Patti

Hey guys!

So far, we have been to the states of Uttarakhand, Delhi, Rajasthan, Uttarpradesh, and Punjab! It’s pretty awesome that we will have visited FIVE states while in India for just one month.

Hmmm, so what should I tell you about the week in Patti? A LOT. We got there Monday from Dehradun in a vehicle that definitely required 4-wheel drive to get through the rugged terrain. Patti is a small village that has a clinic funded completely by CFHI. At this clinic, patients can be seen by a physician and a pharmacist. They commonly see cases regarding fever, upper respiratory infections, scabies, snake bites, wound infections, and diarrheal illnesses. Since this clinic is completely funded by CFHI, all doctor appointments and medications are free for the patients. So that’s pretty cool! The doctor we worked with for the week practiced both allopathic medicine and Ayurvedic medicine. Ayurvedic Medicine is doctors regard physical and mental existence, and personality as a unit, with each element influencing the other. It’s a holistic approach used during diagnosis and therapy and is a fundamental aspect of Ayurveda. Ayurveda also utilizes different types of medical herbs and spices such as ginger, turmeric, alavera, basil leaves, and panchakarma to treat certain illnesses. Turmeric is used to treat common skin infections, alovera is used as a moisturizer and anti-acne treatment, basil leaves served in tea can help treat the common cold, Hadith is useful in constipation, and chronic patients may undergo something called panchakarma that is used as a purification technique to eliminate toxic elements from the body.

Our day started at 7 am with a one hour yoga session with our Yoga teacher. We then had breakfast, rotation at 10:30 am, and then another 1 hour yoga session at 5 pm until dinner. It was cool because the clinic was right above where we were sleeping, eating, and doing yoga—so it’s all in one location! I found yoga to be so physically and mentally relaxing, as well as challenging. Before coming to Patti, I had only attempted yoga a couple times, but I’m so glad I had increased exposure to it.

On Tuesdays and Thursdays, there was a “health camp” that takes place from 10 am-1 pm. We hiked about 1.5 kilometers to the rural clinic where the physician and pharmacist see patients from certain villages who live far from the CFHI clinic. Patients are seen for issues such as upper respiratory infections, fever, cerumen impaction, and scabies. The health camps are mainly coordinated by 6 health promoters located throughout the surrounding villages. Each Tuesday and Thursday, they rotate to a different village and see patients at the home of the health promoter. We thought it was so neat how the health promoters open up their home to everyone to be seen by the doctor. Another example of how truly community-oriented India can be.

Patti was truly breathtaking. Me and Lindsey went on a couple walks together on the gravel roads and just marveled at the breathtaking beauty of the green landscape and mountains in the distance. It felt like a dream being there. We had so many great conversations with the clinic staff and their families. There were discussions involving the different types of crops grown in Patti, spirituality, religion, and techniques to better meditative practices. I feel like I have learned so much from these conversations. Specifically, we had a really great conversation with the brother in-law to the wife at our homestay in Dehradun. He explained to us how our thought processes ultimately affect our personality. Thoughts lead to feelings which lead to actions which lead to habits and then lead to what forms our personality. He said being able to generate positive thoughts (even if it might not be instinctual for you to do that) can change so many outcomes of situations. I just wanted to share that!

On Thursday of that week we were able to celebrate our first ever Holi festival! Holi represents the festival of colors and love. In the morning, we were invited to celebrate Holi with the CFHI village clinic pharmacist and his family. They served us a wonderful and delicious breakfast and showed us how to play Holi. I felt so honored that they invited us to celebrate their sacred holiday with them together as a family. We were shown how people walk up to each other and dip their hands in bags of colored ground up flower petals that serve as a safer and cleaner form of paint. When you walk up to the other person, you wish them a “Happy Holi” and place your fingers in the middle of their forehead, then down the sides of their face with the color and then the other person does the same thing to you! Sounds pretty chill, right? Well, it gets way crazier than that! On Holi, schools and most businesses are closed to honor the celebration. This meant that our village clinic was closed for the day, so me and Lindsey celebrated Holi at our coordinator’s friend’s house. This celebration was AMAZING. People were throwing water balloons and bottles of liquified flower petal paint on each other. At one point earlier in the day, I was even just sitting in the car with the window down and someone threw paint IN THE CAR on my face. The driver wasn’t even mad about the mess…he just laughed. And so did I 🙂 it was such a great day, and one that I will never forget. The food, music, and dancing were spectacular and everyone made us feel so welcomed and included. I couldn’t have asked for a better Holi experience!

We are now back in Dehradun for OUR FINAL WEEK IN INDIA. I can’t believe I’m typing that sentence, but it’s a real thing and it’s actually happening. In some ways, this month has flown by, and it’s a bittersweet feeling to be approaching my last few days in this ever so beautiful country (:

-Meredith

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A weekend in Jaipur and Agra

Hello!

Lindsey and I had quite the jam packed weekend of travel, sight seeing, food, and culture enrichment.

To start, this past Friday we took our first ever night train from Dehradun to Delhi (it left at 11:30 pm). Sleeping on a bunk bed amongst strangers in a moving train was certainly an interesting experience, but I ended up liking it much more than just sitting on a train for so many hours because I was actually able to sleep. YAY for sleep, am I right?!

Once we got to New Delhi that morning, our CFHI driver drove us to a town called Amer. Once we got there, we explored the Amber Fort. (So our Delhi coordinator provided us with a plethora of information regarding all of these historical/tourist sites, so a lot of what I’ll write in this blog came from information that she provided us!) This monument is a fortress-palace of white and red sandstone that was built by Raja Man Singh I, one of the first war chiefs of the trusted Emperor Akbar in 1592. Emperor Akbar considered him to be among one of the nine “Navaratnas,” or the gems of the royal court. Singh I later became the Rajput (King) of Amber, a state later known as Jaipur. Amber Fort is known for its artistic style, blending both Hindu and Rajput elements. With its large ramparts, series of gates, and cobbled paths, the fort overlooks the Maota Lake at its forefront. I also got to see my first elephant ever up close!! I never understood how beautiful and majestic they would seem, but after witnessing it first hand I was truly taken aback.

After we finished exploring the Amber Fort, we were on our way to Jaipur, the Pink City! There, we stopped and took a picture in front of the Water Palace! After that, we went to the Wind Palace. For those of you who have never heard of the Wind Palace, I have a history recap for you! So…in 1799, the (Kachhwaha) Rajput ruler, Sawai Pratap Singh ordered the construction of the palace. At the time, the Rajput royal ladies were not allowed to be seen by strangers or appear in any public area. Therefore, the construction of Hawa Mahal (Wind Palace) allowed the royal ladies to enjoy street activities and royal processions without being seen, otherwise known as the Purdah System. Hawa Mahal was built in the form of Krishna’s crown because Sarai Pratap Singh was devoted to Krishna, the Hindu god. The mahal has small pink windows, balconies and arched roofs with hanging cornices. The large number of windows in the palace are each the size of a peep hole so the royal ladies could not be seen by the public.

Once we finished at the Mahal, we checked into our very quaint hotel at the Jaipur Inn. I will say…. if you ever find yourself in Jaipur, you MUST stay here! This hotel has such kind and good natured staff that is attentive to everything you need. The manager of the hotel even invited us on some of his Sunday outings. After we changed clothes at the hotel, we went to the much anticipated Chokhi Dhani. Choki Dhani captures the vibrant spirit of the Rajasthani experience. Both foreign and native tourists of India come here for the amazing experience it offers. Choki Dhani shows the real Rajasthan through recreated sets of Indian villages and states, paintings, Bani Thani art, evening performances, the ‘manuhar’ (a delicate request to eat till your heart’s desire), traditions, and costumes.

After spending the night in Jaipur, we woke up bright and early to leave for Agra (a city in the state of Uttarpresh). Agra is where the Taj Mahal (!!!!!!) and Red Fort are! Wow. Do I mean The Taj Mahal as in one of the man-made seven wonders of the world?! You got it! The Taj is a white marble tomb that was built in 1631-48 in Agra by Shah Jehan for his wife, Arjuman Banu Begum. Shah built the monument during the Mughal empire reign and it is representative of Islamic architecture. In 1983, the Taj Mahal became a UNESCO World Heritage Site and was cited as “the jewel of Muslim art in India and one of the universally admired masterpieces of the world’s heritage.”

Agra (Red) Fort is a UNESCO World Heritage site also located in Agra, India. It is about 2.5 km northwest of the Taj Mahal. The fort can be more accurately described as a walled palatial city that worked both as a military strategic point and a royal residence. Agra played an important part of Mughal Empire as Akbar decided to make it his capital in Agra in 1558.

After we were done gazing at the magnificent Taj Mahal, we drove back to Delhi to catch our night train. Before we took our night train, we stopped and had dinner with the New Delhi program coordinators for CFHI. We all enjoyed some delicious chicken biryani while discussing Indian history, culture, politics, and religion. I am learning and absorbing so much from every conversation I have with someone here, and it feels great.

We got back to Dehradun and then left for the village of Patti shortly after that. We will be doing our rotations here until Friday (3/22), so I will be sure to inform you guys all about this experience during the next blog post!

-Meredith


Majestic Scene in the Village of Patti

We do not typically know much about what our week holds until we arrive on Monday. I had much anticipation for this week because all we knew is that it was “rustic accommodations”, where students had seen scorpions and large spiders, and that there would not be anything to do in the evening, such as visiting coffee shops. As soon as I arrived I immediately felt at peace. It is extremely quiet (very different than Dehradun where cars are always honking) and the landscape is absolutely beautiful. We are surrounded by mountains and vibrant green wheat plants. The area is also filled with beautiful parrots and other chirping birds.

The clinic here is entirely funding my CFHI (the organization that brought me here), which is awesome to see. Even medications are entirely free. It is made up of a physician, Dr Dheeraj Joshi, and pharmacist, Mr Vrinder. They provide basic outpatient healthcare such as prevention, upper respiratory infections, diarrhea, etc. However, they cannot provide any ancillary testing (I.e bloodwork, ekgs) so if that is necessary they are referred to Dehradun (about one hour away by car from here). I also learned that if an emergency were to occur or if a woman is pregnant the government provides free ambulance services.

In addition to the main clinic, every Tuesday and Thursday there are health camps held deeper within the villages. Throughout the month they travel to 6 different locations (by foot). Each site is hosted at someone’s home. CFHI chooses one person in each village to become a “health promoter”. These individuals are provided many resources on healthcare information and serve as a resource to that part of the village. In addition, the health promoters will host a health camp at their home once a month. Today we were able to visit a health camp that was about 1.5 miles away. They were very welcoming to Meredith and I while there and we were able to see a few diagnoses such as earwax impaction and scabies.

We are staying in a small apartment below the clinic. I have to say I was excited to see a western toilet (Indian toilets are just a hole in the ground). All meals are made by Mr Vrinder’s (the pharmacist) wife, Mrs. Rita, and so far have been delicious. We also participate in yoga sessions twice a day. Our yoga instructor trained and still currently lives in Rishikesh (where we traveled the first weekend and is know as the yoga capital of the world). It is challenging but I am really enjoying it. The weather has been fantastic (in the 70s) and it has felt similar to camping only with way better food!

-Lindsey

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.