Namaste, India

Namaste means hello and goodbye in Hindi!

After a very long flight and discovering that they forgot to pack our luggage on the plane, we finally arrived home. It feels very bittersweet. When Meredith and I decided we wanted to do an international rotation, we chose this program within what seemed like 10 minutes. We didn’t even explore many other programs or do much research into whether it was a good time of year. It just felt right. I couldn’t be happier with my decision to choose India or CFHI and I truly will miss being there.

It turns out, March is a fantastic time to visit India. The weather was great almost the entire time we were there. In Dehradun, the weather was in the upper 70s in early March and upper 80s in late March. Mussoorie sits on one of the foothills of the Hilmalayas so it is typically colder in the mid 30s. However, since it is before peak travel time it is very quiet and easy to appreciate all the views. In addition, March is when Holi is celebrated! I am so glad we were able to participate in this wonderful festival of color.

Having participated in an international rotation after my first year of medical school in Botswana (country in Africa), I thought I had an idea of what to expect. However, this rotation was much different because we were fairly independent throughout the month. We lived with a host family and found our own transportation to work. Initially, that felt very daunting and scary. As time went on, I realized how appreciative I was for having the opportunity to truly be immersed in the culture and every day life.

Besides all the beautiful outfits and all the delicious food, the thing I appreciated most about India was the people. Everyone was profoundly kind and flexible in a way that I wouldn’t have been able to understand without experiencing it. For example, Meredith had her arm outside a Vikram one day and one of the other riders signaled her to keep it inside to prevent it from getting hit by any moving vehicles. Another time, we switched seats on a train and one of the other riders spoke for us (since we don’t know Hindi) when the people assigned to our seats arrived.

In terms of medicine, one thing I witnessed throughout the month is the profound sense of compassion and responsibility each physician had for their patients. It is more than just a job for them. Each physician we rotated with worked at least 6-7 days/week and would not stop seeing patients until everyone had been seen, knowing that patients may have traveled a long distance.

Child and Family Health International (CFHI) was absolutely fantastic and I would recommend their programs to any pre-med/medical student interested in participating in an international rotation. I originally chose CFHI because they are non-profit and run through local people that live in country year round. Beyond the basics of what is presented in the program, there was a profound amount of hospitality. Throughout the month Meredith and I met many family members of our homestay family, we were invited to numerous family events by our local coordinator, Myank, and were invited to dinner by the Delhi coordinator, Hema. Even with having students year round, they always managed to make us feel welcome and include us in their family functions. These people are what really helped make this experience unforgetable.

Finally, while any travel abroad will pose its challenges, I have learned that perspective is everything. Remaining positive when things don’t go as planned is the key to making the most out of an experience.

Namaste,

-Lindsey

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Our Final Days

This week we are back in Dehradun. It’s nice to be in a familiar environment and have the chance to explore more of the city. Our goal is to see a Bollywood movie before we leave!

We are also able to continue doing yoga here with a guru named Dr Deeraj. He explained that Deeraj translates to patience in Hindi. He certainly has a lot of patience in accommodating my lack of flexibility. He holds the sessions in a yoga gym above his home. Although it is at 6am we always walk out happy we went!

Our rotations consist of cardiology in the mornings and pediatrics in the evenings. Both are private clinic settings. One thing I learned about healthcare here is that health information is not private. Many people wait in line within the same room to see the cardiologist. I later confirmed with Myank that it is not private here like it is in the US. 

There is a large public hospital in Delhi that is funded by the government and is entirely free. One of our preceptors shared that patients do not want to go because there are no appointments and you will likely be waiting all day causing them to miss work, etc. In addition, there is a high risk of being seen by inexperienced physicians. Since the pay is much less than the private sector, new docs may begin working there part time as they build up an outpatient practice.

Insurance, or lack thereof, here is another interesting thing I learned about. Very few people in India have insurance and when they do it is only used in rare circumstances. Medicine is very cheap so patients pay out of pocket. For example, an office visit at the pediatricians clinic this week was 300 rupee (69 rupee is $1 USD). Because of how inexpensive the care is, medical tourism, where people come to India to seek medical treatment, is increasing.

A final interesting thing I learned is about rising antibiotic resistance here. There are three important contributing factors. First is doctor shopping, Because office visits are cheap, patients will see multiple physicians until they are written a script for antibiotics. Second, our preceptor said there is “back stabbing”. For example, if a patient were to go for a second opinion which differed from the first opinion, the physician may say “that doctor wasn’t good”. The third reason for antibiotic resistance is that there is no law enforcement on drugs. If patients are educated enough to know some drug names, they can go without a prescription to any chemist (equivalent to a pharmacy in the US) and ask for it. If patients are less educated they may see a “quack” who will prescribe a much higher dose than what is necessary for treatment of their illness. Finally, if a chemist works near a certain physicians office they may begin to learn treatments for various illnesses. They then will give medicines to patients without seeing a doctor.

I continue to learn so much about both culture and healthcare every day I am here. I wish I had more time!

-Lindsey

Taste of India


Before coming to India I didn’t have much exposure to Indian food. One of my roommates during med school, Shachi, introduced me to a few things (such as Maggie noodles which are amazing) but other than that I’d eaten it out maybe twice. I also did NOT have a high spice tolerance at all. Luckily, I was amazed by how much I loved all the food and adjusted to spice quickly!

Almost every day while here I’ve started the day with chai. I remember my friend Vibha telling me how amazing the chai was here and she definitely wasn’t wrong. One variation I learned for making it includes water, tea, milk, and sugar. To make it “masala” chai you can add cinnamon, crushed cardamom, fresh ginger, and/or fennel seeds. Every place we had it there was a slight variation but they were all equally good! It was definitely an adjustment to cut out coffee from my morning routine but it was worth it. 

Something else I ate almost every day is chapatati, which translates to bread. We were typically served a type of bread called paratha for lunch and dinner every day. Sometimes we would also have it for breakfast, which was then typically deep fried. Instead of utensils it seems that people use chatpati to pick of their food.

One of our drivers in Delhi said that 90% of India outside of big cities is vegetarian. Besides a few dishes, I ate entirely vegetarian and I really enjoyed it. Instead of meat they seem to eat more lentils, chickpeas, potatoes, paneer (which is cottage cheese), and beans. During one of our weekends traveling in Amritsar, Meredith and I went the American route and ate at McDonald’s and Subway. Much to my surprise they were both entirely vegetarian and had solely indian style food. At subway everything was frozen and heated in the microwave but it was still good!

Eating out, I had some really delicious dishes. One  of our favorites was Nav Ratan Korma. It was essentially a vegetable and fruit curry. It was so good we went back to the same restaurant to eat it again. Another favorite was butter masala. It’s similar to a creamy tomato sauce and pairs really well with either paneer or chicken. My final favorite was biryani. It is a spiced rice dish that pairs really well with vegetables or chicken. After eating at restaurants, they typically serve some combination of sugar and anise seeds. At one restaurant it was also mixed with sprinkles and dried fruit. It is supposed to aide in digestion and actually tastes very good. 

While in Rajasthan, a state in India, we had a 16 course meal of traditional food. For the full experience we were served sitting on the floor in bowls that were made of leaves that are completely biodegradable. Meredith and I were very overwhelmed as all the food began to come out. We had to look at our neighbors and just follow what they were doing 😂

Finally, something I ate all too often, were these delicious chips. They were 20 rupee’s (69 rupee is 1 USD) and were on every street corner.

I am really going to miss all the delicious foods I was able to try. I hope to learn more about using spices and begin making some of my own dishes!

-Lindsey

Post-trip thoughts

Hello everyone!

I wanted to start by saying THANK YOU if you are reading this because that means you (probably) read all of our blog posts until the end! Which makes me feel happy 🙂 While it was not always easy to write and post blogs on the internet while we were in India, it was made easier knowing that we had people who were keeping up with and enjoying our blog posts. I’m also very happy that I now have this blog for myself and anyone I want to send it to in the future. Initially, I was somewhat hesitant to share with others so much of what I usually keep for myself, but the writing ended up being a cathartic experience for me while I was in India.

In the short time since I have left India (our flight got back to the U.S. yesterday evening) I have been able to reflect on a lot from my month. Since this was my first time out of the country, everything felt very intense, exciting, scary, and sometimes overwhelming. Adjusting to not only being in an entirely different country, but having a much busier schedule than I am used to was a lot for me initially. Eventually, I became used to the ever-changing, and sometimes busy, schedule.

I have been thinking a lot about everything I experienced there from my host family, preceptors, people who approached me in different places we went, to the animals and architecture we saw. I have thought about the stories I heard on rotations, life lessons given to me by wise and experienced people, and the kindness shown to me by total strangers. And I can’t forget about the food, right? Ultimately, I have thought about how this experience has helped shape my views and understanding of the world. There was so much I didn’t know before, and now I feel like I know more regarding India’s culture, healthcare, geography, food, weather, transportation system, values, and religions. I know that this knowledge will stay with me as I move on to becoming a physician, as well as through other walks of life. I am so grateful I was able to experience this global health rotation, and there so many people I have and intend to thank for making it a possibility. Thank you for reading!

-Meredith

Sans

This week was our FINAL week in India. It was a bittersweet experience, to say the least. Throughout the week we made it a point to take any last pictures and videos of things that felt important to us. I decided to title this blog “Sans,” as that is the Hindi word for “breath.” I heard my cardiology preceptor say it many times to his patients when he would listen to their lungs, and it got me thinking about a lot of things. Breathing is so essential to everything we do; whether it’s during yoga exercises, when we’re feeling anxious or upset, or when the doctor is asking us to do it to better auscultate lung sounds! Throughout this month in India there were so many exciting, memorable, and sometimes stressful occasions when I just needed to stop, reflect, and simply take a breath.

So, now I’ll tell you all about the last week! Since we were back in Dehradun (which is where we started out the trip three weeks before), we had a new set of preceptors and rotations. Every day, we were scheduled to rotate with a cardiologist for about 4 hours and then in the evening we rotated with a pediatrician for a couple hours. Both physicians were in private practice and eager to teach us everything they knew!

For the cardiology portion of the rotation, we observed our preceptor see patients with a multitude of illnesses including severe hypertension, “cardiac neurosis,” atrial fibrillation with and without rapid ventricular response, mitral regurgitation and stenosis due to prior infection with rheumatic fever, dilated cardiomyopathy, ischemic heart disease due to coronary artery disease, and many other conditions. In particular, there was one pediatric patient who presented with a blood pressure of 140/80 that had previously been 190/110. This type of blood pressure in a 16 year old was somewhat striking to see, especially as there was no underlying cause for the hypertension like coarctation of the aorta or renal artery stenosis. Our preceptor explained that if both a mother and father have hypertension, then their offspring will have a 50% chance of also being hypertensive at a much earlier age than average diagnosis. Otherwise, if ONLY a mother or the father are hypertensive, then there is only a 25% chance of also being hypertensive at a much earlier age.

We also saw patients with dyslipidemia, angina (precordial chest pain), aortic stenosis, and Gilbert syndrome. He discussed some of the differences between systolic and diastolic murmurs and how to best auscultate their sounds. We also saw patients with amoebic colitis, preventricular contractions, vitamin D deficiency, and allergic bronchitis. We reviewed myocardial perfusion scans, chest Xrays, and many many many EKGs. Overall, our preceptor stayed extremely busy in his work. He stated that he saw about 70 patients in the morning (11 am-2 pm), and then about 50 patients in the evening (2 pm-6 pm). This number seemed extremely high to us, but to our preceptor it seemed like any normal day and another part of his duty to serve healthcare to those in India.

For the pediatrics portion of the rotation, we mainly saw patients with viral upper respiratory infections and standard immunization visits. We also saw patients presenting with papillary urticaria, mucosal blisters from “lip sucking,” colic, gastroenteritis, and failure to thrive. In addition to medical education, our preceptor provided us with other information regarding healthcare in India. For example, he told us how India has become a huge hub for “medical tourism” because healthcare is so much less expensive to attain in India than other parts of the world. MRIs, invasive procedures, and other imaging are much more affordable in India. He also told us about some of the differences working in private practice in India versus working for the government. The government is implementing stricter parameters for private practitioners to follow in India, therefore making it more costly and challenging for them to go into private practice. He also told us that if doctors work at a government hospital they will likely see many many more patients and receive less pay, but are offered retirement pensions and aren’t required to spend years of time and money building up their own practice. The act of building up one’s practice is quite challenging in India as the government does not allow providers to advertise their practice, so they depend on word of mouth. In addition, our preceptor told us that patients can get prescriptions written from “quacks” claiming to be medical providers, and that a pharmacy will fill them. If a pharmacy knows that a particular provider writes certain prescriptions, then they might possibly sell it to a patient whether or not they have a prescription. Lastly, we learned that you do not need a referral to see a specialist in India. If a patient has a headache, they can go straight to a neurologist if they so choose.

In addition to rotations, our last week was filled with some last minute shopping at Fab India (round 2 for us), a return trip to a delicious restaurant called Kumar Veg, meeting another medical student in the program, and taking 6 am yoga classes in the morning. It was a fantastic final week.

-Meredith

“Straight Outta Punjab”: A weekend in Amritsar, Punjab

Greetings! As mentioned in the title above, this blog will cover our weekend in the state of Punjab. I saw this quote on a T-shirt when we were walking around, and it just seemed too clever not to share with you guys.

Well, we had quite the interesting and explorative weekend in Amritsar, Punjab! On Friday, we got back to Dehradun and immediately got ready to leave for Punjab. It was quite a busy day as I had been pretty sick the night before and had hardly slept. After arriving in Dehradun, we just barely had enough time to unpack from Patti, pack for Punjab, and eat some food (most importantly, of course). Exhaustion and stress aside, we persevered and got to our night train on time!

It was a 12 hour night train, but I was able to sleep just fine and get some much needed rest. Once we arrived in Punjab that morning, we were taken to the beautiful Sawera Grande Hotel and got ready for the day! First thing we experienced—our very first Indian McDonald’s! The setup was very similar to what I was used to, but the menu was ENTIRELY different (in the best way possible). They served vegetarian options, spicy seasoned fries, and cuisine reflective of Indian culture…but McDonalds style. I got a Fanta float and was “lovin’ it.” 😀 Many of the sights were just a quick walk from our hotel so we were able to explore and more fully immerse ourselves in the people, smells, and culture of beautiful Amritsar. While walking around, Lindsey and I found very colorful and bright scarves. I may also have found a pair of very cute flats.

After that, we continued to walk around shops. We stopped at an Indian cuisine Subway, and it was quite delicious as well. After that, we walked to the Golden Temple. The Golden Temple is the holiest Gurdwara and the most important pilgrimage site of Sikhism. Essentially, the Golden Temple is a very sacred place for people who follow the Sikh religion to come to, worship, and experience. Before entering the temple, everyone was asked to cover their heads with a garment, wash their hands, and remove their shoes before walking through a small pool of water. Many people removed most of their clothes to walk in the sacred pool of water that surrounds the temple. The temple is made of gold (hence, the name) and is spectacularly beautiful to see in real life. Just standing there and gazing at the entire temple amongst so many followers allowed me to feel what a holy experience it was for so many people. It was such a privilege to be able to experience it along with them.

Once we left the Golden Temple, we headed back to the hotel to catch our ride to the Waggah border aka the India-Pakistan border for what is most commonly known as the Wagah-Attari border ceremony! And this is a a big thing, let me tell you. The Wagah-Attari border ceremony happens at the border gate, two hours before sunset each day. The flag ceremony is held by the Pakistan Rangers and Indian Border Security Force (BSF). The ceremony shows the changing of the guards for both countries on each side of the border. Obviously, we sat on the Indian side. As we arrived at the border, we heard loud cheering from audience members and patriotic music being played. The entire ambiance of the place gave me goose-bumps. Just witnessing the pride and love that Indians have for their country was something I know I’ll remember for the rest of my life. Once the guards directed us where to sit, we purchased little India flags that we were fully prepared to wave once the ceremony started. With the bright and relentless sun beating down on us, we watched as the ceremony commenced with hundreds of people dancing and everyone repeating exciting chants to the main guard who was keeping the crowd amped. At 4 pm, we saw the Indian guards march down the steps and come to the center of the arena area. One by one, they walked down with the most impressive and militant stance, not to mention some amazing high kicks. Wow. As the guards walked down, the gates to both sides of the border finally opened and each Indian guard faced a Pakistani guard with a greeting. Once all the guards from both sides had greeted, the gates closed and the guards had officially changed. It was incredible.

After we got back to Amritsar, we went to an excellent restaurant called The Crystal. You can imagine that its aesthetic was as elegant as its name. We were so lucky to be able to eat there. Lindsey got some delicious vegetable biryani and I ordered some mushroom soup, as I still wasn’t feeling super great 😔. Afterwards, we went back to the hotel and had a great night’s rest. 

The next day was mostly filled with more shopping and walking around. We explored more of the city by foot and got to see a memorial dedicated to Indian civilians whose lives were lost during an attack by the British. What is known as the Jallianwala Bagh massacre involved the killings of hundreds of Indian civilians on the orders of a senior British military officer, Reginald Edward Harry Dyer. The massacre took place on April 13, 1919 in the heart of Amritsar, the holiest city of the Sikhs, on a day sacred to them as the birth anniversary of the Khalsa (Vaisakhi day). A crowd of people had gathered in this area when Dyer blocked the main exits and ordered his troops to begin shooting toward the densest sections of the crowd. This lasted for ten minutes and approximately 1,000 people were killed. It was an extremely sobering experience for Lindsey and I to walk around the memorial as we saw bullet holes in the walls of where the attack had occurred.

After exploring, shopping, and eating at The Crystal (again… because it was just that good) we were dropped off at the train station to catch our 12 hour night train back to Dehradun. Until next time!

-Meredith

Lets Play Holi!

Internet has been infrequent this week. One thing we learned is that if there are strong winds or rain, the villages are usually impacted far more than cities and may go without power for days.

This was truly one of my favorite weeks. Thursday we were able to celebrate Holi. Holi is a celebration of color. Myank, one of our coordinators, said “the color we have is the love we share”. I thought that was a really special way of looking at it. There are two types: Wet and dry. Dry is using powder, which is now more frequently being made of crushed flowers so the color is more natural on the skin. Wet is using water, either mixed in with color or from squirt guns/hoses. One lady poured an entire water bottle filled with blue water down my back!

Since it is one of two major holidays in India (the other being Dawali) the clinic was closed. For breakfast, Mr Vrinder and Mrs Rita invited us to their home. We were able to try some traditional Holi foods. One food was gujiya (which is made with dried fruit and sugar then deep fried). We also had deep fried vegetables. I tried to look up more specific names but had a hard time. It was really sweet that they made this elaborate spread of food specific to Holi for us but also a little awkward because they just watched us eat it. They always ate as a family after we left. After eating, we played Holi (meaning we painted each other’s faces with color) with their entire family. Next we headed to Dehradun to continue the celebration. There we met with Myank, who kindly invited us to celebrate both at his home with family and then at a large celebration hosted by one of his friends on a farm. There they had even more food and a ton of color. This is such a big holiday and I was so appreciative of how inclusive he was of us in that joy and excitement.

Our yoga instructor left to celebrate Holi so Friday I went on a hike up the mountains overlooking both Patti and Dehradun with Mr Vrinders son and nephew. It was absolutely beautiful and I was even able to witness some adorable mountain goats.

Wednesday and Friday the clinic was pretty quiet. Since there are no appointments the schedule is never known but because it was surrounding a holiday many people were likely just spending time with family. 

There may not have been anything “to do” or coffee shops to frequent in Patti but just walking around enjoying the sounds, smells, and views brought me as much joy as any city ever could. Even though the changing environments has been an adjustment I wouldn’t have changed this experience for anything.

This weekend we will be traveling to Amritsar, a city in the state of Punjab. We will be visiting the famous Golden Temple, a very holy place for those of Sikh religion, and to the WAGAH border, the border of India and Pakistan. We have heard great things about the city so I am excited to experience it. 12.5 hour train ride here we come!

-Lindsey