Day 7

Day 7

Today was the first day we worked in the mobile health clinic associated with PHRII (Public Health Research Institute of India). It is a women's health clinic doing a basic health screen and educating pregnant women. The way it is works is like this: there is a women's interest group in the community. PHRII contacts these groups to find pregnant women in the community and bring them for a health screen. The women who come are compensated and the women's interest group is also compensated per woman they bring in. The pregnant woman gets educated on the importance of getting exams for cervical cancer (here in India, they do not do Pap smears, they do visual inspection because most women will not pay for a Pap smear as it is expensive for them, so visual inspection is better than nothing) and health issues involved in pregnancy. The main goal of the health clinic is to prevent the transmission of HIV from mother to child. The pregnant women comes in 4 times. Once in the first trimester, once near delivery time, once when the child is 6months, and once more when the child is 1yr. They are also educated on how to stay healthy during pregnancy. As part of the medical exam, they consult with one of the women's health physicians who will also give a physical exam if necessary. As part of the exam, the women are checked for high blood pressure. Give a urine sample for high blood glucose and proteinuria. Do a self-administered vaginal swab for bacterial vaginosis. Give blood for HIV testing and blood typing. I aided in taking blood pressures but also in the collection and processing of the different patient samples.

The health screening took place at a school in a very rural village in Mysore. I took tons of animal pics, some oxen, cows, chickens and cute little goats. I really like this place, the people seemed so grateful to have the health clinic come out here. The kids at the school were super awesome! They saluted us and sang us a little song when they introduced us to them.

The school we were working at.

The kids were cute! Saluting us as we took a picture.

Measuring height/weight of the pregnant women

Blood pressure check and blood draw.

Blood typing

The self help interest group meeting with the PHRII people- get orientation and trying to recruit more pregnant women.

 Lunch line

 LUNCH TIME! plus lunch ladies

 Our set up... Blood typing, BP check, vaginal swabing, urine collection, blood tubes.

Haha! Love these kids! They are the best!

Candid moment.

Another candid moment. (checking my slides)

  Our lunch time... phew! what a long day!

Day 5-6

Day 5-6

Today and yesterday we spent time at JSS hospital in the pulmonology department. Our attending was named Dr. Mahesh. All the residents and other doctors referred to him as “sir” and would say “the sir” has ordered me to this this or that. One thing I noticed that was quite obvious was the relationship between physicians at different levels. It seems almost military like, the residents would only speak when asked to. They would not speak if not spoken to, and say yes sir, no sir to the attending. I come from the assumption that rounds is more like a back and forth dialogue with the attending, that was one thing that is different in the medical culture here. When the attending was around the Indian residents always seemed at attention, and waiting for orders. When he was gone, the residents expected the same from the students- to be at attention and waiting orders from the residents, expecting a military like hierarchy.

During down time, it was refreshing to see that the residents here are a lot like the medical students and residents back home. They all had Facebook, they were showing us their photos, and we even had an in depth discussion about the show “The Wire.”

JSS hospital itself, though better funded than RK hospital, was shocking to me in terms of lack of privacy and the sheer number of cases they see a day. When rounding, the attending, 5 or 6 residents, med students, nurses, PharmDs would all crowd around and discuss the case right over the patient without any problem, without regard to who else was listening. Lack of privacy is very noticeable. HIPPA does not exist in India. Today an interesting point was made about the lack of privacy- one of the physicians said, we do not know if lack of privacy in Indian hospitals is a bad thing or something that is completely unavoidable and has not effect. In the hospitals and doctors offices here, when one patient is being examined and interviewed, there are so many other people in line waiting in easy ear shot, sometimes people in the same room shirt off ready to be examined as the doctor is consulting another patient. Patients just seem to be crowded around everywhere, anxious to get a little face time with the physicians.

Something else I noticed- people usually present to the doctor or the hospital in the late stages of their disease. Most people came to the hospital with late stage cancer or advanced disease. Because the people are so poor, they do not regularly visit the physician for screening and only come to see a doctor when they have symptoms. By that time it is too late. For example, in COPD patients, symptoms don’t usually manifest until the patient has lost about 50% lung function. By this time, it is almost impossible to help the patient. Another example would be, women do not regularly get Pap Smears. As a result, they will only go see a doctor if there is vaginal bleeding. By this time, the cervical cancer is already late stage and has poor prognosis.

We saw MANY interesting cases today- diseases and situations that are rare in the US but commonplace here in India. There is a very high rate of TB in India, and since we were following a pulmonologist, we got to see many TB cases. Back in the states, when dealing with a patient with TB, the patient must wear a respirator mask and so must the health care providers. In India, that does not happen. I am told there are TB sanatoriums where people with TB are treated, however what me an Alex saw these past days were people with active TB with in the general in patient and ER population, no mask on. I wonder what the rates are of hospital acquired TB in patients and health care workers.

One skill that doctors have to be very good at here in India is reading X-ray films. Since patients cant afford more expensive tests like CT, it is extremely important for each physician to be masters at reading X-ray film. Unlike in the US where physicians have the X-ray digitally on a computer screen, can zoom/manipulate it, or send it to a radiologist instantly for a 2nd opinion, the physicians here have an actual physical film to look at. I feel that after a month in India, we would be able to look at any X-ray and be absolute experts on how to read it.

 ICU at JSS hosptial. ALOT more equipment and resources than the RK hopsital's ICU.

Day 3-4

Day 3-4


These last two days we went to the local government run hospital called R.K. Hospital. It is a free hospital that gives free treatment and medicine to the poor and those below the poverty line. (It is basically the Mysore version of Jackson Memorial hospital in Miami.) The conditions in this hospital are very, very different from hospitals in the US. On the basic level, things like equipment, contamination, and infection are a huge issue in this hospital. I will post pictures of the make-shift emergency room so you can see the conditions and lack of resources the physicians here are dealing with. I am in shear aw as to how amazing these physicians are in caring out their duties with such a lack of recourses. As the ICU attending told us, the conditions are very dirty yet the people here have a very strong immunity because they are used to living in unsanitary conditions to where they sometimes make miraculous recoveries from very serious infections.


So on Monday (day 3) we spent most of our time observing and shadowing in the MICU. It was there where I watched somebody die for the first time in my life. All but 4 of the 12 patients in that MICU were there for Organophosphate poisoning (something you do no see at all in the US yet is extremely common here due to easy availability of organophosphates) The patient we saw die was in the MICU for organophosphate poisoning. He had been hospitalized for I believe 3 weeks during which he acquired ventilator associated pneumonia and died from septic shock. We watched him crash and they did CPR and used Epi to bring his heart rate back up. Eventually they declared him dead because they could no longer feel any pulse and he was brain dead because he had no pupillary reaction to light. Defiantly a somber moment. We didn’t spend much time at this hospital today. After about 2 hours in the MICU we left the hospital.

Tuesday 7/2 (day 3)


Today was an eventful day. We spent most of the day shadowing Dr. Mukesh, an oncologist. Dr. Mukesh is one of the best physicians I have ever met, he was great to learn from, extremely knowledgable and loved to teach. We talked about everything, from cancer treatment to religion and Eastern philosophy. Great guy to hang out with and amazing physician to learn from! Anyway, in the US we are supposed to spend minimum 15-20 minutes per patient. Very different in India, because there are SOOO many people at this hospital that the physicians spends maybe two or three minutes with each patient. Only when Dr. Mukesh makes the initial diagnosis of cancer does he spend 20-30mins with patient because that is a serious time. What I learned shadowing an oncologist today- if you like forming a deep, long term relationship with your patients, oncology is for you. However, be prepared to lose a good number of patients. You can not take lose too personally or you will not do well in oncology.

So, basically today was patient after patient after patient, and the line is very long and everyone is extremely eager to see the doctor. Everyone crowds in the room, breathing over each others neck, crowding the patient and the doctor as the doctor is performing the patient consultation. Hall ways were so crowded, you couldn’t even pass through. There is no privacy at all (except during pelvic exams).
 Aside from shadowing Dr. Mukesh, we also went into the minor surgery ward. Minor surgery basically deals with small traumas, putting on fresh bandages, removing stitches/staples, and treating abscesses/infections. It was absolutely the most jaw dropping 2 hours of my life. We saw some horrific infections- 2 people with diabetic foot infections all the way to the bone (osteomyelitis) who needed amputation but did not want to consent to amputation. We saw a case of leprosy that shocked both me and Alex, yet is apparently very common ailment seen at the hospital. I told the Indian medical students that in the US I will probably never see leprosy ever in my life, and they were shocked saying they see multiple cases every day.

Very eye opening and intense experience these last two days. These are the only 2 days we are spending at RK Hospital. I think the greatest thing I will get out of visiting this hospital is how they are able to help so many people with so few resources. We are truly spoiled in the US compared to India. The physicians here seem almost super human in dealing with the shear number and severity of cases per day with little to no recourses to help their patients. Their clinical skills are amazing. With no money to order labs and images, they are able to perform very detailed and accurate physical exams to determine diagnosis.


Make shift ER rounds. Almost no equipment at all in this ER. They didnt even have heart rate monitors. The electricity kept turning on and off.

Outside of RK hospital.

Mysore Medical College across from RK Hospital.

Patient waiting in waiting area before hospital hours.

Day 1

1st day in india... AWESOME!

We got orientation for what we'll being doing this summer. The people here are soooo nice! we have a house keeper family here, they clean our stuff and make chai 2x a day... mmmm  masala chai 

Breakfast is amazing... Fresh fruit plus toast. Fruit here is everywhere- abundant and cheap. I could eat a million little banana's. The mangos are SUPER delicious- its mango season and there are carts everywhere trying to sell them (about 50cents a kilo)

So our 1st job of the trip was to take BP's in the waiting room at an OB-GYN office. I was taken back, they asked us if we knew how to take BPs.  Apparently only in 4th year do Indian med students learn clinical skills, they learn only theory 1st-3rd year. Today was a short day, we spent only a few hours taking BP's and measuring weight. We couldnt take the BP's on the muslim women, because men arent allowed to touch the women unless they are family members or their husband... culture check. The resources they have are super limited. The exam room was small, with the bare essentials. The blood pressure cuffs they gave us seemed to be from the dinosaur era, really puts into perspective what we have back home.

The Indian people in general seem to be fit, there is little obesity. Our blood pressure screening was effective as we were able to identify people with previously undiagnosed hypertension.

Its interesting in India... they start their days at 10am. (I could get used to that.) They do go to work and the children do have school on Saturdays, usually a half day- starting at 10am and finishing around 1pm.

Food was sooooo good today. Got dahi puri from a cart (prob not a good idea as dahi puri has raw vegitables, and the cart vendors have no way of washing their hands) it was SUPER good then went to a restaurant and got paneer chole.. best thing i've eaten ever, and it was like $1.75 for the entire meal (+naan +mango juice +masala chai). We got burfi for desert (funny name) super sweet and delicious.

This is a picture of outside our front door in the morning of the house we are staying at. Absolutely beautiful house.

A picture of a child at the OB GYN office getting his BP and weight checked.