Well today's the last day of the externship. In 1 hour I'll be on my way to Banglore and then off to see my family. In 3 days Nisha and Joel will depart to the North to go on a tour of Agra, Dehli, Jodhpur, Jaipur, and Pushkar.....not necessarily in that order.

So some have had a wrong impression from my posts, so I shall clarify a few things.

Through the last 1 week, I didn't per se get to touch or feel things like Nisha's and Joel's physicians let them do because I was mainly with PG registrars aka residents and not attendings. So they were less willing as they themselves were very clueless of the purpose of our visit and program.

I did see some things in my time there. organic phosphate poisoning, a case of suspected cushing's syndrome, HIV patients, rheumatic fever patients but the chance to ask questions about treatments and how they were going about the care options were not there because I was amongst a group of 10 people, mostly other residents and required to stay with the same group for a week.

But I would like to stress to those reading this blog that medicine in India is not too different than american healthcare. I didn't talk a lot about diseases because outside a few small situations, most were HTN and DM (hypertension and diabetes mellitus). This cna be said of internal medicine in America too. It is common fact that African descented, Indian descented, middle eastern descented, and Asian descented families have these 2 ailments esp. DM run in their families--something that is partially due to the diet, but also partly genetics and environmental factors. Even amongst the ID cases most were HIV, Tuberculosis, and leprosy had its own clinics at CHAD and Karagiri. Nisha's already told you our Karagiri story so no need for me to repeat it. Except for Leprosy the other 2 infectious diseases (HIV and Tb) are prevalent even amongst US populations especially in Detroit where I study. So this too was nothing truly unique. Does it mean I learned nothing?? No not necessarily. What it means is I learned the reality and value to appreciate that just because we are America, and just because we have the best of the best does not mean that we are the onlly place that has decent healthcare. The treatments are the same regardless of the country, the medications, the management, the diseases that are common in fields in America are also true to other countries like India.

My most important lesson is not details of exotic diseases. It is not how to manage htn or dm because these are things I will learn when I'm a 3rd year, they are things I will learn in med micro and immunology and pharmacology next year. This is not the value of such a trip indeed. It is this which is the value I've learned to take away from this trip.......

That no matter where you go where western medicine is practiced the same. sure there is less A/C and less sterilization or stuff (see my post the downsides of medicine and Nisha's post), but it is the same in the end in most differences. It is this reason i've not posted much about specific diseases.

Secondly, I reaffirmed from my own experience and from hearing from Joel and Nisha theirs in different sections that Internal medicine is something I want to consider and that surgery and ob/gyn are not amongst my interests.

Peace out!!!

Ekta

LCECU

We went to the LCECU today. Spent some time in the OPD. I guess I lucked out and got paired with a doctor who was willing to teach. He would give me a medial history prior to the patient coming in and then would translate what the patient was saying.

1. Saw a 35 year old woman with mental retardation due to hypoxia during a difficult birth
2. Palpated a uterus of a 22 week old pregnant female
3. Doctor taught me how to use we pregnseny wheel. Then asked me several "quiz questions"
4. A pregnant cervix feels like an earlobe. A non-pregnant cervix feels like the tip of a nose.
5. Doctor knew of many other doctors who had ties to Wayne State University SOM.

Week 2

Saturday

We went to the Golden Temple today. So beautiful. Everyone there was also very helpful. I think they saw that we looked out of place and came to escort us to the ticket counter. Joel even bought a pativaisty (had to since you're not allowed to wear shorts). It looks like a towel that has been wrapped around the waist. We ended up buying the ticket that allowed us to bypass the insane line which was awesome because even just waiting the 30 minutes was hard. So hot, so sweaty, so loud. The people in line were very talkative and loved to stike up conversations. We talked to this one family that basically told us about the hot spot temples that we should visit before leaving Vellore.

Sunday

We took a mini tour of a town about an hour outside of Vellore called Kancipuram. Saw three temples devoted to Vishnu, Shiva, and I don't remember the third. So beautiful. Kanchipuram is also known for its silk sarees so we went shopping. I ended up buying a saree for my mom (HAPPY MOTHER'S DAY, MOM!) and a scarf for myself. Silk. So baller.

Monday

Today, I had to face the cold woman that turned me away last thursday. When I got to the hospital I went straight to the OB/GYN department. The secretary escorted me to the surgery floor. I was told to go to the ladies dressing room where the nurse handed me a pair of "scrubs". Mismatched, oversized, and linen. the pants were more capri like and the shirt felt like a smock. Did I forget to mention that the shirt had a giant blood stain on it? I got to wear my flip flops into the O.R. I did get a pair of booties to put over them though. I was also handed a face mask and a surgical hair net. Once I got all dolled up, I was told to go to operation theatre 3. The cold doctor was standing gaurd waiting for me. She told me I was going to observe a laproscopic hysterectomy. AWESOME. This was the first surgery I had ever seen. Lessons learned:

1. From the point that I arrived to the hospital to entering the O.R, not once was I told to wash my hands
2. The only people wearing gloves in the room were the surgeons. The nurses and I.T personnel did not have gloves on but were touching all the surgical instruments.
3. 99.9% of everything used in the O.R is reusable
4. Everyone wears flip flops
5. At one point, the surgery was paused so that various insturments could be assembled
6. People were texting and talking on their cell phones in the O.R
7. None of the lights hand plastic film on them. The surgeon kept adjusting the lights and by the end, the lights were covered in bloody handprints
8. People kept walking in and out of the O.R
9. I now know what burning flesh smells like

Even though I was assigned to the laproscopic hysterectomy, the operating rooms are set up so that 2 glass walls are the dividing feature between adjacent O.Rs. Because of this, I was also able to see 2 C-sections that resulted in the birth of 3 babies (twins + 1). My time in the O.R has confirmed several things for me.

1. I do not want to be a surgeon
2. I do not want to be an OB/GYN
3. I will never get surgery in India


Tuesday

We went to CHAD clinic today. It's a rural clinic that caters to a lower socioeconomic population and functions as a secondary hospital (while CMC is a tertiary hospital). When we got there the social worker gave us a history of CHAD and how they have 2 key functions. The clinic (OPD) and the mobile clinic. The mobile clinic takes doctors, nurses, social workers, and elective students out to the rural villages and tribal areas and provides preventative medicine and conducts research studies. It was unfortunate that there wasn't enough space in the van for us to go out with them that day. Instead, we spent the morning in OPD. The first doctor I was with was training in community health (which apparently is different than family medicine). The second doctor I was with was phenomenal. She kept switching between the regular patients and the high risk anti-natal patients. Prior to the patient walking into the "office", she would give me a brief medical history and chief complaint. She would quiz me about various lifestyle disease and was very open to questiosn from me.

1. Genetic diseases are probably concentrated in the tribal populations
2. 9 out of 10 patients were diabetic
3. Education for diabetics is provided but everyone is too poor to change their diet/lifestyle (sounds familiar, doesn't it?)
4. A 10 year old boy who had rheumatic fever 5 years prior, currently on penicillin prophylaxis, was seen for residual heart problems
5. Woman in 50s diagnosed with epilepsy came in because she forgot her medication plan. Doctor was impressed that I noticed the patients hyperflexed IP joints. I also mentioned that it could be due to a injury to the ulnar nerve (since she seemed to have almost a claw hand).
6. A teenager with Cushing's Syndrome

The most surprising case was about a mid 20's woman who was 30 weeks pregnant and left diagnosed with intrauterine death. She also has been diagnosed with anti-phospholipid syndrome which predisposes her to abortions. G3P1. She has been pregnant 3 times but only given birth once. The first child was still born. The second child was a succesful normal delivery. Now, the third child died at 30 weeks. She was being admitted for further investigation. I found it odd that she seemed okay. I didn't observe any emotional distress, tears, or anything that would indicate departure from a normal disposition. After the patient left, I asked her why the patient seemed emotionally stable in light of such a tragic event. The doctor told me that she wasn't sure when the fetal heart beat disappeared and because this young woman had already been through a similar tragic event with the first pregnancy and nearly lost the second one, she learned to become emotionally detached.

My time at CHAD further confirmed how much I adore family practice and that it encompasses everything I'm looking for in a lifestyle and practice of a physician.

Wednesday

Today, we spent time at Karagiri, a leprosy village. This was an unbelievable experience. We recieved a tour which included the various labs (micro, patho, and basic testing). Next, we were taken to the animal lab where the attendant explained to us how they were testing different drugs and their effects on leprosy. Mice were the chosen animal model since testing on humans is unethical and the only other host is armadillos which cannot survive in the indian weather, even in air conditioned rooms! After that we went to OPD and sat in on a few patient encounters. The doctor did a wonderful job of explaining what Leprosy is, diagnosis, prognosis, and maintaenance. We saw patients who had been treated and years removed from the disease and a patient who was currently undergoing treatment. After this, we went to the rehab center which is more of a lifestyle rehand instead of physical rehab. Everyone is taught how to earn a living and regain self-esteem. (Leprosy was and still has a social stigma associated with it.) Joel and I bought beautiful bags that had been hand made by some of the patients. After this we were shown a video that told us the history of the the village. Lastly, we were taken to Shantigaram. This is a place for people whose families refuse to take them in. Many of the residents there were 70+ in age.

1. CBA mice were the animal models (cross bred albinos)
2. 3 drugs are used in the treatment of Leprosy
3. Pauci or multi (2 categories of Leprosy)
4. Leprosy=Hansen's Disease
5. Loss of temperature sensation is the first sign of leprosy
6. 28 day drug packs for one year is the standard treatment. If replase, treatment is extended for 2 years
7. Hypopigmented patches, enlarged peripheral nerves, and loss of sensation are the 3 keys features
8. Psorasis is a side effect of one of the medications
9. Leprosy is thought to be transmitted by droplet just like TB (actual mode is not known)
10. Incubation period can be from months to years
11. Second generation drugs are avaliable if resistance to first line defense drugs is formed.

The plan for the rest of the week is to go to the Low Cost Effective Care Unit (LCECU) on Thursday and Friday. This clinic is similar to CHAD except it caters to the urban population instead of rural. We are also planning on going to the Vellore Fort tomorrow.

It's been raining the past few days which is good because the nights seem to be cooler but the following day is more humid. Also, I seem to be the only one that keeps getting bit by bugs. I know how 3 annoyingly large bug bites.

Thedownside of Medicine in India

The downside of medicine in India. In many ways India is coming up and medical tourism is increasing, but as someone who was raised in the US, I was raised witnessing doctors take the utmost precautions for sterility. For instance, doctors always wash their hands before going onto the next patient in clinics. Although the signs are there to do such in the out patient clinics, I rarely witnessed any of the residents do it. Only saw them use the hand sanitizer on the wards. Otherwise hand washing was virtually non existent and even when it happens they have a regular kitchen  napkin like napkin and not paper towels. so how clean can that really be? Nisha also told me today that sterility was lot less in the OR. From people walking in randomly while the surgery is going on (by people I mean lay people not nurses who are scrubbed in), and less hand washing. Instruments are cleaned but not autoclaved and plastic disposable stuff is not used to cover the patients. I'll leave her to expand more. But the point is medical tourism is increasing but at what cost to the patient? The cost is cheaper but the sterility is less. One really has to question it. The other thing I noticed here is that at this very christian medical school, some of the doctors have the same hardcore christian views against all other religions as I witnessed growing up in Florida. As a hindu Indian I find this disheartening.


On the bright side I did get to visit the temples of Kanjipuram and also buy a kanjivarm sari. That city was far more exciting. But I suppose most of the happening places in Tamil Nadu are  outside of Vellore. although we also did go to the golden temple of sripuram 15km outside of Vellore. it was beautiful. Wasn't allowed to take pics but google has some good images so you can get an idea from such. but then it was constructed only in 2007 so its state of the artness (gold and lighted with huge chandaliers and huge gardens surrounding it)  for a temple compared to the ancient temples elsewhere in tamil nadu shows.

Our first week at CMC is done and I have had some great learning experiences. I have been in the internal medicine department and everyone in my group has been very helpful and accommodating while I am there. So far I have been with them during Grand Rounds, split rounds, outpatient clinic, MICU rounds and diabetic clinic. Grand Rounds was fun because the first patient was there for a snakebite, (most likely a cobra or viper) which apparently is not all that uncommon here in India (this terrified me at first, but I soon realized that these patients lived in rural areas :) ). Also, most of these types of patients have a pretty good prognosis if they have made it to the hospital. Most of the other patients that day were still interesting, but relatively common diagnoses in the US. During Split rounds, I followed one of the residents and got to see a patient with Tuberculous Meningitis. This is India's most common form of meningitis as tuberculosis itself is very common here, and it can be quite devastating. It's really exciting to see and learn about diseases that I may never come across in the US.MICU rounds was also exciting and I got to see another patient who was suffering from Tuberculous Meningitis. Unfortunately though, this patient didn't have as good of a prognosis and he had already undergone a partial frontotemporal lobectomy due to complications from the disease. Outpatient clinic is probably my favorite time here at CMC. Partially due to the fact that I get to sit down the entire time ;), but mainly because the physician I am with is an excellent teacher. She constantly is quizzing me on various diseases and then teaches me more about them. Once pharmacology comes in the fall, I'll definitely have a leg up as I now know much more about anti hyperglycemic agents :). Today was a little slow as most of the patients were just coming for check ups, but on Wednesday it was more exciting with a patient diagnosed with tuberculosis and a patient admitted with complications from hepatitis C. The majority of the patients that are seen in the outpatient clinic are not local and come from all corners of India. This is because CMC is considered to be the best and the patients are willing to make the journey. That's it for now, but next time I post I'll be sharing more about my experiences here in India outside of the hospital . Look forward to it!

End of Week 1!!!!!!!!!!!

The Good and the Bad!!!

Firstly, sorry if this sounds like babbling. But I'm just writing my thoughts as they come. Now onto the post.

Firstly, the good. Proud to be an Indian in many ways!!! It is incredible how many westerners think our country is backwards, generally out of ignorance. It is incredible how many people assume USA, Australia, Europe, and Canada are the only places where modern medicine exists. But this is simply not the case. Yes, there may be less airconditioning, but I suppose this is a property of energy conservation. In a country of 1 billion plus it is not always easy to have centralized A/C and other things we take for granted in the USA. But this I almost expected having been to India several times in my past, most memorable trips being in 1994 and 2007. In India, the a/c and certain comforts may not be there, but for the most part the hospital system is not that different. They have an EMR system, its just that no one uses it except to check lab results. Again, I suppose this is because most are not taught two hand typing. They have the same departments and clinic days vs. ward days vs. grand rounds just like us. The difference is their grand rounds is not just a powerpoint presentation of different cases but rather going on the rounds itself. And most surprising of all, they had journal club. This was surprising because in many parts of india, medical schools don't have journal clubs or literature reviews due to lack of research activity. This last point is one that was made by my ex roommate (a Mumbai dental graduate) and one made by the bollywood "Three Idiots". CMC, in this respect, has shown that they are quite advanced in that they have access to the best US medical journals and what not. But overall, the structure was very similar to the US system for residency. Something else that was different was that they had fields of medicine that specialized in physiology and pharmacology. This is not something we have in America.

But the most striking thing to me as far as the good goes is the following........ Doctors in India don't use middle men. They don't have CNA, MA, PCT, etc. They perform the vitals on the patients by themselves, take time to actually give a thorough patient history and physical exam, not just spend 15 minutes with patients. Here there are no insurance companies pushing doctors around telling them they can't perform a certain test or only have 15 minutes to see a patient or trying to pass a physician's job to another allied healthcare professional. USA could learn a lot from such. It makes it more personalized. But there's a downside too. I'll come back to that. Also they finish with each patient before going onto the next one, not like my doctor at home who just saw me for five minutes then makes me wait for 15 minutes only to come back for 5 min. more to see me. This impresses me much.

Some more notable things about India--> medicines are cheaper here because this was a socialist country to some extent, procedures are cheaper here, healthcare overall is cheaper here. This is the very basis behind medical tourism that drives rich from developed nations to come here (medical tourism).

Now for the bad...... I suppose I expected that there would be more interaction and teaching on the part of the physicians we observed. it seems that many of these residents and interns are kind of uninterested and that sometimes we feel like we are getting in the way. Though the pathology is unique compared to what we see in the states the ability to get the full picture is a bit tough because physicians seem uninterested in taking the time to explain and sometimes have a bit of an attitude. of course this could be because they are just soooooo busy and overworked. You really truly learn to appreciate that the complaints of billing issues, lack of payments by many, endless time spent on paperwork documenting everything, and feelings of being overworked are not unique to American physicians but true to all physicians everywhere. Next time I hear a physician complain about their life in america, I will find myself remembering the conditions of my own birth nation and find myself thankful for what I have.

Day 2-4

If theres anything ive learned in the past few days its that it doesnt matter what department youre in as long as the doctor is willing to teach you, the experience will be worth it.

Day 2

This was my second day in the internal medicine department. I was hoping that thintensens would be more wiling to actually talk to me and explain what was going on. However that was not the case. In the morning, 8:30am, we had a prayer session. It was all about forgiveness. The chaplain read a passage from the bibble about how many times Peter should forgive his brother. "An unforgiving heart is the root of many problems." After this the interns kept to themsleves while they discussed their rounds. A visiting observer physiology masters student struck up a conversation with me and it was incredible. We talked about the politics behind medicine in India from getting into medical school to getting a promotion. He specificially told me that he's interested in neuroscience but he's not allowed to rotate through the neuro department at CMC because the chief of the neuro department at his home institution and the chief of CMC's neuro department aren't on the best terms. 

High school

5.5 years medical school

1 year internship

2 year required service at secondary hospital

Residency

Day 3

Since I wasn't learning much in the medicine department I decided to switch into the ob/gyn department. As much as I dont want to be an ob/gyn I thought it would be a good idea to rotate through the department that handles the insane reproductive rate of India. This was my favorite day by far. The doctor I was shadowing was a graduate of CMC who spent some time at Mayo Clinic and eventually ended up back at CMC. He did an amazing job of including me in his patient encounter by giving me a quick preview of each patient before they came into the office amd then would ask me questions to test my knowledge of embyrology/reproduction. The following are some notes I made durig my time in his office:

-Do you have sugar? = Are you diabetic?

-He asked every family if they had engaged in family planning. Almost every woman who was done having children had a tubectomy

-Every female patient came in with a male escort who did all the talking. Even answered questions regarding the length and description of her menstrual flow

-Most doctors engage in a paternalistic practice ("Whatever you think is right, sir")

-The doctor always informed the male counterpart that he was going to preform a vaginal exam before he entered the examination room.

-A female chaperone must be present during the exam

-"sir"=doctor

- Medical tourism. IVF in US=$20,000 whereas IVF in India=$3,000

-A Bangladeshi patient got a bill for 10,000 rupees for tests. Add that with the travel and living expense for 5 additional family members. This is the caveat of family centered societies. Patient could have come with only 1 family member and saved a lot of money. 

-Doctor offered to let me do a pap smear but I chickened out

-I got the chance to palpate many abdomens where the doctor pointed out large masses. One felt like a brick.

-During the physical exam the doctor takes advantage of the time and does a fairly quick breast exam (oppurtunistic medicine).  Many women only come to the hospital when they are in extreme pain. If women are stil giving birth at home, the chance they'll come in for a routine pap smear or breast exam is unlikely.

-block slides=histology slides

-Even though problems are dected at these out patieny clinic, patients cannot get into the operating room until a month later. A very overrun system.

-EMR exists at CMC but has not been fully implemented

-Interesting patients:

  1. Woman who had a hysterectomy done 10 years ago but upon ultrasound a uterus was found

  2. Obese patient with BMI of 39.1who is also an asthmatic came infor abdominal pain. The doctor stated that obesity is rare and the patient was unwilling to exercise. Doctor literally said, "You are fat. Lose some weight, please."

  3. Woman with ovarian cysts that contained hair, teeth, nails, etc.

  4. Huge goiter

Day 4

Today sucked. I had planned to shadow Dr. Abraham, same doctor from yesterday, but he was pulled into surgery. So i went to rhe department to see if I could shadow another doctor. They sent me to her office and whenI got there she basicaly told me to GTFO. Mrs. Sheela, who does the department assignments, put down the wrong dates for my ob/gyn rotation. This hadn't been a problem until now. Even though I was supposed to be there, she kicked me out and didnt even let me explain. So rude. So my day was cut short and I came home. This also means that I don't have a hospital assignment for tomorrow either. Maybe I'll use that time to do some touristy stuff around here.

At first I rhought it was just the medicine department but almost every woman Ive met that is either a doctor or an intern has been very cold. I dont know if that is just their natural disposition or if they just dont like international students. 

.

First day at CMC

Hey all! Today was our first day at the clinic. What an experience. We got there around 8am and the entire campus was full of people waiting in line. After paying 60 rupees and asking a few security guards for directions, we were finally in the internal medicine department. Joel, Ekta, and I were assigned to different departments. We had to meet with the head of each department to get our assignments. I was in department 2 which was doing grand rounds today. A man, who appeared to be the office aid, led to the the MICU (medical intensive care unit). When I arrived the doctor had already started rounds. There were two residents and about 10 interns. The residents (called registrars in India) presented the cases and the interns were asked questions about the medical notes. (From what I understand, the medial interns are students who completed 5 years of undergrad right out of high school. After they finish their intern year they will continue onto residency). It seemed like I was in a game show spitfire round. The doctor was throwing out questions left and right by randomly choosing students. At one point the doctor asked about the nuclei of the cerebellum and I quietly said the answer. The resident that was standing next to me acknowledged my attempt with a smile. Right after that we moved on to another patient and the doctor explained motor deficits. Then it was my turn to get grilled. Doctor: Let's ask our international exchange student. Name a syndrome that results in purely motor deficits. Me: (Blubbering like an idiot) uh....I don't know. Doctor: What year are you? Me: Second year. Doctor: So you have taken physiology haven't you? Me: Yes. I just don't remember. I'm sorry. Doctor: So you're just like our students. Forgetting right after an exam. (EVERYONE LAUGHS) That was intense. Had everyone not laughed, I would have been so embarrassed. So glad that the "learn and dump" approach to medial school crosses all cultures. Now I'm going to read all about motor deficits so I can contribute at least one intelligent comment during tomorrow's journal club. I also met two other girls during rounds who are from the UK. They've been here for about 3 weeks prior to which they were doing and elective in Sri Lanka. It was nice to get some information and tips about site-seeing and restaurants. We've made plans to have dinner on Wednesday during the international night at Darling. All in all the first day was super interesting. Lessons learned: 1. Everyone wears sandals in the hospital. Even in the operating rooms. 2. Sterility, in terms of random people walking into patient rooms, doesnt seem to be a priority. 3. White coats are nonexistent. 4. Lunch breaks are called coffee breaks. 5. Patient records are very disorganized. Imagine a folder stuffed with random folded papers. Computers wer primarily used for visualizing test results (CT, MRI)

More pics from our trip.........Pics by Joel VanderSchuur

Pictures

5/14/2012 Went to cmc today to get our papers in. Campus was quite beautiful. Lots of palm trees and green gardens around the main school building. On the way back we got our first bus experience. Will post pics soon. Ekta

Finally Here!

Hey Everyone, After over 36 hours of traveling we finally made it to our hotel! Being here is total sensory overload - the honking, the colors, it's a lot to take in. I had a pretty rough first day here. I felt awful and was super anxious, but found out those were side effects of my anti-malarials and I'm feeling a lot better now. Today we went to the college to get our assignments. I'll be in OB-GYN this week. Next week we're all going to do clinics aimed at the rural population so we're all really excited about that. We found out today that the CMC has over 2,700 beds in one hospital. To compare, the DMC has just over 2,000 in all it's hospitals combined, Royal Oak Beaumont has 1,070 and Port Huron Hospital has 186 beds. The director of the student externships also told us that many people come to the CMC to get an accurate diagnosis, and that elsewhere they might just get test after test, with no clear answers. So far, the thing that has been the most striking is the driving. I thought the cab drivers in Miami were crazy, but that was nothing compared to here. Everyone pretty much just does whatever they want and honks constantly. On our three hour drive here from Chennai, we were constantly passing, and not just cars. We were passing motorcycles, rickshaws, bicycles, cows, goats, you name it. The number of animals just walking the street is crazy. We've seen tons of goats, cows, dogs, chickens and turkeys just strolling around and we're not even in a rural area! Our hotel, the Darling Residency, is very nice. It has air (thank god!) and the service is great. I ordered room service last night and the waiter brought everything to me in bed, even put the straw in my Pepsi (the glass bottle kind) for me. There are four different restaurants here. Since I wasn't feeling well, so far I've only got to try grilled cheese and I had some orange juice this morning (so delicious - tasted just like being in Florida), but everyone else said the food has been great. Some other things I've noticed: a lot of cab/bus drivers don't wear shoes, they call speed bumps "speed breakers", Indian tv reminds me a lot of dramatic Spanish soap operas, the honking is constant, the outfits are beautiful and everyone is very polite. It's also very obvious to everyone that we're American. Joel is the only other person with blonde hair I've seen since we were in Amsterdam and we've gotten a ton of curious looks everywhere we go. Overall, it's been really interesting so far and I'm excited to go to the hospital tomorrow and see what it's like :)

It's Thursday. Officially done with the first year of med school and I have no reason to go back to Scott Hall for the next 2 months. Life is good. 


It's Thursday. We (Liz, Ekta, Joel and myself) leave for India tomorrow! 


Detroit-->Amsterdam-->New Delhi-->Vellore


We're going to be international "observer-ship" students at the Christian Medical College for about two weeks. We have the opportunity to rotate through specialties of interest. In addition, we will be participating in rural clinics. This will bring us to the forefront of preventative community medicine in the world's second most populated country. There are lessons to be learned here people! The following are some highlights about the school:


1. One of the largest medical schools in India.
2. Founded by Ida Scudder--One of the first women graduates of Cornell University
3. Caters to 5500 outpatients, 2500 inpatients, 75 surgical procedures, 22 clinics, and about 30 births every day.
4. Site of:
       A. First successful open heart surgery in India, first middle-ear microsurgery in India
       B. First kidney transplant in India
       C. First trans-septal carotid stenting procedure and first trans-jugular valvuloplasty
           procedure in the world.
5. Dr. Ida Scudder had a passionate concern for the health needs of the rural poor. This found an outlet when she began "roadside clinics" in 1906. The department of Community Health was established in 1957 to integrate with CHAD team and mobile clinic teaching and research with the community programs.


After our time at CMC, we will be heading back to New Delhi and traveling in the region for a few days before we finally return to Detroit.


Delhi-->Jodhpur-->Pushkar-->Jaipur-->Agra-->Delhi-->Paris-->Detroit


This is going to be a great start to what will definitely be an incredible summer!