The First Few Steps

DAY 1-- COWS AND RICKSHAWS:

Thanks for visiting my blog! I'm finally here after a year of anticipation! When I first stepped out of the Chennai airport at 5am (minus my check-in bag which is hopefully still pending arrival), I first noticed the crowds of people, the humidity, and how the smell of spices and sweet fruit mixed with the smell of cow dung. After meeting up with Janet and Karina across town, we crammed with our luggage into an auto rickshaw to travel to the bus station, where we would catch the bus to Vellore. This rickshaw ride gave me my glimpse of India--I got a taste of the beautiful and rich colors which dressed the women, cows and roosters grazing in the streets, traffic jams of buses so packed that people would dangle from the entrance with one arm or stick their torso out of the windows, abandoned buildings, dust, chaos, traffic.... the countryside was never a true green and untouched area that I had imagined, and was instead littered by building or structures which seemed to a have never been finished. Yet, the surroundings carry an unexplainable charm.

Getting around has also been an adventure, as most people outside the hospitals speak limited to no English. There is also the difference in gestures. I remember when I explained to a woman working on the airport staff that my luggage had not arrived, she rotated her head as if to disagree. I didn't know this is their way of nodding! And it remains bizarre when to find myself in a conversation when I'm nodding while the other person is simultaneously shaking it from side to side. Getting around has also been a physical adventure as we dogde the congestion of buses, motorcycles, and auto rickshaws who threaten pedestrians in the streets, and the ditches, sun-bathing cows, or dawdling donkeys in the sidewalks.

DAY 2--FIRST DAY ON PEDIATRICS

While our first days have been spent soaking in the culture and environment as we journeyed to and within Vellore, journey takes place within the hospital walls. All three of us are taking Pediatrics, and was assigned to the unit specializing in Infectious Diseases, Oncology, and Endocrinology. The day started out with a chaplain who gave talk about removing judgment while treating patients with diseases often carrying stigmatism (HIV, leprosy). The wards filled in the rest of the mornings.. The ward was a large walkway branching into areas of 6 beds with bright green sheets, between which a traffic of nurses in white caps and gowns would float. The patients are a mixture tiny infants to young teenagers, almost always with their concerned parents at bedside. I observed as Dr. Rose and two residents cases of Dengue Hemorrhagic Fever and Shock, Nesidioblastosis (causing congenital hyperinsulism), a possible Tay Sach's in a child with splenomegaly, seizures, and developmental delay, Common Variable Immundeficiency, and Tyrosinemia. This is just the morning.

The afternoon are clinics are spent behind rooms closed off by curtains, through which anxious waiting parents would peek and tug. My first day was spent in my first pediatric oncology experience, seeing cases of Ewing's sarcoma, ALL, medulloblastomas, advanced retinoblastomas. Patients came from all over India and from many different countries. Although Indian citizens receive round 40% healthcare expense coverage from the Indian government, the hospital is entirely self-pay. As I tried to imagine the monumental expenses of chemotherapy and surgeries for the majority of families struggling to feed themselves, I understood why 75% of families must turn to charitable grants for which CMC will help them apply. Within this disheartening context, I watched as children wearing masks and hairless scalps came in only with their warm smiles, shy stares, and eager greetings.

DAY 3-- PEDI ID!

My second afternoon was an amazing experience in the Pediatrics ID clinic, where we followed many young children who contracted HIV vertically. One of them was a quiet 8-year-old girl who had HIV encephalopathy. She had consistently slow developmental milestones, but I noticed something else: her mother attempted to set her down on legs which were fixed and crossed like scissors. As we examined her, we saw that she had spasticity, clonus, and brisk reflexes bilateral lower extremities. Did she fail drug therapy? We also had an interesting case in a 18 month old originally treated for TB, but only began to improve rapidly after...prednisolone? Turns out that he had Pulmonary Hemosideridosis.

In both clinics, the discussion of results, management, all took place before the family. Here, it would seem unthinkable to walk into a patient room and spend only 5 minutes at the bedside, with the remainder spent before a computer screen. The patient is always present before our eyes and ears, at the center of our attention.

Tonight, we also had a rooftop dinner with several other International students, including some 4th year medical students from Singapore who are also staying at our hotel. Glancing at the other international students, I realize that wearing local clothes may make us blend in even less. Maybe we have not mastered the fashion. Nevertheless, when I walk into a crowded waiting room where all faces turn to watch me, I can't help feeling that I've walked into a spotlight for interrogation of who I am and why I am here. Why am I here? Because, right now, there's no where else I'd rather be!