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.

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.