Saturday, October 15, 2011

The Undergrad's Post: What a Medical Experience

By: Jonathan

I heard about the India trip that Dr. George Chandy was planning for a group of medical students when he came to visit Santa Barbara last spring. I was so excited when he offered the invitation to join him this summer to India.
The plan was to visit three different hospitals in Southern India for 3 weeks in the summer of 2011. First week was to spend in a premier teaching hospital called the Christian Medical College, Vellore. The second week was to be spent in a rural hospital in a remote area up on the hills serving local hill tribes, called the Adivasi Hospital in Gudalur, and then, for the rest of the trip, to visit an advanced cardiothoracic surgery department in the heart of Silicon Valley of India called, The Narayana Hrudayalaya Hospital in Bangalore.
I met Dr. Chandy in Los Angeles, and we both flew out to India. After stopping over in Tokyo, and laying over in Singapore for a day with Dr. Chandy’s extended family, we made it to Chennai in Tamilnadu. There, we met ten other young people aspiring to become doctors. We all packed up into a bus and took the long drive to Vellore. The ten students stayed in the CHTC (Community Health Training Center) guest hosing, Dr. Chandy stayed with his cousin, and I was able to stay in the home of Dr. Aravindan and Dr. Sheila Nair. After eating, I quickly fell asleep in the early afternoon, and only woke once to eat a small dinner, before calling it quits once again before the next day.
Day 1:
During the first day in Vellore Christian Medical College, we met Dr. Anu Bose and Dr. George Kurian at CHTC. They both explained the history of the medical school, and also gave us the different perspective of doctors working in India versus the United States. Since India’s health system does not have strong funding, it is difficult to organize strong healthcare organizations. Also, Dr. George explained that in India’s free market system, there is a huge disparity between the rich and the poor. Those without money cannot afford proper healthcare, nor can they afford certain aspects in their lifestyle that most Americans take for granted, such as a clean bathroom and pure water.
After this discussion, we visited some villages on the outskirts of the city of Vellore. Most houses were very simple, consisting of one to three rooms, with some having straw-built rooftops. One patient we visited was a young schoolgirl experiencing epileptic seizures. After viewing the various symptoms of her condition, doctors have put her on Phenobarbitol, Sodium Valporate, Phenotoin, and Folic Acid to control her seizures. A second patient was a pregnant female also experiencing seizures. Her sickness also may have caused menstrual problems, so the blood factor for the baby was also taken into account for proper treatment. Due to the extreme social differences between the United States and India, it is much more disheartening for Indian children to become afflicted, since the likelihood of recovery is much less than that of a child in America.
Later in the afternoon, we visited CHAD, the Community Health and Development center in Vellore. We were introduced on how to test a baby’s development by observing the Trivandrum Scale. Each reflex was tested, from the Moro reflex to the startle reflex. Also, the grasping and rooting reflexes give insight as to proper development of the brain. We also took blood pressures of babies and the children and listen to their hearts in order to check for any heart murmurs. The UC Irvine students were undertaking a project where they were testing an electronic stethoscope attached to a cell phone. This stethoscope would hypothetically make it easier to analyze the heart sounds and murmurs without the need for the patient to be brought to the hospital and be seen by a cardiologist to diagnose the cardiac problem. Once refined this will allow the health care worker to visit villages and diagnose complex cardiac conditions early on and triage patients appropriately rather than forcing patients to make the long trip to the hospital after their condition became more advanced and symptomatic. Although the stethoscope was working fine, the phone connected to the stethoscope repeatedly played music, making it difficult to record the heart beats of the patients. The difficulties were recorded, and we ended the first day in Vellore.
Day 2:
The next day, Dr. Sunil gave us a presentation of Tuberculosis and its prevalence in India. One fifth of all severe cases occur in India, due to the poor socio-economic status of the people in the country. A slight cough and fever, if left undiagnosed early on, would lead to amore advanced resistant case of Tuberculosis. Tuberculosis is treated by the DOTS therapy, or Directly Observed Treatment, Short-course therapy. There are five components of DOTS: government commitment, case detection by microscopy, standardized treatment observed by a doctor, regular dosages of drugs, and a normalized recording and reporting system. Several pills and treatments are given and performed three times a week, such as Isoniazide(INAH), Streptomycin, Rifampicin, Pyridoxine, and Ethambutol to name a few.
Later in the day, we visited some patients. One child had a case of Ricketts, which is caused by a defective Vitamin D receptor. Physical therapy and Vitamin D treatment is used to help these types of patients. Another patient had Bradycardia, which was observed through the use of a normal mechanical stethoscope. The cell phone stethoscope was also used to record the heartbeat, as only one was functioning properly at that time. The patient felt very weak, due to low heart rate resulting in poor circulation in the various tissues. This took up the majority of our day, as we visited several patients while observing the hospital. Because the hospital in Vellore cares for so many patients, it is much more crowded than most hospitals in America. Even so, the doctors in India are very well organized, and have managed to conduct an efficient system of treating patients.
That night, we visited the Golden Temple in Vellore. One man meditated for such a long time, that people built a temple of near pure gold around him and proclaimed him a “god”. Although it was quite a sight to see, the temple had become inundated with commercial sellers looking to make a profit out of visitors and tourists. The gold was beautiful at first, but it seemed that a magnificent work of art had become tainted, and I quickly become put off by the whole thing.
Day 3:
On the third day, I unfortunately came down with a fever. Some of our group the previous few days had experienced severe nausea and slight fevers, and at this point it had caught up to me. I was prepared to tough it out, but while walking outside I became extremely dizzy and sweaty, and had to call it a day. Previously, before visiting India, Dr. Chandy, told us the dangers of eating food, since most vegetables and meats are not clean like in the United States. On the first day, we ate at the Darling Hotel, which served dish after dish of Indian food, which was very delicious. Unfortunately, the bathroom was extremely dirty. The next day, we ate at the campus canteen for dinner. During one of those days, I must have contracted a virus. Luckily, the doctors I was staying with provided me with proper treatment, allowing me to be functional and attentive, as the next day we were to visit the LCECU.
Day 4:
The LCECU, or Low-cost Effective Care Unit, allows poor patients to be treated without charge. We met Dr. Sushil John, who gave us a presentation on the history and goals of the LCECU. Ida Scudder, the founder of CMC &H, when she first came to Vellore, over 100 years ago, started her first out reach clinic in this facility. The Mary Taber Schell hospital made in 1902 for women preceded the current CMC Hospital, demonstrating that the roots of the entire hospital in Vellore are very old. The idea of an urban health center was brought up to provide secondary care with low technology, and without high cost. This eventually became the LCECU. Around two hundred patients a day are treated here, from normal cases such as arthritis and carditis, to bizarre cases such as the dancing of Sydenham’s Chorea. We viewed patients with cases of fever and arthralgia, hypoxemia, and rheumatic heart disease. The stethoscopes were used again on the seven intercostal spaces in the back to listen to the lungs for any signs of heart failure. One patient was diagnosed as having an atrial fibrillation, caused by the quivering heart muscles. This is caused by mitral stenosis and left atrial enlargement, and results in rapid heart rate. Dr. Sushil John showed us how to feel a water hammer pulse, which is caused by the pressure of aortic regurgitation. Another patient had Eisenmenger’s Syndrome, which is caused by pulmonary hypertension resulting in a left-to-right shunt due to a congenital heart defect. Some of the symptoms of this patient were clubbing of the fingers, cyanosis, arrhythmia, kidney problems, and a high red blood cell count called Polycythemia. We were given an overview on the types of pulses, from a collapsing pulse to a slow-rising pulse, and also given a demonstration of a Bisferiens Pulse. The types of murmurs were also presented, from aortic regurgitation and mitral stenosis, to mitral valve prolapse and congenital heart defects. All of these cause much greater secondary problems in various parts of the body, as noted by the multitude of symptoms of each patient.
That afternoon, we split into three groups, and visited the slums of Vellore. In the slums, there is no running water, very few houses have roofs, and it is generally extremely dirty. The only signs of opulence seen here are the churches and temples, which are given much more importance in areas such as these, since most people living here need a sign of hope in order to cope with their everyday lives. This allowed us to see why the suicide rate in India is so high, since people living here have no basic luxuries most Americans take for granted. Alcoholism is also widespread, as most males revert to liquor to forget about their problems. One patient that we visited was a woman in her sixties, who looked much older than she was. One of her sons had died, and another one had become an alcoholic and could not provide for her. Her grandson was attending a college with the help of one of the doctors, which to her gave her sense of existence. Her small brick hut was covered by a straw roof, which does not guard from any rainfall. The stagnant water was a haven for mosquitoes, and other annoying insects. The doctors in Vellore were treating her for depression. Her Christian faith in God and the treatment provided to her free by the LCECU has given her hope. This may have been one of the most tremendous and extreme experiences of the entire India trip, as it has changed my perspective as to what is valuable to me and people in general. Luxuries are very precious, and are not necessary for a quality lifestyle. A strong, loving family and a basic household with water and food is really all people need to be happy.
That night, for dinner, I decided to not risk eating outside, and was treated to a healthy and delicious meal by my gracious hosts. I believe that at this point, I had learned my lessons as to what could happen if the necessary hygienic precautions are not taken.
Day 5:
On this fifth day, we had the privilege of meeting the head of the spinal injury department, Dr. George Tharian. He told us he would team up with a stem cell researcher from UC Irvine, Dr. Hans Keirstead, and perform the first known human trials of stem cell transplants in spinal injury patients. This was amazing to me, since I had worked in Dr. Keirstead’s lab a few summers before, and also this would probably not be approved in the United States at this time. After introducing us to the spinal injury department in Vellore, Dr. Tharian led us through the rehabilitation facility. He explained that with trauma comes the loss of neuronal activity. The purpose of rehab is to regain the functionality of those nerves. One patient had jumped out of an auto-rickshaw, and had lost feelings in his legs. Dr. Tharian explained that there was a possibility he could regain the use of his legs with proper therapy.
That afternoon, the medical students, Dr. Chandy, and I decided to visit the campus pool. Palm trees and a garden surrounded the clean and chlorinated pool. While about to jump in the beautiful water, I noticed a large snake slithering away from us in the bushes, while trying to get closer, it quickly hid itself between the trees and shrubbery away from view. The females of the group also decided to buy their own material to get tailored for their very own traditional Indian attire. After a relaxing afternoon swimming and playing ping-pong, we decided to eat once again in the campus canteen. This time, no one picked up any diseases.
Day 6:
On this day, we were able to visit the obstetrics ward. When we first entered this section of the hospital, we noticed the number of beds that were packed into the building. There were much more patients here than would be found in an American hospital. While walking through the ward, we were given an overview on the processes and complications of pregnancy and birth. The death rate of babies in India is much greater than the death rate in the United States, because most mothers do not seek medical attention till it is time for the birth. A presentation on obstetric concepts was given, as we were introduced to the Robson’s Classification of C-sections, which describes the type and severity of the pregnancy. It was also shown that vaginal births after cesarean sections (VBACs) have had less post-op complications in the past ten years. Also, we were informed on the rate of Repeat Cesarean Delivery (ERCD) versus the plan of Trial of Labor after Cesarean (TOLAC), based on the severity of the cesarean section. Following the presentation, we were able to view a live birth. With the help of about 3-5 nurses and doctors, the mother was able to successfully give birth to her first child. One noted complication was that the umbilical cord of the baby wrapped around its neck, forcing the doctors to gently roll the baby over to allow for a successful release. Following this live birth, we were also able to see a live cesarean section. After putting on medical scrubs, facemasks, gloves, and booties, we surrounded the procedure. This was done very efficiently without complications, as the baby was found healthy with no obvious deficiencies. After this, we were told about the risks of cervical cancer, sexually transmitted diseases, and other infections that could prevent proper births and normal pregnancies for Indian women. Also, the Indian government had only recently legalized abortion, resulting in proper family planning.
Following our visit to the hospital, we ate at an Indo-Chinese restaurant in Vellore. At this point, my stomach was feeling a little upset, so I only ate rice, yogurt, and some other bland vegetables. Despite my stomach, I was still feeling strong and functional. We visited the medical bookstore in order to purchase books, but they did not have any texts we needed at that time.
That afternoon, we visited the Pediatric department with Dr. Jiji Matthews, wife of Dr. Prasad Matthews. She explained to us what happens when upper or lower motor neurons lose their functionality in patients. Also, she showed us a patient that had developed a pulmonary embolism, which is a result of a clot dislodged from lower leg and landed in lung blocking a pulmonary vessel. After walking only half a mile, this patient would start to feel sick. A second patient had uncontrolled diabetes, so insulin was being given as a treatment. A third patient had tried to commit suicide by eating yellow oliander leaves, which had poisoned the patient. Dr. Matthews explained to us that suicide is a problem in India, as it still is prevalent at a very high rate. He also informed us that the state of Tamilnadu sells alcohol in order to fund government programs, which actually encourages alcoholism. He then led us to some more patients. One case of Gangrionosum was found in a nineteen year old man. This disease, caused by the autoimmune disease called Systemic Lupus Erythematosus (SLE), makes antibodies against its own organs, which eats away the body. A treatment of Mycophenolic Acid was given to treat this malady. Another notable twenty-four year old patient had an enlarged spleen and a shrunken liver, due to Cirrhosis. This liver problem was caused by a copper storage disorder. The patient also had Kaiser-Fleischer ring in his eyes, clinching the clinical diagnosis. A treatment of albumin was given to quell this problem. We also met a ninth grade student, who had injuries to the third and sixth cranial nerves. A heliopathic craniotomy was done to relieve intracranial hypertension. The parasympathetic fibers had been injured causing third nerve palsy and dementia due to the cerebral pressure. Therefore, speech difficulties and walking problems had arisen. The final patient we saw was a Farmer who experienced seizures due to Todd’s Paralysis. This has caused general facial and body weakness. Larval cysts had had also been discovered in the brain which are causing the infection. Steps were being taken to find a way to get rid of those Hydatid Cysts. Following the tour of his patients, Dr. Matthews told us doctor and patient confidentiality if less secure in India, due to the poor medical and government infrastructure in place. One important quote he told us is that “Happiness is possible in pain and sufferings … But pleasure alone can never create happiness.” This resonates with one of the central themes that has been reiterated through all our experiences, that one needs more than material and superficial luxuries in order to be happy.
Following this long day in both the Obstetric and Pediatric wards, we walked to the house of the Drs. Jiji and Prasad Matthews to have a homemade Indian dinner. Dr. Chandy was living here, as Dr. Jiji Matthews is his cousin. After eating a sumptuous meal complete with various curries and Indian pizza, we talked about our amazing experiences of viewing a live baby being born, and also about the various diseases seen while being guided by Dr. Matthews. A few of us had the opportunity to perform for a night of evening entertainment, consisting of singing and dancing. I was able to play the acoustic guitar to accompany a dance. All in all, this was a great day full of informative and powerful medical cases.
Day 7:
For the final day in Vellore, we visited the Dermatology ward, where we experienced the most visually gruesome cases of our trip so far. We met Dr. Renu George, who took us through her workplace. We split into three groups, and rotated through three patients. The first patient had ulcers on his left foot, contractures of fingers, and skin tightness. He was being diagnosed with leprosy, and was receiving treatment of Rifampicin and Dapsone. The second patient was a thirteen-year-old boy diagnosed with alopecia and lichen planus, characterized by skin lesions and hair loss. The third female patient was said to also have skin lesions and blisters along her skin. She was being treated with immunosuppressants at room temperature. As we went through more patients, each case became more severe. One older woman had a fungal skin infection that had eaten away most of her skin. Another patient had Norwegian Scabies, characterized by black clumps along the skin. I had only previously observed cases such as these in books, and to actually see these in person was both shocking and fascinating. Although I could not help feeling sorry for these patients to live in their states, Dr. George and other doctors were taking every measure necessary to make sure they were being well taken care of. The doctors told us they needed to know a patient’s prior medical history before being examined in order to diagnose any sickness. Then only could they take steps to prevent the spread of the disease. This in itself is difficult, because some patients in India do not have a strong medical history in record, forcing the doctors to try and cure the illnesses without knowing what caused these problems in the first place, and also how to prevent the recurrences. After this half-day in Vellore, we thanked the doctors for their generosity in leading us through their hospital, and made our way back to the medical campus. We decided to rest and pack for phase two of our trip, as we prepared to make our way to the villages of Gudalur and the Ashwini hospital.
Day 8:
That night, after departing from Vellore around 9:30 PM, we made our way in our A/C deprived van to the Vellore train station. The train arrived right on time at 11:40 PM, and took us on a pleasant journey to the city of Mysore where we arrived at 8:00 AM. After eating a normal South Indian brunch in a hotel restaurant, we decided to visit some of the tourist attractions in the city. First, we visited the grand Mysore palace. The ornate building was filled with gold ornaments, ivory-coated walls, and various stained glass ceilings. The palace even had a supply of cannons that had been maintained throughout the years. Next, we drove to a sacred bull carved out of a single stone. Apparently one man took the time to carve out the stone, making it a religious monument for some of the habitants of the area.
After taking in the culture of Mysore, we embarked to the villages of Gudalur. As we drove, we noticed the weather changing from pleasant to inclement; as Dr. Chandy told us it was monsoon season. Luckily for us, we loaded up on medicine and other supplies to prepare ourselves for any grave events to come. After driving through a tiger reserve filled with monkeys, elephants, and deer, we finally made our way to Gudalur. There, we met Dr. Nandakumar Menon and Dr. Sheila Devi, who helped us settle in our visitor’s house. All of us were excited to experience the Ashwini hospital, so we grabbed some homemade vegetarian dinner and prepared for the upcoming day in Gudalur.
Day 9:
Following our day of rest, we walked down from our house to the outpatient hospital in the morning. There, Dr. Sheila summarized the origins of the hospital to us. She and Dr. Nandakumar worked in New York during their early years as doctors. After saving up enough money, they returned to India in order to set up the Ashwini hospital. From 1986, with the help of donations and charitable organizations, the facility has grown from a one-bed clinic to a full-fledged forty-bed hospital today. Both doctors act as facilitators, making sure that the hospital truly belonged to the people of Gudalur. They entrusted the tribals to basic medical positions, as they have set up training programs for the native people of the area to become workers in the hospital. The Adivasi people of Gudalur consist of four separate tribes with several villages that are all interconnected through trade and the hospital. One interesting value that we learned is that most of the tribal people are content with their lifestyle, and resist dramatic changes to their culture. The practiced religions of the area are very unique, but all demonstrate peace, kindness, and altruism.
Later in the afternoon, after a tea break, we met Dr. Abraham, a young doctor about the same age as ourselves. We split into three groups, and shadowed the doctors. We met several patients with similar maladies as the ones we visited in Vellore. However, each patient was seen for his or her checkup, quickly diagnosed, and then sent away with the correct treatment. The quickness and efficiency of this hospital, without any hindrances, allowed each doctor to see patients at a much higher rate than doctors in the United States. Patients from all over South India come here for treatment, because the reputation of Dr. Nandakumar, Dr. Sheila, and the hospital is so great. In addition, the respect of the patients to the doctors is much greater than I have observed in the United States. The culture and values seen in this hospital allow the patients to be treated efficiently and effectively.
That night, we were treated again to another delicious and purely vegetarian dinner. We also were given the schedule for the coming week, and realized that we were going to organize some entertainment when we were to have dinner with Dr. Nandakumar and Dr. Sheila in their house later on.
Day 10:
On this day, we once again went through the rounds of seeing patients. This time, we saw cases of patients that were injured with their encounter with wildlife in the area. We saw pictures of a woman whose face was mauled by an elephant. Several other patients that we saw yesterday returned again for post operation checkups. We also tested the working electronic stethoscope on several more patients with heart disorders. Dr. Abraham gave us a lecture on Tuberculosis and its presence in India. Anyone having a prolonged cough is determined to be at risk of TB, since around 2 billion people are infected with the bacteria. Tuberculosis can manifest in nearly any organ, so it is hard to detect the presence of TB when it is dormant. Once it becomes active, it can spread throughout the body.
That afternoon, after a tea break and discussing the various patients we observed, we traveled to the Mudumulai Tiger Reserve. We saw droves of spotted deer, herds of elephants, and large wild boar. Although we did not see any tigers, we saw a leopard sprinting into a brush before we could capture it on camera. While driving back to our guesthouse, we slowed down for pictures. Since we have heard stories and seen pictures of animal attacks, it was very intimidating when we drove an arm’s length away from elephants and bison. The size of the animals was much more dramatic when seen in person, one could understand why old Indian armies used elephants as their source of heavy cavalry.
Day 11:
On the Wednesday of that week, we travelled to the tea plantations to visit the tribal people in their villages. We learned that tea was the main source of income for the villagers, as they spent several hours a day picking tea in the humid and wet plantations for very little money. Our group met Jiji, one of the educated hospital social workers. We traveled to area health centers and villages in order to observe how patients could be treated near their homes without travelling a long distance to the main hospital. After travelling to the area center of Murukambadi, we also met Janu, a health care worker who was in charge of the pharmacy and basic clinic facility. There, she can perform physicals and check weight and blood pressure. We watched her check the weight of a young boy with sickle cell anemia whose parents were both carriers of the disease. Next, we travelled to the Vattakolai village of the Kattunaikkan tribe. The people of this tribe survived on a steady diet of rice and vegetables while living in brick and straw houses. Each child has a record sheet for weight, diet, and medicines. I made the mistake of standing too close to a blind dog, which leaped at me. Luckily, it was blind and missed me, though unfortunate for it. An older woman beat the dog with a large stick for attacking a guest. Also, I made the mistake of wearing track shoes, believing they would offer me some traction on the slippery clay slopes. They did not, and I slipped and slid my way with the group to the village of the Paniyah tribe.
In this second village, some of the houses had televisions, which was a great step toward being connected with the rest of India. Jiji explained to us that some patients have hookworms in their system, and are given Albendazole for treatment. We visited the third village surrounded by pepper plants. After being laughed at by some village children for falling again, I took off my shoes, walked with my socks, and joined the group to learn about the Educational program. Several of the children go to school, but their families hold some back because they need to take care of their family’s jobs and bring in income. Now, education is starting to take hold and become more permanent in the culture of the villagers.
In the last Karthanaka village, we saw elephant tracks and broken tree trunks from a recent wild elephant attack. Villagers are injured and killed by elephants every week, so the native people are used to these events. The hospitable people gave us a mat to sit down and offered us a batch of hot tea. This gesture was very generous, as they only generated a little more than a dollar a day of income.
We returned home amid some carsickness on the bumpy Gudalur dirt roads. As we were driving, we saw children on their way back home from school, waving at us as if we were rockstars. We ate dinner and played a hilarious game of charades with Dr. Chandy before heading to bed.
Day 12:
On Thursday, we once again went through a full day of rounds at the hospital. We also observed the treatment of a woman who had severe burns after having her dress light on fire from a candle. This drastic case was hard to watch as Dr. Nandakumar and other health workers scraped off dead skin and applied treatment to the painful burns. Following the operations, we sat through a suture workshop, where Dr. Nandakumar explained to us how to properly apply stitches with the various types of suture equipments and materials. We also saw pictures of case studies. Although the medical students had much more experience of observing cases such as these, this was a great experience for me, as I saw how symptoms and signs (history and physical) were described and then assigned a certain diagnosis of disease or injury.
After our tea break, we observed the lab of the clinic, where blood and tissue samples were analyzed. Dr. Abraham also gave us a lecture on the details of an EKG, and explained to us the details of the P, QRS and T waves. Most of these terms were new to me, but were a great introduction as to how in depth medical doctors must understand these terms.
Day 13:
On Friday we had the opportunity to travel to the tea estates and watch the tribal people work. Following the muddy and bumpy ride, we saw the grand view of the jungle from the mountains. The tea estates are located on the borders of the states of Kerala and Tamilnadu. While walking on the path through the tea plants, we hopped through the waterfalls caused by the monsoon season. Another result of the wet weather was the onset of leeches that happily latched on to our fresh American skin as we trod through the marshlands. Every five minutes we had to check ourselves as the leeches made our way up our legs. One leech started to crawl up my knee before I wacked it off.
The tea workers of Gudular use tea clippers to prune the tealeaves on the top of the plants. They quickly picked the leaves from plant to plant. When we also picked some leaves, we noticed we were only slowing their work down, and got out of the way for the experts to continue. 25kg of tea must be picked in order for a worker to earn the daily wage of $1.50.
We drove back to the hospital after a day of leaf and leech picking, and attending a small ceremony for Dr. Abraham. He had been interning in this hospital after graduating from Medical School, and now was going to leave. Jiji and other health workers were telling stories, singing songs, and giving gifts to him. It definitely showed that the villagers and workers in Gudalur had appreciated Dr. Abraham very much.
Day 14:
In our last full day in Gudalur, we visited a tea-processing factory in order to see how different strains of tea are made. The large factory allows for different flavors to be packed and sent for delivery for profit to different countries. Green and black teas come from the same leaf, but the fermentation and oxidation of the leaves allows for the teas to change from green to black. For lunch, we visited a restaurant where we loaded our stomachs with our first meal of meat in nearly a week. Following our delicious meal, we contently left with full stomachs back to our guesthouse.
That evening, we made our way to Dr. Nandakumar and Dr. Sheila’s house. We were given a tour of the gardens, and bird coop, and even got to play the national sport of cricket with some boys from the area. As we got ready for dinner, we met some other exchange students from Britain and discussed with them the differences in education between the two countries. American medical students start medical school much later, with the average age of first year students being 26, while European students start when they are 18. However, American students are able to experience other aspects of their life that add to their education. The evening entertainment before dinner consisted of a Bollywood dance, some singing performances, and even a ballet performance that I was taught to assist in.
We thanked both doctors for their hospitality and made our way back home. Our time in Gudalur was filled with life-changing experiences, from differing lifestyles to severe cases of injuries. Living in Gudalur may take some time for one to adjust, but in the end is very pleasant and rewarding.
Day 15/16:
After finishing packing our belongings, we ate our final meal in Gudalur before driving to the Mysore train station. The train brought us to our final destination in Bangalore (Bengalaru). There, we made our first stop at a steak restaurant, dispelling any misconceptions that eating beef was disallowed in India. After trying to eat the same amount as in America, I realized that after leaving Gudalur, my stomach had shrunk from all the vegetarian food. After meeting Dr. Chandy’s cousin and nephew, we arrived at our hotel late in the night. We set ourselves up for the upcoming day in the large Narayana Hrudayalya (NH) Heart Clinic on the outskirts of Bangalore.
During our first day, Dr. Chandy told us how the NH Clinic was started. Dr. Devi Prasad Shetty believed that a network of hospitals must be created in order to provide adequate healthcare for the entire world. Although he started with limited funding and little support, he has built the largest hospital network in the world. To put the size of NH in perspective, the Heart Clinic itself consists of one thousand beds, while the largest medical center in the United States, Boston Medical, has 300 beds. Dr. Shetty has helped make healthcare global, providing numerous countries with modern medicine.
For our first overview of the clinic, we were given the opportunity to observe three patients undergoing separate heart surgeries. One baby was receiving a Blalock-Taussig shunt in order to direct blood flow into the lungs. This patient had his aorta and pulmonary vein connected to each other’s targets, causing cyanosis. A small shunt was placed on the vein to send blood to the lung. The other patients were also undergoing similar treatments, but I focused on this one child. Drs. Edward Blalock and Dr. Helen Taussigs’ names were given for this shunt, but it was actually a plumber who first discovered how to redirect blood flow. Following this three-hour portion of the day, we visited the Pediatric ICU to view post-op problems of complicated heart surgeries. Next, we were directed into the Echocardiogram facility. Several patients’ hearts were analyzed for defects in each valve. The larger hospital allows for more people to be treated, which in turn allows the clinic to cost less money. More efficient healthcare is therefore possible with less money.
That night, some of us decided to explore the city of Bengaluru. We were both surprised and relieved to find the streets of Bangalore orderly, much like a large city in the United States. When the British took over India, they named Bengalaru as Bangalore, demonstrating that several buildings in this city have an English influence. The modern feel of the city allowed us to walk around amongst other tourists. In the mall, the girls felt right at home, while I walked around just content to be in a lively city. We returned back to our hotel tired after a long day in the city.
Day 17:
During the second day at the NH clinic, we listened to an Academic Quiz held by the hospital’s doctors online. They went through all the different degrees of cardiac conditions and several kinds of heart blocks. Next, we were given an introduction to different findings in P and QRS complexes in EKGs that could denote various types of heart blocks. The Purkinje system and its various anomalies in the system that give rise to different types of heart blocks were discussed, hence this must be analyzed very carefully. There are several different types of surgeries depending on what exactly is halting the heartbeat, so the type must be specified. Genetic disorders can cause congenital heart blocks and some Cardiomyopathies can also result in rhythm disturbances. These Cardiomyopathies are classified based on the cause of the disease. We were lead around by different doctors, as they showed us various patients that had contracted these diseases. The specialized hospital here was much better equipped at handling these conditions as compared to the hospitals in Gudalur and Vellore. This all relates back to how important funding is for a hospital, as better equipment yields better treatment.
After another tea and lunch break in the doctors’ cafeteria, we were given walkthroughs on how a pacemaker works. This device introduces electric currents to prompt the heart to beat at a normal rate. This can help regulate the effects of both Tachychardia (fast heartbeat) and Bradychardia (slow heartbeat). The pacemaker relieves the symptoms of Arryhythmia, such as fatigue, palpitation, chest pain and shortness of breath. The heart has many electrical components. One male patient that we encountered had a third-degree AV node block caused by a congenital heart defect. A pacemaker was given to this individual to relieve his symptoms.
That night, we arranged to have our laundry to be washed. From Vellore to Gudalur, we have not had much opportunity to wash all our clothes. I was excited to rid my clothes of mud and leech blood stains contracted from the tea estates. We once again had dinner in the hotel lunchroom, which satisfied us once again.
Day 18:
On this day, we underwent rounds with three different doctors. One patient was seen to have a Mitral valve prolapse as indicated by an EKG. Next, after analyzing a dropped P wave in an ECG of a patient, the medical students analyzed this abnormality as a second-degree AV node block, or Wenckebach/Mobitz 1 periodicity. This is normally caused by a disease, with the rate of the P wave to the QRS complex to be between 2:1 or 3:1. Next, we were told that in order to find the proper pacemaker to give, the doctors needed to know the physiology and disease of the patient. It also depends on age of the patient and the cost of the pacemaker, making it hard for a poor individual to afford one on his or her own without this helpful medical community. One other patient had her two ventricles switched, meaning her right atrium was travelling to her left ventricle. A surgery will take place to transpose her congenital defect. Another patient had Noonan’s syndrome, which causes dwarfism due to improper blood flow. Following the doctors and looking at numerous patients, we also had a chance to test out our stethoscopes and listen to the heart irregularities.
After a long day of rounds, we made it back to our rooms satisfied and well educated on the different types of heart defects in humans. Our laundry was not done at this time, which worried me, but I was told it would be done on the next day. We ate again in the hotel restaurant and prepared for our final day in the hospital.
Day 19:
For our last day in Narayana Hrudayalya, we entered the Echocardiogram (ECHO) center to see live patients being analyzed. In order to properly interpret the results, the rhythm, rate, axis, and age of each patient must be taken into account. Different changes in P, QRS and T waves and their intervals were corresponded to different diseases, and each patient was then sent away with an evaluation.
Following the Echocardiogram room, we were given a powerpoint presentation on how exactly the heart waves worked. The shape of the complexes is named after “William Marrow” left to right. Abnormalities in different areas of the complex can denote different diseases. For example, ventricular hypertrophies correspond to the Q-wave, and ion channel diseases can be identified in the S portion of the QRS complex. Some causes of QT prolongation can be due to electrolyte abnormalities or certain drugs.
After thanking the doctors for spending time out of their schedule to give us a tour of the facility, we went back to our hotel. After the tour we realized the extent of work and stress the medical professionals endured day after day in this large hospital. While it may have been much different than Vellore and Gudalur, the work seen here relates most closely to that seen in the United States. Even so, the vast expanse of the medical campus is unlike anything in America. The specialization of each doctor allows for efficiency in such a large organization.
That night, we took a car to eat at a famous restaurant in Bangalore, called Koshy’s Restaurant. The prices here were comparable to those in the States, unlike the rest where we got away with paying just less than five American dollars for a full meal! Even so, the food was spectacular. After a few hours of food and drink, we heard stories from Dr. Chandy on what it actually took for him to become a professor in UC Irvine. We finally walked back to our car, rode to the hotel, and slept soundly.
Day 20:
The next morning, I was still disappointed and worried to see that my laundry had still not arrived. After a few more hours, a van pulled up to the hotel and dropped off my clean clothes. Although they were still slightly wet, I was thankful that I was not going to smell of the jungle. That afternoon, after packing our belongings, we took our cars to meet Dr. Chandy’s cousins. They were very hospitable, offering us drinks and telling us where to spend our afternoon. We then drove to the main city of Bangalore. The male medical students and I went to different shops, and painfully realized that although some of the stores here sold reliable goods, the prices were modernized. No bargaining here was going to allow us a cheap buy. We ate at a McDonalds and KFC, and saw that the menus here had a distinct Indian influence. KFC still tasted the same, but at McDonalds I had a spicy chicken wrap that clearly was coated in chili powder. It was delicious.
After nightfall hit, we said our goodbyes. The medical students were going to pursue other research projects in different towns, and Dr. Chandy and I were going to visit family in separate towns. The medical students had been extremely hospitable to me, especially since I hardly knew much about the medical process as an undergraduate. Dr. Chandy and I departed on the same train, away from Bangalore.
All in all, from the medical campus of Vellore, to the lush jungles of Gudalur, to the bustling city of Bangalore, each stop offered me an educational experience that I would not trade for the world. The culture and history found in each of these places will stick with me for the rest of my life. It certainly makes me appreciate the life I live in the United States, regardless of any difficulties I may encounter in America. After three weeks of little sleep and several hours of medicine, I was content and thankful for the opportunity offered to me by Dr. Chandy.