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!!!

7/12 - Singahad Fort

First day of relaxation!!! We woke up at 5:00 AM in order to get ready for some much needed exercise.

Quick history lesson.

The Fort of Singahad (AKA "The Lion's Fort") is located around 30 km from Pune. Built upon a cliff for natural defense, it was the site of multiple conflicts throughout history. The most famous one was a recapture offensive in 1670, pitting defender Udaybhan Rathod against Tanaji Malusare. Tanaji was a commander under Shivaji Maharaj of the Maratha Empire. Despite being outnumbered 500 to 5000, Tanaji led the Maratha troops to victory and lost his life in the process.

The name Maratha sound familiar? Yep. Marathi is the name of the language spoken in Pune, and Maharashtra is the name of the state in which Pune resides. Both of these terms are widely speculated to hold origins in the Maratha Empire.

We got to hike this fort today.

There was at least 200 other people hiking alongside us. At first the path was easy; just a broad rocky road. However, the farther up we went, the steeper, slipperier, rockier, and smaller the path became. But at the end.....man. Cannot deny that view.

The hike.

1,312 m above sea level.

Started from the bottom now we're here.

At the summit of the fort, stands with drinks, a temple and even a hotel was present. We snacked on some delicious onion bhaji (Indian onion fritters) before heading back down the path.

When we got back to the guest house we all collapsed from exhaustion. Spent the rest of the day sleeping and relaxing. Took a moped with my caretaker to pick up some custom wear I bought a few days prior. Gotta wake up early tomorrow.....for Mumbai. 

7/11 - Dugad Hospital (Day 3)

Last day at Dugad Hospital. What did I learn about?

1. Cervical polyps.

2.  A Medical Termination of Pregnancy (MTP, AKA an abortion). In India, if there is 1) a substantial risk to the life/well-being of the mother and/or 2) there is a high risk that the child will be born with mental/physical disabilities. then an MTP can be performed within 20 weeks of pregnancy (during the 2nd trimester). Only the mother's consent is needed. According to Dr. Dugad, an abortion can still be performed after 20 weeks under certain circumstances, which includes but is not limited to:

a. Pregnancy induced from rape.

b. Failure of sterilization.

c. Pregnancy in mentally handicapped individuals.

I learned so much from Dr. Dugad over the past 3 days. His dedication towards medicine, helping others, and humor are nothing short of inspiring. It will be hard to top this clinical experience!

Also, after our last shift his wife took us shopping. Woot woot.

Lookin' good.

7/10 - Dugad Hospital (Day 2)

Second day with Dr. Dugad!!! 

To his memory, Dr. Dugad has performed over 5000 cesarean sections in his lifetime. We asked him if he ever gets sick of it, and he responded with this:

"A painter does not get sick after 5000 paintings because he is a painter." Do what you love, and you will always love it.

Words to live by.

Laparoscopic sterilization is another procedure performed in this clinic.

According to Dr. Dugad, it is not uncommon for a patient to request open hysterectomies instead, being a more financially appealing option.

See below.

Here is something interesting. The above sign is not only prevalent at Dugad Hospital but Siddhi Hospital as well. In 1994, the Indian government passed the Pre-Conception and Pre-Natal Diagnostic Techniques Act. The act forbids the usage of an ultrasound or any technique for the purpose of finding out the gender of the baby before the birthing period. The law was implemented due to gender ratio imbalance (a high social preference for sons) and high rate of female foeticides (sex selective abortion).

Last day with Dr. Dugad tomorrow!

7/9 - Dugad Hospital (Day 1)

Next stop: Dugad Hospital. Another privately owned hospital, except this one is run by a single doctor, Dr. Dugad (OB-GYN) himself. Like Siddhi hospital, Dugad Hospital specializes in obstetrics and gynecology. Both open and laparoscopic procedures are performed here.

The outside of the hospital.

Before Dr. Dugad arrived, we shadowed a visiting pediatrician giving vaccinations for Hepatitis B, Tuberculosis & Typhoid. 

Some observations of note:

1. Like Siddhi Hospital, open-toed sandals are used in the OT.

2. Many tools, such as the laparoscope, gloves, clamps, etc. are cleaned and reused rather than disposed.

3. Tea breaks!!!

Below is what I learned about today:

A uterine septum, a condition in which a malformation causes a barrier of sorts in the uterine cavity. This has been known to be correlated with higher rates of premature births and even miscarriages. To rectify the problem, the surgeon enters and cuts the septum.

Polycystic Ovary Syndrome (PCOS) is a condition in which multiple cysts arise in the ovaries, causing hormone imbalance. Many females diagnosed with PCOS have problems with conception (in other words, infertility). Using the standard laparoscopic procedure these cysts can be drilled and drained of fluid, allowing natural recovery of the ovaries.

Every Thursday morning, Dr. Dugad volunteers his services at a government hospital (which is more or less the equivalent of free clinics in the US) and offered to show us what the majority of Indian citizens receive (a glimpse of, and I quote, "The True India"). For reference, according to Dr. Dugad:

1. Health insurance is relatively new in the country. Approximately 5% of the populace has a form of health insurance similar to what a US citizen would consider as health insurance. Around 30% has some medical plan (although not similar to health insurance). The rest have neither health plans nor health insurance.

2. Many medical practitioners are required by the government to provide their services to these government hospitals for some X amount of years, as a way of repayment for medical education costs.

3. The American healthcare sector is extremely specialized: gynecologist, pediatrician, dermatologist, laparoscopic surgeon, general surgeon, anesthesiologist, neonatal surgeon, immunologist, etc. India has this too, albeit on a smaller scale. Enlisting a specialist (if even available in the area) is extremely costly. Thus, a wide range of health issues are taken care of by a single doctor.

4. The level of care received in these governmental hospitals varies, not due to equipment or supplies but because of staffing. At the hospital we visited in particular, the attending staff are fully trained to handle births. Dr. Dugad frequently visits just in case an emergency occurs during the process. Not all clinics are this lucky.

Walking in to the governmental hospital, the quality difference between public and private care was stark. No photos were taken for privacy reasons.  

7/8 - Siddhi Hospital (Day 2)

Second and last day in Siddhi Hospital.

Whenever there is a possibility(s) that certain health complications will be present in the child and/or the mother during the childbirth process, it is up to the discretion of the obstetrician to perform a Caesarean section (AKA a C-section). This is commonly due to breech or transverse positions of the baby in the womb.

This was the first childbirth I have witnessed in person. And, cheesy as it sounds, this post cannot even begin to describe how incredible it is to see. I spent close to an hour admiring the newborn with Kim, Daschel, and the nurses. It was an amazing way to finish our first shadowing experience. 

Our first group photo!

We decided to use the evening to learn navigation around Pune without the assistance of Dada. Kumar Pacific Mall was not unlike a lot of the malls back in the United States: attached is a one-stop supermarket for general needs, the top floor has a large food court, and name brand stores are abundant. The girls each purchased a sari (traditional female garb).

Kumar Pacific Mall.

New clinic tomorrow!!!

7/7 - Siddhi Hospital (Day 1)

My first shift begins today.

The first stop in the program is Siddhi Hospital, a private clinic that specializes in laparoscopic surgery. Dr. Kothavale (OB-GYN, laparoscopic surgeon) was our supervisor. Each morning, we would follow him on rounds before changing into scrubs and observing the operations performed in the Operating Theater (OT).

Typically, when an individual thinks of surgery they imagine the stomach being sliced open for the surgeons to play around in. Laparoscopy, on the other hand, is a minimally-invasive modern surgical technique. Rather than making one giant hole in the pelvic or abdominal cavity, small punctures are made that allow fiber optic cables (laparoscopes) to enter the cavity and operate on, well, whatever needs to be operated. This lends itself to some nifty benefits:

1. Less pain.

2. There is far less probability of blood hemorrhaging during the operation.

3. Because there are smaller wounds, recovery time is usually shorter after a laparoscopic procedure.


Two kinds of laparoscopic procedures of note that are performed at Siddhi Hospital:

1. Lap Hysterectomy - Excision & removal of the uterus.

2. Lap Cholecystectomy - Excision & removal of the gallbladder.

After around 7 hours of non-stop standing in the OT, we were ready to head back home.

Spent the evening playing with Dada's daughters and helping the elder one (Sanskruti) with homework.

7/6 - Luggage

Lufthansa finally shipped my luggage to the Pune airport!!!

I finally got to change out of the clothing I have been wearing since last Thursday. Unfortunately, I had to skip my first work day in order to retrieve it. 

Feeling relieved is quite the understatement.

Since I did not really get a chance to do anything today, let me take some time to talk about the cuisine:

As mentioned in the previous post, the majority of people in Pune are vegetarian. Vegetarian restaurants are literally everywhere in Pune, and many food products have a green circle label on them denoting them as vegetarian-friendly. However, that is not to say the food here is strictly reduced to grains, fruits, and vegetables.

The most common proteins consumed in Pune are chicken, lamb, & fish. Beef & pork are far less available due to Hindu & Muslim religious practices. In fact, beef was recently banned after the Maharashtra Animal Preservation Bill (created in 1995) finally was approved by the president in early 2015.

I was surprised to find many Chinese & American (KFC, McDonalds, Subway, Dominoes) restaurants as well during our drives.

Almost all of our meals, sans breakfast, follows the same general outline: chapati (similar to roti, a type of flatbread used for dipping), an assortment of mixed vegetables (tomatoes, okra, cauliflower) seasoned with spices such as cumin, and a more saucy dish with a pulse base (dal) for the dipping.

For those reading, I am sure you are curious as to whether or not the cuisine here delicious. I can only say this:

You want this. Yes, you do.

Bread with spicy soup. Incredible.

Sandwiches made with tomatoes, cucumber, & mint chutney. Strong flavor.

7/5 - Pune....Without Luggage.

I finally touched down in Pune International Airport at 5:00 AM on July 5th.

Unfortunately, because I bought new tickets, the transfer for check-in baggage was not made between Etihad & Lufthansa. Oops.

With only my camera, carry=on backpack, and the clothes on my body I met my caretaker, Dada Waghamode. After trying to help me find my suitcase, we decided to drive back to the guest house and wait until later in the day before trying again (which unfortunately, proved to be unsuccessful).

The guest house is owned by Dr. SM Dabak (OB-GYN), who has been working with CFHI to host the students who come here to Pune for the program. Dada lives here with his wife (Manisha) & family (grandfather, grandmother, mother, brother, and 2 daughters: Sai & Sanskruti) and has acted as caretaker for the past ~9 years in the program. Many nearby university students also frequent the guest house in order to purchase meals prepared by Manisha.

My room for the next month. It is attached to the other guest room.

I also met the two other CFHI students that would accompany me for the month:

Kim Obey, 1st-going-into-2nd year med student studying at Michigan State University College of Human Medicine.

Daschel Franz, incoming junior pre-med student studying human physiology at University of Oregon (Fellow Duck!).

The general layout for the program is as follows:

• Weekdays would involve shadowing physicians at the various clinics in Pune.
• Breakfast, lunch, & dinner would be provided by Dr. Dabak's residence. 
• After each shift & during the weekends, we could do whatever we want (so long as it was legal and within the guidelines set by CFHI).

As today was Sunday, it was simply an orientation and the rest of the day was free. In the wake of recent events, I resigned to my bedroom.

Some initial thoughts on Pune:

1. The climate is extremely similar to that of Kuala Lumpur, Malaysia. Not searing hot (still hotter than the US), but quite humid.

2. Mopeds & rickshaws are the main mode of transportation. That being said, driving here is like playing nonstop Tetris, if Tetris had no bottom level and 50 blocks were falling at the same time.

3. A vast majority of the populace here is vegetarian due to financial as well as religious practices. 

First shift starts tomorrow!!!!

7/4 - Abu Dhabi

Shorter post.

I woke up at around 5:00 AM from the hotel to check out. I was overjoyed to receive my tickets from Etihad & Jet Airways and finally continue on my journey.

I touched down in Abu Dhabi around 7 PM. My flight to Pune was at 11 PM, but unfortunately there was a 1 hour delay.

On the way to Abu Dhabi.

Leaving Abu Dhabi! The view was beautiful.

7/3 - The Most Expensive Nap of My Life

I can never sleep well during flights.

Couple that with long flights and wait times and you have yourself an exhausted travel. While waiting for my final flight from Frankfurt to Pune, I set three alarms and decided to get some rest.

Usually, I am very secure with my luggage. So I wrapped my backpack and camera case around my legs before dozing off. It was a good thing too, because when I woke up I still had all my valuables and there were no signs of theft.

Actually, there was not anyone around at all.

Because I slept through my alarms and my flight. I missed the takeoff by 20 minutes.

Commence 10 additional hours of staying awake, calling back home, and running back and forth throughout the Frankfurt airport trying to get a new flight. Unfortunately, I had to purchase entirely new tickets.

Because the earliest flight was not until tomorrow, I had to bite the bullet and stay at the nearest hotel. A very fancy one, might I add, filled with various kinds of room service, gourmet restaurants, and bars. That hot shower was probably the only good thing that happened for the rest of that day.

This is what 160 Euros will get you. 

Next post will be about my new, unexpected stop: Abu Dhabi.

7/2 - Departure & Flying

Welcome to Day 1 of my journey.

On July 2nd, 11:20 AM, I said goodbye to my family and departed from Portland International Airport.

Let it forever be known that I am not fond of flying. And by that, I mean the "getting from point A to point B" bit. I can never sleep, it is very loud, and I cannot help but worry as to whether or not I will lose my luggage in some freak accident. This is the third time I have traveled by flight in my life, and the first one alone.

Leaving PDX. Ah, the classic carpet.

First stop from Portland was in Denver, Colorado. 2-hour flight.

My food on the 2nd flight. 

During the following 9-hour flight, none of which I could catch some shut-eye.

My next stop was in Frankfurt, Germany. After passing through baggage check once again, I did some exploring. I happened upon a special cafe, the likes of which I have never seen before in the US. The star ingredient? 

Caviar. Lots and lots of caviar.

Unfortunately, I did not have any Euros in my wallet to grab a quick snack.


Next post will probably arrive when I touch down in Pune.

Pune

Google Maps!

For the Maternal & Child Health program, I will be traveling to the western city of Pune. 

Some quick facts on Pune:

• India is divided into many different states. Within the state of Maharashtra, Pune is the 2nd largest city (Mumbai is 1st), with a population of 4.5 million. In terms of the entire country, it is the 9th-most populous. 
• Pune is home to a wealth of high-prestige educational institutions (i.e. universities). As such, it is commonly known as the 'Oxford of India'. It is the only city in India where there are 7 universities.
• Marathi is the common language spoken here; English and Hindi are also frequently understood and spoken. 
• Pune has the highest number of pubs in Asia, as well as the larger number of cigarette smokers in India. 
• Pune has the highest number of 2-wheelers in Asia.