R&R

The team is off in Mumbai for the weekend. I am told they went to the Elephanta caves today, something I've always wanted to see ever since reading the associated Amar Chitra Katha as a kid. I am taking a day off myself tomorrow to spend with my family here in Hyderabad.

On the gastronomic front, now that I am back on a regular diet (more like soft mechanical with aspiration precautions) we had another dose of Indian Chinese Wednesday night. It wasn't the best, but I am definitely going to miss that stuff when we get back to Cleveland. Have also been having guavas daily. Still in search of the elusive sapota.


I spent some time today with a social scientist who has done some pretty cool work on HIV prevention. This brings my perspectives on HIV care in India to five: a government-sponsored center for antiretroviral therapy, a tertiary care, academic referral hospital where patients pay for everything before its done, a private "corporate" hospital that serves the upper middle to upper class, a non-governmental organization, and today's social scientist. Each perspective has its unique aspects, but there are some themes that cut across organizations. Everyone thinks that the HIV problem here, despite the recent reduced estimates in prevalence, is spiraling out of control. Everyone also agrees that there is a ton of money floating around, but little accountability for how it is spent. I am surprised to see the universally negative feelings toward most NGOs. The glaring exception, of course, is Sivananda. Opinions on them range from: "they are in it for the money" to "they want to convert people to Christianity" to "they are incompetent". Nobody is particularly happy with the government response either, calling it a bunch of hand-waving. For my part, I am happy to have met people both in the government service and in the private sector who are really devoted to the cause.

Another common complaint here is about the brain drain. This is an often devastating problem in Africa as well. It is interesting to see that in India, this applies disproportionately to physicians. The boom in the tech industry has led to IT people who stay here leading extremely comfortable lives. This obviously does not carry over into medicine, so a lot of people are always finding ways to go overseas. Despite this though, we have come across some incredibly intelligent clinicians.
I feel like working with these guys for a month, in a resource-limited setting where you can't just blindly order tests, would be an invaluable, required rotation in an internal medicine residency. For attendings like me too!
Finally, in answer to the query about tea, if you are only getting tea twice a day in India, you are getting shortchanged. We have had tea pretty much 4 times daily here. Plus coffee. Nice.

Lecturing and such

While the team has been seeing cool clinical stuff, I have been spending my time lecturing, networking, and writing concept sheets for grants. Clearly a different experience, but just as educational. It has been an exhausting first 10 days for me, but I am content to know that I have accomplished a great deal in that time. I have given 5 lectures so far, with 3-4 more to go. Being a faculty member, lecturing is certainly not a new concept to me, but maintaining relevancy of my message to persons whose clinical experiences are so far removed from what I see has been a neat challenge.

Now speaking of lectures, today I had to give a talk on HIV drug resistance. Given the state of my exhaustion and some major abdominal pain I have been having, the team decided, on their own, that they would prepare my lecture for me. Over two nights, these guys researched antiretroviral resistance in textbooks and on the Net and put together a pretty impressive talk. I delivered it today with minimal modification and it has easily been the best received of all my lectures so far. So a pat on the back for my peeps here; they are truly the best, and I was very touched at their generosity. More that that, thought, it was fascinating to see the enthusiasm, teamwork, and brain power on display over the past two nights. My fellow travelers have blogged a bit already and have talked quite a bit about the opportunity to just learn, without interruption or any other pressure. Watching them work with such focus, such motivation, and actually seem to have fun doing it was completely unexpected, given that when assigned something like this most of us tend to groan. Now this response from them could clearly be just a reflection of the magnitude of my pathetic appearance, combined with some obviously humanitarian tendencies of this group. Part of me does like to think, though, that they actually learned a lot from going through this self-assigned exercise. I feel like I have witnessed learning in its purest form, driven entirely by the learner. Maybe there is a model there for medical education...

For those concerned (Amma), I have pretty much recovered from my aforementined GI ailment and am back to eating stuff I have no business eating. Today was a banner day, with notable items including avakaya , hot pepper bajjis, and guava. No sequelae to report. Feeling great. Although...I do have two lectures early next week...hmmm...I wouldn't be surprised if I had some more abdominal pain starting Sunday afternoon or so...

New Perspective

Hi everybody,

Hope you all are doing well back home. We're all doing well, and I think I speak for everybody when I say "THANK YOU" to all of you for being so concerned about us. Hearing from all of you has really meant a lot to each one of us.

I think I also speak for everybody on this trip when I say that our experiences over approximately 10 days have really given us some new perspective in a lot of different ways. I think you have all read our blogs from last week regarding our excitement for some of the programs here that really amazed us with their efforts, so I don't need to say more about that aspect of new perspective.

This past weekend, the blasts definitely had their impact. It really is quite a different experience to read or watch the news on CNN each day and hear about the 30 or 40 people across the world who died because of blasts compared to when you're actually in the city where the blasts took place. You see and feel the effect on yourself, the people around you, the city as a whole. This morning, we were scheduled to go to one of the 2 hospitals where a lot of the victims had been taken from the blasts on Saturday night, but the security levels are so high right now, strikes were taking place today nearby, family members are swarming the hospitals, etc. that we were advised to hold off from going to the hospital at least for today. We may be there tomorrow morning, and I can only imagine what things are like right now, especially for the family members of those victims in critical condition. My prayers are with all of them.

Today, we went to NIMS, which is a different hospital here in Hyderabad, and even there, we had a moment of silence and saw a lot of grief on the faces of the medical faculty as one of their doctors had passed away in the blasts. Anyways, I think you all get the idea. Wish we could do something more about it. For now, glad we're alive and well. Let's all pray for the victims and their families.

Continuing along with today, I think we all had quite an educational experience that offered some fresh perspective. We went on rounds today for several hours with one of the medical teams at NIMS hospital. These rounds were GREAT in many ways. Residents (five of them) were not paged or called a single time by a nurse or anybody else for any orders. The attending literally was teaching for 3.5 hours while we were with them, and we left before rounds were over. So how could 3.5 hours of rounds be great for residents with so much work to be done, right? Well, when our group left their group, we also realized that the residents didn't really have any orders to place afterwards, any discharge planning to solve, no to minimal notes (I'm pretty sure none). Only limited things could be done, so there wasn't as much work afterwards. They were just learning from their attending and focused on thinking about their patient's care. After lunch, they had time to come attend lectures (topics included HIV Perspective in India, Candidemia, and Rhinosporidiosis) for a couple of hours (in addition to the one hour conference that we all attended this morning). Imagine if we had 3-4 hours of teaching rounds and 3 hours of lecture/conferences every single day. Obviously, our systems are different - there is only so much that can be done for these inpatients due to the lack of money. Lab tests, imaging, treatment options are all limited due to cost. Before every potential diagnostic test is ordered, the attending discussed the costs involved and whether it would be feasible to pursue further diagnostic testing for these patients. Often times, the efforts were focused on empiric treatment rather than any labs or imaging with the goal being strongly on getting the patient better with what the best clincal diagnosis was rather than using any of the cost on extensive labs or imaging. Not too much focus on evidence based medicine. It really was quite interesting to see. The ward consisted of 20 beds across one huge room (talk about your geographic localization). In this entire room, there were only 2 iv poles hanging - one person getting IV abx and one getting a blood transfusion. Nobody was on nasal cannula. Diagnoses being discussed on these patients included HIV opportunistic infections in the lung (i.e. PCP, pneumonias, TB, fungal infections), malaria, TB, snake bites, leptospirosis, brain mets, lung effusions/lesions, HIV medication complications, DIC, lactic acidosis, etc. Somehow, they all looked fairly healthy. Just an incredibly unique experience.

Not even half way through the trip, eyes are wide open!

Keep in touch,

Vijay

We're okay!

Hi everyone
Some of you may have heard tonight about the bombings in Hyderabad. About 3 hours ago there were two separate bomb blasts; one in a park crowded with people seeing a laser lights show and the other in a restaurant. The origin of neither has been determined yet. Over 30 people have died and several more injured. The police have recommended avoiding public places for the time being. Our group was on the verge of going out for a night on the town immediately prior to finding out about this, however we're now all sitting around, contemplating what has happened. For the most part, our immediate thoughts went to our families, and I believe we've all now called and let you know we're okay. We know how worried you all must be, but please know that we're doing fine. On a personal note, it helps to know that there are 5 other people here who must know exactly how crappy this feels and I think we're all doing a good job of keeping each other's spirits up. This isn't really one of the experiences we were expecting to have in India, but nonetheless, it's just as significant as all the others. I really don't think, though, that this can detract from all the other incredible things we've seen this week. We've seen people at their best and at their worst now, and I can say for certain that I know which sticks out more clearly in my mind........
Time to lighten things up a little. Tomorrow, we were planning on spending the day sightseeing, however needless to say, that will no longer be happening. Instead, we get the pleasure of each other's company. I can honestly say though, that I don't mind!

Rainy Saturday afternoon in Hyderabad

I figured since I hadn't posted anything for about a week that I should probably do so, even though I don't think I'm going to reinvent the wheel with my blog after reading everyone else's from this past week. As everyone else has said, we are having a great time with each other and have quickly set up what can probably best be described as a very dysfunctional family away from home. One of the attendings from NIMS (Nizam Institute for Medical Services, where Dr. Y has been spending most of his time) who had lunch with us, was quoted as saying we were "interesting" and found us amusing, which Dr. Yadavalli says she meant in a good way, but I think the jury may still be out on that one. We've had terrific Indian food all week and as Jess said are seldomly left without a cup of tea in our hands or our bellies empty(in response to Dr. Armitage, I think tea at conferences and available somewhere at 4pm would improve resident morale tremendously, if nobody else's then at leaset mine).
Currently, I'm sitting in the internet cafe downstairs from our apartment, listening to the rain falling and with every good intention to work on presentation I'm giving this upcoming Thursday on C. diff, which surprisingly is said to not be a very big problem in India. Earlier in the afternoon it was a beautiful day, but now its been raining for about the past hour. Since getting back from a morning of lectures and briefly rounding with a hematology team and discussing a few cases, we've been playing this as a typical lazy Saturday afternoon with a good deal of napping and lounging. Bindu's having the most excitement as she is (finally) Sari shopping with one of Sujan's aunts. This morning, Dr. Yadavalli gave a talk to the internal medicine department at NIMS (Nizam Institute for Medical Services) and then one of the professors in the microbiology department gave us talks on the Chikungunya and Dengue fevers.
As everyone else has said, this week has been a tremendous experience with our exposure to the Sivananda Rehab Home. I was most amazed with their coordination of medical and social services for the leprosy patients, first by treating them (antibiotics and correcting disfigurements secondary to their illness) and then providing vocational training so that they can return to their homes and be able to be provide for their families and be an active member in their community. Ultimately the best part of these services is the restoration of pride in these people who may have been shunned by those around them because of their condition as there is a great deal of social stigma in India regarding the illness.
As everyone else has said, the leprosy care is just one aspect of the work done at Sivananda. They are involved in the national TB program, which Bindu previously described and are expanding their work on HIV, including a new program dealing with reducing mother to child transmission.
The one thing I have to add to everyone else's comments from this week and I have found interesting is the difference in the differential diagnoses here. From speaking with the residents on rounds this morning and from our experience with the TB program, much of what the internist sees is infectious and their primary causative bacteria are completely different from ours (for example on rounds this morning we saw aplastic anemia secondary to what they thought was an unidentified hepatitis virus, malaria and leptospirosis). Their first thoughts to cases are often such illness as tuberculosis, malaria and chikungunya, illnesses we only have a very limited exposure to or none at all. I asked a resident this morning how often he sees cases of malaria and he said usually one to two every other day and speaking of chikungunya, this area had 8,000 cases (I think, it may have been 80,000, but I thought best to underreport) in a recent epidemic in this city of 4 million estimated. If you think about it, in our most notable insect-borne illnesses we have seen about 2000 cases of West Nile and 20,000 cases of Lyme disease per year in the entire US population, compared to just this one locale (and its outlying areas). Pleural effusions here are looked at as tuberculosis first, anything else second. Well its about 5:30 here now and we're planning on starting our evening on the town in about half an hour so I'm going to get going. Guess I'll get to working on the presentation later. Hope everyone is doing well, keep us posted on what's happening back at home. See everyone back at Case in a couple of weeks.

Tea Time

Hi Everyone.

Welcome to my first solo-blog. As the others have noted, we have spent the majority of our time at the Sivananda Rehabilitation Center during this past week. Not wanting to sound like a broken record, but what we have seen has been truly remarkable. The staff and patients are inspiring and epitomize selflessness in it's purist form in the medical profession. I have been fortunate to see similar settings of community and charity in other parts of the world, and this place is no exception of how an individual or group of people can aid marginalized populations and instill a sense of confidence and pride in them so that they can have the opportunity to flourish.

Now that the deep thoughts are out, I'd like to comment on the mundane and quirky things that I find so amusing. First, tea. I love tea and I love having tea all day. It's always an appropriate time for tea here in India. In the morning, upon arriving at the rehab center, before putting your mask on while heading into the OR, perhaps even taking a break from the OR during a case. Don has also embraced tea and will incorporate this wonderful gesture in his apartment in Cleveland.

However, the most mundane and quirky things regarding the trip, thus far, have been my travel mates. The humor is constant and the quips are being fired off at lightning speed.

Well, I'd better get going. See you next blog.

Jones

Here's a link to a video about Sivananda Rehabilitation Home - the place where we have been at for the last week, and has been inspiring in multiple ways to everyone.

Making a Difference

Yo Peeps,

Hope all is well back home. From Gopal being a great big brother to Dumford being a fun roommate and providing me with DEET to keep all the mosquitoes away to Jones being cool and having one of the best IPod selections ever to Sujan's fantastic jokes and stories to Bindu's easygoing sense of humor to Indo-Chinese food, the trip is off to a terrific start.

The past couple of days will stick with me for a long time to come. On Monday, we began our involvement with the Sivanand Rehabilitation Home. This place was started in 1958 and simply performs outstanding work. They work with patients who have leprosy, TB, and HIV, and they do so much more than just provide treatment for them. They really invest their time and energy to making sure their patients have as good a life as possible. This place gets the patients and sometimes even the patients' family members help with education, jobs, rehabilitation, psychiatric matters, and even transition back into the community. There is an orphanage for HIV infected children who receive education and health care on site. There is even a home for the elderly. There is also an alcohol detox program. The best part about this home is that it provides everything to its patients for free! And yes, this includes medications and surgical procedures for the leprosy patients as well!

As many of you know, I started a national service organization in 1999 called New Life Volunteering Society (www.NLVS.org). Though NLVS has accomplished great things including starting tutoring programs, health education programs, and a free health clinic amongst many other strong efforts across the United States, our long-term goal is to work towards setting up schools, free clinics, and orphanages in Third World Countries. No easy task. However, I can tell you that I personally have been very inspired with the work this rehabiliatation home has accomplished, and I now feel that it is very realistic to make a huge difference in the lives of so many people on a global scale. It's great to see the proof in front of your own two eyes after hearing about so many stories of failure due to obstacles of funding, government support, time, resources, etc.

The rehabilitation home's wall had a quote I'd like to share with you:

"Those who carry on great public schemes must be proof against the most fatiguing delays, the most mortifying disappointments, the most shocking insults, and what is worst of all the presumptuous judgment of the ignorant."

Means a lot to me, and I hope to you as well. We all carry the potential to make a difference in this world. It's just a matter of finding your niche and giving 100 percent. I've already spoken with the rehab home's chief administrator today, and it looks like we will likely have collaboration between our organizations in the near future. Come join the fun if you'd like!

Vijay

ps. Miss everybody at home! Keep in touch :)

My first time

Okay, since Brian may croak if someone doesn't post something soon, I'm stepping up to take one for the team. This is our official fifth day in Hyderabad, and third day at work. It seems like everyone's having a pretty darn good time too. Minus the constant grief I'm getting from my beloved new friends (and for those who care about me back home, it's a lot of grief!!!) I really like this city so far. Haven't spent that much time here before, as most of my time is centered in Mumbai around my family. Our first few days at Sivananda Rehabilitation Center have been pretty cool. We've been learning all about leprosy, the stigma still associated with it and all the aspects regarding treatment, rehab, etc. Our own Dr. Dumford even assisted in surgery, and can probably now be called one of America's leading surgical experts on leprosy. We also got a tour of the facility, which is huge, covering a 50 acre campus, in a very beautiful wooded area. My favorite part (and possibly the saddest) was seeing the kiddos with HIV, all of whom were orphaned by parents with HIV. They were cute as could be, and seeing two of the oldest ones sing "We shall overcome," is something I probably won't forget for awhile. All these kids were taken in from the streets, fed, provided clean water, medicines and some TLC, and have reportedly all recovered well. I guess the really sad part is knowing how many more are out there. The people who run this place were explaining too us how the budget doesn't allow for very many kids but they're trying to expand if they can.
Of course I can't leave out the social part. I think we'll all agree that we had some really good mango milkshakes today at my insistence, and the McDonald's veggie burgers are about the best thing ever. We're all eating pretty much all the time, with tea interspersed about every few hours. Whoever comes and picks me up from the airport will need a forklift. So, there, that's my first attempt at blogging. More to come.........

Indian Chinese

One of the greatest gastronomic experiences for me each time I go to India is the consumption of Indian Chinese food. It is very difficult to describe what this is to someone who has not had it. It is not Indian food at all, but it is not Chinese food in terms of what is available in the US. Never having been to China myself, I can't say what is more "authentic". Neither is probably close to the real deal. We sampled a large number of dishes last night: sweet corn soup, manchow soup, Szechuan noodles, spring rolls, paneer satay, and, of course, the greatest of Indian Chinese vegetarian dishes, Vegetables Manchurian (see picture). Very satisfying.

We got to do another favorite activity of mine today as well: Carroms. None of us is particularly good, yet, but playing carroms is way fun.

The first week of the trip, to be spent at Sivananda Rehabilitation Home and NIMS, is pretty much set. We have one more day of R&R. Hopefully, we can catch some sightseeing before the learning starts in earnest, bright and early Monday morning.

My two cents

Alright, so this is my first blog ever (like most of the group). So here we go.

Just a few initial thoughts: When we arrived at the Hyderabad airport, I was really excited. I was a little nervous about my role in the group. Kind of an outsider being a student and not knowing everyone as well. But also, since we were staying with my family, I feel like I am a pseudo-host. So my initial excitement also contained some anxiety about whether these other guys would have a good trip.

But by the time we finally arrived at the apartment, I felt extremely comfortable. My family help build this apartment building a couple of years ago, and I have stayed here multiple times. But this is the first time where it felt this close to a "home". I don't know exactly what that means, but it was a good feeling.

But then I woke up this morning and we started walking around the neighborhood. And I realized that I know very little to nothing about the community around me. And that is what makes this trip so interesting for me. Besides my family and their friends, I have rarely interacted with other people living in India.

The last thing I wanted to mention was the change from Amsterdam to Hyderabad. For the next two days we are free and have no agenda (much like my two days in Amsterdam). I wasn't a great "tourist" in Amsterdam, but I knew what to do because being a tourist is so easy and defined. Both Amsterdam and Hyderabad have museums and monuments and the like. But Hyderabad isn't a tourist driven place. It's a place where there are a large amount of people living typical Indian lives. I've thought for a while that if foreigners to the US wanted to see how most Americans live, they would go to Cleveland, or Charlotte or St Louis or Albuquerque - not NYC or LA. I see Hyderabad as that kind of city in India- and that's also kind of the reason why I am intrigued to learn more about it. That probably doesn't make sense, and/or you don't agree with it. But that's just a thought.

Top 5 of the Day

Hi Everyone.

Everyday while in India, we will be creating a TOP 5 LIST.

So, for our first day here, this is our list of Top 5 Quotes from Yadavali regarding this blog:

5. SO...have you heard about this blogging?
4. SO.. you guys can start posting at anytime now.
3. SO...I've put in my blog for today. I'm worried that no one else is going to blog.
2. SO...You guys should really CONSIDER posting a blog before we leave.
1. SO...You know, even my mom is worried that no one else is going to blog.

Hope that you enjoy our first post!

The Group (minus one Yadavalli)

Somewhere over the Atlantic . . .(late entry from flight)

(This is from about 20 hours ago, but I couldn't post while I was in the air)
Currently between Detroit and Amsterdam on leg 2 of our outbound journey. As you all know, our final destination is the city of Hyderabad, capital of Andrha Pradesh, which along with Secunderabad is referred to as the twin cities of India. From what I hear, its an area steeped in history nd is now a booming city, partly due to its tech industry (there's actually a part of the city referred to as High Tech City). So I just woke up from a nap. Fairly smooth flight to this point, with just a couple of minutes of turbulence. I think at this point we have about 10 hours of travel left, which is okay because I've only covered 45 of my 913 songs in my iPod.
So how did I end up at this point, travelling to the Indian subcontinent? Well, your protagaonist's journey began, I guess, about 5 months ago when Jess Jones said that Gopal was setting up a trip. Knowing that it would have an infectious disease slant, I jumped at the opportunity. So we booked our flight, set up our itninerary. Over the past few months, those of us on the trip and some of our colleagues at home have been meeting and discussing different medical issues and conditions we will encounter to prepare for the trip. About six weeks ago, I med with KBA in the travel clinic and got my hepatitis A shot, my oral typhoid vaccine and my malaria prophylaxis, mefloquine (of which a side effect can be psychosis, not that you'll be able to tell the difference). In the past few weeks, I've been stocking up for the trip- I've got my 98% DEET insect repellant (my skin may fry with the 98% but at least I won't get Chikungunya fever), replaced my lost iPod, read up on my Indian history and culture. And in the few days before the flight I was just enjoying some things at home, I may not have at India like Chai tea (totally kidding, I heard you trip over two chai stands everywhere you go here) and steak (since half the population views the cow as sacred I figure I can go without for 3 weeks).
We'll be sure to keep you posted on the journey as we encounter the interesting medical conditions we encounter, the culture and cuisine of Hyderabad (looking forward to the local specialty Hyderabadi biryani), and whoever comes down with the Mughal curse (my proposed Indian name for Montezuma's revenge, cast your guess for the first afflicted traveler).
Well, its breakfast time and I want to read something nerdy like an article on arthopod-borne infections, so I'll bid adieu for now. I'd like to thank the Invanz drug rep for the excellent pen I used to jot down my blog entry since I wrote this on a pad of paper at 30,000 feet.

Arrived in Hyderabad

So here we are. The flight from Schiphol to Begumpet was pretty fun; five of us sat in a row and Sujan was close enough that he visited often. Movies were Spider-Man 3 and Dhoom 2. I had seem both before, but did enjoy the Mr. Bean episode. Had an extremely interesting conversation about service projects in the developing world. There is clearly a spectrum of enthusiasm for these among our group. It will be interesting to see if anyone's view changes in the course of the next 3 weeks. We reviewed the map of Hyderabad/Secunderabad and I pointed out the places we'll be going.

Once we arrived at Rajiv Gandhi airport in Begumpet, we were greeted by Ravinder, Sujan's cousin, and his posse. We had a caravan of three vans to Tarnaka and saw Hyderabad streets at their most desolate (it was 2:30AM). Our accommodations here are outstanding and Sujan's family has been extraordinarily welcoming. Had apples and water. Off to catch a few Z's.

Amsterdam

Freshened up at Schiphol airport. I can never tell exactly how big this airport is, but it takes a really long time to taxi in from the runway. We all sat separately on the flight from Detroit. I got almost an entire talk done for the upcoming symposium. Saw part of "Lucky You" with Eric Bana and Drew Barrymore, but it was intolerable, so slept. I am so glad I brought the iPod, but now I need to get some noise-canceling earphones. Khiani tells me I slept in various "interesting" positions. We met up with Sujan immediately upon deplaning. Sounds like he had a good time in Amsterdam. Hopefully, we can all sit closer together for the next segment of the journey.

T-90 minutes

Sitting in the Hopkins Presidents Club with the Canuck. Everybody got here and checked in without incident. Passed out the travel dossiers created by my Second Assistant Marche'. Sujan sent out an email that he is still alive and kicking in Amsterdam. All seems to be in order. Despite this, I just can't shake this nagging sensation that I am forgetting something...

T-3 Days

First blog for me and, I think, first blog for all of us on the team. In 3 days we head to Hyderabad, India, for what will hopefully be an enlightening medical and cultural experience. The team this time consists of one med student, four internal medicine residents (four Americans and one "Canadian"), and one vaguely nervous ID attending.

I had my daily (q 4h is more like it) moment of panic when Sujan called and said he had not received any info on his e-ticket since May. Obviously, I said to myself, I had messed up the batch ticket process and 1) Sujan would be doing a consult month/plotting my destruction and 2) we would be living in the slums of Hyderabad, Shantaram-style, after Sujan's family denies us entry into their apartment. Turns out that he has a reservation after all. So he will be heading for Amsterdam for his "sightseeing" and will join us on the flight from Schiphol to Begumpet. Dodged that bullet.

The plan as it stands now is Week 1 at the Sivananda Rehabilitation Home, Week 2 on the medical wards at Osmania General Hospital, and Week 3 at the rural medical facilities of Mediciti. With some lectures at NIMS every week on a variety of ID topics. And much fun for all. Questions in my mind at this point: Will it be educational? Will we all stay healthy? Will I be the only one blogging?

Finally, this may mark the first time in my 8-10 trips to India that I take malaria prophylaxis. Heck, if Bindu is taking it, it must be important.