Surgeons in Flip Flops

What a crazy week!  I'll start off slow...riiight.

So...we made it to Panvel to the leprosy colony.  Not too much rain, but still very muddy.  Actually, the entire week was beautiful, luckily.  The day we got there however was another terrential downpour.  Imagine going camping, arriving at the camp site in the middle of nowhere, and then walking a half a mile on DIRT ROADS in the middle of a downpour.  And dirt roads translate to mud roads in monsoon season.  The scenery was beautiful though.  There were hills off in the distance with square tops, and everything was just green and serene.  Hey that rhymes =)  But we decided to take a walk when the clouds cleared (ponchos and rain coats in hand just in case, rain can happen at any moment for any amount of time) and found a cool river.  On the way I deciced to collect some mud...inside my shoes.  I brought it back squishing it in between my toes!  Then we got back to where we were staying.  I will do no mercy describing this place...but let me try.  You walk into a teeny room, and about ten mosquitos greet you at the door.  There are two matresses (I dare not call them beds) with a tapestry like sheet hanging from it, mosquito netting over them (sweet!)  Muggy never had meaning until you stepped into this room, as you can practically see the water droplets hanging out in the air.  There is a gecko dude on the wall, trying to eat the flies (thanks gecko dude!).  There are many many holes in the screens that are already hanging on the windows, and unfortunately in the mosquito net (I plugged those bad boys up with tissues...the wet ones from my soaked backpack)  It's dark because the electricity is out, however its still light out.  The electricity goes out intermittently, along with the water.  The toilet (actually has a seat! not that id sit on it) is impossible to see because of how far back it is kiddy cornered off the side of the room.  Kate's quote of the week, "I just wave my hand around my bum so the mosquitos dont bite me there."  It was, quite bluntly, miserable.  The best part, in my opinion, was when I finally decide I couldnt stand being awake anymore, sweating in my scrub pants tucked into my socks with a tshirt and a long sleeve lab coat on (no bites for me!), I would have to lay down on the wet bed, watching the mosquitos land on the netting and hoping they dont find a hole.

"Pure in Cleansing" Week in Shantivan

The food is something else.  Its supposed to be "pure and cleansing" but all it really is is bland and disguisting.  Try beans with something that looks and tastes like dirt on it, shreaded carrots and cabbage, some sort of other vegetable, yellow soup that looked like chicken broth but apparently wasnt (no animal products here!), another one that looked like carrot soup?,  rice, and flat bread (like a wheat wrap but less flavor).  No spices.  EVERY NIGHT.  Nothing like variety.  My trick, mix it all together and dunk it in the mildly warm soup, makes it like a stir fry...kinda.

We also went to service in Shantivan (the name of this leprosy colony tucked nicely away from the rest of Panvel), where maybe like 20 people gathered on a blue tarp in a small barn like building, women on one side, men on the other, and a man with no fingers or toes holding an old notebook and bible type book sitting in the middle.  We watched/listened to the news for 20 minutes (didnt understand a word of that) while rats were running around their vegetables in the corner.  Then they took attendence and sung to Shanti Shanti Shanti!  It was actually quite interesting...if you were dozing off like me and letting the Hindi words jumble in your dreams into English where your brain is creating a fabulous story for you!  Quite enetertaining that way.

Despite living quarters...the clinics were well worth the accomodation downfalls.  The first day we went to an orthopedic surgeon.  Let me give a brief visual of the scene:  Instruments all sitting in a closed cabinet (no idea if those were sterile or not), an autoclave off in the back, everyone barefoot (oh, yes,they take their shoes off in the hospitals), the surgeons tossing on FLIP FLOPS to go into surgery!  Reused caps (normal) and masks (NOT NORMAL!) The main surgeon was actually wearing boots (lucky guy) for the arthroscopy because of all of the water that goes in and out of the wound so the camera can see.  We got to watch a knee surgery, where they poke two holes, one for the camera, and one for the tools.  Here they dont do MRI's first because of the cost, so they just jump right in with the artroscopy (they would have to do that next anyway, also costing money) and then cut on in if necessary, which it was, so we watched that as well.  This we watched from behind a window in another operating room.  While we were watching, an ob/gyn (YAY!) came in and did a DNC.  I have no idea what this stands for, but it's when there is a miscarriage and they have to scrape the inside of the uterus lining to remove the build-up from the initial pregnancy.  I wont get any more graphic than that, but it was interesting to watch an ob/gyn!

Day 2 was the coolest day, and might be of the whole four weeks.  We went to a general surgeon and his wife's clinic (most doctors are married to each other here, the man one kind of doc, and the wife usually a gynocologist, and they run a hospital).  First we saw an appendectomy on a 12 year old boy.  That was pretty typical, but the doctor was having trouble finding the whole thing, he kept feeling something strange that seemed like more to remove.  Then he pulled out the intestines and straightened them out, when he let go, they coiled back up! (not normal)...there was a roundworm inside this boys intestines!  Oh man.  Imagine that.  He didnt remove it however, he was just going to give him something orally to take care of it.  Ahhh, I dont want worms!

The second surgery was done by the ob/gyn (she was awesome) and the did a tubal ligation (tubes tied) from the abdomen.  That was pretty normal, and awesome because I had never actually seen a fallopian tube or ovary before!  Now I have!  So cool.  Third surgery was also by the gynocologist, a five month pregnant woman (who was only about 90 pounds, crazy how little people are here) had her cervix tied up for the remainder of the pregnancy so she wouldnt miscarry. It was pretty cool to see gynocological surgeries because I have always been more interested in the obstetrics aspect more than the gynocology, but all these surgeries and cool things involved in the gynocology have actually made me really really like the gynocology part.  If this clinic did not stregthen my desire to be an ob/gyn, then I dont know what will.  I am just so incredibly sure this is what I want to do, and I love that the more I see, the more my desire strengthens.  AWESOME!  Who wants me to deliver than baba!  Just kidding.  Maybe someday =)

Third surgery was NASTY (guys you might want to cover your eyes here).  There was a man who had a hernia....in his scrotum.  You know that turn and cough...yeah well they found something, except they didnt have to turn or cough, it was about the size of a large grapefruit!  Not only that but he had "sebacious cysts" (more like big warts) all over himself.  Not pleasant.  We asked him how long he had had this problem...THREE YEARS!  Oh that poor guy.  So what the surgeon did (weak stomachs skip the rest of this paragraph) was cut on in, pull out the problematic tissue, removed it (this was the size of a pound of ground beef and looked like, sorry if i ruined dinner), and then sewed back up.  When the surgeon was stitching up the different layers of tissue, he was showing us the different types of sutures used.  For the permanent inside layer he used polypropylene stitches!  After he finished using the strand that he had, he wanted to show us how strong the stitches were, so he actually took the needle and leftover stitches straight from the wound and tried to hand them to me!  AHHHHH NO!  So another girl (shes a brave one) put her hand out and he put them right in her hand.  Oh have I mentioned that all of the assistants are barefoot and have no gloves on!  At least we got to wear flip flops in.  I dont even want to get into how gross I think this practice is.  Its very hard to overcome everytime we walk into a room.  I dont know if it will be a good thing to get used to either...

The rest of the day consisted of removing a sebacious cyst (a real one) and draining two abscesses  (big big big bacteria filled zits).  One on a chin, where he gave her local anesthetic, and another on a 6 year old boy where he only poured some liquid with a cooling effect because he could not pay for the anesthetic!  He was SCREAMING his lungs out, kicking and crying while the medical assistants held him down.  This was BY FAR the worst part for me.  If I had known, I would have paid for the damn anesthetic.

So a quick mini fact: medical care is not paid for by the government here, it is all out of pocket, straight to the doctors.

Education tid bit:  Doctors decide to do medical school in 10th grade, then there is one road where they end with one degree...a bachelor of medicine, bachelor of science. If you tell them you have a bachelors degree here, and dont know something they ask you, they think you are a poorly trained doctor, haha.  We had to explain our educational track about 100 times.  They cant have bachelors degrees in anything else, like we can.

Last day we started off with a gastroenterologist (digestive tract for those who dont know).  His wife, of course, was an ob/gyn, so I asked to go hang out with her.  This was clinical visits, and therefore I learned cool things about the culture.  In one village, girls have arranged marriages before they even hit puberty, and they will live with their parents until they mentstrate, and when they start, they are shipped off to live with their husbands.  These girls tend to have babies young, at about 18 or 19.  In other villages (like the one we were in) there were also arranged marriages, but the girls wait to have babies until they are in their 20s.  It was hard to understand everything she said, but I believe she said something about after a certain age, they get a tubal ligation.  I guess this would be to decrease the birth rate over here.  There is, however, an interesting contradiction, where you are not allowed to find out the sex of your baby by ultrasound or any other means before the baby is born, to decrease the rate of abortions (which are not allowed here).  I have a lot more to learn culturally, and I am sure I will in the weeks to come.

Alright, so thats the clinical week...now for the shopping!  Haha I am such a girl.  Things here are fantastically cheap.  Even when you are getting ripped off (my blond hair makes me a fabulous target), its still an awesome price.  I could spend hours not only bartering with the people, but just telling them no over and over again in many ways.  Some of todays No's:

Trying to sell me a drum made of camel skin and mango, "I dont know how to play!  I am terrible at singing along.  That wont fit in my suitcase.  Its too noisy.  I dont like camels.  I dont know what to do with that!"  Yes these excuses were all to the same man who followed me for about 20 minutes.  I have so much fun with these guys!  They must think I am nuts.  This man actually stopped and chatted with us asking me my name, where I was from, and gave me tips of where to go on the weekends.  People are sooo nice here.

A man trying to sell me saffron who followed me for about an hour, and even waited outside indoor shops to keep trying! "I dont know what saffron is.  I dont cook very well.  I think I would use too much and it would taste bad.  I dont know what the kinds of foods you are telling me to use it with are.  My boyfriend doesnt like saffron." (Sorry Jaymo I dont know if that is true, but I wouldnt trust what was inside it anyway).

One man got me, he asked to shine my shoes for 2 rupees (ummm...like 5 cents) so I was like sure!  Then I realized this might not be the greatest idea since my shoes are rubber (Go anti-crocs) and it rains alot here...so I just tried to give him the rupees, and he was like (imagine this in an indian accent) no ma'am, taking without service is like begging, and begging is not gooood.  So I was like Ohhh, alright (he was too sweet not to let him!  I cant believe I just called a shoe shiner sweet).  While he was shining my rubber shoes, I talked to him and found out he was from Pakistan, where he could not do his job (shoe shining) so he is here in Mumbai, where he doesnt have enough money to have a box on a street corner, so all he has is his bag, but he is happy with his bag and is proud to shine shoes and not beg.  These people live incredible lives.  Not ones I would want to lead but a totally honest living, which I find incredible.

I have also noticed that here people do not steal very often.  Not even in the slightest.  For having so many people (and therefore distractions), its such an honest society.  On the trains, people selling things will hang them and walk away.  Stealing would be very easy, but if someone wants something, they wait for the person to come back to guy it.  Beggars will follow you forever asking for more of your money, but they will not take it without you being willing to part with it.  Children on the streets will run along side the train, but will never take without asking.  One boy on the train saw one of our girls leave a coin purse under the seat, and he actually ran after us to give it back.  Of course you give them money after that, but the girl who lost it would have been shit out of luck, and the children would have gotten what they wanted.  But this is not how they want it.  Also, I have decided that I will NEVER go somewhere without packing up my leftovers (as if that was abnormal) because as little as you pay for it, the children and mothers appreciate it  more than the money.  I gave two boys leftover spring rolls, and the smiles on their faces were priceless.  They went and told their friends and pointed us out all happy to have some food.  I think with money they have to report it to an adult, who decides when to feed them, and this is all they get out of it, but when its food, they can run behind a stairwell and snack.  I really like this new plan.  I have also been giving out small trickets and jewelry, which they also seem to appreciate alot.  This is such an incredible country...except for all of the dirt.  I just scratched my neck, and my nails now have dirt in them, lovely.  Not to mention that a bucket shower is not the most effective way to get all the dirt off.  I will say however, that no matter how many times the water turns off in Mumbai, it will never compare to the accomodations in Panvel.

Now that I have talked your ears off (typed your eyes off??) I will finish with this:  India would be nothing without its buckets and tarps.  Roofs, floors, places of worship, all have lovely blue tarps, while every bathroom is equipped with a beautiful bucket or two.  I hit up the bathroom in one of the hospitals, and first of all you are barefoot, then you have to stand over this hole in the floor, squat down, do your thing (with baby wipes of course because there is no TP) and then bucket anything you left into the drain at the back end of the hole, wash your hands at the sink and get the heck out of there and find the nearest Purell!

Fact of the week:  Renu (yes, the contact solution) is used as normal saline in hospitals here.  Not for IVs!  Thank goodness.

Hindi word of the week: Dahnyavahd  (Thank you)

Hang out of the week:  Leopolds, where they have American food and people for Hindi (but not too Hindi) prices.  Great tourist place, when you are in the mood to be a tourist.

Non-hang out of the week:  The bedrooms in Shantivan!

Lesson of the week: Check mosquito netting BEFORE you close yourself in.  A skeet got stuck in my netting with me the last night in Shantivan and bit me everywhere my lab coat did not cover...10 bites on my face and neck and 7 on my hands and wrists.  It is confirmed...I am allergic.  Good thing is it was just one skeet, less chances of Malaria than if they were not from just one.