and yet they still just did not make brushing a priority. Something so painful and yet so preventable and they just don't take action. It goes back to what I was saying in my last entry and even my very first entry. This population of people is so isolated that they have trouble with abstract thinking. Seeing is believing for them. If they can see the cause and effect, they can make the necessary change. But otherwise, the concept of preventative health care is lost on them, most specifically in circumstances like cavities, things that take time to develop.
Before I left I asked how many would brush their teeth everyday. All hands went up, but Vinayak Bhai assured me that they were just trying to make me feel good...they weren't actually going to start. And the truth is, why would they? I taught them nothing new.
Vavar
I just spent 3 days in one of the tribal villages outside of Dharampur. It was incredibly green and beautiful! It reminded me of the rainforest..less foresty, but WAY more greener than the rest of Gujarat, which can often be desert looking. Daxa auntie has established a homebase in Vavar , and I stayed with one of her friends Vinayak Bhai. He had a little home with a clinic in the front. There was a kitchen and a proper bathroom (sqatting toliet of course) but no running water. There are hand pumps scattered throughout the village, so before going to bed every night, we would have to go down to the hand pump and stock up for the next day. In a way, I was grateful! It was good physical training for Ladakh!
The children are sweet and generally very well behaved but incredibly shy. They eventually open up, but for the few days I was there it was so frustrating!They refused to ask me my name, and in front of me they keep telling V-bhai to ask me. I even extended my hand a few times but they refused it. What a change from the kids in the Dominican Republic!
In the morning we saw patients. V-Bhai is not a doctor but he can provide basic primary care and knows how to recognize cases that should be sent to a doctor. One patient came in saying that he went to a private hospital for malaria treatment but he only had a few tablets with him. We realized that there wasn't enough so Vinayak Bhai gave him the remainder medication for his course. He told me that many doctors in the rural areas do that (and get away with it) so that patients keep coming back with the same problem, and thus keep paying the medical fees. Clearly, the problem with this is that it is causing serious drug resistance. I'm still having trouble comprehending how they could do such a thing!
The next adventure of the afternoon was a drunk mute man that came in asking for (motioning for) money. I admit, I was a little freaked out--especially when he took a moment to pet my head. I was 1% concerned that things would become violent. Luckily, when V-bhai escorted him out, he did not resist.
After my nap we hiked up the hill to a beautiful viewpoint he calls Little Kashmir. As we hiked up, a whole batch of children joined us. As we sat at the top overlooking the valley, the younger kids played and the older ones sat and talked to v-bhai. Again, out of shyness, they pretty much ignored me. V-bhai sang song with the kids and then we played memory games, going around in a circle trying to remember the chain of fruits and vegetables we were calling out.
At night we went back to make dinner. Vavar is famous for Agna--big lightning bugs that come out before the rain falls. It's the most amazing thing I've ever seen! There must have been thousands! They lit the trees like little christmas lights!
A note on the education system here...it's ridiculous. The classes are all taught in Gujarati (the state language), the teachers speak only Gujarati, and the students speak only Kokani--a dialect. As result, students have no idea what's going on, and not only do they miss out on crucial academic development, they also just plain loose interest in the concept of education. Their minds remain unstimulated and it only compounded by their minimal exposure. Now to be fair, this is not true EVERYWHERE, but it DOES happen and that makes it enough of a problem. It makes me want to overhaul the entire bloody education system here.
The children are sweet and generally very well behaved but incredibly shy. They eventually open up, but for the few days I was there it was so frustrating!They refused to ask me my name, and in front of me they keep telling V-bhai to ask me. I even extended my hand a few times but they refused it. What a change from the kids in the Dominican Republic!
In the morning we saw patients. V-Bhai is not a doctor but he can provide basic primary care and knows how to recognize cases that should be sent to a doctor. One patient came in saying that he went to a private hospital for malaria treatment but he only had a few tablets with him. We realized that there wasn't enough so Vinayak Bhai gave him the remainder medication for his course. He told me that many doctors in the rural areas do that (and get away with it) so that patients keep coming back with the same problem, and thus keep paying the medical fees. Clearly, the problem with this is that it is causing serious drug resistance. I'm still having trouble comprehending how they could do such a thing!
The next adventure of the afternoon was a drunk mute man that came in asking for (motioning for) money. I admit, I was a little freaked out--especially when he took a moment to pet my head. I was 1% concerned that things would become violent. Luckily, when V-bhai escorted him out, he did not resist.
After my nap we hiked up the hill to a beautiful viewpoint he calls Little Kashmir. As we hiked up, a whole batch of children joined us. As we sat at the top overlooking the valley, the younger kids played and the older ones sat and talked to v-bhai. Again, out of shyness, they pretty much ignored me. V-bhai sang song with the kids and then we played memory games, going around in a circle trying to remember the chain of fruits and vegetables we were calling out.
At night we went back to make dinner. Vavar is famous for Agna--big lightning bugs that come out before the rain falls. It's the most amazing thing I've ever seen! There must have been thousands! They lit the trees like little christmas lights!
A note on the education system here...it's ridiculous. The classes are all taught in Gujarati (the state language), the teachers speak only Gujarati, and the students speak only Kokani--a dialect. As result, students have no idea what's going on, and not only do they miss out on crucial academic development, they also just plain loose interest in the concept of education. Their minds remain unstimulated and it only compounded by their minimal exposure. Now to be fair, this is not true EVERYWHERE, but it DOES happen and that makes it enough of a problem. It makes me want to overhaul the entire bloody education system here.
Saturday, June 16, 2007
Baroda
I just got back from a relaxing 6 day "vacatoion" in Baroda (a much larger city closer to where I am from). I spent the first two days with my mom and dad's friends from medical school. Uma Auntie is an academic pediatrician and Siddharth Uncle is a pediatric surgeon. I went on rounds with Uma Auntie for the first two days, and again, I was just really impressed. India has really well established medical academics. I hope that progressively, the government will even better utilize their resources. The medical system here is like the education system in America. There are government hospitals (which are the academic hospitals) and there are private hospitals (Western Style hospitals for the rich). Uma Auntie strongly believes that the quality of care is almost on par with the quality elsewhere. The problem is twofold. First, because Gujarat is a wealthier state, it attracts patients from all over the country. Thus, the hospitals are majorly over crowded which obviously reduces the quality of healthcare they can provide. Secondly, the people who come to the hospitals are poor, and often unhygenic which invaribly creates an unhygenic atmosphere. So essentially, the knowledge and machienery is there to provide excellent care, the problem is in the neonatal ICU there are 3 infants to 1 bed.
Now, I'll be totally honest and say that I know very little about the American health care system (I know, that's VERY bad). So that as my disclaimer, I can't help but feel as though India doesn't deserve its bad rep. I mean, true, the care in the government hospitals could be better, but at least we are striving to provide affordable/free care to the poorest and most needy. I can already think of arguments back and forth, but I'm not going to delete what I've typed. I think it could make a very enriching conversation topic :)
After my two days exploring the Indian Academic health care system, I spent two days with my dad's cousin--which was great. Her daughers are my age and I had a great time with them. I was a little frustrated because they hospitality is so overwhelming that they wouldnt let me lift even a finger. They seemed to believe that I wasn't capable of anything (girl from America, what would she know?) It's incredibly frustrating, and I had to yell at them a few times..I think the message barely got through.
The one thing I was thinking on the train ride back is how incredibly lucky I (and my first cousins) am/are. Comparing our lives to my cousins here..it's just so different. We have SO SO SO much freedom education and exposure that I take for granted. Every time I come here I remember how lucky I am. Everytime I come here I try to remind myself not to take it for granted--but I always do. It's incredible to think how far we have come in just 3 generations. I can't wait to see my grandpa next week and give him a huge hug and thank him for all his sacrifices. It's because of him that I am able to travel this much, and its because of him that I have the education that I do.I'm adding this quick tid-bit for my family to read because I know they will understand that I mean. Sorry friends, you might not get what I am talking about I can go into detail later if there is interest.
Humm..thats about it now I'm back ready to hit the villages!!
lots of love!
Now, I'll be totally honest and say that I know very little about the American health care system (I know, that's VERY bad). So that as my disclaimer, I can't help but feel as though India doesn't deserve its bad rep. I mean, true, the care in the government hospitals could be better, but at least we are striving to provide affordable/free care to the poorest and most needy. I can already think of arguments back and forth, but I'm not going to delete what I've typed. I think it could make a very enriching conversation topic :)
After my two days exploring the Indian Academic health care system, I spent two days with my dad's cousin--which was great. Her daughers are my age and I had a great time with them. I was a little frustrated because they hospitality is so overwhelming that they wouldnt let me lift even a finger. They seemed to believe that I wasn't capable of anything (girl from America, what would she know?) It's incredibly frustrating, and I had to yell at them a few times..I think the message barely got through.
The one thing I was thinking on the train ride back is how incredibly lucky I (and my first cousins) am/are. Comparing our lives to my cousins here..it's just so different. We have SO SO SO much freedom education and exposure that I take for granted. Every time I come here I remember how lucky I am. Everytime I come here I try to remind myself not to take it for granted--but I always do. It's incredible to think how far we have come in just 3 generations. I can't wait to see my grandpa next week and give him a huge hug and thank him for all his sacrifices. It's because of him that I am able to travel this much, and its because of him that I have the education that I do.I'm adding this quick tid-bit for my family to read because I know they will understand that I mean. Sorry friends, you might not get what I am talking about I can go into detail later if there is interest.
Humm..thats about it now I'm back ready to hit the villages!!
lots of love!
Sunday, June 10, 2007
Dain Ben Trainning
One of the coolest things that Daxa Auntie does is traditional birth attendant training. Given that the villages dont all have great access to hospital facilities, most pregnant women rely on traditional birthing. The problem is, these birth attendants are almost always uneducated, and since I am talking about the very rural areas, they also have little exposure. Their methods are often unhygenic and obviously they don't know what to do in emergency situations.
Daxa auntie does a great job of teaching them when the baby is in a breeched postion and that the mother shuold immediately be sent to the hospital. ok I have to go now oops..I'll add to this later. Basically it was tons of fun, the women are old and spunky and I cant wait to show you all the pictures of today!
Daxa auntie does a great job of teaching them when the baby is in a breeched postion and that the mother shuold immediately be sent to the hospital. ok I have to go now oops..I'll add to this later. Basically it was tons of fun, the women are old and spunky and I cant wait to show you all the pictures of today!
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