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The stay in India has opened my eyes to a completely different world. Traveling we have been able to see the beautiful temples of Madurai as well as take safari boat ride and be ride elephants in Thekkady. The weather has been beautiful with mild amounts of rain here and there since the monsoon season has begun. The biggest cultural shifts were getting used to food and the way people stand in line – sometimes you really have to push to get anything at a store.

The clinics have also been great environments for learning. At Pasam, we are able to be hands on with all patients that come in. In addition, it is nice having Arun by our side to explain what is happening when Dr. Mas gets busy with the patients. We have learned how to properly listen to heart beats, check the lungs for infection, apply dressings, and take a patient’s blood pressure. We were also able to watch Dr. Mas perform a surgery and follow up with the patient in the days after. Most importantly, we have been learning how to make diagnoses with the little resources that are in this region. Dr. Arun has explained strategies such as locating the specific regions of pain and asking the patient about the nature and history of their pain, to find out how to help without needing any lab work or digital tests. Although Pasam has many more patients, the advantage of switching to KHMS this last week is they have many more resources including an ICU unit. This allows us to see patients that need critical care the approach that the physicians take.

The crèches, according to most of us, have been the best part of the time here. Being able to help these small children, as well as play with them, is very rewarding. Working in the crèches has given me an insight in how to properly address the public health issues. Learning how to keep the families bringing their kids, and how to financially balance such places is key to their maintenance.

All around this experience has been rewarding so far. I am looking forward to the next five weeks.

This morning in the KHMS hospital, we had a patient that was severely dehydrated and had to be put in ICU. Although I never like to see a patient in critical condition, the scene let us see the emergency center of the hospital, which was the most advanced equipment I have seen here. In comparison, the ICU of the hospital is less high tech than a normal hospital room in the States. Not much happened the rest of the day, but I did get very interested in the field of cardiology in developing countries. Since last year working in the emergency room, I have wanted to go into cardiology, but I also would like to work in developing countries. My biggest worry was that I would not be able to do both because cardiology may not be prevalent in these nations. Reading some journals today, I was able to discover that the transition in developing nations from malnutrition and unsanitary conditions to more modern practices is increasing the life expectancy of the people. Living longer lives increases the death toll due to heart disease, creating an importance for cardiology. This transition is taking place in regions of India, Southwest Asia, and sub-Saharan Africa, and other places around the world. Anywhere in the world, seeing a cardiologist is very expensive. Given this, working for nominal fees as a cardiologist in these countries is the only way these people will get such specific care. The best feeling I have known is when your dreams start to fall into place, and today was such a day. Adding to that, we are surrounded by the culture of Hinduism. So I will be talking about some of that throughout the weeks.

Causes of death in low to middle income countries – Gaziano

Gaziano, Thomas A. “Cardiovascular Disease in the Developing World and Its Cost-effective Management.” American Heart Association (2005): n. pag. Web. 17 June 2015.

My favorite Hindu idol – Ganesh

Today was the first day at KHMS (Kodaiakanal health and medical services) hospital with Dr. Susheel. Though we do not get to see as many patients as we saw at Pasam, Dr. Susheel shares a lot about India. Instead of going to college after high school, the kids here go straight to medical school. They start taking specialty classes at the age of 16, which pretty much decides what exam they will take and consequently what career. Even though I have wanted to go into medicine since I was in elementary school, making that decision so early in life would be quite daunting. Another major difference, is that entrance into these schools is based solely on the score the students receive on their entrance exams. High school grades and outside work does not have much impact on their acceptance in the school. Dr. Susheel also said that if the family has enough money, the kids can pay their way through school and be guaranteed a seat. I do believe that having strong exam scores is essential to being a good physician, but it is definitely not the most important quality of an applicant. The holistic process in the US that involves clinical hours, volunteer work, and a high GPA makes for better physicians that are committed to and in the field for the right reasons. Beyond the exams, if kids have the same scores, their entrance is decided on their age, and if they are the same age they are given random numbers and chosen through a drawing. Although entrance into schools may sometimes feel like it is randomly chosen, I am thankful for the educational system I am in and cannot wait to continue into my career in medicine.

Literacy distribution – wikimedia.org

Why wouldn’t a cow be kept on the roof?

Religion in India – http://iori-komei.deviantart.com

This morning at mass the priest made a point about coming together as one church, but also emphasized heavily that the country must come together. India is predominantly Hindu, but with Christianity and Islam growing, there have always been clashes. Overcoming these barriers has not only allowed for peace throughout the country, but also the opportunity for outsiders to come in and help the people. Without the patients and the children accepting us in their town, we would not be able to make a change. Another one of my goals while being here is to understand the core beliefs of Hinduism, which is the most prevalent in India, in order to be able to relate to the people of the region. Looking into the future I would like patients to know that even though we may not share the same beliefs I respect theirs based on my knowledge of them. This will allow the patients to trust me and follow directions that will improve their overall health. Later in the day I saw a man attempting to walk his cow down the road. I know we have all seen a dog owner struggling to walk his large golden retriever, with the owners arm looking like it is about to snap. This scene was ten times worse with his feet literally skidding on the ground. The scene was a funny moment to a beautiful Sunday.

Riding side saddle – India version

The four gates of Meenakshi Amman Temple

The gang above Madurai

The ride to Madurai today was much more comfortable, probably due to the fact that we had three less people in the same size care, but nonetheless it felt great. On the way I found out that the highways really don’t have speed limits, and even if they did there wouldn’t be anyone to enforce them. I also saw my first functional traffic light in India, and surprisingly enough, most people followed it. Visiting the Hindu temples gave insight into the culture and mindsets of the people in India. With such intricate temples and rituals, I can see how religion and superstition can play a big role in how people respond to medicine and outsiders in general for that matter. On that note, for Indians to enter the temple it was five rupees and for foreigners it was fifty. We were only there for the afternoon and it still felt that we could not escape the heat. It was 39 ⁰C, which is about 102 ⁰F, and the humidity of the plains surrounded us. I cannot fathom how more people did not perish when the heat wave came through cities like this, but I am beyond thankful for being in the mountains most of the time. We sweat so much that we would drink a liter of water every couple of hours and still not have to use the restroom. The ride home was cool, and the car didn’t break down once. Exploring the rest of this beautiful country will never get old.

Inside Meenakshi Amman Temple

Sunset on the plains

Rural clinic villages

Just a goat resting with a dog

Today was the last day at Pasam until next month. Reflecting back on the last two weeks, I could not be happier with what I have learned clinically as well as culturally from the hospital. I had a great conversation with Dr. Mas that also made me realize how close he has become with that facility. His face sunk when he started to inform me that he would have to give up the hospital to someone that he did not know very well. Being able to go to someone like him in the future and telling them that I could take over such a large responsibility and run it as well as they did would be a dream come true. Even though there are so many paths in front of me at the moment, I can see myself following each one of them.

A rural cloudy valley

The team at Pasam Trust

Checking the heart

Today we ventured to the farthest crèche we work out. As we move more and more out of town, the real villages of Kodaikanal are exposed. The families that live here are mostly farmers that get paid on a day-to-day basis and financially suffer if any amount of work is missed. For this reason, the families do not have any time to take their kid’s to the hospital or a clinic when their child I sick, and especially not for routine check-ups. The crèches are so useful because they provide all that a child needs to grow up well: nutrition, education, and health care. If these things are all the kids have, they will be just fine. The importance of the crèches continues to impress me, and the main goal is to look into how these can be implemented effectively in similar areas around the world. Good evening from Kodaikanal.

Patient recovering from a stroke

Another afternoon of smiling kids

Kids of Mabel

Tour of Pasam – the dressing room

Reading an MRI for a disk bulge

Today at Pasam we were able to be very hands on – applying dressings, taking blood pressures, and giving injections. I am feeling very comfortable with the patient to health care giver interaction, which allows me to learn even more from each patient that comes in. Moving onto the afternoon at the crèches I had some realizations when taking care of the kids. In order to increase health on a large scale in a community where the people do not pay much attention to daily health habits, we must target the kids to bring in the improved generation of health. This starts by working in the preschools and teaching the kids and their parents’ habits such as washing their hands regularly and knowing the signs of diseases such as hepatitis and the flu in order to decrease the chance of an epidemic spreading. As these kids grow-up they will pass on the habits to their friends, family, and eventually children. The health of the region in the following years will spread quickly with this approach, as well as spreading our efforts beyond the physical reach of our organization. The best approach to global health is balancing general health and individual health. Improving the health of these children allows us to focus on individual cases that deserve proper care, while still knowing there is a larger impacted area than just these schools. Going on my run up the hill later in the day I saw a monkey in its mother’s arms. I want to thank my mom and dad for always supporting me through my journeys, my grandparents for helping me with this unforgettable trip, and the rest of my family and friends for being there for me along the way. Thank you again for reading, and any questions or comments are much appreciated. Have a great day and goodnight from the hilltops of India.

Subway Menu in Kodai

A Mother’s love

Driving from Pasam

Cow in the front yard

Tuesdays are usually very slow at Pasam because many of the people consider this day of the week as a holy day and try to stay away from making unnecessary trips. The best part of the day was going to the Joshua crèche and being able to play with the kids. We threw what looked like a volleyball around and it was very interesting to see the different personalities of the kids come out when playing the game. Some were very shy and would do everything in their power to not be near the ball, while some were very aggressive and snatched the ball whenever they can. This made me consider the different types of upbringings each kid has gone through and how this may affect their perspective on having outsiders come into their school to help them. Considering the attitude that kids have, which is directly correlated with that of their parents, will enable the kids and parents to trust us in taking care of them. When trust is formed between the patient and the doctor, especially in a community that does not have much advanced medicine, the limits are endless to how the patient’s quality of life can be improved. The medical aspect is only a smart fraction of improving their health. The majority of this change comes from positively changing their daily habits. I have been taking careful notes of each kid we see at the crèches and plan on developing a research topic to look into based on the effectiveness of the crèches on the health of the children. More specifically, comparing the health of the children in crèches compared to that of the majority of impoverished children in the rest of the region, country, and world. If research can show that projects like these can be efficient in improving the health of these communities, then companies, donors, and locals will be more interested in contributing to building more programs aimed at improving child health in poorer regions.

Examinations at Joshua

Living in the clouds

He doesn’t stop barking – making me miss my old dog Minnie

One of the many views

Tour of Pasam – the recovery room

This morning the cloud cover made the drive to Pasam feel like the movie “The Mist”. Living more than seven thousand feet above sea level, most mornings feel like this. Pasam was relatively slow, but we were able to see many eye abnormalities such as a wrinkled retina and a patient in need of cataract surgery. In the afternoon we arrived at the crèches. These are small preschools throughout the lesser parts of the area that make sure the kids are fed well and taken care of while they are at the school. When we walked in the kids started playing with us like we had known them since they were born. Knowing some of their backgrounds and still seeing the smile run from cheek to cheek is beyond rewarding. These are the moments that will keep me working through the long hours studying, at the lab, and with all else that needs to be done to earn the opportunity to truly heal millions of these children. When I arrived back to the guesthouse, it felt like Christmas with the suitcase on the stairs of the doorway. Although I love the Indian clothes I have bought here, getting into my own clothes was very refreshing. I now feel very settled in, and cannot wait to keep working for the kids.

The cutest crowd around

The view from Nathanael crèche

Girls go shopping, we find chocolate

Presents in India