Operation Theater/ENT

Thursday and Friday Courtney and I spent our time in ENT, which stands for Ear, Nose, and Throat (explanation for you dad since you hate when acronyms aren't explained). We were really excited because the other 2 groups of students had the chance to watch surgeries in the operation theater (OT) what they call the operation room here in India. We went to OT changed into scrubs, put on a hat, mask, and changed our shoes to flip flops and then we went in to watch a surgery. The practices are very different here in India. They are not as worried about having everything in the OT super sterilized. I mean the equipment that they use is and only certain people touch the sterile equipment, but other than that we were all allowed in the room and didn't have to wash our hands or anything. The doctor told us that he knows that would be very strange for us, but they really don't have a huge problem with post-operative infections. He also said that in India they aren't worried about patients suing, which they would be in the US. So we watched the first surgery a patient getting their adenoids out and I was fine with that. Then I started watching them repair a perforated tympanic membrane in the ear and started to feel really sweaty and lightheaded so I sat down. They told me that I should go sit in the hallway so I did that. Courtney had already decided that she couldn't handle it and had gone back to the outpatient department so I decided to go up there and that surgery wasn't the place for me.

Back in the outpatient department we talked with the doctors and residents and saw some patients. We got to see a patients vocal cords which was really neat. The doctor here was great about talking to us and explaining differences between healthcare in the US and India as well as cultural things about India. He gave us tips on places we should visit and things like that, which was really nice. He also gave us tips on how to be ok in OT. He said that we should make sure we eat a good breakfast, to chew gum, and bring snacks in case we get lightheaded again. He really wanted us to get the chance to see some surgeries so said that we would be going there again on Friday.

Today we mentally prepared ourselves for OT and made sure that we ate a good breakfast before we went. As we were both really excited the previous day to watch a surgery we hoped that we would be able to actually make it through one. We ended up watching an almost 3 hour surgery where the patient had a cancerous growth removed from his nose and then had reconstructive surgery on it. It was a plastic surgeon who did the whole thing. He did a pretty nice job of explaining what he was doing to us and it was very interesting to watch. If you'd like more of a description of the surgery I would happy to give it to you, but I don't want to write about it on here to gross everyone out. We also ended up being the official photographers of the surgery and took pictures throughout the surgery so he had them for his own use or to teach with. I'm not really 100% of the purpose of the pictures, but we at least had some part in the surgery. I was very glad that we both were able to watch this surgery and not get grossed out or lightheaded or anything even though it was much grosser than yesterdays. I still don't think I could probably be a pharmacist in an OR all the time, but now I know that I can make it through and not pass out.

We took more pictures on Courtney's camera today of us with our masks/hats, etc. so I'm sure she will post them on her blog soon so you should check them out (and you can also hear her version of the events).

Excited for the first time going into the OT

What the OT looks like and I am standing where Courtney and I were most of the surgery

Women

I obviously grew up the US and so I grew up blessed in a society where as a whole women are valued. I grew up with the belief that really I could do whatever I wanted and didn't have to be stopped because I was a girl. Coming to India I knew that women aren't always held in that same regard. To even apply for my visa since I had to give information about my dad because I was an unmarried female student. While in India I have not felt like I've been treated differently because I am a female (mainly stared at because I'm white) and have interacted with plenty of females who are doctors, residents, etc. so I know that depending on the area and the circumstances women are held in high regards. But I also know that is not the case everywhere in India nor the rest of the world.

On Tuesday in the pediatrics department we saw the labor and delivery ward and asked about ultrasounds. We found out that in India they do have ultrasounds to check on the health of the baby, but that it is illegal for people to find out the sex of the baby. That is because families don't want to have girls and will have abortions, etc. if they know it is a female. The resident who told us this said that these things obviously still happen and even though it is illegal people still find out what the sex is. A few other doctors have also made comments about how parents will go to extreme measures to make sure that their sons are taken care of when sick or have a life threatening condition, but if it is a girl these same measures aren't taken. This is of course a general statement and there are exceptions to these rules where there are families who value the heath of their female children as well as their male children.

Tuesday afternoon I also started reading the book Half the Church: Recapturing God's Global Vision for Women by Carolyn Curtis James. It tied in very nicely to what I was learning about India and I just finished it. The book goes off of another book/documentary called Half the Sky, which discusses the treatment of women throughout the world. How women today in many societies aren't valued and their voices aren't heard. When this happens half of the world is left silent with little/no contribution and this doesn't make a healthy world. So Half the Church is almost like a response to Half the Sky and what the Bible says is a women's role in the world. The author does a great job of explaining how it is important to see what the Bible says about women and how it applies to all women around the world-not just in the west.

She does a great job of talking about women in the Bible and explaining how important it is that their stories are included in the Bible because they would have been living in very patriarcal societies where they often would have had little value. God chooses to include women from the beginning, which goes to show how much he values us and how important we are as his creation. She talks about how we (along with men) are God's image bearers and it is our role to all work together for the church to function as it should. As women (and really men too) we should also be outraged by the treatment of women throughout the world and if we all truly worked together to do something about these injustices then we could have the kingdom here and now.

I'm still processing a lot of what I read and I probably didn't do the best job of explaining things, but it is a great book and so I would encourage you to read it if you have the chance. I also have watched the documentary Half the Sky and would encourage you to watch it as well. I haven't read that book, but may soon do that. 

Market Day

Wednesday is market day so all of the local farmers bring their crops, crafts, etc. to the market to sell. This is when a lot of locals stock up on their produce for the week (or so we were told). It is pretty packed around the market and so you have to weave your way through all the people to see what is being sold. A lot of it was the same things, but it was still really interesting to see everything and also to just see the amount of people out and about. None of us bought anything at the actual market as we were just taking it all in this week, but possibly next week we will buy more.

**Also please keep people in my group in your prayers as some of them have been sick with a stomach bag and colds***

Pediatrics

Tuesday and Wednesday Courtney and I were assigned to the pediatrics department. We went to the outpatient department in the morning and waited for the doctor to come. After waiting a bit one of the residents asked us if we had been to the in-patient ward and when we said no he took us there. We then met 2 of the doctors and then walked around with 1 of the doctor and some of the residents on rounds. The doctor did a great job of explaining what diseases the patients had.

The first part we were in was the ICU and the patients had diseases that really aren’t seen in the US, because we have better access to healthcare and also get things treated earlier. The first patient had rheumatic heart disease, which happens typically when a strep throat infection isn’t treated and develops into rheumatic fever and can lead to rheumatic heart disease.  Then we saw a patient with Guillian-Barre syndrome, which I have only heard of before because it was a complication of campylobacter, so there was a question about it on the form that I used when I interviewed patients at public health. Anyway it is a nerve disorder that can cause paralysis and the doctor described it as similar to polio. The other patient had a congenital heart defect and had a hole between the two ventricles. Then there were quite a few patients with dengue fever, which is transmitted via mosquitoes. Most of the children in this area seemed to have their symptoms improving and the doctor seemed pretty positive about their survival.

Next we went to the NICU and saw lots of little babies. Most of the babies had birth asphyxia so they didn’t get enough oxygen to the brain during birth. There were also babies that were premature and had other things that I can’t really remember. This area of the pediatric ward was a little more depressing because some of the babies didn’t seem to be doing very well.

We also saw the area where the babies were after they left the NICU and were still gaining weight and stabilizing before they are allowed to be discharged. They were all their with their moms.

They then took us to the maternity ward and we were able to see where all of the healthy babies are. They keep all babies and moms in the hospital for at least 3 days after birth to make sure everything is ok. If the mom had a c-section then they make them stay for at least 7 days. We also went into the labor and delivery room. This is also much different than in the US in the fact that there is a room of beds and all the moms are in active labor. Once they are ready to deliver the baby then they are moved to the delivery room. We walked into the delivery room right after a baby had just been delivered. Unfortunately the baby didn’t make it and the doctors said they thought it was a stillborn and had died a few days ago so that was really sad.

Back at the outpatient pediatric department we observed the residents talking with patients. There were so many cute kids and so that made the day go much faster and was really fun to smile and wave at all of the children. One of the residents showed us how they test small babies reflexes so that was really interesting.

After lunch we met up with one of the doctors and she talked with us about vaccinations. She told us about the diseases that they vaccinate children for as well as the schedule of vaccination. Most of this was review as I can give immunizations in the US and so took a class on this. Then we sat in on a case presentation about a baby who was born to an HIV + mother and was loosing weight and started having a fever and cough and was eventually diagnosed with protein energy malnutrition. They discussed how they did the initial history as well as physical exam. They also discussed how they would treat the baby as well as a variety of other things.

Wednesday after slight communication confusion we met up with the doctor again and she talked to us more about vaccinations. Then she went through what drugs they typically use in peds in India as well as some things about nutrition. We also discussed pediatrics in India and what things they need to tell the mothers after they give birth so they can take care of their babies well. She was a very sweet woman and did a great job of teaching us things about the Indian healthcare system. We found out that infant mortality is still pretty high, but she said that is has been reduced significantly since she starting practicing 20 years ago. We also exchanged email addresses and so I hope to keep in contact with her.

When we went back in the afternoon we thought we would be meeting up with her again and then attending a seminar or something. Instead we spoke with another doctor for a little while about what we had learned in peds and compared the immunization schedule between the US and India as well as the use of antibiotics. Then we sat in the outpatient room for the rest of the afternoon. No one really talked to us, but we ended up making the most of our time by discussing random things about life and our futures so it ended up being a productive afternoon.

Immunization Schedule

Lizards/Gecko

So India has what I would call lizards, but is actually very small and probably a gecko. I'm not an expert on reptiles so I don't really know what the difference is. I was first introduced to these creatures at around 4 am when we arrived at our dorm and I saw one climbing on the wall of the hallway. I thought that's gross and I wish that I hadn't seen it, but at least it's not in my room.

A few days later I saw one outside my door and was a little creeped out, but again thought at least it's not in my room. Then on Saturday I believe I saw the first one in my room by my shoes. I freaked out a little and it was super fast and got away before I could tell where it went. I kind of forgot about it thinking it either left my room or was eating bugs and as long as I couldn't see it I was fine. Over the next few days I would spot it randomly in my closet, then in the window, and I saw it outside both of my doors. (I assume there are multiple even though I'd like to think it was only 1).

Anyway today I spotted an even smaller one on the floor in the middle of my room. I would forget about it and then all of a sudden see something move out of the corner of my eye and freak out a bit. I didn't want to try and catch it because I don't really have anything to catch it in. I didn't want to kill it because I didn't want to have to deal with the dead squished thing, so I left it alone and watched it crawl around. Then it crawled on my backpack and I freaked out a bit and pretty much picked up everything off the floor that it could crawl in and forgot about it for the most part until I saw it move somewhere in the room.

So just as I was thinking maybe it left my room finally and I was putting my stuff away to go to bed I felt something crawl on my foot. I shook my foot and the little lizard went flying to the ground. Now I was freaking out. It is now midnight and I have a freaking lizard in my room that can crawl into bed with me so what do I do. I first threw a shoe at it, which only drove it under my bed and wasn't very helpful. Then I looked up things to do online and everywhere said they are fine and not to hurt it, etc. I was very close to wanting to kill it (but still didn't want to have to deal with the dead thing) when I saw it go out from under my bed toward to door outside. I then decided to be brave and open the door outside and shoo it out with my shoe. It worked and the lizard went outside.

Then I was still very creeped out and jumpy and a small little insect landed on my arm and I freaked out and jumped a mile so I decided to go get my bug spray and I sprayed it all over me, on the floor around my bed, by each of my doors, and the windows. Now I know that this probably won't do anything, but it makes me feel better. Now it's about 12:40 am and so about 40 minutes since I had the lizard crawling in my bed so while I'm still really creeped out I do need to go to bed.

So I hope that you found a little humor in my adventure with the lizard and I hope that tomorrow I would find that same humor. Also hopefully this story makes sense, but if it doesn't know that I'm tired and jumpy and will now hopefully be able to fall asleep.

Here's Randall (what Chris named it while it was still my "friend" and was just crawling around my room)

Opthalmology Day #2

Today was our second (and last day) in the opthalmology department. We got there in the morning and weren't really sure what to do. The doctor we were supposed to meet up with wasn't there when we got there so they just had us sit in one of the rooms where they saw patients. We sat and observed for an hour or 2 before anyone even talked to us. Then they had us go to the head of the departments office. She talked with us for a bit and then had us read a chapter in a textbook about therapy for the eyes. It was an ok time reading the textbook. It's been a few months since I last read a textbook and I can't say that I missed it. Then we talked with her for a bit before we went back into an exam room and observed before our lunch break. We weren't having the best time so we thought it woud probably be a long afternoon when we went back. We were proven wrong and the afternoon went much better. The residents talked with us more and explained a lot of the things that they were doing. They even let Courtney try using one of the instruments to look at a patients eye and attempt to find the fundus. She wasn't able to see it, but they did draw us a nice picture of what we should be looking for. We also took this opportunity to look at each others eyes and Courtney even took a picture of my eye. We also talked more with the residents and they were all really friendly. I took a few pictures of our day, but Courtney has more of the them and some better ones. I believe she is going to put them on her blog in the next couple of days so you should check it out here. 

Example of what the different languages look like

Our daily picture together (when we remember to take one)

We're pretty attractive I would say

With a couple of the residents who were very kind to us

“When you travel, remember that a foreign country is not designed to make you comfortable. It is designed to make its own people comfortable.” – Clifton Fadiman

One of my friends posted this quote on facebook earlier this week and so I just saw it yesterday when I got online and it really stuck out to me as being true and something that I need to remember.

The first few days in India were really hard for me. My internet wasn't set up so I couldn't talk to anyone from home, the food wasn't good, and the program wasn't what I expected it to be. I also didn't have the most positive attitude so that didn't help matters. I was super excited to go to India, but when I landed that feeling quickly left and instead I was dreading being here for 8 weeks.  After a couple of days of having a crappy attitude, some prayer, emails with my mom, and talking with Courtney I decided that I needed to have a better attitude and really try and make the most of this experience.

I really love traveling and so at first I couldn't figure out why I wasn't loving India. I then remembered all of my other trips and missing home right away as you settle in to a new country and try to figure out a routine. I realized that though I did really love all of the other countries that I had been for the most part I only remember the good things and the things that I loved doing. The more I thought about it the more I realized that there were many times I had these same feelings. All of this was a good reminder for me that things would be ok and that I would enjoy my time here.

I think it was also somewhat of a blessing that I didn't have internet those first few days and so I really focused more on Jesus and getting my strength from him rather than relying on people from home. Even though this isn't a mission trip and the focus is supposed to be more on gaining pharmacy/health care knowledge I can already tell that my faith is going to be strengthened as I go out of my comfort zone and really experience Indian culture. It really was good for me to pray together with Courtney those first few days (and I hope we continue to do this throughout the trip) and really ask for the strength to get through this experience. We also prayed to really love these people as God loves them and to see them how he sees them. Also that we would be reminded throughout the day that he is there for us in all the small little ways.

Some of the ways that God has shown up already in those small little ways include:

• Amy giving Courtney a journal that she had written in on certain days and on the 2nd day was the verse Ephesians 3:20 "Now to him who is able to do immeasurably more than all we ask or imagine according to his power that is at work within us." and she wrote a note about how much he can do through her even though she is probably doubting how she will be able to survive these 8 weeks
• The facebook status from Grace that is the title of this post
• Chris waking up in the early when I was seeing if my gchat would work and we were able to set up a time to skype (and then actually being able to skype with him)
• My mom emailing me back with wise words of encouragement

Those are just the examples that I can think of right now off the top of my head of the ways that God has shown up these first few days in India when I really needed him to. I am looking forward to the ways he will continue to show up and the ways in which I will grow more in my faith as well as in the healthcare profession. I am also really glad that I am starting to enjoy India and can't wait to see what the next 7 weeks have in store!