Elephants, cows, and monkeys

Here are some kiddos as they prepare for their "cultural show" last weekend - it was GREAT!
This dance was incredible - the girl wearing the head-piece danced with that heavy piece on her head for over 5 minutes, walking on top of people's backs and bouncing around. She was quite tired at the end...
This is an example of some bench-work at the lab. This method of "mouth pipetting" isn't done regularly anymore, but it was until relatively recently!
Cows in India are sacred. And they are always painted various colors - their bodies, their horns, everything. It is quite comical to see painted cows wandering around in the streets of a busy city. I haven't gotten used to the site yet.
These are my friends, Jon and Judith. They are here for a year; he is doing research on diabetes and she is working in the school (he is a physician and she is a teacher).
This is the market in Mysore - all sorts of different colored dyes for different "bindis", which is the dot that is placed between the eyes for many Indians.
This was a beautiful flower stall in the market. Many women wear fresh flowers strung together in their hair.
An example of a "Haddi", or tribal village where the mobile clinic visits to provide basic medical care.
Elephants! So many elephants today on the mobile clinic - we went into the forest and saw so many animals.
Here I am on "rounds" with Dr. R. Prasad and the nurses, as well as a dental fellow (he is taking the picture).


Goodness, it has been a while since I last posted! That is because I have had a busy week, which is never a bad thing. Let me give a quick summary of what I've done:

First of all, I GOT BETTER! That was huge. Antibiotics did the trick and I felt better the next day, thank goodness. I didn't want to waste any more of my precious India-time feeling crummy. There was a large celebration last weekend for the school kids (SVYM has a school just behind the hospital) - this was their end-of-year celebration, complete with dances and costumes and awards and speeches. I stayed for most of it, and LOVED the cultural show.

This past week has been filled with 2 mobile clinic days (including one today where we ventured into the nearby forest to treat tribal communities there and saw many elephants, monkeys, and deer), a day spent touring some of the local government hospitals and public health centers in neighboring towns, a day spent learning about how the lab is run here and how they decide which tests they need to run and not (VERY interesting to learn about, as this is most certainly a resource-poor setting), as well as daily rounds and lectures.

Wednesday was a holiday for India, as it was their Festival Day, celebrating India as an independent nation. I went into Mysore with my friends Jon, Judith, and Nandeeni and had a lovely day there shopping and taking in the sights of the closest city to Sargur. Jon and Judith are here from California spending a year working - he is doing diabetes research and she is working in the school. Nandeeni works here at SVYM in the management department.

I continue to be surprised daily by all of the things I am learning while being here. There is so much pathology to see on the wards, so much medicine to learn from, both in the hospital and in the field. My excursions to learn about the public health aspect of practicing here are equally stimulating and informative, as I get a better picture of how SVYM fits into it's surrounding community and environment, as well as what the major needs of the community are.

I have only a few more days here, which is incredible for me to think about. Tomorrow I am off, and will go to the smaller hospital for an Ayurvedic massage treatment, something recommended to me and I am quite curious and excited for the experience. I have interesting things going on each day this week, including giving a presentation to the kids at the school on Thursday on my Arctic experiences, which should be great fun. Friday morning I depart for Bangalore to begin the next portion of my India adventure, which is purely tourist-based. I'll have 2 weeks with Zach to explore many different parts of India - Agra, Bangalore and the surrounding area, and West Bengal and Darjeeling, which will include a 6-day trek on the India-Nepal border in the Himalayas. We are VERY excited.

Hopefully I'll be able to post again before I begin the tourist-portion, when I'm not sure about my internet availability. Enjoy the pictures above!

Laura

On getting sick in India...

Here is a painting on the side of a wall outside the school that SVYM did - they do yearly assessments of these schools, map out all of the houses in the community, and keep track of how many houses have toilets (none), wells (2), working pumps for drinking water (3), etc. The writing you see is in Kannada, which is the local language.
Here are some of the girls I screened. They are in 7th grade.
Here I am checking in the mouth of a boy - he is in second grade. Quite small for his age, as you can see - that was a very common finding.
Here I am with some of the kids I screened. They were quite playful and enjoyed me, once they realized I wasn't going to hurt them:)
This is the team that went with me. The gentleman to my right (with his eyes half-closed) is Dr. Dennis, an Ayurvedic practitioner who mostly works at a different hospital started by SVYM, but he runs a mobile clinic once/week, as well as doing the school screenings when needed.


Well, I suppose that isn't the most jolly of titles, but it's all I can come up with at this moment. And don't worry, I'm not JUST going to talk about getting sick in India...but I might just start with it. I didn't get the kind of sick I assumed I'd get (the belly-kind)...instead, I ended up with strep throat. After experiencing my first high fever in as long as I can remember, I decided it was time to take some action today. I'm not 45 minutes into my first course of antibiotics and tylenol to help break the fever, and I'm already feeling better. That could be me mentally willing it to be, but I know when my fever breaks I'll feel worlds better. So, moral of the story for me is...don't get sick in India:) It takes away from all the other really cool things I could be doing! Like attending a huge celebration for all of the school kids this afternoon and evening. I'm hoping to still be able to make some of it, as I've heard their dances are quite cute.

Onto a better topic, the end of the week went pretty well for me. I spent Thursday going out and doing school health assessments at a school about 45 minutes from here. It is in a tribal community where SVYM has been working for quite some time, and they send a mobile clinic there every week, as well as helping them with their sanitation and subsidizing their food. We screened 41 children of the 90 who are enrolled in the school (a few ran away when they say us, a number of them were not in school that day, which is pretty typical apparently). The biggest things we screened for were tooth decay, anemia, malnutrition, and skin diseases. All 4 issues were quite common, particularly the malnutrition and tooth decay (one leads to another, as you might imagine). But the kids were adorable and my colleagues great with them, giving out vitamins and anti-parasite medications to all kids. I really enjoy the time I spend in the field here, as getting a glimpse into their lives and struggles is quite compelling and helps me understand more fully their health issues.

Tomorrow (provided I feel up for it) I will head out on another mobile clinic. This week is packed with many activities, with a day off on Wed, as it is some sort of celebration, though I'm not sure what. More to come!

Mobile clinic

Here is Dr. Bhavana, an Ayurvedic provider who I accompanied on the mobile clinic - she is standing outside our clinic van, getting set to go.
Here is the nurse and the medical supplies that are in the converted-ambulance.
Here we are assessing a woman who has a diarrheal illness and giving her some treatment, as well as rehydration packets.
These school boys were quite interested in what we were doing - and we needed to treat 2 of them for skin wounds which were infected.
Here I am assessing an old woman, who had come with complaints of stomach burning and cough. She looked quite old, though I suspect she was in her 60s. She had had a stroke previously and walked stooped with a cane. She was quite thankful for our treatment.


Yesterday I went out on a mobile clinic. It involved myself, an Ayurvedic physician, Bhavana, a nurse, a community worker, an aid, and the driver. Our van (see above) was actually quite well out-fitted, complete with a sink, many different types of medications and exam equipment. We went to 10 local tribal communities. The community worker would head out down the row of houses once we arrived, rounding up patients. The driver would sound the "alarm" on the top of the mobile clinic van (converted ambulance) to let everyone know we were there. And slowly people would trickle in to be seen. We saw a total of 30 patients, with a few of the communities not having any patients because everyone was out working in the fields when we were there. Mostly, our patients were women and children.

It was fascinating work for me. Bhavana speaks wonderful English, so she and I saw the patients together and discussed what we thought was going on and what we could do for them. The nurse doled out the medications, while the aid took notes, wrote prescriptions (so the patients would know how to take the medications, though I think it was more a formality, as I doubt most of the patients can read, let alone read English, which is the language of medicine in India) and collected money for our services. The tribal patients were changed 2 rupees (about $0.04 US) if they were given any form of medication. If they were not given medication, they were not charged. We gave out meds for colds, upper respiratory infections, gastritis, bronchitis, arthritis, sprains and strains, skin infections, diarrheal illnesses, headaches, dizziness, anemia, malnutrition, and dehydration. We also checking in with any TB patients that were in the communities, assessing any barriers to them taking their daily medications. We also tried to register and see any pregnant moms, and did give a few referrals for patients to be seen in the hospital.

I loved the work. Being with the community people, seeing their struggles and doing my best to help treat their illnesses was incredibly rewarding. The children are precious and their mom's shy, but concerned about their well-fare. Everyone was incredibly appreciative of the care we provided them. SVYM sends out mobile clinics 6 days/week, and visits different communities everyday. There are between 120-140 tribal communities in the surrounding areas, and SVYM attempts to have contact with as many of these as possible. Outstanding work.

On India and it's roads...

This is the village where we visited to give some positive reinforcement of the DOT program and providers (see explanation below).
This was during the meeting...can you spot the only white lady?
Administering Vitamin A to all the children
Me and one of my new buddies...
Here is one of the challenges of driving...hay drying on the road. Roads in India have many uses outside of driving.
Cows, cows, cows everywhere. And they don't move out of the way as quickly as you'd think!
People use the road for personal transport as well.
Roads are also only intermittently paved - above shows a paved section.
There are also random speed-bumps that appear and are quite intense - the car slows to about 2-3 miles/hr to go over them. Also, there usually isn't any warning that they're coming. The drivers are just always on the lookout.



Now, don't worry people. I have no interest or intent on driving while I am here. I have, however, experienced being driven...which is an experience all in itself. Today I accompanied a crew out to a local village about 40 minutes away for a meeting to acknowledge their DOT providers and patients (DOT = directly observed therapy, which is done for TB patients). The community was small, only about 250 people. See above for photos of the meeting, as well as the illustrations of why the roads are fascinating to ride upon.

Weekend update

Me being "coached" by Seetharam on the best way to flip the rice, which is prepared over a number of days, preserved as patties, then fried whenever they want to eat it. Yum!
Getting ready for a delicious lunch!
On festival days, the cows get their horns painted.
This is the labor ward - 3 beds in 1 room divided by curtains only. Women labor together, no husbands, partners, or family members allowed in, though they all congregate just outside the door to listen for that first cry! Noone in India knows the sex of the baby, as it is illegal to know - the govt outlawed it when pregnancies were terminated if the family knew it was a female child.
Me with a visiting ENT surgeon, who comes to SVYM hospital in Sargur once per month to perform needed operations. Today he just had 2 surgeries to do.


Life has continued here at busy Sargur hospital - lots of deliveries, interesting conversations, and new friends. A lot of things to think about! I have made a few wonderful new friends - one is a couple from the US, Jon and Judy, both of whom are retired from their professions (physician and teacher, respectively), and are living here for a year. He is doing diabetes research and she is working at the SVYM school. They have been here 3 months, so are "seasoned veterans", as far as I'm concerned. They had me over for a wonderful dinner on Friday, which was co-cooked by Jon and their roommate, Bhavanna, who is an Ayruvedic physician working at the hospital. Now THAT is a good thing to look up! The art of Ayurvedic medicine has been around for centuries in India, and now within the last 20 years or so it has come to have it's own medical colleges and post-graduate studies and standardized exams for licensure, just as MDs do. There are Ayurvedic physicians at SVYM hospital as well and they work together to provide the best of both types of medicine for their patients. Fascinating!

Yesterday I was again invited for a meal, this time for lunch at Sridevi and Seetharam's place. Both of them are physicians at the hospital and are some of the founders of SVYM. Yesterday was a harvest festival, so they cooked special food (and helped me cook some too!) and talked to me about the significance of the day. They were very enlightening for me to speak to about the culture and the surrounding community.

See above for some photos from my recent activities. This upcoming week I hope to spend some time with the TB outreach team, go on a mobile clinic day, go out with the street theater group, who teaches local children about health via theater, as well as continuing to learn more about the clinical aspects of the hospital. More to come as my short stint continues!

Sargur!

Here you can see many people waiting to be seen in the main consultations (offices). In India, a physician has a room and patients are brought into see him/her by the nurses, rather than patients being put into rooms to be seen.
This is where patients buy their medications after they see the doctor. Meds are free for all tribal Indians - there are about 10 tribal communities in the area, which comprise about 40% of the patients seen at this hospital.
This is the hospital - finally arrived!!
Finally I've arrived! My luggage arrived yesterday at the Mysore airport and I collected it - all in one piece...amazing! I was apart of the celebrations at SVYM yesterday, which were for honoring Swami Vivekananda's birthday - he is the man whose principles this organization is based. I then was driven down to the hospital yesterday evening with Balu, who is one of the founders (along with my mentor at North Memorial Hospital, and the reason I know about SVYM) and quite an innovative and inspirational thinker. And I settled into my room, just in time for a 14 hour sleep!

Today I awoke and was given a tour of the hospital, then began seeing patients on the wards with one of the OB/gyn physicians who works here, then spent the rest of the day with the other. Today was quite exciting because there were protests outside the hospital because of a car crash that occurred yesterday involving one of the vehicles belonging to the hospital. I don't know the whole story, but the folks caused quite a commotion for a while and the hospital administrators, understandably, were working hard to come to an understanding with them.

I am happy to be here, while the adjusting to a whole new medical system can be frustrating at times. I learned a lot today about the Indian medical system, which I am sure will be the case everyday. Saturday is a holiday (harvest festival), and the children at the school have planned a celebration in the afternoon, which should be great.

More when I have the chance! I have wireless in one part of the hospital, which should be reliable for me to have internet. Thankful for that!

First few days in India...

Above are the core values of SVYM, the organization that runs the hospital where I will be working. You can check them out at www.SVYM.net.
This is the Mysore Palace...absolutely beautiful. Unfortunately, you aren't allowed to take pictures from the inside, which is also breath-taking.

Well, so far my time here has been great...and unexpected. I arrived safely in Delhi, only to find that my luggage had not. No bother, I thought, I'll continue on to Bangalore and it'll get there eventually. Which it did...a day after I did. The trouble is, however, that I am no longer in Bangalore. I have moved onto Mysore, which is about 3.5 hours southwest of Bangalore by car. American Airlines kindly agreed to transfer it onto the daily flight from Bangalore to Mysore...though didn't inform their colleagues in Bangalore to actually make the transfer. Long story short, luggage supposedly is arriving today - which will allow me to finally get to Sargur and start working!

I have been making good use of my time while being here, taking in the local culture and sights. Yesterday I visited the beautiful Mysore palace (see pics below), which is quite grand and beautiful. The weather is hot and beautiful, which is a welcome change from the deep winter I left behind in MN. Daily personal yoga sessions have felt quite right here, and the food provided at the hostel where I am staying is delicious (particularly their form of coffee...heavily sugared and milked...yum! more like a dessert than a drink, but I'm definitely not complaining).

More to come as my location (hopefully) changes and my medical adventures develop!