Feeling Grateful

Mussoorie was such a magnificent place. It is a hill station within the Himalayas, meaning it is a popular tourist attraction. Luckily, March is before tourists typically visit because most kids are still in school. The views and hikes we were able to do experience were truly amazing. They also had many cute coffee shops that offered a great atmosphere to relax after rotation. 

I learned so many things this week during my time at Landour Community Hospital. One of the things that stuck out most to me was how big of a problem tuberculosis still is in India. Diagnostic tests and treatments are all provided free of charge by the government. However, there is a stigma of having the diagnosis so some patients refuse to get treatment. Of those who begin treatments, another issue becomes compliance. Although they combine three medications into one tablet, the tablets are very big and the dose is based on the weight of the individual, meaning they may still end up taking multiple tablets/day. Treatment is 6 months in total and missing even one day of medication could lead to prolongation of treatment duration. A public health initiative by the government was to begin doing direct observation therapy (DOT). With DOT, patients must come to a clinic every day and be checked off for taking their medication. While this initiative had some effect, the medication was not individualized. Therefore, if someone was resistance to one of the medications, making it an ineffective treatment, then nobody would know and they would continue on that treatment plan and never see improvement. Now they have created a blood test that will show sensitivity or resistance to one of the key medications. In addition, they have begun using an online app to keep track of the patients records and daily medications, making it easier to seek care from anywhere for the observed therapy. While there this week I was able to observe a patient initially diagnosed and the intake information required before beginning treatment, such as HIV status. After this, our preceptor was kind enough to show us a sputum stain under the microscope of someone with tuberculosis (showing acid fast bacilli).

, Something else I learned is the rate of interstitial lung disease in India is very high. Delhi has a lot of air pollution because it’s neighboring state, Punjab, produces most of the food in India and causes a hazardous amount of emissions. In addition, many people who live in small places heat their house with firewood which can also be damaging to the lungs. DAfter leaving Mussoorie, we packed for a busy weekend trip to Jaipur (city in Rajasthan) and Agra (city in Uttar Predesh). Jaipur is known as the Pink City. While there we rode elephants and toured various historical landmarks, One of my favorite activities was going to something called chowki dawni. It was a huge venue that offered activities such as traditional dancing, performances, camel and elephant rides, and a 16 course meal of Rajasthani food. It was entirely too much food but delicious none the less. Agra is where the Taj Mahal is located, one of the seven wonders of the world! I could’ve spent so much time just appreciating it’s beauty. Before we caught a train back to Dehradun our CFHI coordinator, Hema, in Delhi invited us to her apartment for dinner. Her and her husband made chicken biryani, which was fantastic. We really enjoyed getting to know them better

Before catching our train to Delhi, Meredith and I found out where we matched! The moment we have been anxiously waiting for months to know. We couldn’t be more excited to share that Meredith will be doing pediatrics at Akron Children’s Hospital and I will be doing family medicine at Novant Health in Charlotte, NC!

I am truly enjoying every minute of my time here. I feel so lucky we chose this program and have the opportunity to meet and experience such wonderful people and culture.

-Lindsey

A week in Mussoorie

Hey guys! So I have a few updates for you—


Since the last blog I posted, we finished up our week in Mussoorie. The week was great and beautiful, but it was also filled with some challenges. Both Lindsey and I got pretty sick at different points throughout the week, but thankfully we are both recovered and back to good health! Illnesses aside, the week was filled with hiking, gorgeous mountain views of the Himalayas, and lots of learning.


While I was rotating with the orthopedic surgeon, we saw a patient who had a fracture in her foot because a Buffalo stepped on it! Additionally, we saw femoral and humeral fractures, and a child who was presenting with delayed milestones due to the effects of kernicterus as an infant. For all of these cases, the hospital was able to offer X-rays, but patients would have to travel to Dehradun to obtain a CT or MRI. 


Starting at 9 am, there were general medicine rounds led by the FM doctor. We saw cases involving asthma exacerbation, unstable and stable angina, pneumonia, and medication-induced hypotension. The attending also told us about the prevalence of lung diseases in India, and the health outcomes from that. She informed us that many people cook with a wood fire in their house of close quarters instead of using gas. The wood is much less expensive and easier to carry for those traveling from distant areas, and this potent and repeated exposure causes many lung issues for people. Additionally, many patients surrounding a state called Punjab develop lung fibrosis and different types of interstitial lung diseases due to the high amount of smoke and pollution. 


I also had the opportunity to learn about the Pre-Conception and Pre-Natal Diagnostic Techniques Act, PNDT. PNDT identifies sex determination of an unborn fetus as a heinous and punishable crime in India. This act came into place due to the high prevalence of pregnancies being prematurely aborted after patients were informed the gender of their child. For some, bearing a male child as a potential family heir is highly desirable and if a patient is told she is pregnant with a female, they may decide to prematurely abort the pregnancy. The Indian government strictly prohibits healthcare providers from revealing the sex of a baby to patients. 


Also, we learned about a program called Directly Observed Treatment Short course (DOTS) for Tuberculosis treatment in India. DOTS is the internationally recommended strategy for TB control. Tuberculosis has been a huge health issue for many people in India. The general surgeon explained some of the great changes the program has made in the spread of TB in India, but also told us how the program has had to expand its mission to help control the increase in multi-drug resistant strains of TB. 
In addition to rotating at the hospital, we were able to spend some time exploring a part of Mussoorie called Landour. Landour was beautiful (how many times have I used that word since I’ve been in India??) and had great cafes like Landour Bakehouse and Cafe Ivy. These cafes were absolutely DELICIOUS and had spectacular views of the Himalayas….I will never forget the vastness and beauty of those mountains. We walked uphill quite a bit and found ourselves out of breath with the high altitude and change of scenery, but we loved every minute of it. 


….also some news for y’all from this week. Both Lindsey and I matched into residency training programs to become physicians! Lindsey will be entering a Family Medicine program in Charlotte, North Carolina and I will be in a Pediatrics program in Akron, Ohio at Akron Children’s Hospital. We are so excited and cannot believe this is actually happening. It doesn’t seem real that just two years ago we were sitting together studying the anatomy of the head and neck, and now we are about to be doctors. This life can be so amazing. Until next time! 

-Meredith

Greetings from Mussoorie!

Helloooo!

Greetings from Mussoorie! Me and Lindsey got to this small city in the mountains early afternoon on Monday. We are going to be rotating at Landour Community Hospital until Friday morning. 

Just to recap….this past Sunday we went to visit a city called Rishikesh. It was absolutely beautiful. We saw the Ganga River that is over 2,000 kilometers long, walked across swaying bridges, and enjoyed some delicious coffee and food (we may have even indulged in some French fries). Also, we witnessed a fight ensue between two buffalo. It was pretty scary to witness, especially as I ran toward our guide for safety and Lindsey jumped on to strips of wood above ground. What an adrenaline rush! Luckily, a kind man was able to break up the fight with a stick and some stern words for the buffalo. We were also able to see tons of Ashrams! In the traditional sense, an ashram is a place meant to be located far from human habitation, in forests or mountainous regions, in order to create a space for spiritual instruction conducive to mediation. The residents of an ashram regularly perform various forms of yoga. As a lifelong Beatles fan, it was so cool to see the Beatles’ Ashram because I remember reading about their trip to India when I was a teenager, and there I was …experiencing and witnessing the same beauty! It was a beautiful sunny day, and one that I will never forget. 

For this week, as I mentioned above, we will be in a city called Mussoorie. It is about a 45 minute drive from Dehradun, and it feels like I have experienced a 45 degree temperature drop (but really not). We are literally in the Himalayas, living and rotating at Landour Community Hospital, a facility built in 1938 by British missionaries. The hospital is a part of a health network called Emmanuel Hospital Association, or EHA. EHA has 18 different hospitals throughout the northern and northern-central regions of India that serve as missionary hospitals. The hospital we’re at is comprised of a general inpatient ward—separated for both men and women— an intensive care unit, emergency room, ultrasound room, and outpatient offices. The hospital is staffed with 4-5 physicians; one orthopedic surgeon, one general surgeon, and two family physicians (one family physician currently only performs and reads ultrasounds instead of practicing medicine). There are 1-2 nurses per service, and two recently graduated doctors who are completing 2 years of a rural service “bond” for their medical school. Though they are on call every other night and incredibly busy, they always answer our questions and provide resources for us!

For our living quarters, we are staying in one of the apartments on the second floor of the hospital, and it gives me summer camp vibes! Outside the hospital, we have the most gorgeous views of the Himalayas and small buildings encompassing Mussoorie. The streets below us are filled with vendors and their shops, in addition to some super quaint cafes with amazing food that matches the spectacular views the city delivers.

Our knowledge regarding Indian culture, healthcare, and history continues to grow with the more time we spend here. I can’t wait to continue updating you guys!

-Meredith

Mussoorie

Over the weekend we traveled to Rishikesh. I really enjoyed the views and we were able to visit the Ashram where The Beatles wrote many of their songs! I attached a picture of the bridge you cross to enter the city. Truly amazing at how many people, motorcycles, and cows fit on one bridge.

Yesterday we arrived in Mussoorie, a hill station of the Himalayas about 6000 feet above sea level. It offers some truly breathtaking views. One thing I didn’t consider, though, is how cold it would be up here. Since India does not have centralized heat and the sun doesn’t shine in the hospital well, the building is extremely cold. They have small heaters in every room but all the patients waiting in the halls are bundled in their winter best.

Landour Community Hospital is our rotation site for the week. It is one of three public hospitals in this area. Meredith and I are staying in a room above the hospital. It was originally built when the British possessed this area prior to India becoming a county.  At that time, it was owned by Western Missionaries. My preceptor shared that a common misconception is that they still receive funding from these missionaries. They do not get any from the west or from the Indian government. All the funding is generated by the cost of healthcare provided here. If a new machine is needed, they will host a fundraiser. The hospital still holds many of its traditional roots and maintains its Christian faith. Each morning they hold a church service in the chapel before beginning morning rounds. The main services provided include and Emergency Department, an outpatient clinic (which includes orthopedics and general medicine), surgery, general male and female inpatient wards, and an ICU. They also have several doctors that visit once a month and hold clinics such as dermatology.

We begin rounds in the morning with the lead physician, several newly graduated physicians (since India doesn’t have a structured residency system), and a husband and wife from the states who are in the medical field. They are here to learn Hindi but participate in rounds to help share knowledge. The busiest time of day here is around 11am because many of the patients travel hours to get here and must travel back before it gets dark.

One thing I learned about myself this week is that I don’t do very well with rapid change. We had just begun to feel at home within our homestay in Dehradun and then it was time to move to Mussoorie. While I love having the opportunity to explore more of what this country has to offer, it has definitely given me some anxiety. With adapting to new environments. Pictures of my sweet niece and pups always makes it better!

Finally, we found out the greatest news on Monday! Meredith and I both matched to a residency! Now we anxiously await our placement results that come Friday.

Reflecting on the first week….

I have officially completed my first week of rotations in Dehradun! It was so much fun and I felt like I learned so much in such a short time.


My rotations in EM and Pediatrics for the week were very impactful for a multitude of reasons. I got to practice more EKG reading, listen to different heart and lung sounds, and learn more about healthcare and how it works in this part of India. I was fascinated to learn that mitral stenosis is much more commonly seen here than aortic stenosis (which is quite the opposite back in the states) and also that India has the world’s highest incidence of diabetes diagnoses. I also learned that the concept of seeing a licensed medical doctor for patients is a luxury provided only to those who are educated or literate. Those who are not as educated either don’t receive healthcare or receive it from individuals who “claim to be practicing as doctors.” In addition, we learned that doctors in this area frequently open their own hospital or center and provide services to patients that way, rather than working at a hospital or institution. My exposure to pediatric healthcare in India was very insightful and I will be sure to carry that with me on to my future training in Pediatrics. He went over concepts like milestones, upper respiratory infections, vitamin deficiencies, anemia, and many other conditions that he emphasized for us to know very well. 


Every day that me and Lindsey navigated our way to rotation felt more and more natural. We became more comfortable with crossing super busy streets, knowing where to catch a Vikram, and figuring out where shops were. We even went shopping on some of our lunch breaks and bought some cool things. I bought a book called Guru English, so I will be sure to share my thoughts. We also bought tunics at a store called Fab India with clothes that were all made in India, so we are very excited to wear them!
This weekend, we went to Dehradun’s flower festival that is held once a year! Our local coordinator invited us to attend along with him and his family. It was so nice getting to spend the day with them, as well as experience all of the absolutely gorgeous flowers that were on display. I have never seen anything quite like that. Afterwards, we drove up into the hills to a local cafe that served desserts, tea, and smoothies. I had a delicious mango smoothie while watching the beautiful view of the Himalayas. It was surreal, to say the least (the views…not the smoothie 

😉

). While we were there, our coordinator told us how 90% of Dehradun had never even heard of this cafe or would have been able to afford it, so we felt extremely fortunate to be able to experience it.


All in all, I am loving the sunshine, culture, and spicy Masala Lays potato chips that India has to offer, but I do find myself missing my family and my sweet sweet pup, Jack. They are always in my thoughts, and I know they’d love it here. Until my next post!

-Meredith

Blonde hair in a brown-haired culture

This week has gone so quickly! We became much more familiar with the area and it is starting to feel like my second home. With that said, I am still trying to adjust to the number of stares we get every day. It is not uncommon for people to take photos of us or blatantly stare. Yesterday we went to dinner and were waited on by the owner of the restaurant. Today, we were asked if we would take a photo with a group of students from the local university. While none of this seems malicious it is very unusual and has contributed to some culture shock.

Reflecting on this week of rotations: Both the emergency medicine and pediatric rotation sites were private practices. In India, the government allocates very little funding to healthcare so many patients in urban settings go to private practices if they can. While some patients have insurance, many are self-pay. Even with insurance, companies will typically try very hard not to cover anything. Next week we will be living in the town of Mussoorie and our rotation site is in a public hospital. I will be interested to compare the two settings. Another interesting thing I learned is that there are so called “quacks” that practice medicine without a license. I asked how patients can tell the difference and one of the doctors mentioned that many patients do not know, especially if they are illiterate or do not know who to ask.

This morning we woke up early to hike at a place called Forest Research Institute (pictured above). It is one of the most beautiful views I have seen in Dehradun so far. It was very quiet and surrounded by green space. In the afternoon, we went with our coordinator and his entire family (wife, son, and mother and law) to a spring festival of flowers at the governor’s house. We were able to walk around and enjoy all the flowers grown locally and taste some rice pudding made of rice specifically grown in this state. To finish off the afternoon, we went to a small coffee shop that overlooked the mountains. Our coordinator shared that even within the city of Dehradun only about 10% of the population knows about this coffee shop or could ever afford to ever visit. This really put into perspective what a privilege it was to be there and to be able to travel to this beautiful county.

Tomorrow we will travel to a city called Rishikesh. The city is known as a place to study yoga and meditation and a 2000 mile long holy river, the Ganges River, flows through it. Stay tuned for more pictures 🙂

Learning to navigate our first week.

Traveling to rotations has been quite the experience. It has been great for immersing ourselves in the culture! We begin our journey by walking through the neighborhood of our homestay, where we are greeted by dogs, cows and loud horns as cars drive past. Once on the main road, we have to cross lanes of constant traffic to catch a vikram. Vikrams are a form of public transportation that has three wheels and typically fits around 8 people (I posted a few pictures above). At first it felt intimidating knowing when we needed to get off, but we’ve caught on quickly.

Our first rotation of the day is at a place called City Heart Medical Center. There is one physician, Dr Ghandi, who is in charge of the entire facility, which includes regular outpatient visits, an ED, a higher intensity unit (usually for those with an acute heart attack), and a general inpatient ward. No appointments are made so patients are seen in order of medical necessity. Dr Ghandi’s day is not complete until all patients are seen. Being the only physician in the practice, he mentioned that he typically works 18-hour days. In addition, he shares his phone number so people can call him at any time with questions or concerns. Many of the diagnoses we have seen so far are very common in the US, such as diabetes, hypertension, hyperlipidemia, and coronary artery disease. Several interesting things I have noticed so far include taking off your shoes before entering the high acuity ward of the hospital and the amount of drugs reps that come every day. Dr Ghandi refers to them as “the bombardment”. Since there are no patents on drugs in India, they create many versions of the same drug (i.e. 58 brand names for statin drugs used to treat high cholesterol). He allows them to come each day because otherwise there is no way to keep track of all the new names of the drugs.

Our final rotation of the day is at a nursing home, which in India means a medical clinic. Here we see mostly pediatric patients. The structure is similiar to the other clinic where no appointments are made and patients wait their turn to be seen. This clinic also has a small ER and inpatient unit that is used. The diagnoses we’ve seen here are primarily upper respiratory infections and influenza but we’ve also seen some cases of cavities and vitamin D deficiency. The kiddos we see are always so happy and it adds a great atmosphere to finish out the day.

While the language barrier can sometimes make the patient visits difficult to follow, I have already learned so much. The work ethic and care these physicians provide is truly amazing and I am so grateful they have taken time out of their busy schedules to teach us.

-Lindsey

Greetings from Dehradun!

It is officially my fifth day here, and I can honestly say it has been five of the most interesting days of my life. We arrived in Dehradun on Sunday from New Delhi via the train. It was a 6.5 hour train ride, but we were served tea, breakfast, and gorgeous views of the countryside so the long ride wasn’t so bad. When we finally got here our local program coordinator took us to meet our host family that we’ll be staying with for 2 weeks while we’re here in Dehradun. They are so kind and welcoming, we got so unbelievably lucky.

The first thing we did once we got settled in was go to a Buddhist monastery, fittingly called Mindrolling Monastery, that was gorgeous and something I had never seen before. I hope you saw some of Lindsey’s pictures from our trip there…we enjoyed taking those pics!

Monday we started our rotation for the week (as every week is a different rotation schedule). For this week, each day is split up between Emergency Medicine and Pediatrics. Both of our preceptors are so invested in teaching students and providing all sorts of helpful advice in practicing medicine. Specifically, our EM preceptor told us that he lives by a principle with the acronym “ABC: Availability, Behavior, and Competence.” He states that he lives by these principles to help shape his role and impact as a physician. The physician who manages the hospital originally started out with a one room facility that has now grown into highly staffed divisions that treat patients for high acuity, general inpatient, along with 2 rooms serving as an ED. Many of the patients present with conditions similar to what we have seen in the US, such as uncontrolled diabetes and hypertension, acute on chronic COPD, pneumonia, pancreatitis, and myocardial infarctions. At the Pediatric clinic, our preceptor teaches us and the patients on topics regarding each diagnosis and their management. These docs are providing great care and I’m honored to be learning from them

Every morning, me and Lindsey walk to catch a Vikram, or what is otherwise known as one of India’s public transportation systems, to our rotation. Vikrams are tiny cars that can hold 6-8 people that drive a certain route for the day. If your stop is on that route, then you hop on the Vikram and they will take you there along with anyone else who is on that route. It’s so different from anything I’ve ever done, but that’s what makes it so refreshing and exciting. Our walks on the street to the Vikram are shared with quite a few cows, dogs, motorcyclists, and fellow walkers. We never know what we’ll see on our walks to rotation and that’s most certainly the fun of it.

From what I have seen, India is all about sunshine, showing kindness to others, and lots of horn-honking (:
-Meredith

We made it!

After a 14 hour plane ride into Delhi (from New Jersey) and a 6 hour train ride we’ve finally arrived in Dehradun! Apparently neither of us got up enough during our travel because our feet got so swollen they made our shoes almost unbearable. It was also difficult to adjust to the 10.5 hour time difference.

Delhi is a densely populated city and that was definitely apparent while driving. Even after spending a month in Botswana I still experienced some culture shock on arrival. Since increased tensions with Pakistan remain there were many security checkpoints of guards with guns. There are also many things that differ vastly from the US such as their water system, sewage system, how they handle trash, and driving infrastructure. Finally, with Delhi being such a big city the pace is very fast and it feels overwhelming to catch up.

We knew we were close to Dehradun when we began seeing the foothills of the Himalayas, which gave us an instant sense of calm. The pace in Dehradun, even though it has also become more populated, is much slower paced. Our homestay family, Mr and Mrs Mehta, have been amazing. They are an older couple that have been hosting students since 2001. They greeted us with a delicious meal of lentil soup, spicy califlower, basmati rice and paratha. After getting settled in, we took our first autorickshaw ride to a Buddhist monastary, called Mindrolling Monastary. It is one of the largest stupas, a monument housing sacred relics usually associated with Buddha, in the world.

Tomorrow we begin our first day of rotation! We will be working in the emergency department in the morning and pediatrics in the afternoon.

-Lindsey

Meredith saying a prayer as she turns the cylinder

pre-trip thoughts

Welcome to our blog! My name is Lindsey and I am a fourth year medical student at Ohio University Heritage College of Osteopathic Medicine. I am lucky enough to be participating in an international rotation with one of my best friends, Meredith, to Northern India for four weeks. We are traveling with a program called Child and Family Health International. We both plan to update this blog and keep everyone informed on our experience abroad!

We chose this program because it will allow us to explore healthcare in both the rural and urban setting (specifically the cities of Dehradun, Mussoorie, and Pattie). Additionally, I am really looking forward to developing a better understanding of their culture and appreciate some of the great landscape surrounding the Himalayas.

Initial thoughts while planning: “life is better when you’re laughing”. Between applying for a Visa, getting all the required vaccinations, and having heightened tension between India and Pakistan occurring the week of our trip, it has been a constant level of stress making sure we did everything correctly. The only thing we could do was be proactive and laugh along the way. Luckily that was easy to do having Meredith along. I hope you enjoy our journey!

Lindsey