Saturday, August 13, 2011

Gudalur Adivasi Hospital, Tea Estates & Safari

By Cristina

After the hustle and bustle of Vellore's rickshaw-packed streets, Gudalur's lush jungle and fresh mountain air were a welcomed change of pace and scenery. The Gudalur Adivasi Hospital serves 20,000 tribal and local non-tribals and is run by a doctor-couple. Dr. Nandakumar (NK) Menon, a surgeon, and Dr. Shyla Devi, an OB, have trained local tribals as nurses, community health workers, and hospital staff. They are basically the Paul Farmers of India!

This is us walking from the guest house, just up the hill, down past the hospital, on the left in the picture, and walking into town for fresh fruit and snacks. The white truck is the mobile clinic which goes out to Area Centers in the community to treat patients ½ hour to 2 hours away.

On Monday, our second day in Gudalur, Dr. Shyla (center front) gave us the low-down on the hospital and explained why she and her husband chose to dedicate their lives to the tribal people. The couple always knew they would return to India from New York after saving up $100,000 from their medical practices. Now they laugh and say they were naive because that amount is meager compared to the funds they need to run a hospital and are now raising through donations and government funding for tribals. Their hospital has grown from a one-bed facility in 1986 to forty-bed hospital in 2011 complete with delivery room, operating room, outpatient rooms, lab (to run samples for diabetes, anemia, sickle cell, and TB), pharmacy, daycare, and classrooms upstairs to train the staff. From the onset, the couple's philosophy about the hospital was that is belonged to the tribal community-- the community would have power of all decisions about the hospital, while NK and Shyla act as advisers. Likewise, they realized they needed health workers from the community itself in order to gain the trust of the tribals and provide an effective health care system. It was interesting to realize that even though NK and Shyla were from India, they were viewed as outsiders by the tribals. The tribal community is actually comprised of four separate tribes each with their own identity, customs, and beliefs, though all four groups live in harmony with one another. Shyla said that in the tribals, they see the values that have been lost in the world, the values all religions promote- peace with fellow man and the environment, generosity, honesty, and kindness . Over the course of our visit, we found this to be true, and we saw that it was very easy to fall in love with the tribals and this jungle land of jackfruit and elephants.

The view of the mountain from the main street in Gudalur.

Play time! Perfecting our Bollywood moves for Saturday night’s gathering at NK and Shyla’s.

A view of the hospital from the first floor. The delivery room is the first right going through the door in the picture. Inpatient rooms are on the first and second floor on the left.

Tuesday- Seeing patients with Dr. NK and team.

Dr. NK (front right) and Dr. Abraham (back right) seeing outpatients. An anesthesiologist had visited on Saturday, which allowed NK and team to perform many surgeries like hernia repairs, trauma, and fistulas that required general anesthesia. Most patients were back today for post-op follow up.

Dr. Abraham (front center) discussed TB case studies with us. Anyone with cough lasting more than 3 months is suspected of having TB because the bacteria is so common in India—2 billion people are infected with TB bacillus, of which 10% become active cases. We also learned that TB can manifest almost anywhere- abdomen, spine, meningies (brain), pelvis, urinary tract.

Dr. Chandy made sure we had a balanced diet of work and play. On Tuesday we went to the Mudumalai Tiger Reserve in the Tamil Nadu National Forest, about ½ hour from the hospital. The Tiger Reserve spans for miles and we saw tons of animals just driving along the main road- elephants, bison, peacocks, mongoose, and wild boar. During the official safari tour we also saw white spotted dear (below) and some lucky members of the group even saw a leopard that Dr. Chandy pointed out! That was definitely the highlight of the drive, but unfortunately no one captured it on film.

This trip was approved by Martin Hoffman. "Two thumbs up!" 

On Wednesday, Siobhan, Patrick, Jon and I went with JiJi (one of the hospital’s social workers) to several villages to see the Area Centers and the “health animators” – what a cool title! One hours drive up and down windy hilly roads through tea estates brought us to our first Area Center, Murukampadi, where we met Ayyappan and Janu. There were three big rooms in the new looking cement building and a little kitten outside meowing away. One room was the clinic and pharmacy where we saw Janu helping a mom who’s son had sickle cell and was getting treatment to manage the disease including pain meds, vitamins, and an antibiotic for a URI. After the Area Center, we went to a village called Vattakolli (above) which we walked to through the tea estates from the main road. Jiji (in pink) showed us the health cards all children have that includes their growth chart and vaccines.

Walking to several villages through the Tea Estates, praying the leeches will leave us in peace.

Janu (the health animator) is weighing a young boy in the cloth. She then recorded the weight in the health chart which stays with the family. In this area, the main causes of weight loss or failure to thrive in children are sickle cell anemia, hookworm, and diarrhea. Children are given Albendazole every 6 months to kill worms if present. We actually bought some Albendazole before leaving India to “deworm”, as advised by Dr. Chandy!

A Kattunaikkan tribal woman.

An elephant had stomped through the village the day before, crushing plants and damaging some homes. Some villagers saw the giant, but no one was injured. The ground was packed mud, rock solid, and the elephant was still able to leave its mark. Fortunately, we didn’t meet the owner of the prints during our visit!

When we visited the homes, we were instantly offered a mat to sit down on and a glass of hot tea with fresh milk and sugar—in spite of earning only $1.50/day in the Tea Estates! I was completely humbled by their generosity. I was so touched that these people whom we had just met were willing to share with us even though they had very little. Imagine if everyone lived that way.

At the Area Center with Ayyappan, thanking him and saying farewell.

On Friday, we took jeeps out to the Tea Estate owned by the tribals. Needless to say, it was a muddy and bumpy ride!

These 200 acres are owned by the tribal collective.

It felt like we were in a cloud forest!

A set of clippers with a collecting bin on the top for pruning or picking the new tea leaves off the top.

Mind the leaches. (No joke! Check out a previous blog entry about creepy crawlies of India.)

At noon, all the workers weighed their collections and picked through to make sure no bad leaves made it in. Workers must pick 25kg in order to earn their $1.50 per day.

On Saturday, we drove to a tea factory to see what happens to the tea leaves after they leave the tea estates. Unfortunately, we couldn’t take pictures inside. There was one huge warehouse-sized room for drying the leaves, then they were sent via conveyer belt through four grinders until the leaves became finely ground. Next, the grounds were fermented with water for 90 minutes to create black tea. We learned that green tea is made from the same leaves as black tea. The only difference is that green tea leaves they are not fermented, and therefore, not oxidized, so it keeps its greener color and leafy taste.

On Saturday evening we were invited to the home of Dr. Shyla and NK for dinner. We toured the gardens, mushroom colony, chicken coops, and cricket fields before going inside for food.

Shyla gave us saree tying lessons—it’s not as easy as it looks!

The guys looking good in their mundus.

Freshly tied sarees. Thanks Shyla!

Talented men in the kitchen—we were very excited for dinner!


Bollywood dancing in India, we couldn’t resist.

Dawn and Jon were naturals.

What a lovely evening!

Tuesday, August 9, 2011

Arrival In India (July 14-18th)

By Folu
My trip overview.

12 of us embarked on this 4 week trip to India in order to get an insight into the socio-economic aspect of healthcare, which is often overlooked. There are 9 medical students from my school including myself, two premed undergraduates and one of our wonderful professors Dr. Chandy, who is originally from India. Dr Chandy would take us to various parts of India. We would go on to observe healthcare at various levels in India from the town of Vellore, to the rural, jungle and tribal population in Guadalore, to state of the art, world class hospitals in the big city of Bangalore and finally in the rural area of Jamked. We also had two research projects to conduct in India. One is an electronic stethoscope developed by engineering students we are working with at Caltech in Pomona California to help in diagnosing heart problems in individuals, fetus, children in rural areas, so that the recordings can be transmitted to physicians anywhere in big city hospitals. The second project is cancer research and even employing portable devices for taking photographs, with the ability to be sent to a doctor elsewhere like the stethoscope project. And of course do some touring/sightseeing.

Thurs July 14 and 15.

Aboard a Cathy Pacific Airline Flight, myself and 7 friends: Morgaine, Martin, Kimberly, David, Christina, and Patrick left LAX. We arrived in Hong Kong about 13 hours later after a flight full of a lot of good food (lamb, chicken, desserts and the list goes on), and a great entertainment system. The Hong Kong airport was huge and very busy, and after touring it for a while we all sat down to eat some authentic Chinese food (I think) and wait for our connecting flight to Chennai, India. We all wished we had more time to leave the airport and explore the city of Hong Kong since we had heard so much about it and saw how nice it was as we landed, but we had only about 3 hours for our lay over. I had never seen as many sky scrappers in one city in my entire life as I had seen in Hong Kong, despite the fact that I have been to New York City a lot of times.

During the flight, I was excited as we approached India. I was looking forward to seeing India, the people, lifestyle there, cultures, food of course, the tourist sites, healthcare system there which is the main reason I was travelling there, and of course maybe star in a Bollywood movie. Since I was born and raised in Nigeria before moving to the US, I was eager to see how it compared to India. Both countries have a few things in common: both were British colonies, both are countries with one of the largest population in their respective continents, both are countries which a huge variety of traditions, ethnic groups, languages & dialects (over 150 in Nigeria and over 30 in India), and both countries have citizens all around the world especially in western countries who are in search of better opportunities or even to attend institutions of higher education (myself included).

Sat July 16th.

At 130am local time in India, we arrived in the City of Chennai. India is 12.5hrs ahead of Pacific Time in the US (California time) or GMT plus 3.5hrs. The additional 0.5hrs in Indian time was something that really confused us for a while till we got the hang of it.

The 8 of us who flew from the US together had to meet up with 4 other people who were part of our India team and but were meeting us in India from their vacations from other parts of the world or from the US. We quickly saw Molly and Dawn both UCI medical students, Dr. Chandy our professor from UCI who would be taking us around India, Jonathan a UCSD premed undergraduate, which meant we were missing one person Siobhan who was supposed to have arrived from Sri Lanka before all of us. Since we could not call each other upon arriving in India, we agreed to meet in the waiting room with our various arrival times. We were all worried she wasn’t there but maintained our composure and somehow found out that she was coming on a later. We finally saw Siobhan and were ready to exit the airport about 6 hours later.

I walked out of the air conditioned airport and as the first drop of sweat dropped from my face as I stood in the sun, I thought I was back in Nigeria for a second, because the humidity and hot weather in Nigeria was similar in India. One of the first things one notices right of the back is the huge amount of people waiting outside the airport (not surprising since the country has a population of 1.1 billion), some waiting on friends, relatives, and some trying to make a quick buck by volunteering to carry luggage to taxis for newly arrived travelers. The 12 of us got into our arranged van, but before we left, the driver had to load a lot of our luggage on the roof, put some plastic sheets over it and tie it down, which was a sight to see. It is monsoon season in India, so it was to protect our luggage.

Our trip from Chennai to the town of Vellore, which was our first destination in India took about 2 hours. The scenes from the streets, animals roaming around (though there number of cows is astonishing), the mixture of wealth and poverty reminded me of Africa again. As we drove, I learned something about the City of Chennai. It is the home of automobile parts assembly of about 60% of most of the World’s major automobile companies. These range from Mercedes to Toyota, then the parts are exported to the rest of the world for assembly. We also drove past a number of cell phone and computer manufacturing plants such as Motorola and Nokia, which were huge and spread out, each almost like its own little town. I did notice the Indian automobile company TATA was a powerful force in India from day one as I saw a lot of TATA vehicles ranging from SUVs to sedans, trucks, and bus. I also learn that TATA owned two huge car companies: Jaguar and Land Rover.

We soon arrived on the campus of the Christian Medical College (CMC) in Vellore , which is one of the top medical schools in India. It was a beautiful, green, and spread out campus with lots of facilities including a lot of guest houses for foreign physicians or student rotating there, a couple of canteens, volley ball, nice swimming pool and even basketball courts. A few days later, there would be a huge basketball tournament there which was interesting to watch. There were also so many monkeys on the campus which just roamed about freely, and if one isn’t paying attention, they could steal your food.

I looked forward to our first meal. It was good but I was still looking for the meat on the plate. By the next day, I learned the cafeteria to go to which offered dishes with meat and I was a happy man. We all settled in our rooms, which has great with internet access, AC, and my room was lucky to have a working shower and hot water heater. Some of my friends had to use a combination of a bucket and a smaller one to pour the water on themselves.

Sunday July 17th.

Breakfast was great. One of the best things about India to me was how cheap food was. For that reason, each time we ate, we were able to get multiple dishes, and within two weeks we had sampled lots of Indian dishes. For breakfast, I had an egg dosa, some toast (for something familiar), and some idly. After breakfast, we explored the campus and found “The College Store”, which was a supermarket that did everything. They have groceries, deserts, cell phones, sim cards, arranged travel tours, plane tickets, and just about anything. We soon met up with our professor Dr. Chandy at the swimming pool and his fellow CMC medical school graduates the Matthews, who were great and welcoming to all of us from day one. They would eventually host us for dinner at their home twice within our one week stay in Vellore.

The pool was beautiful, there were plants all around, which gave one the illusion that one was at a Caribbean beach or resort. We even learned they had great pizza there. We would later on have pizza (Indian style) at the Mathews’ residence which I admit could put Papa Johns, Pizzza hut, and Dominoes out of business. As the fellas and myself got in the pool we meet a number of other international students from the U.S. temporarily studying or rotating through CMC. Between the pool and walking a round campus, and the CMC hospitals we would eventually meet other international students from Germany, Austria, Holland, Oman, Russia, and Malaysia among others by the week’s end. The pool was refreshing because it was very hot in Vellore, but of course the ladies were all shopping and having tailor made clothes the entire time we were swimming.

After the pool, we went shopping in town for clothes we would wear during our hospital rounds. For the male medical students and even many male doctors in the CMC hospital, the attire consisted of some khaki or slacks, a button up short sleeve or long sleeve shirt, and sandal. Shoes were not required because the sandal were more comfortable in the heat.

From shopping, we went to Darling restaurant at the Darling hotel, where we eat some delicious Indian dishes like garlic and butter naan, tandoori chicken, mutton Biriyani, various curry dishes, and a mango lassi (somewhat like a smoothie). Among the 12 of us, we ordered a lot of food and shared it but the amazing part was we each paid maybe the equivalent of $5 for it, which would have been about $20 per person in the U.S.

Monday July 18th.

After breakfast, we attended a seminar on Ulcerative Colitis and the use of antibiotics in caesarian surgeries. We were introduced to Dr. Bose Anu, a pediatrician from CMC’s CHAD hospital. CMC is the biggest hospital in Vellore and has a number of hospital there. There is the main CMC hospital with over 2500 patient beds, the CHAD hospital the Low Cost Effective Unit Clinic) LCEUC, and an Eye clinic. At CHAD we learned some history behind the hospital and their mission. It was set up about 100 years ago to be a missionary hospital whose mission is to cater to the poorest of the poor. Since then it has grown to be one of the great teaching hospitals with a medical school in India to provide primary, secondary and tertiary care to patients. CMC allowed patients to pay for their treatment on a sliding scale. This means that the poor paid only as much as they could afford and their healthcare was covered by the hospital which is able to do this because they charge the richer a little more for their treatment. CMC as a whole also receives million in donation from all around the world. They also rely on the large volume of patients seen, which allows them to charge less. This is an impressive model because I saw how the poor were able to receive life saving healthcare without worrying about death because they can’t afford it.

We saw a few pediatric patients and we able to test the newly developed electronic stethoscope and we used it to record some pediatric heart sounds as we heard a few murmurs and heart problems. Another interesting approach CHAD employed for medicine was to send nurses along with village health workers (who are elected by their villages to represent them) to visit the nearby villages and provide care. We accompanied them and were impressed by this approach because it eliminated the need for poor patients to come all the way to the hospital for care unless if it was something serious. Many of them are so poor that taking a day of work to travel all the way by public transportation wasn’t an option, It was cost a lot to travel, they would lose a days pay of 100 rupees a day (for a farmer), which isn’t much but a lot for these poor villagers. We checked on a few pregnant women, and an epileptic young girl. It was very interesting to see how young the village women got married. By 18years, many were married.

During the course of the day, about 3 of my friends had to return to the bus to rest as some suffered from dehydration or upset stomach which was a combined result of the hot weather, eating new unfamiliar foods, and just being in a foreign environment. But the day’s end, we were all tired.

Look out for more post coming soon.

Balls of Glory

By: Molly

My serious blog has been posted. Now I want to talk food. The trip has almost come to an end and between the twelve of us we have been blocked up, flushed out, and up-chucked. Despite all of this, I’d say we universally agree that the food in India is supreme. It’s spicy, sweet, saucy, savory and with 4 cups of sugar-soaked tea a day to settle it all in, it’s strangely worth the midnight visits to the toilet. After all, squatting over an ominous pit in the ground is one of the only exercises I’ve done in India. What would a night be without a good squat?

Here’s the In-N-Out (I would pay big rupees for animal style fries right now) on the food that makes every squat count. I saved the best for last.

1. Chapathi and Honey: not exactly Indian, but it makes the list. This recent gem of a discovery was made in Jamkhed. Take a warm chapathi (imagine a fluffy wheat tortilla) and cover it in honey. Instant satisfaction.

2. Mutton: Time to get serious. The lamb in India is unreal-so tender and juicy that no sauce is necessary. Although a good creamy masala smothered on top is never a bad choice. It comes in little bite sized cubes so they even cut out all the work that American steak eaters must endure.

3. Aloo Gobi: Aloo, meaning potato and Gobi, meaning cauliflower, makes a delicious combo when mixed with a curry or masala. It’s a veggie dish that I am happy to sacrifice my primal meat cravings for. Cauliflower is used in just about everything here, and I seriously hope to reinstate it into my veggie-lacking diet back home.

4. Paneer: Squares of mozzarella-like cheese in creamy sauce. Need I say more?

5. Biryani: Just another name for a long grained white rice, but it comes in all sorts of varieties. If Forest Gump lived in India he would have said Biryani was like a box of chocolates rather than life. You may never know what you’re gonna get, but it’s always good. Ranking on the top are mutton, egg, and veg. It may seem like a simple rice and veggie mix, but the blend of spices they cook it in is magical.

6. Butter Naan: Butter smeared on anything warm tastes like grandma’s kitchen, but the Naan is so soft and doughy that I always eat to the point of explosion. Surprisingly I haven’t found garlic Naan in India, I’m wondering if it is a special invention of Indian restaurants in the US. Nevertheless Naan never fails to make my day complete.

7. Dosa: put an egg in it, put chicken in it, put masala in it. Doesn’t really matter, it all tastes good. It’s pretty much a crepe that can be molded into something that looks like a dunce hat. Completely inappropriate to eat this with silverware. For breakfast, the masala dosa takes the cake.

8. Mango Lassi: If you haven’t tried one at home, do it. Yogurtland move aside, the mango lassi is creamier and can be consumed through a straw. Plus it is considered a legitimate item to pair with any meal. You get one dessert with dinner and don’t have to feel guilty about ordering a second at the end.

9. Hurry Hurry, Chicken Curry: There are probably over 50 different curries in India. All good and all worth trying. Put it on rice and eat it with your right hand. Shoveling curry rice in your mouth is liberating.

10. Balls of Glory (Gulab Jamoon): The name says it all. Ball shaped little donut like morsels, fried and covered in something like maple syrup and honey combined. Put it over vanilla ice cream and your arteries will sing. I will find these in the states, or will soon move to India and start my own gulab jamoon stand. I’m sure someone will microfinance this venture.

Vellore to Gudalor

By: Siobhan

Saturday we packed all our bags into a single room before heading to our half-day dermatology clinic. We came home in the middle of the day to one shower, one toilet and two twin beds for 10 people.  We took turns napping and showering, and we tried not to bump into each other too much while we waited for our 9:30 pm departure.

Our first traveling experience within India began with a party bus! Our driver tried to make up for the fact that there was no A/C in the sweltering van by pumping the jams and Folu preformed some of his famous dance moves in the aisle. We arrived at the train station with ample time to spare and decided that we would embrace the spirit of India by passing out on the ground like the locals do.

The Mysore express arrived at 11:40pm and we were very grateful for the sleeper car. Most of us had never traveled by train in this fashion and we were pleasantly rocked to sleep. Why can’t airplanes be this comfortable? In the morning we woke up many miles from the chaos of Vellore to find ourselves rolling through rice patties and palm groves. The air was fresh and clear and those of us who were never meant to live in the city took a sigh of relief. Walking to the end of the sleeper car we discovered that the doorways were wide open and there was nothing to stop us from hanging out of a moving train (very carefully)!

We arrived in Mysore around 8am feeling almost rested and excited to see a new part of the country. Already we could tell that we had entered a different environment. The foliage seemed more lush and the air more cool.  Our driver warned us that he had driven through buckets of rain on the way to pick us up. The Monsoon! Just the night before Chandy had warned us that two years ago there was so much rain and flooding on this trip that the UCI students found themselves wading through waist high water. But that’s not the worst of it, those students got leeches from wading through that water. Leeches! But don’t worry too much about us because we are armed salt so we should be able to withstand any impending leech attack.

We decided to take a few fun detours along the way from Mysore (state of Karnatica) to our final destination of Gudalor (state of Tamil Nadu).  We first checked out the Mysore Palace, which we were surprised to find open on a Sunday.  The palace looked impressive from afar but having been on some tours of fancy buildings in the past, I didn’t expect too much.  But I was wrong, this palace was like no building I have ever seen before. There were cast iron pillars with gold leaf paint, hand carved teak ceilings, doors inlayed with ivory, solid marble banisters and peacock stained glass. We all decided that Patrick should propose to Cristina in front of the palace and he obliged so now they’re engaged! Actually this happened several weeks ago in Minnesota but now they’re doubly sure!

Our next stop was a temple with a marigold draped statue of a sacred bull carved out of the stone of the hillside. Here Dawn ran into someone she knew from college in California, what a strangely small planet we live on.

Finally we undertook the three hour drive to Gudalor through intermittent rain and two national parks. Mudumali park is actually set aside specifically as a tiger reserve but we were not lucky enough to see a tiger. Instead we saw spotted deer, wild bore, a red fox, peacocks, macque monkies,, and a family of three elephants!

Arriving here in Gudalor we were delighted to find a jungle landscape rich with the sounds of life. We chatted with Chandy on the front porch about all the incredible work that Doctor Nandu Kumar and Doctor Shila have done to improve the lives of tribal people in this area. We can’t wait to learn about the comprehensive set of projects they have set up here to not only improve health but better the lives of these indigenous peoples.

Our house in Gudalur

CMC Vellore

By: Kim

CMC Vellore has been amazing. The diversity of patients we saw was mindboggling, and at times it felt like we were on information overload. Our days usually start at 8 in the morning. Some days we’d end at 2pm, other days we’d end at 9pm.

Our first day started at the CHAD (Community Health and Development) Department. We rounded with a physician and saw a variety of patients: a child with rickets, a 12 year old boy with seizures and cerebral palsy, a child with ascites, a typhoid patient, pregnant women who had pre-aclampsia and possibly neurocysticercosis, etc. We went out to the villages with the nurses to make home visits to a young girl with seizures and a couple of pregnant women. We listened to the fetal heart sounds and palpated the fetus’s head, back, and limbs. After heading back to CHAD, we learned about the developmental milestones for a newborn, and the different neurological tests you would do on different age groups (primitive, spinal, brainstem, midbrain, cortical). Lectures were sprinkled onto our schedule, such as the TB medication lecture and the history of CHAD. By the end of the day, we were pooped, but managed to use the last bit of our energy to research some of the drugs and diseases Dr. Chandy assigned.

The rest of our week followed a similar schedule.

One of my favorite patients at CMC is the dextrocardia patient we saw at the internal medicine ward. Instead of his heart normally pointing to the left, it was pointed to the right! The doctor then checked for situs inversus by percussing his liver. We found that, indeed, the patient did have situs inversus and his liver was on the opposite side as well. It was great seeing percussion, a skill we learned in our Clinical Foundation course, being effectively used to determine situs inversus. The physician then explained why it was better to have situs inversus with dextrocardia rather than having normal visceral organ orientation with dextrocardia.

The endocrinology clinic was also a blast. We all sat in the endocrinologist’s office while he brought patients in for us to diagnose. The first patient had a huge goiter, exopthalmos/proptosis, eyelid lag, and an irregular menstrual cycle. Her symptoms pointed to hyperthyroidism. The second patient had a moonface, a small humpback with striations, and a cough. Can you guess what he has? We all shouted “Cushings Syndrome!” but it turned out that he was just a slightly overweight man with hypothyroidism! The last patient came in with high calcium level, nausea, weight loss, general aches and pains, and muscle weakness. She has parathyroid adenoma.

With the little foundation of knowledge we have in cardio-pathology as incoming second year medical students, the stethoscope project has given us a slightly better grasp of heart murmurs and pathologies. We’ve listen to patients with rheumatic heat disease, eisenmenger syndrome, tetralogy of fallot, transposition of great vessels, ventricular septal defect, atrial septal defect, aortic regurgitation and stenosis, mitral regurgitation and stenosis, pulmonary regurgitation and stenosis, and tricuspid regurgitation. We use the APTM technique and learned how to differentiate between a systolic and diastolic murmur when listening to a patient.

For the visual learner inside of us, the dermatology clinic gave us much to see. It was shocking seeing the rarer diseases we’ve only read about in textbooks, such as pemphigus vulgaris, psoriasis, and leprosy.

If I had to sum up my experience at Vellore in two words, I’d pick crazy and educational. It was crazy in two senses. One, our schedule was as busy as the streets in Vellore.  And two, seeing everything—from the variety of patients to the environment at the slums--for the first time was extremely shocking and took a while to sink in. It was educational, too, needless to say, but not only because of the numerous patients we’ve learned from, but because of the inspiring physicians, social workers, and village health workers we’ve met. Below are some of the quotes I’ve written down from physician and social worker during a lecture or conversation.
Quotes from some of the physicians and social worker at Vellore:

“Bye bye baby or bye bye practice.”
-During our discussion between the Indian health care system (more primary care, more patient-doctor relationship, less paperwork and hassle with insurance companies, but higher infant mortality) and the American health care system (more paperwork, more hassle with insurance companies, but lower infant mortality)

“In India, you can have the perfect solution, but it needs to be effective in a less than perfect system.” 
– Dr. Anu. During the TB lecture, Dr. Anu talked about how a solution or intervention may be perfect on paper, but ineffective in an actual community. One must take into account factors such as drug incompliance, cost for the patient, transportation for the patient, and the social environment the patient goes home to after leaving your clinic.

“I may be only one, but I am one. And just because I cannot do everything, I can do something. And I will not let what I cannot do interfere with what I can do.” 
–Sushil, after our visit to the slums, speaking about the overwhelming feeling you get seeing the huge disparities in social and health care. But just because you can't "do everything" does not mean you can't do anything. One of my favorite quotes of the trip.

“Completeness with brokenness.” 
– Dr. Tharion. After our visit to the Physical Medicine and Rehab clinic. Dr. Tharion talks about the architect of the temple at the clinic, purposefully built with “incomplete,” interposing walls, and relates that to his patients, who many never heal completely and may remain “broken” on the outside, but they still and will always have the chance to be “complete” spiritually and mentally on the inside.