Dead post

Well folks I had a post all typed up and ready for you but then my computer died and pages does not auto recover so...no more post. I am staying at a hotel that will have internet tomorrow night so I will post then. Ttyl.

ps mom, sorry!

They chased us for two blocks to get the picture and then followed us for at least another two screaming goodbye and shaking our hands. Rachel and I felt like super stars. 

Part of the Hill station we visited on Saturday. 

Gotta have the cat. This girl was so sweet!! 

My group at the hill station.

The view from the top of the Hill Station.

Me on top of the Hill Station that we went to on Saturday.

One of the slums that I took water samples from.

A family living on the sidewalk.

Dada our driver. He is so great!!

A mother and son in the slum where the vaccine clinic was held.

Monday June 22nd

Today we went to Sasoon Hospital and BJ Medical College where the well known Jonas Salk, creator of the injectable Polio vaccine, once spoke to hear a lecture on coronary artery disease. The lecture was fantastic.  It just so happens that a Doctor whoes name I had been given a few days before from a woman who owned a store I purchased something from was one of the three guest speakers. Funny how life works. His talk was great; all about non-surgical management of arterial disease. His brother is also a cardiologist and he spoke about non-surgical management of coronary artery disease. Then a surgeon followed them with a disscusion of the surgical management of coronary artery disease. 

After the lecture we all went to the Poona Club for lunch where Mrs. Dabak (my host) introduced me to Dr. J.S. Hiremath, the cardiologist I had been told about. He gave me his card and asked me to come to his office in Ruby Hall Clinic on Thursday so that I can observe. I am very excited about this because this is THE BEST hospital in Pune and I will be observing vascular surgery and open heart surgery. SO EXCITED!! He said if I liked it I could come back as many times as I want. Yay!

In other news I have 5 initial results from samples collected. Three of the five samples were positive for Coliform bacteria. I am getting concerned that I will not get 30 samples before I leave; it is difficult because I need someone that speaks Marathi to go with me and so I have to work around their schedule. 

I am going to post this b/c the power is about to cut. So I will post more in about 30 min.

Okay so I guess the power is not going to cut today. 

Tomorrow I am not sure what I am going to do it the morning. In the afternoon I am going to do surveys with Apoova and then we are going to the maids house to see their savings group and I will take pictures and do surveys and take water samples. Then Wednesday I will have to go to the lab in the morning and then I am not sure which hospital I will go to. Then Thursday we were supposed to go to the rural site and that would be a great place to get water samples, but I want to go to Ruby Hall Clinic. Mrs. Dabak said that we might go to the rural site Wednesday so we will see. 

I guess that is all for now. Michael comes to India July 3rd and I fly to meet him the 5th. I will be staying at the Osho Ashram on the 4th all day doing meditation and yoga. Can't believe how fast this trip has gone. I am tempted to stay for another 4 weeks on Selvie's second half of her trip which she cannot stay for. But of course I won't do that. Miss my animals and family too much. Notice the cat always comes first....

laters,

Kymberlee

Vaccination Clinic

(I do not know a few names and dates, so in there place I have put lines. Please excuse this. )

A collaboration of different healthcare providers in Pune, India is making a difference in the lives of individuals who would otherwise not have access to healthcare by providing wellness checks, medications, treatments, and education at little to no cost. In India, the government provides many vaccines free of charge to anyone who makes the effort to get them. Some of the vaccines, such as the Polio vaccine are very important, and so outreach campaigns will often occur in community centers to make sure everyone gets vaccinated. Unfortunately, there are a few vaccines, which the population could benefit from, but that the government finds too expensive to administer free of charge; these include: MMR, Hib, Typhoid, and Pneumococcous vaccine. In an area where 400 families share 8 toilets, diseases run rampant. The importance of preventative versus palliative medicine can be appreciated in such situations, and the inclusion of all the available vaccines to protect a child is very important. In thirteen different slum communities around Pune, ____ has decided to make some of these vaccines available at a largely reduced cost.

The vaccination clinic began on Sunday the 21st of June 2009. The morning was still cool due to the monsoon rains, which had arrived the day before. Never the less, the temperature was expected to rise to a warm 90 degrees Fahrenheit by the afternoon, making the absence of a fan due to power cuts that much more miserable. Soon around 20 people gathered to help with the tasks of the vaccine clinic. Mothers and their children began filtering to each of the tables where the different vaccines were being administered. Three vaccines, MMR, Typhoid, and Hib each had their own table with multiple healthcare workers as well as volunteers. The patients checked in outside where their health records would be checked and they would be instructed on which vaccines they needed to get for each of their children. The cost for the vaccinations was 50 Rupees per child. One of the vaccines being given costs over 500 Rupees alone so the reduction in cost is significant.

Soon the room begins to warm up as more and more people fill the floor. Looking around volunteers can be seen preparing vacc

inations, restocking supplies, and restraining screaming children whose anxiety has overcomes them. Tea and coffee are distributed to the workers as they scurry around. Each patient’s health record must be checked and the date of the given vaccine must be recorded. Some of the children get all three vaccines while others get only one. There is a wide range of emotion; some of the children seem un-phased by the screams of near by injection recipients, while others are only further convinced that what’s about to happen to them is going to be a painful, and potentially deadly experience. Over two hours pass and one can barley cross from one side of the room to the other. The noise level has maximized as infants and children both scream out of fear. There seems to be very little order or control over the situation, but each vaccine is given, decreasing the worry of a sick child in each parents mind.

The chaos subsides as quickly as it arrived. Somewhere around 300 children are vaccinated and the group begins to clean up a room which hours before was empty, quiet, and clean. The team sits down for a moment of relaxation. Everyone is given a sandwich, which is quickly devoured as talk of the next days work begins.

There are 4million people living in Pune, 70 percent of them live in slums. Public funding for healthcare is far below the countries boasting top healthcare systems. Without the work of groups such as ____, healthcare would be in a much poorer state of desperation.

Since starting work at the hospital it has become fairly difficult to find time to blog and then make it to the internet café to post. The café is about 10 min from my flat, they don’t open until 9:30 (we go to work about that time), and the power goes off everyday at 5pm for 15 min to an hour; hence the lack of posts since last Saturday.

This  week my group has been observing at Deenanath Hospital which is a very nice hospital here in Pune. They are funded through donations/trusts, and serve both wealthy and less well to do  families. The standard of care between Deenanat and Kamale Nehru definitely is different, but a single night stay in the pediatric ICU at Deenanath is ~700 Rs. while it is 5 Rs. at Kamale Nehru. This does make for a difference in the care given, but Kamale Nehur does a great job with the available resources. 

At Deenanath Hospital I spent some time in the Pediatric out patient clinic where I shadowed two amazing doctors. There were some interesting cases of ischemic hypoxia during child birth. The doctor demonstrated how the children were not meeting their neurological developmental milestones to us. Then I also went to the Emergency Department where I saw a few motor vehical accidents as well as a man who had HIV, but did not know because the family had decided not to tell him. I will address this more in depth in my next blog because it is something that sharply contrasts the US. 

We spent a lot of time working in slums this week, and today I finally took some water samples in two different slum areas. I have learned so much about what is really relevant for these people and interestingly enough it is not what you think it would be. 4million people live in Pune and 60% of them live in slums. There are around 600 slums in Pune, and around 570 of those have been recognized by Pune Cooperation, meaning that those people now own the land that they live on because they have been living there since before 2001. All of the recognized slums have water provided to them by Pune Cooperation, which means that the water for every house in Pune including 95% of the slums is all the same water. This makes my study a little less important, but I feel it is still relevant and here is why. Although the water is provided by the cooperation, people still store there water in jugs for at least one days duration sometimes more. Also the social workers expressed concern that the biggest issue facing the slum dwellers is not healthcare, or food, or water or even housing, but rather personal hygiene. There for the water has plenty of opportunity to become contaminated.

I took lots of pictures today of the people I surveyed and took samples from and then had them printed so that I can given the pictures to them. I will post the pictures tomorrow once I upload them onto my computer.

Yesterday I was extreamly ill and could barley get out of bed. I slept until 7am then again from 8-10:30 then again from 11:30-2pm then again from 4pm-7pm then again from midnight to 7am. Today I feel 99% better! Thank god for Norflox because I would still have ‘loose motions’ as they say here without it.

Be safe everyone in Colorado, I have heard about all of the tornados threatening our state these past few weeks. Scarry. Today here it rained, finally!! The monsoon was supposed to start the 7th of June and it has only rained two times this month....Crazy. SO send your rain our way because its stinkin hot here.

Talk to you later. Oh and comment! I like to hear you thoughts and thus far my dad is the sole participant.

Bye

The elders on my street hanging out around dinner time. They do this every night.

This is the post natal ward at Kamala Nehru Hospital.

What a crazy fun day! Michael’s friend Rasul picked me up at 9:30 am, and after breakfast we spent the entire day giving people pictures of themselves, most of which Michael and I took last year in January.

I started off at the hospital. There had been a c-section a few days before, and the woman had a very rare placental condition, which required an operation. Because it was such a rare surgery and they wanted to document it, I became the photographer for the surgery. I was pushed into the front row of the 20+ people in the room and began shooting the events. Today I gave two pictures to the mother of her baby right after it was born, pictures to the surgical department of the surgery as well as a group photo we had taken the day before. The nurses in the pediatric department also got pictures of my group holding a baby in the department. There were also a few patients in the pediatric department that I had taken pictures of and so I gave those images to the mothers. Everyone was all smiles and excited to have the pictures. 

When we were done at the hospital we drove around for quite some time looking for a bridge where some of the other pictures were taken. We did not find the bridge and soon went to meet the other girls for lunch. After lunch we were driving back to Rasul’s house when I saw the art gallery, which was near the market where the other images were shot. After eliciting the help of six or seven rickshaw drivers we finally found it, the dried fish and goat market! I was so happy I could barley contain myself. The people were so happy and welcoming. They recognized the people in the pictures and directed me to the woman who is sorting fish in the picture. Her reaction was priceless, I have never seen someone more excited/confused/befuddled/happy in my life (see images below). When we were leaving the man in the goat market appeared. No one had been in the market when we arrived, but when I looked in I immediately recognized him. What a great experience! I have the card of the fish market so I can easily return again sometime which would be fun. The people there all love me now, guess I am an official punite…

 

We finally made it to Rasul’s house. We had dinner and watched a bit of Spiderman III. Then Rasul and I met up with the other girls in my group to see Angels and Demons. Interesting experience to say the least. The Indian national anthem began playing, and everyone stood up and froze what they were doing. Then half way through the movie there was an intermission…. Weird.

Rasul then drove me back to the flat, and by the way, riding a motorcycle in India is perhaps the best thing in the world! So much fun.

Type at ya later,

Kymberlee

P.s. some of these pictures are from Sunday and not Saturday. I will post sundays blog tomorrow. Thanks!

My apartment bld.

She sells veggies in the market.

Sells bangles in the market.

Sells kumkum in the market near Laxmi Road

Chai wallah.

Security guard.

Man that works in the goat market.

I am really tall in India. 

Woman in the dry fish market. Muchlie in Hindi.

One of the best photos ever!!

The staff in the surgical ward at Kamla Neruh Hospital

Patient in the Pediatric Ward

Patient and mom in the Pediatric Ward

Patient in the Pediatric Ward

Baby born by Cesarian 

Rasul and his sister and her daughter

Thought you all might want a map of where I am. The first image shows the Hospital (B) that I have been going to for Monday Tuesday and Wednesday. My flat is in the bottom left under Parvati Hill.
The second image shows a closer map of the area where I am staying (Tulshibagwale Colony which is in the south west corner of Pune below Parvati Hill.) Then there is a terrain map, my street is the street below Dasbhuja Ganpati Marg all of the way to the west at the end of the street.  

More posts tomorrow!

Day 7

Tuesday June 9, 2009

Today we arrived at the hospital and were able to observe the beginning of an inguinal hernia repair, the end of a breach cesarean section, and three DNC’s. After lunch we rounded with the doctors on the cases in the Obstetrics and gynecology ward. Before leaving for the day we stumbled upon three little girls playing in a large open area of the hospital. We asked them their names in Marathi and then took our pictures with them. 

Day 6

Monday June 8, 2009

Today was the first day at the hospital. Jill and Selvi are both in my group and we were immediately thrown into surgery. We observed a tubule ligation, cesarean section, and hysterectomy. The cesarean section was the first time I have ever seen a human being born. It was amazing to say the least. The baby girl was so little (~5.5 lbs) and just cute as a button. During each of the surgeries the women were given spinal blocks but were not given general anesthesia. This is normal in the US for cesarean sections, but not for the other surgeries mentioned. 

After surgery we attended the antenatal clinic where we observed the nurses taking the patients blood pressures. Then the doctor examined the women, and the three of us were allowed to palpate the women’s abdomens and were instructed on how to determine the week of pregnancy based on how many fingers one could place between the “belly button” and sternum.

One interesting observation of the day is that everything was done via assembly line. The surgeries were much like surgeries done during spay neuter clinics, one patient is finished and the other is immediately brought into the room. And at the antenatal clinic, women lined up to be examined and had to crawl through a window in the wall to get onto the examination table. (I will try to get a picture of this so check back in the next couple of days).

All in all this was a great first day! Lots of surgery which I enjoyed the most!

Day 5

Sunday June 7, 2009 

Two more girls arrived at 4am, Jill and Rachel. Both of them go to Boston University, and just finished their first year of medical school. The other Rachel, roomie Rachel, met us at the Dabak’s home from breakfast. Orientation followed and we got our rotation schedules. We then headed back to the house where I gladly took a two-hour nap.

 

Day 4

Saturday June 6, 2009

Today was a load of fun. After an hour of yoga and a very cold shower I headed off to the Dabak’s. I have a hard time not being early every day; it’s because I’m American. Breakfast was good, sliced cucumbers, tomatoes, and an Indian bread ball which was fried I believe and spicy with stuff in it.

I spent an hour at the internet café and then headed back to the flat. Rasul, one of Michael’s friends here picked me up after lunch at 1:00. Before driving the hour to his house he introduced me to friends at his work place. His nephews were at his house; one of them I guess lives there permanently with him and has since he was 6months old. The two boys are complete opposites. One is so well behaved, quiet but not shy. The other is the biggest manipulator I have ever seen. He runs the house, crying and screaming at everything to get his way. My phone, my bike, my rupees, mine mine mine, he says in Marathi. We have chai, Rasul eats, then we go for a walk around the complex. It is the very start of the monsoon and so it rained for about 20 minutes.

On the way back we stopped in camp and walked around for a few minutes. Rasul ate fast food, but because I was not feeling

well and had just eaten, I refrained. It was very fun to ride on the motorcycle; the only downsides being that one’s limbs could easily be smashed by a car/truck/bus/wall, and also, your face/clothes etc become black from the exhaust and road grime.

When I returned two of the other girls had arrived, Selvi and Lalita. Both are Indian and one speaks the local language Marathi as well as Hindi. Selvi just finished her first year of medical school and Lalita just graduated from undergrad and is taking a year off. We chatted and enjoyed ourselves until after midnight. Sleep came easily; I had spent over 3 hours on a bike, traveled from the west to east side of Pune, and met some great people.

Day 3

Well the trip ended just as it began. Off the plane in Mumbai with no one there to pick me up. Found the agency that was supposed to take me, and they had no idea who I was or where I was supposed to be dropped off. Having been to Pune before I was not too worried, and would have simply stayed at a hotel had things not worked out properly. Luckily a few phone calls were made, and I arrived at my ‘flat’ around 3:30am.

Could barley keep myself awake in the taxi, but was awake enough when I arrived to wash up and read a bit before crashing at 4am. I woke up at about 8am, just as three girls- two left over from last month and one who is going to be in my group- were leaving to go to the hospital. Found the bathroom, took a shower and was starving so decided to not wait around any longer. Despite not having a key to the flat or a phone I was off to find an internet café and somewhere to eat. Café successful. Michael and I caught up on video skype for an hour before I left to find some breakfast. After not really finding any place that looked open I went to the grocery store and got a banana, yoghurt, water, and snack bag. There had not been any water in the flat so I was quite thirsty.

I headed off back to the flat, tired, hot and hungry. After a 15-minute walk I found the complex, but was on the other side of a cement/barbed wire wall from it. I walked to the next street over, but the complex was not there. Feeling like I was in some sort of a time space continuum I decided to go back to the wall and jump through the wire; I had noticed quite a large gap in the wire where the wall was in someone’s driveway. Up and over no problem, and off to the flat. I get there and knock, no answer. So I sit down on the stairs and begin to enjoy my snack. Then the security guard arrives. He must have seen me jump the wall and wants to know what I am doing. “Dada” I say; this is the name of my driver, who let me in to the flat last night. The guard nods and knocks on the door. Again no answer; he must have thought I didn’t try that… So he leaves. I move on to the yoghurt after devouring the banana. Pop, the guard is back, but this time he brought a friend. She hands me a phone, “Hello?” No response. I give her the phone back. This goes on for some time, her trying to call and saying hello then trying again. She and the guard leave and then out pops Dada from the stair well. He appears stressed and says come. We get in the car and drive for a few seconds before he stops and Dr. Dabak, whom I have yet to meet at this time, starts ranting about my disappearance. I apologize and insist I am fine and was just hungry and thirsty. The caravan drives the three blocks to the doctor’s house where Mrs. Dabak is waiting. We discuss my morning and evening arrival while she cooks me an omelet.

All is well, Dada drives me back to the flat and I rest until two of the girls arrive. We introduce ourselves and share stories for an hour or so. Thunder, some of the loudest I have heard, wakes me from a two-hour nap. Outside it smells like honey as the rain pours down, and kids play in the parking lot of the complex. A fantastic dinner is followed by a trip to the bus station to drop off two of the girls who are going to Goa for a week. The third girl has left to a synogog for the evening and following day because of Sabbath. Dada droppeds me off at the flat where I move into my final room and unpack. It is now 11:50pm, and I need to head off to bed. I will post in the morning when the internet café opens at 10am.

Tata for now,

Kymberlee 

Almost there!

Well folks, I am almost there. After a small error by United in Denver I missed my flight to Frankfurt, and had to stay the night in Washington D.C. Lucky for me- and over 100 other individuals- United footed the bill for the taxi, hotel and breakfast. Michael rebooked by flight, and although I spent a great part of the evening trying to reconnect with my bag I did get some sleep and made both flights the next day. So instead of traveling Denver, D.C., Frankfurt, Mumbai I traveled Denver, D.C., New York, Zurich, Mumbai. Well I haven’t actually left for Mumbai, but I am sitting at the gate having made it through four security gates, one customs gate, and one customs gate left to go in Mumbai. (below is a photo of my bags and then a photo of my plane getting ready for boarding)

Normally, I would not mention the number of security gates, but I am carrying a Styrofoam box with my bacterial media on ice for my water-testing project. Obviously they do not let you carry ice packs on the plane unless it is a special circumstance, so the number of gates is rather nerve-wracking in my particular situation.

So my first recommendation to everyone is to fly Swiss Air. Yesterday I would have said Lufthansa, Lufthansa, Lufthansa, but I have to say that I continue to be extremely impressed by the Swiss, and their ability to do things so elegantly while maintaining complete and often times excessive performance. Each and every seat had its own personal entertainment device with a remote/phone on one side and a game controller on the other. You could select from one of about 20 movies to watch, or 10 audio books, music, games, or flight simulation. The meals were great, attendants pleasant, and the best part of all, I got the very last seat in the back of the plane with no one next to me, and no toilets to keep you awake. It was a great flight to say the least. Suffice it to say I am excited for my flight to Mumbai with Swiss Air which departs in roughly 1.5 hours (2am Denver time June 4^th).

So I guess that is all for now. It will most likely take me a day or two to find a good Internet access spot that I can frequent. Luckily I can type things up on my computer ahead of time, and then just post them once I get access to the Internet. So I hope you are all enjoying your patch of rainy weather before the hot dry weather sets in for the summer.

Type at you later!

--Kymberlee