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. 

7/25 - The Zoo

Our final weekend in India before heading back to the states. We decided to go to Rajiv Gandhi Zoological Park and Wildlife Research Center for a little relaxation and animal-viewing. But first, during breakfast we finally got to meet Dr. SM Dabak (OB-GYN), the doctor in charge of the Maternal & Child Health program (he was visiting the states during the first three weeks). Having taught (according to some of the doctors we have met) around half of the doctors in Pune in some way or form, Dr. Dabak is probably one of the most well-known and prestigious medical practitioners in the city. 

The majestic white tiger.

This was the first White Tiger (Panthera tigris) I have seen in the flesh. Surprisingly, White Tigers are not albinos or a different species; they are simply Bengal Tigers with a recessive genetic trait for white fur. These creatures are extremely rare, so much so that they no longer can be found in the wild.

A butterfly.

That monstrosity of a snake below is known as the King Cobra (Ophiophagus hannah), the longest venomous snake in the entire world. These can grow up to around 17 feet in length, making an angry one capable of viewing you at eye level even from the ground. That, and the fact that they eat other snakes surely make their title quite fitting. The amount of venom from just one bite is enough to kill 20 people and even an adult elephant.

King cobra.

 Went back to the guest house to relax afterwards.

Chilling.

Tomorrow: yoga!!!

7/24 - DMH Hospital (Day 5)

Our last day at DMH.

Today we briefly visited the PICU again before seeing more patients with Dr. Joshi in his office. 

In the office we talked with Dr. Joshi as to why he became a pediatrician. His response was quite simple: it is an extremely social job. We all noticed it during our shifts, but Dr. Joshi absolutely loved to interact with the children and the parents alike. To him, to be a doctor means engaging with your patients and trying to understand them as much as possible. Not only does this keep the profession but going stale, but it helps you enjoy what you do all the more.

After our final shift we decided to see a movie: Minions!

Some interesting observations while about the cinema:

• Very rarely to people purchase their tickets at the door. It is almost always done online. That being said, tickets are extremely affordable. 
• Both Indian and American movies are available. Some have subtitles, others do not. 
• All seats inside the movie theater are reclinable. Quite relaxing.
• There is an enormous variety of snacks to choose from. Sandwiches, popcorn, samosas, ice cream, creamed corn with chutney, cakes, candies, hamburgers, pizzas, etc. 
• In the middle of the film, there is a 5-minute break period for viewers to get snacks or use the bathroom. 

Meet Kevin.

As for the film itself......7/10. Entertaining, but not much going on plot-wise. Sure is nice to hear your name spoken over and over again in a movie.

Our final weekend starts tomorrow!

7/23 - DMH Hospital (Day 4)

Today we did not shadow Dr. Joshi; instead we opted to check out something new: the Pediatric Intensive Care Unit (PICU).

Admittedly what we saw today was a lot harder to swallow than everything we have seen prior. All the children were in very critical condition, and the atmosphere was a lot more solemn than what we were used to.

What I learned about today:

Wilson's Disease: a buildup of copper in the body. These deposits occasionally leave a characteristic golden encirclement around the eye, dubbed the Kayser-Fleischer ring. Wilson's Disease also manifests in the liver of the patient, leading to liver failure and an extreme stage of jaundice.

Sometime during the middle of the shift I went to go see an inguinal hernia surgical repair. Due to protocol only one observer was allowed inside for the operation, so I elected to go. In essence, a hernia occurs when the inner contents of one's body protrude out from where they are supposed to be held. 

Last day at DMH tomorrow.

7/22 - DMH Hospital (Day 3)

Our second day with Dr. Rajan Joshi led us to the Outpatient Department (OPD), a place for patients who visit a hospital but are there less than 24 hours (not "checked-in").

In an earlier post I talked about jaundice, a condition brought about by high levels of heme catabolism product bilirubin in the body. This is a quite common occurrence in children and premature births, as the liver is not always developed enough to remove the excess bilirubin from the bloodstream. As a result, the yellow coloration of the bilirubin causes the characteristic yellow discoloration of the sclera and skin. Due to this common issue, Dr. Joshi has made it an important point to us as one of the major conditions to check for in newborns.

Another condition I learned about today was renal agenesis - a condition where one or both kidneys fail to develop in an individual. If one kidney is present, it is known as unilateral renal agenesis. If neither are present, it is known as bilateral renal agenesis. A lack of both kidneys cause the majority of newborns to pass away not long after birth. On the other hand, if one kidney remains there is no major risk to the well-being of the child as long as said kidney is functioning normally.

Not willing to make the same mistake of waiting to take a group picture on the last day, we took a picture with Dr. Joshi today.

Hooray.

7/21 - DMH Hospital (Day 2)

Today, we got to shadow the consulting pediatrician at DMH Hospital.

Dr. Rajan Joshi practices pediatrics at other hospitals, although multiple days during the week he travels to DMH to contribute his services. He has traveled to the United States frequently, both for professional and tourism purposes. Since his involvement with CFHI, Dr. Joshi has been in close contact with many of the past program participants. In fact, he even acted as the one cloaking a past participant during their white coat ceremony back in Michigan.

This lovely gem of a picture was right above Dr. Joshi's desk.

The majority of the day was spent in his office, watching him treat and diagnose patients. 

7/20 - DMH Hospital (Day 1)

First day at Deenanath Mangeshkar Hospital (AKA DMH Hospital).

This was the first government-run hospital that we shadowed over the course of our trip.

The inside of the main building.

A few general observations:

• Befitting that of a governmental clinic, the hospital is absolutely huge. Almost all medical services are available here. 
• Recently, DMH now is comprised of two buildings: the original hospital and the newly-constructed Super Specialty Hospital (ex. OB-GYN). 
• Available medical technology is state of the art. The majority of all work and patient information is processed electronically. 
• Protocols for sanitation and patient confidentiality are extremely tight here. ID tags were issued to all of us for additional security. 

The entrance to the new building.

For our first day, the three of us shadowed in the Neonatal Intensive Care Unit (NICU), a place where newborns that severely require medical attention are treated.

All the babies seen in the NICU were premature ones, usually in the 30-32 week range of gestational age. There are multiple factors that can contribute to a premature birth, including but not limited to:

• The presence of multiple babies in the womb (i.e. twins)
• Stress 
• A shortened or weaker cervix

As one may expect, a premature birth can be host to a plethora of complications for the newborn. Infants are generally at a greater risk when it comes to visual and auditory problems. In addition, developmental delays become far more common. These risks only become more severe the earlier the child is born. In order to keep the newborn as safe as possible, in the NICU they are usually kept in specialized warmers to monitor their oxygen levels, feeds (nutrients), blood pressure, and temperature. 

Laryngomalacia - Literally meaning a softening of the larynx, it is an extremely common issue in newborns where the weakness of the epiglottis folding in on itself causes airway obstruction. The characteristic sound produced by this is known as stridor. Although surgery is rarely needed for treatment (usually the larynx develops after a while to its sturdier state as the newborn ages), cutting said epiglottis folds can allow for restoration of airflow.

As a final note for this post, NICU services are quite expensive. Warmers cost ~20000 rupees a day (roughly $322 USD). Hospice care is available, but they are currently extremely few and far in between.

7/19 - Sightseeing Around Pune (Day 2)

More sightseeing today! To be more specific, the Balaji Mandir temple in the outskirts of Pune.

A bit more on religion in India:

~78% of the population in India practice Hinduism.

~14% practice Islam.

The remaining ~8% are comprised of other religions/groups, such as Christianity.

The Balaji temple we visited is a Hindu temple. Balaji is in fact another term for Venkateswara, a form of Vishnu. Vishnu, along with Shiva and Brahma, compose the Trimurti (the great trinity of deities in Hinduism). As mentioned in a previous post on Elephanta Island, Shiva is the Destroyer. Brahma is the Creator, and Vishnu is the Preserver.

An overlook we stopped by to take pictures.

The entrance to the temple.

Unfortunately, the temple forbids photography in the interior (which is a shame, because the inside is absolutely beautiful). The temple also requires that one must go in barefoot. Basically, the people entering follow a path from which they can pray to various statues in multiple shrines. After exiting the temple some free sweets are given to visitors to eat. 

Sai really liked to run up to the camera.

Delicious, delicious, bhutta.

Those delicious specimens you see above are known as Bhutta: roasted corn on the cob with salt, pepper, lime juice and chili chutney. There are literally hundreds of mobile bhutta food carts in both the rural and urban parts of Pune. For less than 1 USD, they are absolutely sublime. 

Next: DMH Hospital!  

7/18 - Sightseeing Around Pune (Day 1)

The weekend has finally arrived, and that means fun. Time to explore the touristy sites of Pune.

First stop is the Raja Dinkar Kelkar Museum, home to a wide variety of ancient Indian artifacts. Here are just a few of the displays I thought would be nice to share:

Rawr.

 The lion-esque figures in the above photograph are mythical creatures known as Yali. Bestowed with absolute supremacy in the animal kingdom, you will commonly find these standing guard in and around temples in South India. Yali are usually carved upright, with some demonic head under their feet - a symbol of all evil spirits or thoughts entering a holy ground being crushed.

A kumkum box.

What exactly is a kumkum box? Simply, it is a holder for kumkum, A.K.A. kumkuma. By grinding tumeric or saffron into a fine powder (which is subsequently dyed), kumkum is used as religious markings by people throughout India.

A cutout used for shadow puppetry.

Next stop is the Shaniwar Wada, an 18th-century fort built in the middle of the city by the Maratha Empire. Now, it is a popular tourism site.

The most photogenic people I have ever met.

Shaniwar Wada courtyard.

Our last stop of the day is Aga Khan Palace, an incredible piece of architecture built in 1892. Mahatma Gandhi was imprisoned here during the Indian independence movement in 1942. Gandhi's wife, wife Kasturba Gandhi, passed away in the palace in 1944.

Overlooking Aga Khan Palace. There were also fish in the fountain.

Feeling fabulous...

....and then some.

Next post: Temples and religion! 

7/17 - Jiviraj Children's Hospital (Day 3)

Last day at Jiviraj Children's Hospital. Luckily both Kim and Daschel were able to accompany me.

During our tea break, we had a chat with Dr. Kothari about the current state of patient care. We also asked why, like the other private hospitals we have seen thus far, are camera monitors kept in the doctor's office.

First, as mentioned in a previous discussion with Dr. Dugad, the infrastructure of the health system in India is undergoing a great amount of change. With each passing year the number of individuals receiving health insurance is increasing. However, the overall percentage is still extremely low in the grand scheme of things. That is not the only changing paradigm; the number of patients filing lawsuits against their doctors are also on the rise. In regards to the camera displays, Dr. Kothari explains that over the years failure to treat certain patients have been met with rage. Relatives and close friends of the deceased would bust into the clinic and beat the physician with sticks for his failure. As a response, the state of Maharashtra issued a law of 3-years confinement for assault of a doctor. This offence is non-bailable. The cameras are installed as an extra comfort.

The next day, we planned to join Dr. Kothari and his wife for a morning walk in the park (supposedly filled with peacocks). Unfortunately, he had to cancel at the last minute. Which also meant no group photo.

):

Later in the day, Dada and his family took us to Ranka Jewellers for some shopping. To be more precise, shopping for the girls. The quality of jewellery in India is quite high and quite affordable by US standards, although one must have a keen eye for authenticity among the hundreds of small stores dotting the city. Luckily Manisha was able to show us what was what. 

The outside of Ranka Jewellers.

Next round of weekend fun coming up!

7/16 - Jiviraj Children's Hospital (Day 2)

Today I returned to Jiviraj Children's Hospital with Kim.

Saw a good amount of patients again, but because this was a morning shift there were far less children.

Fun fact of the day: a lot of the younger babies made it a point to try to discover the flavor of stethoscope. This is known as oral fixation, the stage at which babies just like to....well, put items in their mouths.

During our tea break we had a nice chat with Dr. Kothari, where we talked about education. As one can imagine, in India the process of becoming a doctor is quite different.

In the United States:

1. Upon completing their undergraduate (or at least the ~3 years required to complete course requirements), an individual can apply for medical school.
2. Medical school lasts for 4 years, during which an MD or DO degree is awarded which allows practice upon completion of a residency program (which a medical student applies for during their last year).
3. This is typically followed by (during the last year of medical school or the first year of residency) a 1-year internship.
4. Next up is residency, in which time spent varies from speciality to speciality. For paediatrics it is 3 years. 
5. A 1-3 year fellowship could also be done after residency, where an individual specializes even further in their residency choice. 
6. Upon completion of the above and passing the examinations, an individual finally becomes board certified to practice. 

In India: 

1. Grades up to 12th grade (the equivalent of senior year in a US high school) are referred to as standards. 10th, 11th standard, etc....
2. Once a student completes 12th standard, he/she goes straight to medical college. This lasts for 5.5 years (1 of these years is an internship). Upon completion, the student then receives a Bachelor of Medicine, Bachelor of Surgery degree (M.B.B.S.). 
3. Individuals can then choose to pursue a postgraduate education. This lasts 3 years for a diploma. 
4. Upon completion of the above and passing the examinations, an individual finally becomes board certified to practice. 

Interesting, no? 

Final day with Dr. Kothari tomorrow!

7/15 - Jiviraj Children's Hospital (Day 1)

Finally back to the guest house and the daily medical rotations. Next up on the list is Jiviraj Children's Hospital, a private pediatric clinic run by Dr. Dushyant Kothari.

This was the first and only late-night shift taken over the course of the trip. Unfortunately, I was alone. You see, although my stomach is made of the highest grade industrial steel, Kim and Daschel were not yet totally acclimated after a week's worth of Indian cuisine. Thus, I had to go this one alone.

Jiviraj Children's Hospital.

Some initial observations on the clinic:

1. The clinic, minus the lobby and waiting room is split into 3 separate patient rooms. This includes the doctor's office.
2. In the short time I was there (around 3 hours), I must have seen around 100 children. Dr. Kothari usually spent no more than 2 minutes on each one. Nurses bustled back and forth between the narrow entrances to prep each child before they were seen.
3. There was a lot of crying.
4. There were also a lot of adorable children in adorable outfits. 

Because the previous clinics dealt with OB-GYN cases, I now find it most appropriate to discuss what I learn in each pediatric clinic. First up: Vaccinations, as I saw Dr. Kothari give A LOT of them.

As in the United States, newborn children are prescribed a series of vaccinations for their active acquired immunity. Here are just a few:

At Birth:

BCG - To prevent tuberculosis. 

OPV0 - To prevent polio. In India, most polio vaccinations are in the form of oral drops. They are cheaper in comparison to needles. 

Hepatitis B - To prevent liver infection caused by HBV. One prominent risk in newborn children living in India comes from failure in the liver, which then escalates into jaundice. 

6 Weeks:

Pneumococcal Conjugate Vaccine - To prevent pneumonia. 

Rotavirus - To prevent severe diarrhea in newborns and young children. The rotavirus is the most common cause of this. 

6 Months: 

Flu Vaccine - To prevent flu. The 2nd dose is given after 7 months. 

Others:

Measles/MMR + Vitamin A - Given after 9 months. 

Typhoid (TCV) - Given after 10 months. 

Anyhow, it was an interesting experience. We will be returning tomorrow, so there will be much more to learn!

7/14 - Mumbai Trip (Day 2)

Day 2 in Mumbai.

Woke up around 7:00 AM in order to catch the ferry to Elephanta Island. No; there are no elephants on Elephanta Island. All three of us asked Dada the same question. The name came from the Portuguese when they found an elephant structure around the 18th century upon arrival. Said structure is now on display somewhere in Mumbai.

Now, the main grab of the popular tourist attraction is the cave temple(s) built to honour Lord Shiva, the Destroyer. So, after one extremely shaky and seasick-inducing ferry ride, we finally reached the island.

So tranquil. Besides the roaring tourism.

A happy(?) family. 

The first thing I did in a car when I touched down in India was search for monkeys. Besides the dead one we found during our morning hike, Elephanta Island was the first spot where we saw live ones. Actually, we saw at least a hundred of them. Notorious for stealing from shopkeepers and tourists alike on the island, we were told to steer clear from all monkeys. That, and numerous dark red spots all over their body that led me to believe that getting bitten would be a bad idea. Funny story: a few years back one girl from CFHI had her purse (with her passport within) stolen by one of them. 

The 120-some steps leading up to the cave temples.

The caves. A lot more impressive in person.

One of the numerous sculptures found inside.

 These were the first ruins I have ever visited. Quite impressive!!!

Alas, after that our trip in Mumbai came to an end. We picked up some Starbucks (Yes, that is everywhere) and started on the long road home.

Sorry!!!

I had little to no internet for the remainder of my trip. Now that I am back in the good ol' U S of A, posts on this blog can resume. Stay tuned!

7/13 - Mumbai Trip (Day 1)

Woke up early for the next part of our mini-vacation: Mumbai!!! Roughly a 2.5 hour drive from Pune.

Some quick facts on Mumbai: 

• Mumbai is the capital of the Maharashtra state in India. Originally, it was known as Bombay until its official name change in 1995.
• With around 21 million inhabitants in the metropolitan area it is the most populous city in all of India. 
• Despite being the country's wealthiest city, more than half of the population lives in slums.

First on our list was sightseeing. Here were our stops:

1. The Gateway of India. From 1858-1947 India was under occupation & rule by the British. Upon a visit to India in 1911 by King George V & Queen Mary, the Gateway of India was constructed to commemorate the arrival. It is, by far, Mumbai's most popular site for tourism. 

The Gateway of India.

2. Nariman Point. Located at the tip of the Mumbai peninsula, it is the business district of Mumbai. 

3. Marine Drive. A circular boulevard that hugs the coast. Nice view.  

On Marine Drive.

4. A Jain temple. A place of worship for Jainism, the oldest religion in India. 

An elephant statue decorating the Jain temple.

5. Malabar Hill. The rich residential district of Mumbai and home to the house of Maharashtra's Chief Minister. 

6. The Pherozeshah Mehta Gardens. Nicely arranged flora in the shape of various objects and animals.

7. The Tower of Silence. Just next to the PM Gardens, the tower serves as a place for the flesh and skin of the dead to be removed by scavenging birds. Originally used by Zoroastrians. 

8. The Mani Bhavan. From 1917-1934, this was the residence of pacifist and Indian independence leader Mahatma Gandhi himself. Now, the mansion serves as a historical exhibit (President Obama visited in November 2010). 

Gandhi's room.

9. The Dhobi Ghat. An open-air laundromat originally built for British soldiers during their occupation. Now, it is used by the Mumbai populace to wash their clothing. 

10. The Victorian Building. Home of some universities. 

Next, we did some shopping. I bought some swimming trunks for our imminent swim at our hotel. Souvenirs here are quite expensive even by US standards; most of my gifts will be purchased back in Pune. 

McChicken. No beef here due to obvious reasons.

After a 'refreshing' lunch at McDonald's we decided to check into our hotel of choice: The JW Marriott Mumbai Juhu. This was my first ever 4.5 star hotel I have ever stayed at. That being said, I will let the below pictures do the explaining. 

Our room.

Our pool. Out of 3 other pools.

Our dinner at Spices restaurant in the hotel.

Next: Day 2 of our Mumbai Trip & Return to Pune!!!