Final Reflection & Acknowledgements

At the University of Oregon Robert D. Clark Honors College, around 1/3rd of students study abroad at some point in their undergraduate education. Of those whom I have conversed with, the common consensus was that it was something one had to experience for themselves. In fact, I was hoping to travel outside of the United States at least one more time before medical school. Living in Oregon for so long, I was vying for an escape...a traveling catharsis, if you will.

Looking back at the program I proud to announce that I got exactly what I wanted out of the program. Pune, India is a beautiful city. As evidenced by the advances in technology and infrastructure, India is a rapidly developing country. However, one midnight walk reveals a land still steeped in traditions lasting generations and generations beyond. It was an honor to immerse myself in the culture and learn more about healthcare on a global scale.

Throughout my journey I gained a wealth of medical knowledge from the doctors & witnessed a ton of procedures. Being mostly related to prenatal, neonatal, and pediatric fields, I feel only more motivated to work towards becoming a pediatrician so that I could see the smile of more happy families. However, I also learned something extremely important during my medical rotations: the humanity of a patient. Being able to see so many hospitals and so many individuals over the course of a month, I initially undervalued the privileges we were given as students compared to the diagnosis. As time passed, I came to realize that the ailment and operation are not always the most important paradigms of medicine: Patients are not simply learning tools for a student, they are people. I believe a doctor should never forget the sanctity of human life, and this is a lesson I will keep with me forever.

That being said, I was extremely overjoyed to have 2 individuals in which I could share my thoughts and future aspirations with. Their coming from different backgrounds also provided me with unique viewpoints concerning culture as well as healthcare.

The connections people form around the world are the ties that bind humanity. And I, for one, intend to fly out and make more ties.


Acknowledgements

I would like to express my sincere gratitude to Child Family Health International for providing me with this learning opportunity. In particular, I would like to thank Program Coordinator Lyndsey Brahm for helping me throughout and after the application process and getting me prepared for departure. I am also grateful to India Programs Director Hema Pandey for providing communications and support throughout the program duration.

To Dr. Dabak, Dr. Kothavale, Dr. Dugad, Dr. Kothari, Dr. Joshi, Dr. Godbole, & Dr. Gange, thank you for making the Maternal & Child Health Program possible through shadowing as well as providing words of wisdom to the minds of the future.

To Dada Waghamode & family, thank you for being more than just a caretaker but an amazing guide and close friend. Your hospitality will not be forgotten.

To Kim Obey & Daschel Franz, thank you for being the most excellent colleagues and friends a guy could ask for in a home away from home.

Finally, to my family & friends in Oregon, thank you for providing me with the support and encouragement needed to see the outside world with my own eyes. 

7/31 + 8/1 - A Time for Goodbyes

Not too much to talk about here. We decided to take today off and spend our last day together. After saying our thanks and goodbyes to Dr. Dabak & his family, we returned to the guest house and started packing.

Around 4 PM Kim departed to Mumbai International Airport for her return trip to Michigan. There was a lot of hugs. Also some crying.

The tearful farewell.

Finally, on August 1st at 5:25 AM, I said farewell to Dada & Daschel, and departed Pune International Airport for the long journey back to Oregon.

7/30 - Chiranjeev Clinic (Day 2)

Our 2nd and final day at Chiranjeev Clinic.

As I mentioned before, children also come to this clinic for testing of developmental milestones. Upstairs, a small office and play area is used to conduct these examinations. As per a photo shamelessly taken of a poster, listed below are just a few of the capabilities expected of children at a certain age (give or take):

1st Month - The newborn is able to turn their head from side to side. The ability to fix their gaze on a certain point is also expected.

2nd Month - The child is able to hold up their head. Smiling and co-ordination of eye and head movement should also crop up around this age.

4th Month - The child is able to raise their feet and open their hands. He/She will also tend to feel objects.

8th Month - The child can sit unaided. Object transfer from hand to hand is also possible.

12th Month - The child begins to walk, play, and speak (~5-6 words, as well as the repetition of certain syllables).

After returning from our shift, we got ready for our long-planned fancy dinner at Nimantran Restaurant with the host family. Pictures below!

All dressed up.

Sanskruti loves playing with the camera.

Delicious, delicious food.

Group photo!

The best (and most adorable) host family we could ask for.

2 more days until I depart Pune...

7/29 - Rural Rotation (Day 2)

Another early start for a morning stroll. With a little help from Dada and the car, Dr. Dabak led us on some scenic routes that he frequented during his rural stays. Pictures below!

A nearby dam that supplies rainwater to the village.

Group photo with Mrs. & Dr. Dabak. I have a great smile in this picture.

Now, about the rural clinic itself. Being the closest hospital for miles, Dr. Gange is solely responsible for the 30,000 patients that hail from the surrounding villages.

Some observations on the rural clinic:

• As a governmental hospital, cases observed ranged from snake bites to fevers. Patients also ranged from the extremely young to pregnant and elderly.
• For more serious cases or those who required specialists, ambulances would be made available to transport patients to the city.
• The clinic also provides services for educational students. The day prior, we got to witness a nurse give blood tests to an incoming classroom. 

In regards to the blood type testing performed on the students, the method is quite interesting: First, a small sample of blood was obtained from each student via finger prick. The sample is then subjected to a serum containing a certain antibody. How does this determine blood type? Well, the ABO blood type possessed by humans is determined by the presence (or lack thereof) of certain combinations of 2 antigen types (A and B) and 2 antibodies (A and B) in the blood. If subjected to a serum containing an antibody matching that of the possessed antigen, the blood will agglutinate. For example, if a subject's blood agglutinates due to mixing with a serum possessing anti-A antibodies, that person must have Type A blood.

The majority of the time was spent observing Dr. Gange prescribe treatments for the numerous individuals that came and went from his office. During one of our breaks, Kim and Daschel taught me how to take a patient's blood pressure. Hopefully that is not a skill I forget!

Learning how to take blood pressure.

Photo with Dr. Gange and various other employees.

After our shift we were picked up by Dada and we headed directly back to the city. Overall, the 2 days spent in rural Pune were eye-opening and I wish we could have stayed for just a bit longer.

When we returned home, Dada's wife showed us something special: Henna body art! Both Kim and Daschel received some incredibly intricate designs on their arms.

Sai smeared the art a bit on Daschel's arm. Haha.

3 more days before I depart Pune.....

7/28 - Rural Rotation (Day 1)

After another round of early-morning yoga, it was time for the anticipated rural rotation. Located around 2 hours away from Pune's urban expanse, we would be staying at Dr. Dabak's rural house overnight while attending the rural governmental clinic for two days. Due to the nature of this trip I will talk about the hospital in the following post for better focus. 

Our home for 2 days.

A little bit of background history: According to Dr. Dabak, he along with some of his fellow coworkers owned a piece of this land. However, in the latter half of the 1900's a law enacted by the state of Maharashtra gave the farmland to those who worked on it: the farmers. Still feeling a personal attachment to the landscape and people, Dr. Dabak purchased a house for which he can come and visit from time to time with his wife. Today, the village primarily deals in the cultivation of rice and sugarcane.

Go Ducks.

After settling in we had a chat with Dr. Dabak over tea about India and healthcare. For the most part, the three of us shared what we have learned over the past few weeks and asked any questions that were raised over said course. The bulk of the conversation came down to what was considered to be the main issues with India and health: population control and sanitation. These problems go hand in hand: with the population of India geared to overtake China's population by 2022, there is a rapidly increasing need to improve cleanliness and medical resourcing to meet these density levels.

Dr. Dabak has been quite active in playing his part. One pressing issue in many of the rural sites in India is the lack of latrines. Without a controlled method of waste disposal, waterborne illnesses were extremely common in rural sites. Thus, Dr. Dabak helped fund the construction of 20 latrines throughout the neighboring villages to cut off avenues of infection. Unfortunately, today only about 2 are used as actual latrines. The others were reduced to simple storage shacks.

Milking a cow for the first time.

Not long after our educational talk I did something I have never done before: milked a cow. This opportunity was possible due to the hospitality of neighboring villagers. If anyone has seen people milking cows in TV shows or cartoons, do not be fooled; it is a lot more difficult and physically strenuous than it seems. Unfortunately, due to my dairy allergy I was unable to try the freshly-squeezed milk for myself. According to Daschel and Kim, it tasted naturally fresher and creamier than the milk bought at supermarkets.

Lunchtime by candlelight.

Back when I first arrived in India I was quite fearful of the idea that I would be there during the monsoon season. However, during the first few weeks besides some light rainfall not dissimilar from Oregon I soon disregarded that fact. Which, in hindsight was unfortunate when I packed for this short trip: when it rains in the farmland, it pours. Electricity going out in the village was a common occurrence, and our lunch of hot soup was eaten in almost total darkness. Despite the blackout, the miniature storm was an unforgettable experience.

Our new friend we met at midnight.

Our night was relatively restless. This was in part due to the numerous mosquitoes and spiders crawling about the walls and beds, our horrible teamwork in trying to capture a tiny gecko, and the insane urge to win a game of Uno.

Last day in the farmland tomorrow!

7/27 - Chiranjeev Clinic (Day 1)

After another round of morning yoga we had our first day at Chiranjeev Clinic, run by Dr. Godbole & his wife. We will be returning to this clinic after our rural rotations. Besides specializing in pediatrics the private clinic also hosts a developmental department for milestone checking (I will get into that in a future post). 

Chiranjeev Clinic.

Dr. Godbole.

Some general observations on the clinic:

• As with previous pediatric clinics, there is a lot of vaccinations, routine checkups and crying children.
• The clinic is extremely small, even more so than Dr. Kothari's private clinic. 
• Upstairs lies the developmental testing area, filled with various toys and tools used for making sure a child is learning certain cognitive and motor functions within normal time frames. 
• Dr. Godbole's stethoscope is absolutely terrifying. He also loves the color pink. 

A big hit with the children I'm sure.

During lunch we had an interesting conversation with Dr. Godbole on a topic not really covered in past hospital visits. As mentioned in a previous post, India is a country steeped in religion and tradition. At the same time, the infrastructure is rapidly evolving in response to the changing times (in this regard, most of my observations point out how the medical field in India has modernized). To Dr. Godbole this adherence to tradition can pose as an issue, especially when it comes to increasing health risks. Two examples are given by him below:

1. In some rural villages on the outskirts of Pune, Dr. Godbole has encountered situations in which pregnant women deny c-sections as a method of delivery. Despite heavy risks to both the mother and child if the baby were to be delivered vaginally, the families would argue that such methods are unnatural and thus impure.

2. The Numero Uno & big daddy of all pathological issues that India faces in the health sector is two words: waterborne diseases (this will be covered in further depth next post with Dr. Dabak). The many highways in which said diseases can spread are multiplied the more concentrated the population becomes. The example used by Dr. Godbole was the upcoming Ganesh Chaturthi (September 17th), a celebration Pune is famous for celebrating, as we like to put it, all out. During the festivities, thousands of miniatures of the titular god would be immersed in large bodies of water. As one can imagine, this easily leads to heightened infection rates.

Tomorrow: Rural rotation!

7/26 - Yoga

The past week was mostly associated with later awakening times and overall lethargy post-rotations. We decided to liven up the routine a little with some morning yoga for our final week, thanks to Mrs. Dabak and her personal yoga instructor. Learning yoga in its birthplace from an expert? Sign us up!

Obligatory group photo.

The exact origins and purpose behind yoga are still left to speculation; its usage has been traced even before the creation of the Veda manuscripts in the Hindu religion. Now, yoga is one of the most common activities performed across the world: close to 9% of the adult population in the United States practiced some form of yoga in 2013. That's a lot of people doing yoga. Just last year even, on December 11th 2014, the UN declared to June 21st as the "International Day of Yoga". Due to yoga being a multifaceted activity and my idiocy in neglecting to ask what specific type of yoga we practiced, some general purposes for yoga are listed below:

• Improving flexibility and balance. As a member of the UO Wushu Team, this is very important to me or any sport that involves standing on one foot or doing splits. 
• A form of alternative medicine. Although there is little empirical evidence in terms of causation, many correlation studies have shown yoga to improve mood, depression, & chronic back-pain.
• Establishment of harmony between the world around you and the True Self. According to Mrs. Dabak and our yoga instructor, the state of meditation established by yoga allows one to connect with God (term used loosely here).  

During my Winter 2015 Term at UO I enrolled in a gentle yoga class to give my mind a break in between the daily grind that is hard science. I was pleasantly surprised to see many similar postures and breathing techniques show up during our first day, making it easier for me to adjust. After our 1-hour session, though, I ended up just like Daschel and Kim - sore and worn out in more places than one. However, if any of you readers have done yoga before this is not the same kind of "tried" post-weight lifting. Rather, it is a refreshing and rejuvenating one.

Tomorrow: The start of our final rotations.