June 16th & 17th

We are back in DehraDun. It is amazing being able to stay with the Mehta’s again. Mrs. Mehta is like our mom and treats us like royalty. We all felt like we were “coming home” when we returned from Agra. When we told Mrs. Mehta we were going to make no bake cookies (they don't have an oven) for Varyun (our home stay brother) for his 17th birthday on Wednesday we asked if he liked peanut butter since we couldn't get marshmallows to make Rice Crispy treats. Mrs. Mehta said he really only likes American peanut butter, but "that is too expensive." None of us remembered how much we paid for the peanut butter. Everything is pretty cheap here so we aren't usually too concerned especially when it involves buying food like we get at home. When we looked at the price sticker and saw the price was 235 Rupees, about $5.50 (much more than even a very nice meal at a restaurant here) we thought about the price in Indian terms. A typical office visit with a doctor in private practice is 100 Rupees. Two KG of mangoes (or 4.4 pounds) is $1.25. So I guess that makes peanut butter expensive, but really not that different than in the states. It is funny to think of it this way since peanut butter and jelly sandwiches are generally thought of as a great economical meal in the US. This week we are on rotation with Dr. Nisha Gera, an OBGYN who runs her own outpatient and inpatient facility with an operating room. She is a very pleasant, personable, knowledgeable doctor in her late forties. She also offers us watermelon and coffee daily which is amazing. Dr. Gera has a large, primarily female, very capable and friendly staff. We saw several pregnant women today and got to listen to the fetal heart beat with our stethoscopes and see a few ultrasounds. The lack of HIPAA compliance in India is impressive and particularly shocking to be pervasive even in a private practice like Dr. Gera’s. For instance, a woman’s pregnancy test results (granted they were negative) were announced for the entire room of patients to hear. No one seems to be bothered by this. In fact, no one in India seems to be bothered by very much. While working at our second clinical site with Dr. Vaipin Vaish (a pediatrician who runs his own hospital with his OBGYN wife) we witnessed firsthand just how easygoing people here are. A young newlywed couple came in and the wife was complaining of fatigue and malaise, weight gain and her pregnancy test was negative. Dr. Vaish proceeded to tell her husband that she has “anxiety and depression.” During this explanation (medical terms in India are always in English so usually we can understand the diagnosis but not much more than that in a patient encounter unless the doctor translates), the husband, wife and Dr. Vaish were jovial and jubilant as they laughed and said, “Anxiety!” “Depression!” When Dr. Vaish said he would give her medications they rejoiced. Later a young boy (age 10) came in complaining of fever and headache and was unable to move his neck to place his chin on his chest. Suspecting meningitis, Dr. Vaish did a spinal tap. I saw a few spinal taps in South Africa but it is a pretty cool procedure to observe. The boy’s CSF (Cerebrospinal fluid) was clear, indicating it was not a bacterial infection. When Dr. Vaish went to tell the family the good news, he held up the test tube containing the CSF (to be sent to the lab) and everyone rejoiced that it was “clear!” Amidst the heat, honking, pollution, lack of basic sanitation, smells and general difficulty in logistics of living in India, many of us are finding ourselves worn down quite easily. I am surprised at how difficult this trip has been for me personally. In many ways I feel like the clinical portion is the easy part—the part I can control by applying the medical knowledge I have and adding to it the experience and lessons of the doctors here. The challenge lies in trying to survive here without constantly feeling like you are ready to go home and give up. Not too much is easy other than Pizza Hut, Costa Coffee (or Barista here in DehraDun) and the Mehta’s and it is clear how hard life is for the poorest people living here, especially when the divide between the rich and the poor is so great. This wears on you in ways that are difficult to verbalize and manifests in the form of a lack of energy. I keep expecting to wake up one day and LOVE India for the whole day and just be happy. Perhaps this will never be the case. This is hard to accept. There was a lot about South Africa that I found challenging but when I think about going back there I would get on the next plane out of here to work in a TB ward there. But South Africa had many parts that were like America and when you returned from work you could go “chill out” in a neighborhood that looked like Santa Monica. India is much safer and violent crime is not nearly as much of an issue so feeling safe pretty much everywhere I go and being able to walk around during the day alone is a big relief. I can’t help but wonder if the reason why everyone is so jubilant and upbeat here is because of how much it takes for them to get through a day here. Consequently, when their doctor has a solution to their health care concerns they are so happy it was “this easy.” I hope some of this resilience will wear off on me during the next three weeks. I know some already has, just not at the quick pace I would prefer it to.