White Town here we come!!

So after a long week of adjusting to the hustle and bustle of Vellore, we've decided to take a weekend trip to Pondicherry, this seaside city off the Bengal coast that was once a French Colony, and has been referred to as the French Riviera of the East.

Fortunately, we rented an AC car so the ride was pretty comfortable, despite all the bumps in the road. Our driver was a friendly guy whose English was decent enough for us to share our milk bikis (cookies).

Now there are two sides of Pondicherry, an Indian side (further inland)known as Ville Noire and a French side (on the coast) known as Ville Blanche, and the differences are stark. After driving through the Indian markets with the food stands and people gallore, we came upon some cobblestone roads, colonial architecture and the pedestrian traffic seemed to disappear--we knew we had found what the Indians refer to as "white town" or the French side of Pondicherry.

We managed to get rooms at the Park Guesthouse Ashram for only $10 per night! and we had an oceanfront room!

At first I did not understand what an ashram is, but it is basically a meditation center. Here's the definition from Wikipedia:

"An Ashram (Pronounced "aashram") in ancient India was a Hindu hermitage where sages lived in peace and tranquility amidst nature. Spiritual and physical exercises, such as the various forms of Yoga, were regularly performed by the hermitage residents. Other sacrifices and penances, such as Yajnas were also performed. Many Ashrams also served as Gurukuls or residential schools for children. The word ashram is derived from the Sanskrit term "aashraya", which means protection."

The Park Guesthouse has a beautiful oceanfront garden, perfect for doing yoga or meditating. We spent several hours our first morning using it for this purpose. I did not bring a yoga mat with me so I sat on a bench and watched the sun rise. it was beautiful.

There were all sorts of people up as well, from western yogis to Indian children. Everyone was up doing sun salutations in their own way. It was a site to see.

Outpatient Clinic

Today I shadowed Dr. Karthik in his outpatient clinic. He briefly showed me his list of patients for the day and I was impressed at how long this list was. There was a patient scheduled every 10 minutes! of course this is not nearly enough time to take a history, do a physical and develop a treatment plan...the patients sit outstide, waiting to be called in for hours.

I am so impressed that despite the long waits and seemingly carelessness of the patient-doctor interactions (due to time constraints), the patients have this profound respect for the physicians and are so grateful.

I met this middle-aged Indian woman today who had come in with and MRI of her spine and was told that she would need surgery. She and Dr. Karthik went back and forth (everyone here speaks Tamil, which is a dialect in south India) discussing the alternatives. I was so impressed and how strong this woman was. First of all, she came in alone. Most the female patients we have seen thus far had come in with their husbands and despite being the patient, their husbands gave their histories and did most of the talking.

I could see that Dr. Karthik was getting frustrated as he did not seem the think the converstation was going anywhere and his list of patients was not getting any shorter.

In the end she was referred out to a neurosurgeon.

Grand Rounds

Today was Medicine Grand Rounds. It was what I invisioned when I first heard the word, Grand Rounds. The entire medicine team walks to each patients' bed and presents the patient to the attending, the group discusses the clinical findings and decides on a treatment plan. In the US, grand rounds usually consist of a lecture or case study.

Today was an excellent learning experience for us. Although we missed some of the patients on the ward from yesterday--a woman who supposed had leptospirosis left against medical advice (most likely secondary to the rising hospital bill). And one of the patients who had coded (he was sat'ing in the 70's) during our rounds yesterday, died an hour later.

The medical care here is more than adequate but I think when you are strained with this many patients and limited resources, you cannot save everyone.

On our date of arrival, as we were waiting, there were at least 3 stretchers with bodies covered in sheets, that rolled past us. I think it is appropriate to say that there is certainly a higher mortality rate for many of the same diseases in the US.
But i realize they are doing the best they can here.

Journal Club & Ward Rounds

This morning we had journal club, which was presented by a resident (at least that is what my guess is at this point--the system here is different than the one in the US, i'll explain later).

The article presented was on the use of PPI's and their correlation with fractures in the elderly. The presentation was pretty similar to what we do in the US.

Afterwards we went to the acute care area to admit patients to the wards. The acute care area was filled with patients and even more waiting outside. There is no AC and mosquitos were buzzing around. They use glass vials for the normal saline which i had never seen before.

You can easily pick the nurses from the doctors as they are dressed in white saris with a blue stripe and a white hat pinned to their hair. The physicians for the most part are male and dress in slacks and khakis.

The nurses appear to do their own rounds from bed to bed.

The patients here were surprisingly diverse. There was a 22 y/o female who was 5months pregnant who has presented with sob and difficulty breathing. We found that she had a pleural effusion.

There was another patient who had just walked in with what we thought was a stroke, which was confirmed by head CT.

I have found that yes the resources here are limited to some degree but the patient care is very similar to that of the US in some respects.

Medicine I

Today was our first day of medicine. We started on a Tuesday, which is their outpatient day.

Their list of patients is neverending. We arrived around 10:30 after meeting with the program director and my attending was still seeing patients from 8:30!!!
They allot 10 min for each patient (in the US, it's usually 15min). And their histories are much more succint. And while many of the patients have driven or flown from other parts of the country to receive their medical care here in Vellore, there seems to be very little concern for the waiting time.

The teams are just overwhelmed I suppose. I was surprised at the similarities in disease process and patient population here vs in the states. A lot of diabetes and heart disease...

Day 1

We arrived into Vellore only a mere 3 days ago but it seems much longer as we have been immersed in a whirlwind of bustling activity. Vellore is a small city in the state of Tamil Nadu in the southern part of India. It is most well known for its hospital, the Christian Medical College, which has been called the best in southern India and it is the reason we are here.

Why are we here? Why would medical students from US be interested in coming to a third world country? I cannot speak for everyone else in our group but I was looking to forward to seeing medicine stripped to its basics--I feel like we so often get caught up in the technology of medicine that we sometimes forget that we are here to treat people.

I have lived in San Antonio, TX for the greater part of my life but I have been fortunate enough to have some travelling under my belt. And of course I did some research before coming to here but I do not think that anything could have prepared me for the cultural differences.

Our first day here was very hectic. The hotel we planned to stay at was completely booked, as there is a conference in town. We tried meeting the staff at the CMC hospital but could not find anyone. We were stressed to our limits when Collin came to our rescue. He is the pastor at the Meditation Center here. He was able to find us a hotel to stay at so that we could at least get settled in (we hadn't showered in like 2 days--our flight here was ridiculously long).

Once we had the hotel booked, we went to the main campus to meet the coordinator and receive our schedules. We took an autorickshaw as we were much too tired to try to figure out the bus system or walk. At the time we thought our driver was great as he waited the entire time for us, however we later realized that he only did this to charge us the waiting time (we paid $200 rupees for a $100 ride) . But we got our schedules and were ready to begin.

We had dinner at a nearby hotel restaurant (we're sticking to safe food for now) and made it back to our room by 8pm. We were exhausted. After my cold shower (warm water only from 6-10am) I fell asleep as my head hit the pillow...

Namaste India

It only took us 2 days to arrive but we finally made it into Vellore, Tamil Nadu, India.

I am a 4th year medical student at the University of Texas Health Science Center in San Antonio, Texas so yes, I am very far from home.

I am here with several other students from our medical school to act as observers of the Christian Medical College, which is an internationally renowned medical center in southern India.