CMC-Vellore

Just a word

2008-05-12T09:20:00.000-07:00

I guess i haven't really conveyed how much my trip to India had given me an appreciation for how good we have it here. We have access to clean water, to food, to health care, jobs, clothing. No, not everyone has these things, and we are still a work in progress here, but India is something else entirely. And yet people carry on, with quiet resolve, despite all the obstacles that may be in their path. India produces great minds and achievers consistently, and when I think of my journey to this point in my life, it looks so easy compared with one coming from such an environment. The people of India impressed me with their patience and way of always getting done whatever needed to be done, regardless of all the absurd bureaucracy, power failures, and overall counter-productive nature of things. I have a deeper respect for people, and a much greater appreciation of the gifts that I have been given, as well as a more profound sense of responsibility to use them to their utmost.

Pretty heavy, huh?

I am very very glad that I had the wonderful opportunity to take this trip. It was all I'd hoped it would be and more, so I would like to express my gratitude to the Paul Brand Scholarship foundation and UTHSCSA for making it all possible. I strongly encourage any students considering this experience to go for it.

But bring plenty of TP and gatorade powder in case you have to rehydrate!

Bye!

Mumbai - the last day

2008-05-11T18:58:00.000-07:00

Hello everyone,
As mentioned before, we spent our last day in Mumbai. Actually this was my birthday too, and I had kind of an ambitious itinerary for it, but Felicia was game, so off we went. First, we walked about 15minutes north of our hotel to the famous Victoria Terminus, the Grand Central Station of India.

As you can see, there's old Victorian architecture aplenty. Its kind of crazy to look at.

Then we went inside to see the ridiculous masses of people. I think we were a little late for the stereotypical images of people riding on the roofs of the trains, but I've heard it does happen all the time. We got there far enough after rush hour that everyone was crammed inside the trains, at least. They say that when it gets really busy, the rail authority refers to it as "Super Dense Crush Load", meaning there are 16 people for every square meter of floor space per train. How do you breathe? Personal space is not expected in India. Everyone pushes all the time, there is no concept of a line, people cut in front all the time, and push, shove, and push again for the slightest little thing. Its very annoying.

After VT (as it is known) we kept walking "uptown", passing more interesting architecture. I have no idea what this is, but it sure looks cool.

As you walk along, this is a common sight, in Mumbai, Delhi, even Vellore. At almost every corner there is a guy with a pile of sugar cane stalks and a stand. They put the cane through a press and collect the juice, mix it with flavors, and serve. There are almost always lines for these stands, even though they are everywhere. They all use real glassware, and I did not see any hot water anywhere, so I shudder to think of what you can pick up from those glasses, much less what is in the special cane-juice additive.

Felicia and I kept walking north, past a busy fruit/veg/livestock/spice market. We thought about it for a minute, saw they wanted to charge us to go in, and decided we'd seen enough similar markets at this point, so we pushed on. We entered another "market" district of town, with some streets all jewelry, some all silk, etc etc. Along the way we ran into a temple, surrounded by flower vendors. Here's the top of it.

We kept walking, and then decided to push farther north into what is know as the "thieves bazaar" to find some old movie posters to fill a request from a friend. We asked two different shopkeepers, and while they could not identify the address we were looking for, they both said it was dangerous to go there, even in the daytime, and that we would likely be robbed. We then asked a policeman, who said the same thing. This was kind of strange, because all the guidebooks we have speak extensively about this place, but are quick to point out that the name is a misnomer, and recommend it for shopping. Well, we decided to take a cab, figuring we could always tell the guy to keep driving if we didn't like it. Our cab driver, of course, had no idea where we were going, and could only get us within 2 blocks of the place. we grabbed our stuff and hustled it down 2 alleys and there it was! The people at the shop were very nice, gave us cold Cokes, and helped get us a cab and give the driver directions when we left. A success!

So, our next stop after that was the Mahatma Gandhi museum. This is free! Based in the house he stayed at in Mumbai over 20yrs, it is small but nice.

Upstairs, there is an awesome room dedicated to telling Gandhi's life story through about 40 highly detailed dioramas! somebody put a lot of time into these things. They make the shoe boxes I used to take to school look pathetic. Here is one of the rows of dioramas.

This is an example of one of the dioramas. All the little people are very detailed dolls, with hair and detailed clothing and all kinds of cool stuff.

This one depicts his assassination. I guess you can tell I thought these were pretty cool.

This is Gandhi's bedroom. They tried to keep it the way it was when he lived here, except, i think they added a couple of portraits of him. Either that, or the guy was very narcissistic.

For lunch we went to a place that was kind of like Denny's for Indians. They even had a large Mexican food section (I passed on that). Felicia got a poori, which is like a giant balloon bread. Fun stuff!

After lunch we headed over to the side of Malabar Hill, where a very popular Hindu temple is located. Unlike many previous temples, they actually let us inside this one, we were just prohibited from taking any pictures inside. It was up a really long flight of steps, and was topped with beautiful white marble. We were amazed at how clean they have managed to keep the thing, considering how dirty many things, especially the air, in India can be.

Here is a view of part of the bottom half of the temple. Lots of people came and went to prayer as we were there.

We climbed up some steps behind the temple and wound up on the top of Malabar Hill. From a park up there you can see the bay and downtown, with Chowpatty Beach in the near distance.

Here is Felicia, enjoying a break from the heat and all the walking.

The park at the top of the hill also had a giant Old Mother Hubbard shoe, so I fought many children (seriously, this was actually quite an undertaking; nothing in India is simple) and made it to the top for this pic.

After the park, we headed down the hill to a Jain temple. I need to read some more about Jains. They seem like Hindus, but a lot more laid back and friendly.

Here is the outside of the temple.

Inside, they were fine with me taking photos, and didn't even try to charge me anything (hear that, Hindus?). There were many small sparkly shrines set into the walls, with images of various gods, or incarnations of gods.

After that, we headed over to Chowpatty Beach. This is famous as the place that real Mumbaikers head to on evenings or weekends. The water is apparently disgusting, and we saw sewer pipes draining right on the beach where people were swimming, so out feet stayed dry. It was pretty amusing, though. As the sun set, lots of people were out, and lots of vendors roaming around selling peanuts, roast corn, etc, etc. Some guy walked up to me and offered me a massage. No, thank you.

Here are some of the people gathering on the beach.

Chowpatty Beach is famous for one of its foods sold at all of the stalls, called bhel puri. Well, we were getting on a plane in less than 12 hours, so I told Felicia to put me on the plane home no matter what was happening to me. Then I went to the most famous place, Gupta's, and got some. Bad idea. It hit me on the plane. That was a long, uncomfortable flight, during which I enjoyed none of the 5-star cuisine I had been looking forward to. This one was my fault. Do not eat street food in India. Seems like a no-brainer, huh?

As we sat there on the beach, eating my poison snack, there were some carnival rides next to us. We realized that there was no power out there, and these were all being run by human power. The Ferris wheel was powered by the guys standing on the structure and pushing it with their feet, faster and faster. Occasionally, one guy would grab onto a passing car and jump off, using gravity to pull the car down even faster. This was nuts.

Here is a shot of a guy hanging onto a car. The guy on the side there pushes the wheel round with his feet. I was sure I was about to witness and amputation or something. I have attached a great video of this at the end, so please check it out, its worth a look.

Well, after all this we headed back to the hotel.
Felicia had gotten a sari made, so the tailor had delivered that. Then she took me out to eat at what is probably the nicest restaurant in Mumbai, for my birthday. It was really, and the wine list was ridiculous, and it was a very sweet birthday present for which I am extremely grateful. We had a wonderful evening on the top deck of the restaurant, and weren't attacked by monkeys or anything. Then we went home, packed up, and headed for the airport at 2:30AM. You already know what happened on the flight home.

So,
five weeks in India, 3 bouts of GI distress (the last totally my fault), about 15 pounds of weight loss, 1 car wreck including a concussion with stiches on my face and likely broken ribs (they still hurt pretty bad 3 weeks out, I'm seeing someone here in the next day or two). My rotation at the CMC in Vellore was great. I saw a lot of the country, and I have decided that Vellore is without a doubt the dirtiest place in that entire country (only slightly edging out Agra, which is a hole and exists solely for its architectural points). I made new friends, saw and did new things. I survived, had a lot of fun, but man am I glad to be home. I can drink the water! No more Indian food 3 times a day! I have about 6-7 gigs of pictures that I'll be posting online, so let me know if you want a link to my gallery once it is up. I may post one or two more times, but this is the meat of it here.

Felicia and I appreciate you reading along with our adventures, and hope you have been entertained. Now all I have to do is graduate in less than a week and move! Good times.

Don't forget to check out the goofy Chowpatty beach video. If y'all want to see anything else, let me know and I'll post it! Thanks for reading!

mumbai wrap-up pending

2008-05-09T20:21:00.000-07:00

hello,
Felicia and I are back in the US. I just wanted to let you know that a lot more Mumbai stuff will be posted in the next day or so, along with some of my final impressions. We had an absolutely awesome time there, and I'll have some fun video too!

A quick note though: do not eat street food in Bombay. It will make the flight home very very long.

See you soon. It'll be fun!

-chris

Mumbai so far

2008-05-07T09:54:00.000-07:00

Hello,
We're in Mumbai/Bombay, obviously. I, at least, had heard a lot of sketchy things about this place, and also heard that overall its just too crowded, noisy, etc etc.....so far we like it a lot. I know there is definitely a bad part here, but perhaps we just have not seen it yet. Crowds? i haven;t seen anything worse than NY. Dirt? I've seen worse in Vellore. Shady characters....see DC, New York, etc etc. So far, its been a pretty good time. Admittedly, we've been doing touristy things and pretty much frequented the tourist-heavy areas, but we'll be venturing out a little more tomorrow, so we'll see....

Here's a pic from Trivandrum of the local Hindu temple. Felicia hadn't seen one of these yet, so she thought it was pretty neat. Lots of religious trinkets and stuff for sale around it. And a big "pond" for sacred washing. Lots of people showed up for evening prayer when we were there.

Closeup of the intricate details on this temple. Every inch is some sort of figure doing something.

In Mumbai, there are areas like the Mall in DC, or big parks, called "Maidens". The Oval Maiden is the most famous, especially for the constant games of cricket going on. Here is one of them.

A view of the Queens Necklace at dusk, wrapping around the back bay of Mumbai. Felicia and I sat here for a while. Lots of people strolling and just sitting happily.

The Gateway of India. Iconic, on the waters edge near the Fort and Colaba. We departed from the steps here on our boat to Elephanta Island today.

View of the Gate as we pulled away on the boat.

Neato Victorian architecture abounds, amidst heat, humidity, palms, etc.

One of the many very large figures in Elephanta Caves. It is a world heritage site 1-hour by boat from Mumbai. These are giant caves carved from solid rock around 6th century AD, with many columns, and large figures of the gods doing all kind of stuff. A lot were damaged by the Portuguese and others over the years. Here is Felicia for scale.

There is a giant 3-faced Shiva in the center of cave 1. Actually, the whole site is all about Shiva. This depicts 3 different faces, a fourth implied facing backwards. He is destroyer, kind, wise, all kinds of stuff in these. Amazing stonework deep in a cave temple (about 50 yards), all done by hand.

Another view of 3-faced Shiva, flanked by attendants.

Shiva again. Felicia is normally about 6 feet tall, so look how big this is in comparison!

Here's one of the cave temple entrances for example. They go real deep, with the large figures of Shiva and others all over. Too many awesome pics to post.

Churchgate train station at night. Lots of double-decker buses running around here. Pretty fun to see.

More cricketers at the Oval Maiden, with the High Court behind.

OK, that all from me. See you later. 1 more day, then home! I'll post a follow-up w/ more pics once I get home! -chris

Words from Felicia:
Hey all,
We have had a couple of really long days, so I'm being really lazy and I am not going to post any pictures this evening. I just want to say a few things. I think Mumbai may be moving to the top of my list as my favorite city we have been to in the past two weeks. The old European buildings with modern Indian people and lifestyle is very interesting and unlike anything we have seen thus far. Today we committed one of the seven deadly travelers sins. We ate at McDonalds. But I have to admit after weeks of eating Indian food something familiar we GREAT. Maybe there will be time to post tomorrow before our flight home, but in case there isn't time this has been a great trip and it has been fun sharing it with all you loyal readers out there.

Felicia

Mumbai / Bombay

2008-05-06T19:50:00.000-07:00

Hello all,
We have made it successfully to our last stop on our trip. Trivandrum was sleepy and great. We had a layover in Banglaore, and while we were only there for about an hour, the weather was awesome. Nice and cool(ish) and dry.

Mumbai is a big big city. Like New York on steroids. I've heard some pretty dodgy things about this place, but so far its bee nice, probably because he haven't moved around too much. There was definitely some shady business at the airport with our cab ride into town, but if anything I overpayed about $7, so whatever. We are staying in an are called the Fort, apparently where the Brits originally had theirs, although nothing remains today. We went past eh Oval Maiden yesterday, a big lawn where all the locals were playing cricket. And then headed on over to the Back Bay area, where we sat on the sea wall overlooking the Arabian Sea. The streetlights there ring the bay, and are called the Queen's Necklace, as the resemble a string of pearls. We watched the lights come on, and then headed across the street to get pizza and beer! Almost perfect, although the sauce still tastes funny. They always add "something" to make it taste Indian.

Today we are going to catch a boat to Elephanta Island, a big island in the bay renowned for its hand-cut temple caves. Felicia is very excited about this. Then for some general wanderings...

I'll try to post some more pics later.

Trivandrum (or, as close to the bottom of the subcontinent as we can get)

2008-05-04T23:30:00.000-07:00

Hello,
We are now in Trivandrum (aka Thiruvanathampuram...say that 5 times fast). Its the captial city of the state of Kerala, and almost at the very bottom of India. For a good sized city, it's really nice and laid back. Vellore was ten times more crowded and dirty, and it was just a little town with no real claim to fame other than a hospital.
To get here we took the train, one of my goals for the time in India. We got unreserved sleeper car tickets, and I was initially worried that we wouldn't be able to get on the train. You know...unreserved, only a couple of spots per car since they are sleepers....wrong. "Sleeper" means that there are bunks and stuff, but the closest I can come to describing this car was the pics I have seen of troop carriers ferrying US soldiers over to Europe in WW II. People all over the place, on bunks, in the aisle, hanging out the doors. Felicia and I get on with our backpacks and go "Whoah". We crush past people through 3 cars, finding nowhere to even stand, get off the train, go back up 4 cars, and then wind up I think back on the very 1st car we had gotten on. We found that if We took off our packs, slung our smaller bags up onto a bunk with other baggage, we could lean against the wall in the back of the car, between the doors and the bathrooms, with about 8 other people. Luckily, nobody closes the main doors on the cars, so there was a breeze to take away the revolting stench from the bathrooms once we got moving. It was soooo hot and humid too, sweat was pouring off of us. And these guys kept pushing through the cars selling hot coffee and tea the whole time. Nuts. Well, after about 1/2 hour some people got off, and then about another 1/2 hour later we managed to snag a bunk/seat next to window. The trip was much more enjoyable after that. Watching Kerala go by, with the breeze and traveling like the locals do, it was pretty neat. The whole thing took about 3 1/2 hours, pretty reasonable. Our tickets were Rs 84 each ( a little over $2, so what do you want), nobody even came by to check them. We decided that Kerala is officially beautiful. Sorry I have no pictures of the train trip, but there were so many people that were all crushed in there, and trains are so notorious for theft here, that I locked our bags and chained them to the seat. Just take my word for it, it was an initially unpleasant experience that improved significantly. And cheap too.
We got in, got to our hotel, with a/c and hot water (yes!) and feel a little like real people again. Unfortunately, it looks like most stuff is closed here on Mondays (?) so we will do a little sight seeing, a little shopping, and finish recharging ourselves before heading into the proverbial lions den that I hear Mumbai can be. We leave tomorrow AM, get into Mumbai around noon, will probably get to our hotel by 2PM (if lucky). We are there for 2 1/2 days, and hear it is the craziest place of all in India. Wish us luck.

Here are a few last pics from Kerala. I'll stop now, I promise.

These are people waiting at a "bus stop", since all transport on the backwaters is via boat.

If you don't take the bus, you take the family car. This is the only way to get out of the house.

Kerala was the first place to ever have a freely elected communist government, back in the 50's or 60's. The party is still popular, and you see stuff like this all over. Commies in paradise. Hey, if it were this vs siberia, I'd take this.

Our little friend who lived under the sink in our outdoor bathroom in Alleppey. Sometimes would serenade me at night, thanking me for splashing so much water all over the place.

Typical first thing I would see in the morning at the rustic Malayalam Lake Resort. Hot water? - no. A/C? - no. Mosquito net or screens? - no. Electricity? - usually. View and atmosphere - oh yeah.

Twilight on the backwaters. Man, this was nice.

We're off to shop and take pictures of temples and stuff. Mumbai will be nutty, but I'll try to get a post or two in from there. Thanks for reading!

- Chris and Felicia

Alleppey and the Backwaters of Kerala

2008-05-03T22:52:00.000-07:00

Hello,
This is Felicia! Vacations are awesome. We just spent a relaxing 3 days amongst palm trees on the relaxing backwaters of Kerala. I have become very good at doing a whole lot of nothing. Getting back to work in the lab is going to be tough. We stayed in a cute little cottage, ate some good home-cooked meals, and then spent a day on a houseboat that took us though the backwaters of Kerala. That trip was fun because we got a small window into what it is like to live back there and see their fields and stuff. I was quite and experience. We had the best south Indian meals so far on the trip. No we are on to Trivandrum for a little less relaxation and hopefully some cool sights, before we eventually head for home. When we get home, I'll show everyone some great pictures of Chris in his Indian garb. Bye!

Hi there, this is Chris. I second what Felicia said. Kerala is just an green, calm, beautiful place to kick back. The little mom-n-pop place we stayed at on the water was great and cheap. Thatched hut, outdoor bathroom & shower, candlelight home-cooking by the water's edge at night. Kind of like roughing it a bit, but fun and nice. We went out on a boat set up by Manish (of my prior Kerala trip). It was great, and we had a wonderful time together. I got to drive it for a while! When tied up in a canal for the night, we discovered our boat was next to that of two Swedish students that had been my hostel-mates back at the CMC in Vellore! They are taking a long weekend. Small world, huh? Anyways, Felicia and I got even more lazy, and floated around, drank some beer, read some books, played some cards, and ate really great food. Today we hop a train to Trivanrum for a few days, then fly up to Mumbai, and from there eventually head for home in less than one week. This has been a long trip for me so far, but it is far from over......

Here are some recent pics of us:

This was our little piece of heaven. Our hut is tough to see, over on the right side.

Yes, Chris has a sickness. He had to fish in India. Not quite enough for dinner, but at least its something!

Our front porch, where Chris kicked my butt at blackjack.

Felica ponders gene mapping and haplotypes.....or snoozes as we cruise along. The beer in the foreground might be involved.

Felicia and a tree. Oh yeah, also really pretty canal and lots of green nature stuff.

Chris on the houseboat. In a dress (no, that's a dhoti, thank you very much!)

Our view from the boat. Begin jealousy now.

That's all for now. Thanks for reading! We'll see you soon from somewhere else.
-Chris and Felicia

Flood of Pics

2008-05-01T00:01:00.000-07:00

Hello I'm back. Felicia is working on apost of her own right now, so please forgive us if there are duplicate photos.

First: I am alive. And, I got to shave! The loveley and talented, soon to be Dr Gomez in her own right, proved deft with scissor and tweeser, and successfully removed my stitches. Oh joy. So, you will all be able to tell the pre and post pics. Man, that scruff was driving me crazy in this heat.

I'm going to start out w/ some left over pics from Vellore I never posted.

This guy is sharpenning scissors in the marketplace.

The fancy shmancy hotel (or at least the closest facismileto one) in Vellore had this mural covering the wall in its restaurant. Now, I may be a culturally insensitive American, but I think I know one Indian from another.

Menus in Vellore were also goofy. For chicken dishes, the heading would be "Cock-a-doodle-doo" Seriously. I forgot to get a pic of that. Enjoy the description of the typical "American Meat Salad". Yum.

Well, its no Cock-a-doodle-doo, but why does a butler need a salamander. Under a pizza?

So, we have moved on from Fort Cochin. I will not be defeat by thins nation. First off, lets tally this up. In 3.5 weeks, I have had 2 GI problems requiring fasting and antibiotics the most recent one really brutal), plus a car wreck involving a concussion, what i believe to be fractured ribs (I still fall to my knees when I sneeze, it really hurts sometimes), a deep laceration requiring stitches to my face, and other assorted scars. The other day I felt so bad that I started counting down the days until we left. But I feel a lot better now, so here we go! I have some more pics from Delhi and Agra.

On the way to Agra we passed a wedding procession. I actually got out and danced like a fool with the drummers. This is what they thought as we moved on.

We saw about 10 tombs in 1.5 days. This was one of them . I forget who is in here (sorry).

Another neat looking tomb, either in Delhi or Agra, of somebody famous and now dead.

Felicia, as always, drew a crowd. In many touristy places, everyone wanted a picture with her. It was funny at first, and then I think it started to get old.

Felicia explores Agra Fort.

Felicia in the public hall at Agra Fort.

Agra Fort again. I really liked the red stone. This place is still 60% occupied and used actively by the Indian Army.

B&W version of the previous pic.

Walls and moat of Agra Fort.

Veiw as you enter the main court to the Taj Mahal. Pretty sweet.

We stayed at Fort Cochin 3 nights. Finally got me out of the house on the last night, to go see the local dances. These are incredibly ritualized, the closest thing I could conceive of comparing them to would be Kabuki in Japan. It was really neat, and even though it is the off-season and there were maybe 15 people in the audience, the troupe was took their work seriously and were very impressive. This is an art form native to Kerala (the state on the southwest coast where we will be for the next week). It is called Kathakali.

This is a Kathakali guy dressed up as some demon king. Pretty detailed story told only through dance and music. If you get to the show hall early you get to watch him put on his makeup. Only men perform this (in both male and female roles).

Well, this AM we bid farewell to Cochin, and made it down to Alleppey (a.k.a Allappuzha) by 10AM. We are staying at the Malayalam Lake Resort. It is impossible to find, and I only heard about it on an internet message board. I am already impressed. Yeah, its basic. No screens in the windows (lots of DEET at night), no TV, open air bathroom/shower, but it is right on a canal, incredibly relaxed and peaceful, and the staff are very nice. They brought me some ginger juice and mango to help my stomach. And they gave us a canoe to cruise around in this afternoon. We will be here 2 nights, then spend a night on a houseboat, before heading down to Trivandrum. Alleppey is not bad at all, except lots of people bug you to take a ride in their houseboat or backwater tour. No thanks, we're getting that taken care of already.

Be it ever so humble.....

Here's Felicia chilling out on the little day-bed that sits over the water. So stressfull....

Well, thats all for now. We'll keep on keepin' on. I now have to try to work on graduation stuff and apparently my intern-year schedule all from India, so this is a little goofy, but whatever.

See you soon! -chris

Hello from Felicia

2008-04-30T23:26:00.000-07:00

Hello Everyone,
This is my first time blogging, so please be a bit patient while figure this out. Chris has already told you about most of our activities, so my plan is to just fill in some of the details and post some more pictures. My arrival into Delhi was mostly uneventful......aside from the hotel mix-up (which was a pain in the butt). After we both arrived in Delhi we did our tour of the city.

Here is a picture of Humayun's tomb. This was probably my favorite thing we saw that day. This building is supposed to be one of the inspirations for the Taj Mahal. It was very peaceful and grounds were beautiful.

Here is a picture of Chris and I at the tomb. I have posted this picture as an example of my inability to take good pictures. We have so many pictures that would be great if I did not have my eyes closed. Oh well, such as life.

Here is Chris at the B'hai temple. This is a classic Chris pose that I thought deserved some blog attention.

The next day we went to Agra and visited Agra's Fort and the Taj Mahal. As Chris said there were tons of beggars (both kids and adults) in Agra. I'm never quite sure how to act around them and at times they can be a bit much. However,some of them are very entertaining. After consistently telling one kid that we are not going to give him money he threatened to call the police, and walked away from us yelling "Police, Police!" It was great.

So, in Agra I was a rock star. We met so many people who could not believe that I really exist. It was great. Several Mongolians and also Indian tourists wanted pictures with me. Here is an example of one of the many pictures I took at the fort. I should have started charging for pictures. I might have made a profit on the visit

Here's Chris making a face. I'm not sure what else I can say about this. You just gotta love him.

Here is the obligatory monkey picture. So cute!

After Agra we hopped on a plane and flew to Cochin (and stayed in an area called Fort Cochin). As Chris has already mentioned Fort Cochin had its ups an downs. We had a great time with the elephants, but the weather on our first day was really not great, making site seeing no fun, and Chris was sick for a a good bit of the visit.

Anyway, here is a picture of the Chinese fishing nets that are used along the beach at Fort Cochin. Basically they use big nets to catch fish that swim by. The fishermen here also use more moder methods of fishing, but I think these are still very much apart of the fishing industry.

While we were in Cochin I also got to pretend that I am an MD, and I removed the five stitches that Chris got from the accident. Maybe I have a second career in plastic surgery......

Here are some more elephant pictures. This was an awesome morning! I had so much fun, and by the looks of it think Chris did too. At the end of this post is some video of Chris washing the elephant! Have a look.

Just in case you couldn't tell I am having a great time. It is trips like this that make almost three years of long distance well worth the time and effort we have both put in. Right now we are in Alleppey and are staying in a small resort on a lake. It is awesome.

More to come in a few days. I hope everyone at home is good. Can't wait to hear what everyone else is up to!

OK, we're back in business...sort of

2008-04-30T03:59:00.000-07:00

Hello everyone.
Sorry about the hiatus. Its been a little wacky, but we're online (at least for today). Since we last spoke (or rather, I monologed) we have had a whirlwind last few days. So, Felicia and I met up in Delhi. Our hotel room was most entertaining. As mentioned before, we got a car and driver for a day in Delhi and Agra. Delhi was fun. Agra was ridiculous. For the first part, our driver stopped off several times during the day to take us to "museum/shop" places that were really just stores full of tourist stuff. When we got to Agra, we were hounded by people begging (especially the kids, which is tough and they know it....one of them kept calling me Uncle). Actually, Delhi was pretty bad too. Its a shame, because all these people getting in your face insisting that you buy stuff makes you a little paranoid and on edge while you try to enjoy the sights. Having white skin is like having a target on your forehead. But black skin has its own issues too. If people sometimes stared at me, Felicia was very very popular. You'd think these people had never seen a black person before. Many Indians are as dark as her, but they looked at her like she had just stepped off of a spaceship. Amusing, especially when they all wanted their pictures taken with her.

Here is Felicia inside one of the mausoleum "annexes"

So, we went to Agra. Saw the tomb of Akbar. Had lunch. Went to the Taj Mahal. It was like running a gauntlet to get through the people trying to scam you out of every little cent. I really began to feel like all Indians just want to nickle and dime you to death. I know this was just sypmtomatic of the locale, but it got old really fast.

Here is the lotus-shaped b'hai temple in Delhi. They were very nice. It was free, including shoe storage.

I think this is Akbar's tomb. Its all blurring together.

Inside of Agra Fort.

Holey Moley, I can see the Taj mhal from here!

Yes, we are very cute.

Our hotel in Agra was ok, not much better than the one we had in Delhi. We did get a free breakfast again, though! We left early to make sure we did not miss our flight out of Delhi that afternoon. The two cities are about 120km apart, but on Indian roads that can easily take 4 hours. Our driver stopped again at the same little rest area as before, this time there was a guy with a cobra out front. So we walk over, I figure it will be a couple of rupees. He wants to put a python on Felicia's neck but she declines. He pulls out the cobra which gets all worked up and puffs up. We take our pictures. And then he demands 500 rupess. Wow. My mistake for not agreeing on a price sooner. We haggle, I give him 300 (about $10, still way too much), but he is a dirty nasty old man and I just want to get on the road.

We made it to the airport in enough time and got to Cochin with no problems. This place is so much more laid back than around Delhi. It was a little cooler, if more humid, but cleaner and less hectic. Our homestay sent a car to pick us up, for what amounted to a 1hour drive to our new home. We were very pleased with the new digs, went out to eat, then home to sleep.

In the AM, we got up early and headed over to the elephant training center, where orphaned elephants are taken in and trained, so that they can lead productive lives working for the forestry department or in temples. If you get there early enough, you can help wash them in the river!

Here is Felicia scrubbing away with a coconut shell! We scrubbed a 6-yr old female named Asha. She was very clean in the end.
Here is footage of the acutual elephant scrubbing. There are shots of me too, we'll put them up in a few days. Anyways, it was a dream come true for me to scrub an elephant. We got a ride on the big adult female too. Wow. Thats a lot of animal.

On the way home I realized that India is trying to kill me. I began round two (and by far much more severe) of my gastro-intestinal difficulties. It has been pretty rough. Felicia is wonderful, though. We were supposed to have moved on today, but we stayed in Fort Cochin for an extra day to let me be a little more presentable in public. I probably won't eat at all today, but you gotta do what you gotta do.

Tonight we'll try to see some ritual dance performances, and then tomorrow its on to Alleppey, and eventual houseboat time.

Here are a few words from Felicia:
Hey, world! Look Mom I'm blogging. The next time we get to another internet cafe I will put up a proper post, but I just want to say "Hi!" and let everyone know that I am doing well and I am having a great time. So far I have not had much gastric upset and for the most part the climate seems to agree with me, although Chris may have a different opinion. We have got to run to the theatre, so I will leave you for now. Thanks for reading! More to come!

Hello From New Delhi

2008-04-26T09:33:00.000-07:00

Hi all,
I made it to New Delhi without incident. My flight was on SpiceJe, one of the low cost carriers here in India. It was actually a rather pleasant experience. Non-stop from Chennai to Delihi, on-time, my bags made it. Not too bad. Felica was there to meet me at the airport. There was a bit of a mess when she got in in the AM, but she got us into another fine hotel and they were there to meet me. We're staying at the Karat 87 Hotel, in Karol Bagh ( a part of New Delhi). Its actually not too bad. The place has friendly staff, great lighting, 24-hr room service, hot water, tv, and free breakfast every day.
This morning we arranged a trip with a travel agency to take us to Agra tomorrow. We had the use of a car and driver all day today, and then he'll pick us up tomorrow, take us to our hotel in Agra with some sights along the way, then to the Taj Majal and Agra Fort. Monday AM he'll take us to the airport for our trip to Cochin. Good deal actually.

Today we say the Gateway of India, a really old mausoleum that the Taj Majal is patterned after, and the giant Bahai temple which is shaped like a lotus flower. Then we had dinner on a rooftop in the chaotic Paharghang district, did some shopping, and came home. A full day already.

I'm impressed with New Delhi. The contrast between this and the dusty, filthy town of Vellore is stark. In New Delhi I see a lot less trash (although Felicia, not having seen Vellore, might differ in opinion), a lot less cows (although they are by no means absent), many more cars than motorcycles and ox-carts. The roads are paved, and I see what appear to be middle-class neighborhoods. Don't get me wrong here, there are still plenty of people living in terrible squalor and poverty. This is still India. I guess that Vellore shows me one side of this nation, how many people live amongst filth and dirt and disease, how people eke out a bare subsistence every day. I come to Delhi and see wide roads, shiny condos, and the economic powerhouse that this nation has become. It is a remarkable dichotomy, best represented by my strolls though the city this evening. Beautiful city and filthy reeking alleys with handicapped beggars wallowing in filth as cattle roam freely. This place never ceases to capture my attention.

I took a bunch of great pics today. This camera I borrowed is really getting a workout. The web -access at this hotel is crummy at best, though, so no pics today. Hopefully tomorrow I'll be able to put up a bunch from our hotel in Agra. I'm having more and more fun every day. Part of it comes from being a lot more nonchalant about stuff, as a "veteran" in comparison to Felicia. Part is also just how happy I am that she is here. Its great to see her. I've really looked forward to seeing and doing new stuff like this with her, so good times all around. Plus, I'll probably make her take the stitches out of my face in a day or two!

Awesome!

OK. Well, sorry about the pics, but like before, hang in there. There will be a deluge once I get the right kind of access.
Wish us well.

Goodbye to Vellore

2008-04-24T21:44:00.000-07:00

Well folks,
I am about to embark on the "after" part of my Vellore - n -after trip. Goodbye shreiking giant mutant bats that wake me every morning. Goodbye crazy Vellore town. Goodbye CMC, which I got to know from a variety of viewpoints! I got to see and do and learn a lot. Some disappointments, but I'm still very very happy with my experience overall.

So now I head up to Delhi this evening. Felicia already got there this AM. She called to let me know that the hotel there we had been corresponding with regularly, which had arranged to pick her up at the airport when she got in at 5AM 1) did not pick her up 2) had no rooms available when she got there. Stupid Hotel Tara Place. You will get some bad on-line reviews from us.
The last I hear, she had found another place, but could not check in until noon, so I guess she's hanging out in Delhi for a few hours. In theory they will pick me up too.....let see what happens.

We'll spend 2 day in Delhi, and take a day trip to Agra to see the Taj Mahal. Then we fly down to Cochin in Kerala, stay there a day (hopefully wash some elephants), go down to Alleppey, back on a house boat, then down to Varkala for a night, then to the very bottom and Trivandrum (Thiruvanathapuram). From there, fly up to Mumbai for a few days, and finally head home on the 9th of May. Wow. I am going to need a vacation after this trip.

Internet access may be spotty. I'll post text whenever I can. Pics will depend on many things, but I shall try. Felicia's going to post on here too.

2 more weeks of wacky fun! Wish us luck!

Chikungunya Virus

2008-04-24T00:44:00.000-07:00

CHIKUNGUNYA - A Problem for Vellore, Tamil Nadu, India, and the World

Overview

Chikungunya fever is a re-emerging viral disease, especially in South India, characterised by abrupt onset of fever with severe arthralgia followed by generalized fatigue, fever, chills, nausea, vomiting, lower back pain and rash lasting for 1-7 days. The disease is usually self-limiting, and rarely fatal. The virus (CHIKV) is an RNA virus beloning to family Togaviridae, genus Alhpavirus, and derived its name from the Makonde word meaning "that which bends up", referring to the stooped posture developed as a result of the arthritic symptoms of the disease.

History

There are apparently two distinct lineages in Africa and Asia. This arbovirus shows some diversity between these two strains. In Africa, the disease cycle is maintained between monkeys and wild mosquitos in the forest. In contrast, the Asian lineage cycles between humans and our old friends the Aedes aegypti (also the vector for yellow fever, Dengue, and other fun diseases. Basically, they are jerks) mosquito. These like to bite during the daylight hours.

The first recorded epidemic was in the early 1950s, in Tanzania. Shortly after that, CHIKV was noted in Bangkok, Thailand in 1958, with viral transmission continuing up until 1964. There followed a period of quiescence, a hallmoark of this disease, followed by a second period of activity in Bangkok in the mid 1970s, finally declining in 1976.

In India, there have been well documented outbreaks in 1963 and 1964 in Kolkata (Calcutta) and southern India. This 1964 outbreak was very well documented, as it was focused on Vellore (home to the CMC), Chennai, and Puducherry. As the rainy season turned to summer, moquito populations bloomed, and as temps dropped and things dried out, the mosquito polulations shrank, with a resultant decline in human cases. A small outbreak was reported in Maharashtra (around Mumbai/Bombay) in 1973. One of the most publicized ourbreaks was among several islands in the southwest Indian Ocean, namely La Reunion, Mauritius, and the Seychelles, apparently ongoing now since 2005.

In keeping with its pattern of activity-quiescence-activity, the disease has also reappeared throughout southern India since December 2005, in the states of Andrha Pradesh, Karnataka, Maharashtra, Madhya Pradesh, and Tamil Nadu (where I am right now). This outbreak continues to the present day. In June 2007 there were 7000 confirmed Chikungunya patients in southern India, and it appeares to have spread from Kerala and Tamil Nadu to Sri Lanka around this time. As of Jan 2008, at least 8 people had been diagnosed with CHIK in Melbourne, Australia, and in Singapore authorities were given legal power to detain any Chikungunya cases.

Clinical Features

As stated above, this is an acute infection with abrupt onset of fever and severe arthralgia, followed by other constitutional signs, with a rash lasting for a total of 1-7 days. The incubation period is usually 2-3 days. Fever often rises rapidly to 39-40 C, and shaking chills, with this acute phase lasting 2-3 days. The temperature me wane for 1-2 days, then return, in a "saddleback" fever curve.

Arthralgias are polyarticular, migratory, and predominately in the small joints of the wrists, ankles and feet. They usually progress in a specific order, actually. Knee, then ankle, then wrist, then phalanges, then elbow. Patients in acute stage are incredibly reluctant to move, prefering to remain in the flexed position, often confined to bed.

Patients do not exhibit any active bleeding, but do evidence hypotension and GI distress.

Cutaneously, patients present with flushing over the face and trunk, followed by a maculopapular rash, occasionally extending to the face, palms, and soles of the feet.

Other signs and symptoms can include headache, photophobia with retroorbital pain, conjunctival redness, sore throat, and pharyngitis.

Neurologically, encephalopathy is the most common sequela, with alterred sensorium and ataxia. An EEG within normal limits offers a good prognosis and decreased likelihood of mortality. CSF shows increased proteins, increased activated lymphocytes. On MRI, multiple high-density dots are seen (similar to those seen in Nipah virus). There are no spinal cord changes seen. Other than encephalopathy, the other common neurologic manifestations are myelopathy, polyradiculopathy, neuropathy (early > late), and carpal tunnel syndrome (2/2 excess synovial fluid and swelling).

Dangerous sequalea may occur in neonates, who are prone to developing meningo-encephalitis. This disease can be transmitted vertically from mother to fetus. Similar complications occur in the immunosuppressed as well.

The tricky thing is that symptoms of CHIK infection are almost identical to those opf Dengue fever, and dual infections of these two have been reported.

Prognosis varies with age. Younger patients tend to revover completely within 5-15 days, while the middle aged take 1 to 2.5 months. The elderly can take even longer.

Detection

A serological test has been developed and is in wide use throughout affected regions. This is employed via am IgM card test. There are also rt-PCR assays. The actual virus has only been isolated from CSF twice.

Management

At present, as with many viral infections, there are no specific treatments for Chikungaya fever. Luckily it tends to be self-limiting and resolve with time. Stiffness and morning arthralgia can be improved with movement and mild exercise, but heavy activity appears to exacerbate the problem. Many medicatons have been tried. IV Methylprednisone, plamapheresis, IVIg, and others, alone and in combinations, have had poor responses. NSAIDs are recomended, and Chloroquine has been reported as useful on arthritides refractory to NSAIDs.

Otherwise, one should keep infected people away from mosquitos to reduce further transmission.

Prevention

There is no vaccine currently available. A Phase II vaccine trial sponsored by the US in 2000 used a live attenuated virus and showed 85% resistance at 1 year.

Other measures recomended are the same as for all mosquito-born illnesses. Cover yourself, use DEET, eliminate breeding sites by dumping, covering, or draining stagnant water etc etc.

This might work too.

Follow-up

Why Chikunganya exhibits its active-rest-active cycle is as yet unclear. Recent outbreaks have been more severe, and sequencing indicates that the virus may have altered its virus coat protein, aloowing it to replicate in mosquitos more rapidly. The recent vaccine trials are promising, but wide-spread use has been postponed pending the outcome of long-term studies.

2008-04-23T05:50:00.000-07:00

Hi everyone!
I'm doing pretty good, inc case you were wondering. I'm healing pretty well, the ribs still complain from time to time, but so far so good. I do, however, have some pretty bad vertigo if I move my head too fast or close my eyes. I've done a lot of putting my foot on the floor and grabbing the table to steady myself. And sometimes I walk like I'm a little inebriated. Which I should be used to (there, I beat you to the joke! ha.) But it could be worse.

I walked around the past couple to days and took some more random pics of entertaining stuff here in Vellore, in light of my pending departure, but my faithful interent cafe is closed for the day. Acutally, there has been a power cut for all of Ghandi Ave (a mojor commercial street), so a lot of people have generators running on the sidewalk. Just adds to the heat and pollution. However, I was just in a travel agent's office, and it was like a sauna in there. No power even for fans. Wow. Those are some sweaty travel agents. Anywho, I had some funny pics, but only a 50% chance I'll get them up before I head out tomorrow. I shall do my best though.

Instead, some more random musings:

1) It turns out that Anne, she off the head-holding in jerry-rigged C-collar, and I have a connection. I may have already posted this, but I have a head injury so let it slide. I went to All Saints in Manassas, VA for elementary school. I was the skinny kid in the class and my dad was an MD. The chubby kid in the class, who's dad also was an MD, was named Paul Cioletti. He left All Saints around 5th or 6th grade, and I haven't heard anything since. Fast forward a couple of decades, and I remember noting about 4yrs ago that I had a classmate named Cioletti. I just noted the occurrance, thats all. Anne and I (and Cristina and I, for that matter) never really interacted too much over the past 4 years. With a class of 200+ people, its easy to move in differerent social circles. However, since we arrived here about the same time, we started hanging out together in India. Better late than never. And guess what? She says that there is a great uncle or something like that who is an MD in Manassas, VA. Thats right, she's related to those Cioletti's. Small world, huh?

2) I'm pretty bummed about this whole car wreck thing. I was really looking forward to my Internal Medicine rotation this week. The prospect of seeing some fascinating and (to us, at least) rare infectious diseases was part of what drew me to this experience in the first place. However, I definitely have not been stable enough on my feet for a whole day of rounds. But it still stinks. I will content myself with the really neat stuff that I have gotten to see and do already. CHAD was absolutely wonderful, and Neurology gave me good insights ad to how the inpatient services are run, and what facilities they do and do not have access to here. I guess I got an insider's look at emergency medicine too.

3) I'm not sure if I've posted a picture yet or blogged about this, but it really is amazing how many people one can fit onto your average motorcycle. Minivans are for soccer teams, not families. All you need is two wheels. And really good brakes. Everyone here relies on their brakes for their lives.

4) New Foods. I have become the default "Mikey", as in Life Cereal "hey, he likes it!" Mikey. Anne and Cristina, when pondering some new thing on the menu that they want and yet don't want to try, often command me to order it. These are usually things with a title alone, no description, so we really aren't sure what it is sometimes. Yes, I am in complete control of all of my actions, but I am adventurous too....so I usually take the challenge and order it. Its pretty funny when it turns out to be really good and then they call the waiter back to try some themselves. I've definitely had more good luck with this than bad. No, I have not been surprised with a plate of monkey brains or live snakes......yet. This trip is far from over.

Here's a nice little view down one of the cool shady hallways on campus. It is really starting to heat up here. As much as I love my hostel, with no a/c, it is not cooling off at night the way that it did just 2 weeks ago. But it's still fun, especially with all the other students here from around the world. And we have a kitchen with fridge (keep cold drinks in here), hot plate, and washing machine so we can do our laundry whenever.

This is the only great funny picture I can post so far today. This is in the lobby restaurant of Hotel Surabi, probably thje priciest place here.

I'm not the smartest guy in the world, but do they have the right Indians on this thing? I'm so confused.

OK. I'll try to get my disease profile up later today.

My 1st Person Experience with Indian Healthcare (or The Car Wreck)

2008-04-23T01:31:00.000-07:00

TO ANY FUTURE UTHSCSA VELLORE STUDENTS ---- DO NOT TRAVEL BY ROAD AT NIGHT IN INDIA IF YOU CAN AT ALL HELP IT!!!!

As much fun as we all had during our weekend in Kerala, hanging overhead was the spectre of the ride back. Our "bus" ride there had taken hours longer than anticipated, on very narrow, very scary roads. Imagine looking out the windshield, on a two lane road, and seeing four vehicles side by side coming straight at you, two of which are heavy trucks and one a large bus. No shoulders avaialble, no other lanes availablle, nothing. Imagine a similar two-lane road, where evferyone passes at all times blindly.....you are in the mountains, the road is incredible windy. You are sitting on the side opposite the driver, so on turns you can sometimes see further dowen the road than him. He tries repeatedly to pass on the outside of blind curves, where you can see there is a really really big truck coming in the other lane, and you are positive it will all be over in just a second....and all of this at night too, so add to it all the cars, carts, rickshaws that have no lights whatsoever. Anne stopped looking out the front; she just watched my face and knew from my expression the likelihood of death in the following seconds. Hmmm..no wonder everyone says "Do Not Drive at Night in India!".

But we made it. Our driver, though was very sleepy, and though it was daylight on arrival, he was falling asleep at the wheel when we finall got to the houseboat launch. We had a great weekend, and all agreed that it would be aq good idea to head out Sunday AM, so out driver had as much day driving as possible. This was way too long a drive for a single driver, so we needed to help out as much as possible.

Then we got offererred free massages next to Manish's house on Sunday....and we all went for those instead. In retrospect, my classmates and I all agree that we all still had misgivings about leaving later on Sunday, and that if one single person had made a point of objecting, they probably would have too. Instead, we all, like a herd, went together on this. Therefore, this was obviously a completely avoidable incident. We brought this on ourselves. We had the power and insight to avoid this situation and did not....please learn for our stupidity, and don't hesitate to put your foot down when you have to. Luckily, this could have gone a lot worse.

So, we head out around 4PM. We stop off for dinner around 7:30, traffic is not too bad, the driver seems to be well rested. We watch some movies on the van's DVD player. Unfortunately, it is situated in such a way that the driver can actually look up and see it, so I catch him occasioanally with his eyes off the road. It all goes OK though, and we relax. We cross into Tamil Nadu, the winding mountain roads are done, and I relax. The seats are so crapmed tobether, though, that there is no legroom, so I stick my legs out into the aisle. On the left side of the van, Cristina is in the second seat, I'm behind her, Jamie is behind me. On the right side, behind the driver, are Dinesh and Claire, behind them Anne, behind her Vida, and in the back row, Swami (aka Michael) and Kevin, our friends from Oklahoma. The movies are off, we all drift off to sleep.

The next thing I know, I here Dinesh yelling my name. there is a lot of noise, people are yelling, I hear my name a lot, and think "this cannot be a good thing". I hear Dinesh say "His pupils are blown", and people seem generally pretty worried. I am very groggy. The closest thing to this would be when I have over-indulged on adult beverages (I know, its a shock) and someone is waking me up. I open my eyes, and its all pretty hazy. I'm on the floor. Everyone is very excited, and I get the feeling we've crashed. However, I don't know why we're here in the first place. They help me up, and they all seem happy I'm somewhat alert, but I am curious "What happenned?" and "What are we all doing in this van?" seem like reasonable questions. I think we way have been together for dinner. or something. Dinesh reminds me that we were on our way back from Kerala and we crashed. This is all news to me. Kerala.....maybe.....not sure. So, we sit up, but they want to keep my C-spine stable, so Anne gets that duty. Apparently I have a nice laceration on my chin, and I'm bleeding all over her hands while she sits there and holds my head up. I tell her I don't have any funky diseases. Not sure if that helped, but its about all I can do for now. After about 5 minutes, I'm somewhat oriented. Big whopper of a headache, my jaw hurts, my ribs hurt, my thigh is killing me. I look around. Apparently everyone is alive, but apparently Swami's lage hurt, so some classmates are working on him. I have to say, if you are going to crash, having a bunch of people around you who are a few weeks shy of their MDs is a good thing.

I remember thinking how bad I wanted to get out of the van. Thoughts of fire pop into my head. But nobody will let me run around without neck support, so I sit with them. Looking around , I see the sun has just come up, and there are people milling around the back of the van. I hear that an ambulance is on its way. Cristina is sitting next to me. She apparently got banged up pretty good too. I try to crack some jokes but really still am useless and reliant on everyone else. This is not a good way to be. The ambulance arrives in what seems to be not too long. However, they have no C-collars. Really? Really. No C-collars on an ambulance. So we use what we have been using - rolled up towels wrapped around our necks. They start to get us out of the van and into the ambulance, and people start taking pictures of us. Anne has had enough of this and lets them have it. I accept it as payback for all the medical pics I have taken in my life. So we get into the ambulance (all 9 of us). Swami, Cristina, and I seem to be the worst hurt. Nobody has any obvious fractures, My leg hurts like hell but no deformities. Maybe my ribs are broken, but too early to tell. They want to take us to another CMC facility but we insist on Vellore, it is only 120Km away. We were so close to home when it happenned. As we pull away I see our driver standing in the road with a big gash under his eye. I guess he will have to take the second ambulance.

(Here is our van and the truck we hit. I was sitting in between the intact and the crumpled window on this side. Cristina was in front of me. She says she openned her eyes and just saw truck in her lap. There is a seat even farther forward that we had occasionally sat in, next to the driver. If anyone had been there for the crash, they would have died. Lucky.)

As we head to CMC in Vellore, I try to get a handle on what happenned. The driver fell asleep. We his a truck. Apparently I shot out into the aisle (no seatbelts in these things) and they found me under a seat (not sure if it was one that had come loose or not). I was completely unconscious. Snorring, even. Ha ha. But really tough to wake up. They were all very worried and happy when I openned my eyes. Out cold for 3-5 minute total. Cristina got clobbered with something in the side and chest. Dinesh got hit in the face with the DVD player. Everybody else had several abrasions, cuts, painful spots, you name it. We all got beaten up pretty bad. Luckily for you, loyal blog readers, lots of pics were taken!

Here I am holding my make-shift C-collar together in the ambulance. Cristina comforts herself with candy. Even now I know when there is a camera on me. Don't be fooled, I'm in a lot of pain, but even that won't stop me from performing. Thumbs up!

It sure is nice to have connections and a cell phone. Dinesh calls ahead to CMC to let them know we are coming in Swami's mom went to CMC, so the Chief of Medicine is alerted we are on our way as well. Still, when we get there, lights and sirens, nobody is waiting. We get dropped off in the courtyard with everyone staring at us. My leg hurts so bad, I start geting pre-syncopal (light-headed), and have to sit down on the ground. After a minute or two they get me a wheelchair and roll me in. Somebody puts a C-collar on me (finally!). I'm taken back into "Casualty", their version of the ER. Well, they take a quick look at me, no obvious broken bones but possible rib fractures, I'm alert and oriented, not about to die, so they slow thing down a little. I understand how it works. Still, they check my abdomen (no pain), I can move all 4 limbs, etc,etc. However, at no point whatasoever in this entire experience, does anyone do a proper mental status exam on me or a real neuro exam. It still blows my mind, but I guess they have thier protocols, so OK.

Here I am getting my face lac cleaned. I look at this and think, I must be acting. But then remember it really hurt a lot. Maybe I was acting a little.

At CMC, they will not do anything until you pay for it first. I am very lucky I had friends who while hurt, still ran around and got me registered, held my personal effects, and payed for my bloodwork and X-rays. Apparently from what I hear it was kind of a pain in the rear to fill out all the forms and pay and run from window to window fighting all the other families there. The chief of medicine popped in and took a look at all of us to make sure we were going to survive. Actually, that was pretty nice. He seemed to think things were going OK, so good times! Eventually, my x-rays were payed for and they wheeled me in. The view of the ceiling as they wheel you along on a gurney is wuite memorable. Now I know why its used all the time in movies and TV. So they get me in there and start shooting, with no sheilding at all for my personal bits or thryroid or any of me. Femur. Head. Neck. Chest. Shoulder. Wait....my shoulder is fine...They actually called Jamie into the room to have her pull on my arms for proper positioning. She got sheilding. I was not in my preferred attire, the position they put us in was akward, lets just say that Jamie and I shared a moment neither one of us will soon forget. Sorry Jamie! You are a trooper!

Here I am on my wat back from X-ray.

Well, you know how ERs work. Slow. In the meantime, I hear updates on everyone else. Swami is OK, Cristina's still being looked at. Some nurses come by and want to stitch up my face. No way!! Dinesh told me that when he looked he thought he might be able to see my jawbone deep in my cut. Uh-uh, we're having suregeons sew this up. So they agree to get plastics to come and do it.

Here's my laceration. Not too good a pic, but anyways, its deep, through the subcutaneous fat.

This whole time, everyone one else is being very very helpful. I am greatly indebted to Anne, Dinesh, Claire, Vida, Jamia, and Kevin for all of their help that day. They got all of out stuff sorted out, payed our fees (ridiculously cheap by wester standards), and kept talking to us. I couldn't drink until my neck films were cleared, and I was so thirsty. Then Jamie bought a bottler of water and poured it into my mouth. It was messy but so refreshing!

Here's Dinesh with his DVD player shiner.

Plastic surgery comes along and they wheel me into the procedure room. That lidocaine does burn. Yeouch! They do a single layer closure (I asked about double-layer but they said no), and tell me to leave them for 5-7 days. They tell me to keep taking Cipro (?) for the wound. (I went and got some Bactrim DS on my own just in case the unthinkalbe occurs and it gets infected).

Here's my face. I haven't shaved inseveral days now, so I don't mess up the stiches of my other abrasions, but its driving me nuts in ths heat!

Eventually, it turns out that my films are clear, I am cleared for discharge, given an NSAID and thats it. With a whopper of a headache. Actually, they offered me morphine early on, but I delined. Swammi turns out to be fine. Swami and Kevin are done with their rotations, and were planning to head out this day anyways, so Swami's uncle in Chennai sends a car for them. It is late because it got into a wreck on the way here (in daytime no less). We wait around for Cristina to get dicharged, and then I go back to the hotel with Anne and Cristina to vegetate for a few hours in a/c. We have been thinking about ordering the room-service pizza. The only pizza I've ever seen available in India. So we order it. It is not available. Of course.

Well, I made it. I have some pretty significant vertigo when moving from a supine to vertical postition, and we are now 2 1/2 days since the concussion. If this keeps up I may go see a neurologist when I get back to San Anyonio. Maybe I knocked an otolith loose or something. Its really annoying, and makes me feel like I'n drunk when I'm walking. No headaches, though. My ribs are very very angry with me; I think they are seperated. The formerly amusing rickshaw rides are now pretty brutal, as every little bump goes right to my ribs. My leg is doing great, just looks horrible, and all the other cuts and bruises are healing slowly. Everyone else is pretty similar. Anne is getting some really nice greens and blues on her temple.

Here I am, pointing to the gigantor bump on my head that you cannot see. This is what made me go into never-never land for a few minutes.

Here is my thigh. This does not do it justice, though, for the most subtle shades of teal and aquamarine have expanded out to encompass the entire thigh. Spectacular!

Our school has been fantastic about this. Dr Jones and Dr Bergren both called. They are letting us recuperate, requiring only that ID write-up (its still coming!!!). We all had pretty good travel plans after this,. and I think we are all going to continue as planned. We are tough cookies! Its actually hard to beleive that our 3-weeks here are almosy done. We are soon going to split up, travel more, and probably only see each other again at graduation. Well, I have to say, that this is a great group of people, and I am glad that I had them looking out for me. I never want them to need it in return, but I would do my best for all of them if necessary.

So hang in there, loyal readers. I have another day or two left in Vellore. I'm moving very slowly (and wobbily), trying to recover. I have never been knocked out until now, and I am not a fan. The recovery is not, for me at least, very quick. Other than the vertigo, though, I'm hanging in there. I'll have some more pics in the next day or two, and then I will be headed up to Delhi to meet my beautiful and wonderful girlfriend whom I love very much. The whole time I was really worried, all I could think about was how I was supposed to do all this stuff with her, and how I'd better not be hurt bad or else it would ruin all of our wonderful plans together (I'm talking in big picture here, not just the nest few weeks). So, I guess you could say I'm pretty fond of her. Alright, enough sappy stuff.

Tune in next time. Same bat time. Same bat channel.

A Wonderful Weekend in Kerala

2008-04-19T08:41:00.000-07:00

Hello everyone!

Thanks to all who have been reading along with my trip and offering comments. I'm happy you like it, and appreciate the feedback.
Well, as you can by now tell, this trip
to India has been all work work work, no rest for the weary and all that.
But seriously, folks.....So, Dinesh has a friend named Manish, who's family lives in the beautiful state of Kerala, located on the other side of the Indian peninsula. He generously offered to take us all out for a weekend to celebrate our successful matches, so with much arm-twisting, we all agreed. As the trains were all booked up already, we rented a private minibus for the trip with a driver. As we headed out, we saw what is the native water buffalo in an almost-native setting: the back of a truck at a tollbooth.

Long story short, it was a very very very long drive. The bus had a dvd player, and I borrowed some dvd's I'd seen sitting in the lounge of the hostel. Have you ever seen the episode of Seinfeld where he starts recording movies illegally in a theatre with a video camera, for sale on the black market. Well, apparently that same technique was used for our version of I Am Legend. It was hilarious. There are people's heads in the way, you hear the audience cough, only 2/3 of the actual screen is visible, and occasionally a person in the row in front will get up, presumable for curry-flavored popcorn. At the end, you hear the audience in the theatre applaud. Whahahahaha!! We also had a version of Transformers dubbed in Tamil. Its pretty funny at first to see these big robots speaking Tamil, but it gets old rather fast.

When we got there, though, our journey was rewarded. We were taken out on a houseboat. For those of you unfamiliar with this kind of thing, the "backwaters" of Kerala are loads and loads of canals and rice paddies, with the most commone form of transport being boat, and many villages are isloated. With the advent of heavy trucking, a lot of the big rice barges became somwhat unnecessary. A brilliant person years ago had the idea to turn these barges into floating houseboats and charge to take people on relaxing cruises through the backwaters. Today, it is an enourmous industry, and the town of Alleppey, where we embarked, is the center of it. I was excited to be here, but felt a little guilty, as I had already planned to make this trip separately with Felicia. I firmly resolved to have as little fun as possible, so as not to ruin it for our visit in about 2 weeks.

Here is the houseboat Manish set us up with. Three bedrooms, a/c in all of them, plasma screen TV with dvd player, running water, showers. Plus a crew of 3 to cook and supply cold beverages at our request.

So we set off. FYI, I think this backwater cruise thing is on that National Geographic list of "things to do before you die". Well, check this one off. So we headed out. We had an awesome lunch of fresh fish, vegetables, cold beer. I have to say thay the food up to this point in Vellore had been rather disappointing. Lots of carbs, lots of spice, but not many veggies, and unsafe to eat any raw ones you didn't prepare yourself. (by the way, the Ciprofloxacin + Immodium cocktail = success!!!) The food I ate in Kerala was amazing! All hail Keralan cuisine! Lots of fresh seafood, lots of veggies, yum yum! And all home-ccoked helped a lot too.

So we cruised around for a bit, and then stopped off at a local "boat-up quikie mart" to pick up dinner.

This is what a large prawn looks like in India.
Seriously. It looks like it could eat a lobster for dinner. And those crazy long blue front claws. Whats up with that? Well, I bet it tastes good!

Behind the prawn shop is a rice field. Here I am. I was careful to look for snakes, but they sent a local with me just to make sure. Probably always a good idea with me.

So, we cruised along some more.

Here is a guy herding ducks. Really! Hey paddled around and they all swam together into this little canal, there must have been 100 of them. That is something I have never seen. An aquatic duck herder.

As we continued our leisurely afternoon, I was struck by the beauty of the area. Here is a view out the front of our boat, over the driver's head. Pretty nice, eh?

Still, as I had foresworn, I was having absolutely no fun at all.

Later on in the evening, we wound up in a little canal behind a rice barge still being used for its original purpose. Here is the rice guy poling it along silently through the evening. This is incredibly serene.

A nice view of the sunset from the backwaters of Kerala.

As promised, I am miserable. No fun at all. The stress is crushing me.

As you can plainly see, my classmates decided to show solidarity with me, and also refused to have any fun dancing with the crew of the boat. We were lucky to meet some med students from Oklahoma in Vellore, and they came along too. Thats Kevin in the black shirt gettin' down with Vida, Jamie, Dinesh, and the rest.

Again, no fun at all. Here we see Jamie and Michael (Oklahoman #2) so unhappy at the pressures of the 4th year of medical school that they seem to be having some sort of breakdown. From the foreground, you can tell that in the Indian heat every effort was made to maintain adequate hydration.

In the morning we cruised over to another boat-up mart to get some fresh eggs for breakfast. We passed this guy washing his cow. I wonder if this is something he does every day? Maybe it is a show cow? Maybe it was just really dirty. Either way, it is clean now.

We also passed these guys loading up rice onto another barge. I tried to not look like the annoying tourist who takes pictures of other people working really hard, while I am not. But I kind of was anyways.

Just a close-up of a hard-working Keralan man. Actually, I have been using that wrong. The state is Kerala, but the ethnicity of the people there is Malayalam, and their language shares the same name.

After we got off the boat in the AM, we were taken to Manish's family's house. His family is usually out of town, so the house-staff was happy to have someone to care for. We also got to meet his grandmother. She though we were a very attractive group of people. So wise, she is, so wise. We rested, checked email, had lunch (more awesome home-cooked stuff), then were taken to see the local sights.

Nearby was an old Malayalam palace which we checked out. It had some old artifacts, paintings, and neat woodwork.

Here I am in front of the palace. Keralan architecture looks a little more like Chinese/Japanese, with pagoda-like roofs.

An upper-level walkway in the palace, with slatted windows which look out on the garden.

Fun with black and white at the same place.

Detail from a very old frescoe inside the palace. Very vivid colors.

One of the other places we were taken was local ashram apparently very well known around the worls. Like our guy near Vellore, it was run by someone named Amma. This Amma is a smiling middle-aged woman known for spreading love and happiness by hugging everybody she meets. see www.amma.org Apparently she's been doing this for a long long time, and her ahsram is really huge. There is a 17-story apartment block just to house the people who come for stays. There were lots of Westerners there. Unfortunately, she had just completed her hugging for that afternoon when we got there, so we were too late to meet her. We were given a tour, no cameras unfortunately, and supposed to go with the PR guy to meditate up on the stage where Amma meditates. As she was not avaialble, there was just a giant picture of her, and strangely enough, a second one below that just of her feet. Hmm. Anyways, he told us that the energy in that spot is amazing, So we sit there quietly.....and some lady come over and pulls a bag of silk flowers out and starts dumping them in front of the picture. That seems like nothing much, except her plastic bag of flowers went "CRINKLE CRINKLE CRINKLE" every time she moved. CRINKLE CRINKLE CRINKLE....pause.....CRINKLE....thump.......CRINKLE CRINKLE CRINKLE...etc. This occupied almost the entire time spent "meditating". When we were done he asked us "Wasn't that wonderful? Didn't you feel the peace and energy?'. As we all tried not to snicker, Vida did her best and said "It was amazing!" I guess this made him happy. We all found it pretty funny.

Amma's ashram is right on the coast, and was hit hard by the tsunami. Apparently she paused that day, said "something is not right with the sea my children", and ushered everyone in her big hall to the 2nd floor just before the wave hit. She worked very hard to help rebuild the area, and got lots of great photo-ops with local, national, and international leaders. Even donated about $1million to the Katrina relief fund. Still, as a living god, you'd think one would have more notice about pending natural disasters. Thats not really my field, though, so draw your own conclusions.

"Wait" you might be saying. "The tsunami came at India from the southeast, and Kerala is on the west coast, how could it be affected?" Yes, you are paying attention. A very good question indeed. Now, we have all seen how the wave hit the east coast of India (i.e. Mamallapuram) since it origninated off the coast of Indonesia (also to the southeast of India), but it actually wrapped around the bottom tip of the landmass like a whip and smacked the lower west coast as well. Wierd, but I remember seeing a NOVA special on PBC that discussed this phenomenon.

Here is the coast near the ashram in Kerala. There were many homes here. Apparently several hundred people died in this area when the wave hit. The homes were not rebuilt. The palms bear many scars on their trunks, up to about waist-high, from all the debris carried with the water.

The people built a stone sea wall at the water's edge to try to prevent further occurances. I had a pic and then just deleted it by accident. Anyways, just imagine a big pile of rocks at the water's edge, running up and down the shore.

Manish lived right down the road from and Ayurvedic spa/hospital. This is traditional Indian hebal medicine. It was pretty swanky. He paid for us to all get massages. Well, it wasn't the typical; swedish massage I was hoping for. I had to strip naked and put on the skimpiest of loincloths (please please, please I hope they autoclave these things in between uses) and get on a very oily table (apparenty the same one Dinesh had just gotten off of....we all shared each other's oils...ugh) and then a swarthy Indian man proceeded to rub oil all over my body. No reall muscle work at all, no loosening up of tension, nope. Apparently this was medicated oil being appliend through the skin. A lot of oil. The whoke thing lasted 1 hour. I was not relaxed at the end, just oily. So, if you're looking into Ayurvedic massage, just bear my experience in mind. It could have been worse, though. One of the treatments their involved all of the following: herbal enema, oil enema, oil emesis (I think you drink oil and then vomit it back out), purging (what it this if not vomiting, I'm not sure and don't want to know). amd some other thing. No Thank You. I walked back to Manish's house and tried to get all the oil off. Not very successful, despite several showers.

Well, the fun was over after a very entertaining weekend.

We had a wonderful time in Kerala, ate amazing food, saw great stuff. I would like to express my sincere gratitude to Manish and his family for their generousity and hospitality. They threated us very very well, and we all truly appreciated it. This is where I put in my plug for the new medical school in St Lucia in the Carribean that his dad runs (UTHSCSA is, of course, the best ever in the US, but if you are going to go Carribean, think about St Lucia).

I was so miserable the whole time that I can barely think about how I have to come back to this paradise, just me and my beautiful girlfriend Felcia. Somehow we'll make it through. (acutally, I got to see where I'll be staying, and it looks great!)

Stay tuned for my next post. Not as happy as this, but bear in mind that it all turned out relatively OK in the end. Lets just say that I got to experience Indian emergent care from the 1st-person viewpoint. And listen to me now. I will repeat it again for any readers who may be headed to India later. DO NOT DRIVE ON THE ROADS IN INDIA AT NIGHT IF YOU CAN AT ALL HELP IT. It is all dangerous. Sometimes, unfortunately, unavoidable, It is also very dangerous in the day, too, make no mistake. But avoid it if you can.

OK. I'll have all the gory details soon.

Market Pics etc..

2008-04-16T22:06:00.000-07:00

Hello,

Well, I tried to be strong. 36hrs with only a few potato chips and a flat coke, and still no luck. Cipro it is, with lots of H2O. Will go to the "supermarket" today to see if they have something like gatorade too. I'm sure you are all fascinated by this. So lets move on, shall we?

So, I've found an internet cafe which 50% of the time works pretty good. Rs15/hr (lees than 50cents) is a good deal.

So heres one more pic from last weekend at Mamallapuram.

On the pediatric side of the N2 neurology inpatient ward is the childrens' entertainment area. Not much, really. But this familiar character was on. As it was in Tamil, I have no idea what number of bats he was up to. I wonder if they even are familiar with the concept of a vampire, much less one who is friendly and "Counts".

This is just a view down one of the corridors at the CMC campus, out to a really pretty courtyard. Its like a little oasis in there.

Here are two of the monkeys I saw yesterday outside the computer lab window. The pic is a little blurry, but it'll have to do. Perhaps Felicia will be so kind as to offer a guess at what kind these are? Mom and baby, very cute, but I'm not going to try to pick them up.

This is a view over part of Vellore, across the roofs near the central bazaar. I just read that the combined population of Vellore and its surrounding villages is about 300,000. I bet this "town" has 150-200,000 alone.

A view down one of the lanes of the central bazaar. They cram a lot of stuff in here.

Here are Anne and Cristina being asked where they come from.

All kinds of fruits I have never before seen for sale.

Wow. Thats a lot of garlic.

Most of the vendors there begged us to take their pictures. This guy wanted his friend in too. the friedn did not. Guy #1 thought this was hilarious.

Two guys selling piles and pilse of flesh blooms. For all the incredibly disgustingly stinky places in town, this aisle was very pleasant.

Closeup of one of their flower piles. Simply gourgeous.

Big chunks of incense, all different types, some you dip in water, some you burn. I think I'll go back and pick some of this stuff up.

Lots of piles of dyed powder for your forehead, incense figurines, and some sort of food items. This was a "satellite" store for the golden temple.

Closeup of some if the dyes. Very vivid pure colors.

Well, thats about it for now. Neurology has been very interesting, and my tropical disease bit will touch upon the neurological implications of it.

Now I'm going to the drugstore. I am so hungy. So very, very hungry.

Thoughts for Today

2008-04-16T03:06:00.000-07:00

- I have become that which I despise: the idiot foreigner who thinks that talking louder will make it easier to understand me. I will do it for a while before I catch myself. Indians often speak very softly (especially the attendings, which makes it really tough to understand on rounds). I sound like a foghorn. I'm sorry, people of India.

- The CMC radiology department is pretty nice, if I haven't mentioned that before. The reading room is 70 degrees, and the MRI suite looks nicer than the ones in San Antonio. And then you walk out the door back into the heat and chaos.

- Indians have no qualms about coming up to me and asking where I'm from. Actually, in my arrogance, I assume they can tell I'm from the US. Nope. And most of them have no clue what Texas is...ha ha ha. Indian deference to the male > female is pretty evident when Cristina, Anne, and I go out to eat. The waiter often asks me for my order first, only asks me if the meal is OK, only takes the plates when I say I'm done, despite what the two of them say. They hate it, and let me know regularly, as if I set this whole thing up. This culture is rather conservative. But strange. Exposed midriffs on women are standard here, but if you dare to show your shoulders or ankles, you are a loose woman. Whenever a large group of us students goes out for dinner, we obviously have a bunch of males and females socializing. However, you never see males and females socializing outside of families. Actually, you never even see groups of females out at restaurants. Lots of groups of men, familes, but no women. They are out together at the markets, but not in restaurants. Hmmm.

- Cristina and Anne get stared at by men a bunch, and I have a feeling it is the same for the other ladies as well. Now that I think of it, I get stared at a lot too. People keep saying that this a very cosmopolitan town, that they are used to lots of westerners due to the CMC. Well, that may be true for lots of the businesses, but the average person on the street definitely looks at me like I just got out of a flying saucer. Sometimes it is very off-putting, feeling like they are really rude. But I think thats just their way. I know the ladies have it much worse, though. Last night at dinner, Vida was telling us how in the middle of the day a man started following her and Jamie around the town. They went into several stores and he kept following them. They finally were at a travel agency and complained. The guy there yelled at the man, and summoned a police officer, who then promptly slapped the man in the face and threw him into the street.

- Even I had an interesting encounter. Last night while at dinner, in a pretty empty place except for the 7 of us (the San Antonio contingent united: Me, Dinesh, Claire, Vida, Jamie, Cristina, and Anne), a man at a nearby table asked to speak with me. So I go over and talk with him. He says he is upset with me, he saw me in his building earlier and needs to settle this. He claims I was in his building at the very time I had placed my order at the restaurant. Won't tell me what it is all about. Wants me to go outside with him. Well, thats not going to happen. So I tell him he's all confused, I don't know him, and go back to my table. He keeps looking over at me, and about 1/2 hour later tries to send me a beer. Wierd. Dinesh goes to speak with him in Tamil to see what his deal is. Apparently he is so drunk now he can't even speak clearly. Eventually (another 30min later) he gets up, comes over and apologizes to me, and leaves. ....OK then....This town is generally pretty safe, but obviously its a good idea to watch your back. He did not try to follow my rickshaw back to campus. Maybe he just thought I was very handsome. I can understand that. Happens every day when I look in the mirror.

- It seems that the predicted GI distress has now beset me. I'm holding off on the antibiotics at present, hoping to ride this thing out with just fluids and bowel rest. Its not terrible, just really inconvenient and uncomfortable right now. I had to duck out of Neurology early today because it just wasn't worth it to keep standing next to a patient while my insides go all spasm-like. As we have a trip coming up this weekend, it would be nice to have this sorted out before departure. I have my fingers crossed. Cipro at the ready if it comes down to it.

- we went to the main bazaar here the other night, obviously where the locals shop. It was awesome. Just about everyone wanted their picture taken with their produce, piles of iron products, various dyes, big chunks of incense, and buckets of fresh flowers. I got some great pics, as did Cristina and Anne. I'll try to post some up tomorrow. And I may get my infectious disease profile up tomorrow too, we'll see.

I guess thats all for now.

Neurology at CMC Hospital

2008-04-15T20:05:00.000-07:00

Hello all,
Well, this week I'm on the Neurology service, mostly with the N2 service. The wards at CMC are like the old-school kind we used to have back in the US. There is one big room sub-divided into three "halls". Each subdivision is just a big open room with 4-6 beds along each side. Not much privacy, although you can pull drapes when dealing with sensitive issues. The patients are grouped by sex and adult vs pediatric. Most of the kids have at least one parent sitting by their side at all times. These people had to leave their jobs and make the journey all the way here, so the staff trys to make them as comfortabel as possible and get them discharged ASAP. Mixed in with our patients are Neurosurgery patients. One of these is attended at all times by what I believe to be her son. He has not left her side the whole time I've been here, not even changed clothes. I wonder if he sleeps here too? There is also a neuro ICU on our floor. You take off your shoes and put on their flip-flops when you go in. It has a/c! What I noticed in there, though, was how quiet it was. No beeping or booping or other loud alarms like I am used to in ICUs. No ventilators either. Patients that had tracheostomies were on CPAP only. I'm told that the ICU downstairs has vents. Maybe I will see that later this week. The hospital is crowded, but other than the ward set-up and heat, pretty much like other hospitals. All the windows are open and the fans are going, but it is still pretty toasty. I can't imagine what it is like in June when it is really really hot.

The residents stay pretty busy, handling about 10-15 patients each. Several days a week they spend in the OPD, which is the outpatient clinic. They will have two exam tables crammed into a room we can only fit one into, and run through patients as quickly as possible. Because the neuro exam takes a while to do, they may see only twelve patients an afternoon each, but that still means getting out after 6pm or later.

Some interesting cases I have seen so far:
- Cerebral venous thrombosis. Not commonly seen in the US, it is very common here. Occurs predominaely in post-partum women. The residents I spoke to said the etiology is not completely clear, but trhey blame it on local customs regarding childbirthm not giving the mother anything to drink, etc. It presents as a headache with bilateral neurological deficits, and occasionally seizures. This is a diagnosis of exclusion, but is high on the differential list due to the history and physical findings. They rule out Cerebral Hemmorhage because the headache is not as severe, the patient is not so severely obtunded, and the neuro deficits cannot be localized to an arterial source. They also use neuro-imaging regularly, so the MRA helps cement the Dx.
Treatment is similar to a DVT: heparin for several days, then discharge on anti-coagulants for 6 months. Most patients recover well.

- a case of possible Isaac's Syndrome. Isaacs' syndrome is a rare nerve and muscle (neuromuscular) disorder. It may also be referred to as neuromyotonia, Isaacs-Mertens syndrome, or continuous muscle fiber activity syndrome. It's characterized by abnormal nerve impulses from motor neurons of peripheral nerves. These impulses cause continuous activity in muscle fibers. Our patient was in to get an EMG, and the history I gathered was that over a 2yr span, he has developed weakness on one side when trying to run or exert himself. Sometimes when running to catch a bus his hand will clench up in a claw and his foot will suddenly internally rotate due to muscle spasm. He can avoid this if he sees the bus coming and starts to pace a little, "warming up" before he has to jog over to it. The Dx on him is still pending.

- a case of Hansen's (leprosy) vs Myeloradiculopathy. A 63yo male with a history of decreased sensation of tough, temperature, and pain, beginning in his distal lower extremities and progressing proximally up to his mid abdomen (approx T10). He alsso reports recent onset of parethesias and burning, and again greatest in distal lower extremities, gradually diminshing proximally. These have also abated distally as total insensation has set in. Of note, he states the right side is worse in all symptoms than the left. As the Over the past 6 months, also onset of urine retention and constipation. His symptoms have all prgressed to the point where he is bedridden now and dependent on intermittent catheterization. He was diagnosed originally with Hansen's disease at another hospital, and given a course of antibiotics, but these were discontinued after less than 2 months due dermatologic reactions. On physical exam he exhibits significant bilateral lower extremity muscle atrophy, complete lack of sensation to pain, temp, touch, and vibration in both of his legs. He regains sensation around navel level (T10), which is a burning sensation when touched lightly. The jury is still out on him too.

So, due to a case of "thats how it has always been done", the neurology service also gets every attempted suicide by hanging. They don't want them, provide no psychiatric treatment, but still they get them. I saw a resident advise a patient to next time try to drown herself, as it is less traumatic. I think he's pretty sure she'll try it again, but if she fails he doesn't want to have her on the service again.

Also of note, the CMC is apparently not a public hospital. Patients come up to the residents throughout the day complaining of their bills and their inability to pay. I've seen this handled relatively well by the younger residents. The upper levels, who have been dealing with this for years, have not patience. I saw one yell at a woman to sell her bad and her house, do whatever it takes, but pay the bill. Pretty brutal.

Ok, thats all the medical stuff for now. Will post again later.

Electrical panels of CMC college campus

2008-04-14T02:21:00.000-07:00

First off. let me tell reiterate how amusing India is. I'm sitting here in a cybercafe listenning to honking of rickshaws, high-pitched hindi music, and over this comes the call to prayer from the local mosque. This place does not let any of your senses rest for a minute!

Ok. Even on the CMC campus it is very entertaining. On the college campus, all of the electrical panels are dedicated to some scientist or other. I'm trying to catalog them all, but here's just a small sample.

Mamallapuram and Kanchipuram

2008-04-14T01:02:00.000-07:00

For the weekend, Anne, Cristina and I hired a car (with a/c) to take us to Mamallampuram, on the coast. This is an ancient city, and listed as a UN World Heritage Site. The sculptures and temples here defined a style that then spread out over the rest of India and beyond. Probably the most photographed temple is the Shore Temple, dating from the early 8th century.

We also got to get our feet wet at the beach. Indian Ocean? Check.

Here is a guy selling food (fried fish) near the temple. All along the temple, and all over town, were sculptors. Stonework is the #1 industry in the town 9other than tourism), and you hear the "clink clink" of chisels ringing out all over. I bought a bunch of stuff (yes, rocks), and felt great about bargaining the stoneworkers down to less than 50% of their asking price. Until I showed my driver and he laughed at how much I overpayed. I will not show him anymore stuff. Still, my black marble dancing Pravati and red marble Shiva are something to behold. I have absolutely no idea how I will get these home intact.

About 1.5km south of the village center is a "plaza" containing the 5 Rathas. These are all carved out of solid stone, dating from 630-670AD.

Here we see the largest and tallest, the Dharmaraja, and Anne and Cristina resting inside it and listening to our guide (Rs100, a pretty good tour).

This is the Dharmaraja again.

Here's a view of the plaza. On the left is the Nakula and Sahadeva Raja, named after two brothers. Just to the right of that to that (tough to see) is a life-size stone elephant. On the mid-right is the Draupadi, apparently based on the design of a straw hut (note the roof). And on far right again is the Dharmaraja.

We stayed a pretty good little hotel (Rs1200) with a/c. The girls got mosquito net, I covered myself in deet and braved the malaria. The town is definitely designed with tourist in mind, but its is so hot that the season is winding down and there was almost nobody there. although definitely more westerners than in any other place so far. The ladies shopped with a vengeance, I picked up some stuff for friends. I also got a great little box that you can plug into the wall. It play 18 different mantras over and over again. I will drive my neighbors in the hostel crazy with this thing. We ate at a restaurant right on the beach, fresh seafood!

In the morning we got free breakfast, and then headed over to see the rest of the stuff.

This is a giant bas-relief called Arjunas Penance. The story goes that Arjuna did penance on the bank of the Ganges in the hopes that Shiva would part with his favorite weapon. Shiva eventually materialized and picked a fight with Arjuna, and basically kicked his behind, but eventually gave him the weapon as a reward for trying in the face of inevitable defeat. Arjuna is on the left, the elephant is on the right, and the cleft in the middle represents the Ganges.

Closeup of Arjunas Penance.

There were many other temples and bas-relief around, and we saw almost all of them. Mamallapuram was awesome, and I'd love to go back again. It was hit pretty hard by the tsunami, but has recovered well. Our dinner restaurant had a pic of how it was before it hit, and they definitely rebuilt well. The wave actually uncovered a bunch of new structures previously unknown, now being excavated. There will be even more stuff to see when I come back!

Then we got in the car and headed home. On the way is the town of Kanchipuram ("Golden City"), known for 2 things: 1) it is the silk capital of India 2) it has some serious temples.

We stopped off at the Varadarajaperumal Temple. In this lagoon, under the gold thingy, is a statue of Shiva. They drain the lagoon and take it into the temple once every 40 years (next time, 2016). Apparently 4million pilgrims will descend on this town then. Good luck townspeople!

Inside the temple is the 100 Pillars Hall, a wedding hall with intricately carved solid columns, many with risque scenes from the Kama Sutra.

More from the wedding hall.

View from main entrance in. The hall is out of site over to the left. I could not go any further as a non-hindu. And my feet were starting to sizzle on those hot stones. Native Indians don't wear shoes a lot, so they're tough. They laughed at me as I ran from shadow to shadow, but it is really really dangerously hot out there.

Closeup of one of the pillars

Another temple we passed (pretty darn tall)

A third temple we peeked into. All in all, a great trip. The car and hotel were incredibly good deals, and I'll just pretend that I made out like a bandit with my rocks! Maybe I'll post some pics of them later.

Whew. I think I'm all caught up now. Feel free to post comments or requests.

Teaser

2008-04-11T09:23:00.000-07:00

Update: I now have posted CHAD day 2 andf more, so go back and check. We're going to a World Heritage Site town called Mamulampuran this weekend, so I think I will be spending a lot of time when I get back uploading pics (see CHAD day 1 for samples).

In the meantime, here's a tidbit from this afternoon:

Poor quality video, but finally up!

2008-04-11T08:29:00.000-07:00

Here is a street corner in Vellore on a rather slow day. Watch the far corner at 37sec in for a common sight on the sidewalk. I like how it acts like this is "its" block. (audio works too). And a pic of possibly the same pedestrian.

I met a living god, was kissed by an elephant, donned native attire, saw monkeys at the hospital and more!

2008-04-11T04:45:00.000-07:00

Friday was a really big day for me. We went to the Golden Temple, just outside of Vellore. I don't have any pics of my own, since no cameras are permitted and they search you, but I've included some from when it was being built to give you an idea. So, we pay our Rs100 and start in. The temple itself is in the middle of the most beautiful and cleanest grounds I have seen in this country so far. There is a covered walkway in the shape of a 6-pointed star that you wander along around the perimeter, with the temple itself in the middle. During the walk you pass many signs with deep quotes from someone named "Amma", basically a lot of nice common sense stuff, while relaxing chanting is played on the speakers overhead. After this 1.5Km walk, you reach the end, and walk straight up to the temple. The pricey tickets get to go up to it, the cheap ones (me) get to get real close and walk around it. It is ridiculous. Probably the shiniest thing ever. Very nice.

This site: http://www.sripuram.org/ has pics rotating through on the front page and some stuff about Amma.

So, we walk around, I ring the bells a few times, and start heading out. Stop off at the "gift shop" and a nice guy there starts explaining the layout of the temple to us. Tells us all about Amma, how when he was 16 years old, he got a calling, and it was revealed that he was the personification of the god mother of all. So he goes by "she" now, and started an ashram. 16yrs ago. The golden temple just opened less than a year ago. Anyways, he asks if we would like to meet Amma. He has to call ahead to see if its ok, and then we walk across the street to their old temple complex and we are about to go in but I am stopped. I have shorts on, not permitted. So he takes Anne and Cristina in, and I stand there thinking I may have missed out on a chance to meet a deity. After about 10min, I'm resigned to this fact, and an elephant walks out and passes not 2 feet from me. Well. This made my day. It was all decorated and pretty and nice. And then a random guy comes out and gives me a dhoti (like a sarong, the skirt that Indian men wear). So I wrap it on and go in. There are a bunch of temples, and people are all over the place praying, but they lift up the ropes for me and let me past them back into the VIP section, where all the actual faithful are not allowed (not my fault, hindus, sorry). The girls already met Amma, and he's busy now, but my new Indian friend tells me I can join and watch Amma perform a puja, which is a special ceremony. So I follow him into a big room where about 10 people are sitting, a band is playing, 3 women are chanting constantly, this guy keeps ringing a bell, and on the other side of the room is a very decorated cow just lying there. Amma comes in, and starts adorning the cow further with flowers and incense and gold dust and sacred oils. The cow has all kids of decorations, and he drapes her with a bejweled blanket. Spends a lot of time with incense at the rear end, which is probably a good idea. As it progresses, the music goes faster an faster and the bell rings more and more, and they chant louder and louder. The cow, the whole time, looks very unimpressed. For being the mother of all India, she's pretty chilled out. The high point for her is when he (sorry, Amma is a "she") feeds her some fruit. She likes that a lot. They even hold a golden tray under her mouth to catch any drippings. Seriously. Then its over. That is the biggest deal I have ever seen made about a cow. Everybody apparently is thrilled to have gotten to see this, especially my new friend, who says its only because he brought me that he was permitted in here, so I have a great honor. Amma comes over and asks my name and where I'm from, and tells my new friend to take me to the guesthouse and feed me. He/she speaks perfect English, and is about the same age as me, looks like you average hairy bearded sweaty dude. We go and scratch the cow some and she likes it. Nice cow. I mean, all-mother. Whatever. Anyways, so we wander around the temple complex some more, and I keep getting to cut in front of real worshippers to enter temples and stuff. And there's another elephant! This one gives me a kiss in the face and taps the top of my head with its trunk as a blessing. My new friend says it likes me. Then I go and buy one of the nice gold dhoti's everyone one is wearing ($5, a decent deal). My new friend helps me put it on right. OK, what happened was that a man I'd just met helped me put on a skirt and then he told me he loved me. Anyways, after he says "Chris, I love you", I say "Thanks, you are a nice friend". He gives me a red dot on my forehead. The the two ladies, my friend, and an Australian lady name Zoe who now lives there go over to the guesthouse for food. We chat for a bout an hour. They used to work in engineering and pharma, but are much happier spending time with Amma at the Golden Temple now, and want to do this forever. Then we said goodbye. Wow. No $ requests, no recruitment. Just the original price of admission and my $5 skirt, and we got the deluxe 5-star tour and a free meal. Pretty cool.

Later that day we went to the old fort here in Vellore, which is where these pics were taken. There is an old temple there we went in. You have to take off your shoes, and the stones were really really hot. And there were monkeys (see pic below, it'll enlarge if you click on it)

All - in -all a pretty busy and fun day. Just the kind of stuff I was looking for. Saw a golden temple, a living he/she god, blessed by an elephant, donned a dhoti and a red dot, saw monkeys. I could go home now and be content.

More to come though.....

Random Vellore/CMC Observations and Pics

2008-04-11T04:44:00.000-07:00

Just a few random things that don't fit into other posts but that I still want to show you.

Yellow flowers blanketing a building on the college campus.

A leprosy rehab clinic at CMC hospital (don't see those in the US)

A flower vendor on the street. The women apparently buy their fresh flowers the night before. These were just picked.

Turtle mountain. Can't deny the resemblance.

A temple I found down a side alley in Vellore. These this are incredibly intricately deocrated. And there are many many many of them all over.

Ahh, tea. Done the Indian way. Sweet, hot, and delcious. Probably averaging 4 cups a day.

Anne and Cristina's "deluxe" hotel room has a great view! But at least they have a/c.

CHAD Day 2 - Doctors Rounds

2008-04-11T04:43:00.000-07:00

CHAD Doctors Rounds differ from nurse's rounds in that we take an entire "mobile clinic" in the form of a schoolbus to various villages, and the patients come to us. Usually they have been seen by a nurse in the last week or so. The patient population is pretty evenly divided between prenatal visits and chronic illnesses. Both sets of patients have cards they bring which contains all the info about prior visits, vitals, and current medications regimens.

On the bus we had two nurses, two student nurses, several health aides, an intern, and an upper-level resident. On getting to a village they would assign numbers to the patients who were waiting. It was impressive to see how many could show up within 5min of us pulling up. The resident took care of prenatal visits on the bus (measuring fundal height by hand, and checking fetal heart sounds with just a stethoscope, no doppler!), and the intern handled most of the chronic cases, referring patients into the bus if needed. I was very impressed with the MDs' skill set. They had little kids, elderly, pregnant, whatever, just walking up to be treated. If I had participated in something like this during my 3rd year, I would have given Family Practice a much closer look, but it is too late now, so there it is.

I just want to point out how impressed I was with this intern. She was post-call, and we worked a long day. Started out at 8:30AM, did not get to our 4th and final village until about 4:45PM, averaging >2hrs./village. She worked her way through 47 patients in just under 1 1/2hrs. Amazing. We all gave her a round of applause after that.

This was a great experience for all of us. In my pictures here, we see me, Anne, and Cristina with one of the student nurses, Susan. There's a shot of me surrounded by village kids, women recieving their medicines from the bus, and the number-passer-outer guy getting mobbed by villagers who have been waiting all day for us.

I also have several pics of the flowers in the women's hair. Young, and especially pregnant women wear fresh flowers in their hair and bangles on their wrists to give off soothing smells and sounds, supposedly good for the pregnancy. I just think it loks great. And again, the saris are pretty striking at times.

There's also a shot of Susan teaching new mothers about anemia. I also show a tree nearby to where we were working. Villagers tie up and hang cow placentas in this tree to ensure their cows keep giving good milk.

Finally, a pic of an old woman sleeping nearby. I jus thought it looked nice.

CHAD Day 1 - Nursing Rounds

2008-04-11T04:17:00.000-07:00

This was out day to go out on nurses rounds to the villages. Basically, each village or two has a part-time health aideknoknows everyone. She goes around and finds out who's sick, who'shaving trouble with their meds, etc, and makes a list. Onceevery 1-2 weeks, a public health nurse from CHAD comes around the village, meets up with the health aide, and goes to see the patients. She'll make it to about 4 vilages in a day, going to into individual homes. Sometimes the patients only need counseling on how to take their meds. Sometimes they need replacement meds, and aregiven a week's supply with directions to report to clinic within that time. Sometimes nothing can be done and she tells them to go to clinic ASAP, or even the CMC hospital. The nurse has limited meds to offer, mostly Tylenol, some anti-hypertensives, some diabetic. She does not dispense antibiotics.

So, we met up in the morning at the CHAD clinic and I was assigned to a Jeep with Renee (public health nurse, in solid blue sari), Sangita (nursing student in blue/white polkadot sari. a driver, and various health aides, wearing pink saris. It was hot, so we brought lots of water and bag lunches. The countryside around Vellore is beautiful. For all the noise and trash and chaos of the town, the surrounding villages were indeed serene. Some villages had paved streets, and looked like a real town with a center. Others were just random farm houses that happened to be near each other. This was an amazig day. We walked on dikes between rice paddies to get to huts with one room and a thatched roof. We saw 11-day old patients and people so old they didn't remember their birthdays. 100% of the conversations were in Tamil, but the nurses were kind enough to interpret. These patients, who obviously have next to nothing, would invite us in and offer us food and drink. Itwas amazing and heartbreaking at times.

I saw a mother with a growth-retarded newborn and nobody to help her. The husband's family only helps out for the second child, so he and his family abandonded her. She sold all her livestock, has no way to earn money or any help, and broke down into tears while we were there. We couldn't offeranything other than a shoulder.

I met an old man, no major problems, just old and tired. He and his two wives live with their granddaughter. He has seven children but none of them help.

I saw many people, went into many houses, hit my head many times on "doorframes" into thatched roofs. All the villages have electrical and telephone wires strung, most homes have access to power. They plow their fields with oxen, get water from a pump, survive as subsitance farmers. They were all very gentle and gracious, and the kids were ridiculously cute.

It was a long day, and I have the most amazing farmer's tan to show for it, but it really showed me howIndian life is. Beautiful scenery, hand-to-mouth existence.

So, after much work, I have discovered that neither the CMC college nor hospital libraries allow any USB or CR-ROM usage due to virus fears. Thus, I'll have to upload pics at an internet cafe with super-slow dialup and only1 USB port for 6 computers. Thus, the promised pics and video, of which I have enormous amounts, will trickle in slowly. I'll add pics to old blog pages and let you know when they've been updated.

The pictures on this page show the public health nurses going into villages and houses, as well as some of the sights along the way. The woman with the baby was the one who began to cry later in the visit (note the baby mosquito net behind her). We also see a tailor at work, a man drying rice, the low entrances that I banged my head on several times, roadside temple, a doorway where we had lunch (everybody shares what they have) . We see buffalo power juxtaposed with electric power. I have a pic of the old man, his two wives, and granddaughter. The last pic was from the very last house we went to. We had been there talking you a young mother about her baby, in the house for about 5min, when I heard a noise behind me. Turns out she had another daughter too shy to come out to see us, so all we could see were her feet.

Next up: CHAD Day 2 - Doctor's Rounds

(even more pics)

hang in there....

2008-04-10T09:43:00.000-07:00

i will have copious posts and pics in the next few days, to make up for all the stuff i've been doing. lots of excessive detail pending. check back in 48hrs.

Day Two

2008-04-08T04:19:00.000-07:00

Hello all,
Day two of this crazy ride, and I must say that this trip is everything I hoped it would be and more! Awoke this AM to the sounds of many birdsongs since I'm on the lovely CMC campus (Anne and Christina reported their wake-up was honking horns). Met up with the ladies for a yummy <$1 breakfast on campus here, got a tour of the CHAD facility next door, then went into town to register at the hospital.

The CMC hospital campus is very impressive. Its like an urban university campus, with lots of people, motor traffic, all kinds of buildings to get lost in, etc. Everyone is really nice, and willing to help send confused foreigners in the right direction. Honestly, the only real differences I see between this and University Hospital in San Antonio are that this place is designed for lots of open air due to no a/c, and they dry their laundry by hanging it up on the roof. Otherwise, they are very busy, have all the same stuff that a modern US hospital has, plus the nurses are real nice and wear white hats and saris.

After registering, the ladies went across the street to get some native clothing, and I got my SIM card charged up (I think I may have gotten ripped off a bit), then tried to find them, to no avail. Thats OK, though, since I just wandered up and down busy alleys and side streets, where it looks like almost anything and everything is for sale. And cows just wander aimlessly around.

After lunch back at the college canteen, we headed over to the CHAD complex for HIV/TB outpatient clinics. (aside: met up with a student from Tufts who told me about the rumored swimming pool. will report back once have confirmed with my own eyes)
I saw several HIV patients in for continuity visits, all on govt sponsored triple HAART therapy. They are started on this regimen if CD4s drop below 200. My patients all were doing well. One had a son with her that a German med student kept playing with, until we discovered he had scabies, which ended the fun right there.

As we walked back to the computer lab, I took a side detour to check out the supposed giant bat tree, not 30yds from my hostel. And it is true. I thought I was hearing birds squawking, but instead, in this giant tree, were at least 30 very large bats, flapping around and making lots of noise. Pretty cool, provided they are not the vampire kind.

Some interesting things I have seen:

Squeaky shoes: in the US, little kids all have shoes that have little blinky lights that go off when they walk. Here, the shoes/sandals all have squeakers in them, so they sounds like a really loud dog toy every time the kid takes a step. When they get mad and start stomping their feet, the effect is spectacular. They also fit in great with all the horn honking outside. I am now searching for pairs in adult sizes.

Abject poverty: for all the fun entertainment I am getting out of this, I am also seeing true squalor and terrible crushing poverty on a daily basis. People are begging on most streets, little kids, old women with no hands being wheeled around in carts. Driving up and down the roads you see the things that people live in, lean-to's, a tent made of a sheet, on a pile of garbage, next to the fly-infested open sewer. And the garbage is all over, mounds of it, any place that is not walked/driven on regularly in town, is covered in trash.

Saris/women's attire: wow. Indian women, at least those down here in Tamil Nadu, really have great outfits. Their saris are full of incredibly vivid colors and patterns, and they often accessorize this with intricate jewelry, fresh flowers in their hair, and more. For all the poverty, dirt and dust around here, they women, as a rule, stand out. Rich, poor, whatever, they know how to dress.

CMC College Campus: as opposed to the CMC Hospital campus in town. Town is crazy, college campus is absolute serenity, with lots of birds, butterflies, steep mountains all around, big green trees, and neat cool grey stone buildings with dark cool corridors. And all electrical relay boxes are turned into tributes to great scientists (thinking of making a compendium of the electrical panels so far: Neils Bohr, Lois Pasteur, Marie Curie, Albert Einstein, etc etc etc).

I was going to talk about the "south indian head wobble" wobble here, but it is so unique and pervasive, and throws us westerners for such a loop, that it probably deserves its own post. If I ever get the video thing worked out, I'll post some footage of it too.

so pics/video may be every other day, based on how often I get to a cybercafe. I will have lots more, and may resort to an online album as well, we shall see.

Some pics from my trip so far

2008-04-07T04:33:00.000-07:00

Here are some random picks from my day out this afternoon (still have not slept yet). Lots of crowds, lots of cows, some working and some lazing on the street corner, some ladies selling local attire to Christina and Anne, the three of us in the back of a motorrickshaw, and a pic of the guy in the booth who controls the traffic light in front of the CMC hospital. I have some great video from my drive in this AM, but having trouble getting it loaded. People here honk their horns like other people breathe: without respite, no breaks.

I noticed that a certain part of town always smells like seafood when we drive by. On the Texas gulf coast, thats to be expected, but we are nowhere near the sea here. Then we walked by. Ahhh, this town has a lot of open sewer space.

Still, having fun, eating awesome cheap food. Will post as much and as often as I can.

see you later.

Made it to Vellore!

2008-04-06T23:55:00.000-07:00

Hello,
I am now posting from the CMC campus computer lab. I've actually only been in India 9 1/2hrs now, and am way way behind on sleep, but I did make it and so did my bags. Qatar Air rocks, it was a thoroughly enjoyable experience with them, and I highly reccomend them. Not able to post pics at present, but am working on it.

I am staying at the Modale International Hostel here on campus. While the city of Vellore is without a doubt much more crowded and crazy than I could possibly have imagined, and the hospital itself is in the middle of it, the med school campus is a ways down the road, and very serene. Dinesh was supposedly staying with me in the hostel, but I have heard that he changed his mind. Oh well. Its cheap, and convenient, so I'm happy. No a/c, but I lived several summers in Texas without it, so no big deal. Fans are my friends. Apparently I'm the only one of my classmates staying on-campus. They are soft. Dependent on a/c. (of course, I know I'll be begging them to let me cool down in their rooms in a week or two).

I ate at the campus canteen this AM, payed r24 for some sort of egg dish and tea. for r38.8=$1, thats a pretty good deal. They apparently have homemade milkshakes. We will see about that, oh yes we will.

I'm signed up for the CHAD rotation to start tomorrow. Thats the community health and development rotation that everony talks about. Looking forward to it.

Will try to get into town this afternoon to get cell phone charged up, maybe find internet cafe and get some pics up. I hope to one day document the insane ride through town that I saw at 8:30AM today. Actually, it began the moment I got into the cab in Chennai, and just escalated from there. Along the way I stopped off for some tea with my cabdriver at a roadside stand. It was a very entertaining ride, with destitute villages sandiwiched between giant mega-factories from Nokia, Hyundai, Motorola, Dell, and more. Naked people relieving themselves on highway medians. Rice paddies being picked by hand, ornate & colorful temples every few miles, beautiful mountains looming in the distance, and the near ever-present smell of something unspecified burning....and then I got to Vellore for real. Seriously. If this is what it's like every day, then they probably need several trauma centers here. It is chaos. A gadgillion bikes, mopeds, rickshaws, cars, trucks, tankers, ox-carts, all going head-on into each other at high speed without the slightest indication that such a thing a a traffic law exists. Add to that cows standing stock still in the middle of the road causing everyone to swerve out of the way at the last second, plus dogs darting in and out of traffic, and pedestrians who seem completely indifferent to the death bearing down on them at high speed, and you have what appears to be the average morning commute around here.

Will give more info, possibly with pic and/or video goodness later tonight (fingers crossed).

This country is already quite entertaining.
Stay tuned for more info than you probably will even bother to read.

Hit the Reset button....

2008-04-05T14:24:00.000-07:00

Oh, United Airlines, how you disappointed me so....A two hour delay in San Antonio, and here we are! I just missed my international connection by 15min at Dulles in DC. The next flight? Exactly 24hrs later.

So, I got to spend a whole day in DC. Acutally, it could have been a lot worse. Luckily, my lovely girlfriend Felicia lives there, and she was thrilled to see me. And, it just happened to be Cherry Blossom Festival time. I must say, that DC in the spring is really nice.

Here are some picks, including the sum total of my luggage for 5 weeks in India (and a lot of that is empty space), then the two of us at the Tidal Basin and the pretty flowers. I also managed to get a shot of myself in front of Stephen Colbert's portrait which is hanging in the Smithsonian for 2 whole weeks. What luck!

I'm going to try again tonight..... Let's see what happens. I sure hope my checked backpack makes it. Come on Qatar Air, don't let me down!

(btw, still working on making text and pics agree. just enjoy the journey with me)

No, I haven't packed yet

2008-04-03T19:35:00.000-07:00

But I'll get to that tonight. Wohoo! I'm ready to go.

For your viewing pleasure, here are some maps of where I'll be. The second just shows where my route in/out of India will be, via Qatar Airlines, with a layover in Doha, Qatar (indicated by the high-tech arrow).

The first shows my primary location in Vellore (big X next to Chennai), and my planned subsequent travels, namely Chennai -> north to Delhi -> Agra (for the Taj Mahal)-> Delhi -> south to Cochin -> Alleppey (south of Cochin, not pictured) - > south to Trivandrum (at the very bottom) -> north to Mumbai -> home. I think if you click on them they enlarge.

I'm still figuring out how to get my pics to behave in this format, so bear with me.

Wish me luck. I'll post again in a few days with reports of my travels and pic goodness of my new home.

T-minus 40hrs and counting

2008-04-02T18:31:00.000-07:00

Hey there everyone,

I guess its high time I kick this thing off. Well, I'm Chris, and I'm fixin' to go to India. Yeehaw! This will be my final rotation of what has been an amazing four years at the UT Health Science Center Medical School in San Antonio, TX (UTHSCSA). I just finished up my ACLS certification training today, so all that is left is this trip. As you can see above, I'm thinking deeply about the future.

To say that I have been looking forward to this would be the understatement of the year. From the moment I was accepted to med school I decided I would do an international rotation, preferably somewhere completely unlike what I am used to. I love to try new things, and a trip to India fits that bill perfectly.

Here's the plan for my trip: I'll be leaving San Antonio in less than 2 days, flying first to Dulles in DC, then to Doha in Qatar, then on to Chennai in India. The wholw thing should take roughly 24hrs, if all goes according to plan. Hopefully, at the Chennai airport, two of my classmates will also be arriving at the same time. We plan to meet up together just outside of customs, and in theory a car will be waiting for me to take us to Vellore, about 2 hrs down the road. (FYI, lots of the names of Indian cities got changed a few years ago. Chennai = Madras, Mumbai = Bombay, etc. etc. I'll try to note both names of any new places I mention.)

Ah, Vellore, in the south Indian state of Tamil Nadu. Home of the Christian Medical College, my new residence for the next 3 weeks. Here I will have the chance to try a variety of as-yet undecided rotations. Two groups from UTHSCSA have already gone this year, and raved about it, so I have a relatively good idea of what to expect. I'll be staying in the International Hostel on campus. It will be hot. But, I live in Texas already, and spent two whole summers here without a/c, so my body will remember. Just sweat a lot, drink lots of water, and when possible, stick your head in a frezzer for a minute or two. I'll be posting a lot on here about my experiences at the CMC, as well as offering an in-depth profile of a tropical disease that I see. Fun!

After my rotation ends, I'll fly up to Delhi to meet up with my ever-lovely girlfriend, Felicia. We're planning to see the Taj Mahal, then travel down to the state of Kerala on the west coast for a week of relaxation, seeing several sights along the way. We have high hopes that we may get to help scrub an elephant in a river. At the end, we'll head up to Mumbai for the last few wacky days, including my B-day, then come home. I should get back less than 1-week before graduation. This whole experience is my present to myself for getting this far.

It must be noted that none of this would not be possible without the generous gift of the Paul Brand Scholarship I received, which is primarily responsible for funding my visit to the CMC. I've been given a great opportunity here, and will assuredly get the most out of this.

So, I'll be posting pics, both of my medical experiences and otherwise. I'm still figuring out how to do all that, but I'll fix it up pretty quick-like.

thats all for now....