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.