Day 10 (Monday, May 12): Sick Day

Woke up around 7:45am. Anna and I stepped out of our rooms at the same time so we walked to breakfast together at 8:30am. Breakfast consisted of onion pancakes, omelet, veggie curry and tea. Tried Alexa’s bottled mango juice that she bought at one of the stores at the back of the cafeteria. It was good, but not entirely sure if it is healthy (more artificial than natural).

Waited for bus at 9:30am. Sat next to Adam on the bus and asked how he was. He fell ill last night and is not sure what the cause is. Lindsey didn’t go on the field visit at all because she was ill last night also. Adam said his sickness comes in waves. We arrived at the Antiretroviral Therapy (ART) and Directly Observed Therapy, Short-Course (DOTS) buildings.

ImageImageHad a hard time concentrating because of the heat, but I did learn some valuable things. These are the notes that I took at the facility:

Both are testing centers. Service is free of charge to patients. They even reimburse bus fares.

HIV/AIDS

  • Funded by National AIDS and the Bill and Melinda Gates Foundation.
  • Hospital waste management exists. Use color-coded bins.
  • HIV is detected by the CD4 cell test count. CD4 cells are also called T cells, and they send signals to activate your body’s immune response when they detect “intruders,” like viruses or bacteria. Normal count is 1500. At risk is 350. HIV is essentially the loss of immune cells hence its name, human immunodeficiency virus. HIV destroys CD4 lymphocytes.
  • They are using computerized medical records now (not sure how recent)
  • Most common ways HIV is detected in this region of India: heterosexual sex, mother-to-child and intravenous drug use
  • HIV is a disease of behavior
  • A trial HIV vaccine is in the works. Something to do with bees. A challenge is that a virus can modify rapidly unlike bacteria – hard to create vaccine
  • This facility is the only one in state that administers treatment
  • Timeline of drugs: first line drugs = combination of 5 drugs. If resistant = 2nd line drugs. Medication is taken lifelong.
  • Side effects of drugs: bone marrow destruction, peripheral neuropathy, life threatening skin rashes, gastrointestinal problems. If any of these occur, stop and switch drugs
  • Common opportunistic infections include TB and the varicella zoster virus
  • Drugs are given during delivery in the case of an HIV-infected mother to reduce the risk of transmission
  • Okay to breastfeed during first six months because it helps with immunity, but have to balance
  • Mother-to-child transmission can happen in womb, during labor or when breastfeeding

ImageTB

3 step test that requires 1 hour. Testing antibodies. Antibodies typically takes 3-6 months to form. Antigens form first, then antibodies. 1st test might be false positive. 2nd test confirms TB 100%.

DOTS (directly observed treatment, short-course) is the name given to the tuberculosis control strategy recommended by the World Health Organization.

  • Government commitment (including political will at all levels, and establishment of a centralized and prioritized system of TB monitoring, recording and training).
  • Case detection by sputum smear microscopy.
  • Standardized treatment regimen directly of six to eight months observed by a healthcare worker or community health worker for at least the first two months.
  • A regular, uninterrupted drug supply.
  • A standardized recording and reporting system that allows assessment of treatment results.

Source: Wikipedia

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Dr. Kamath asked us to brainstorm how to improve detection and treatment of HIV/AIDS and TB. Here are some of the responses given by our group:

  • Open more centers like these
  • Emphasize on the importance of following up
  • Education
  • Awareness to general public
  • Educate more on mother-to-child transmission
  • Link these testing centers to the primary health centers
  • Provide transportation
  • Universal testing
  • Training more personnel
  • Counseling (India is planning to acquire counselors in schools, not only for HIV/AIDS and TB but for general stress too). HIV, STD, TB. 20-30 minute sessions depending on how comfortable the patient is. Can change counselors or last for a few days. Women counselors available. Reduce suicide rates. Many patients depend on counselor to make decision. Stemmed off of hierarchal society of India.
  • Reducing stigma, which depends on literacy

Kelsey F struck up a conversation with three student doctors as were walking to the bus and asked to take a picture of them. They wanted to know our names so we introduced ourselves. They were so nice and thought we were going to come back to the facilities to help around.

ImageKelsey R and Adam hitched a ride in Dr. Kamath’s car because they weren’t feeling well. The rest of us waited on the bus for Alvian and Sahanna to return from their doctor visit for skin rashes and large bubbling bug bites, respectively. They received medication and ointment.

Left for lunch around 1pm and sat with Alvian and Sesen. Sesen posed a really thought-provoking question: how did people of different races acquire their traits. For example, she mentioned black people have dark skin because of the sun. Then she inquired why Asians have small eyes, and I have no idea what the evolution behind that is. Good question to research. I’ll post my findings! Haha. Not much credible sources out there, but this is what I found:

Not all Asians have “smaller” eyes. This mainly applies to East Asians. Their eyes aren’t technically smaller, either. They simply have an extra patch of skin called an epithelial fold above their eyes.

That fold allows them to protect their eyes against extreme cold and fierce winds that occur in Tibet. Average annual snowfall is 18 inches and the land is severely dry 9 months out of the year.

The epithelial fold is simply the way they adapted to their environment. Tibet is where the ancestors of many East Asians lived for tens of thousands of years before migrating to warmer places. The epithelial fold, however, is part of the DNA now and so continues to be a trademark of East Asians.

Source: http://www.omgfacts.com/History/East-Asians-have-smaller-eyes-due-to-a-g/52005#413wDJXqAKOP8GJd.99

If you live in the tropics, dark skin is a helpful adaptation, because it protects your skin from sunlight (fewer sun burns and cancers).

If you live in the northern latitudes where there is significantly less sun certain times of the year, light skin is a helpful adaptation, because it allows more sunlight to penetrate the dermis, thereby creating more vitamin D.

The primary characteristic of East Asian eyes is called the epicanthic fold, and we believe it may have evolved to protect the eye from harsh winds, but the jury is still out on that one.

Source: http://www.reddit.com/r/explainlikeimfive/comments/1kqquy/eli5_how_did_humans_in_asia_evolve_to_have/

We finished our food and left the cafeteria, but saw Kelsey R walking in so I decided to keep her company while she eats. Saw Raushan eating and we waved hello! Walked to the library. Class with Dr. Raj at 2pm: nutrition and global health. I find this topic very interesting and am familiar with most of it so that’s fun.

Dr. Kamath wanted us to experience a “laser light show” in the building adjacent to the library. I would describe it more like an interactive movie theater. It was incredible. The premise was explaining what Manipal is all about and persuading prospective students to study here. The elaborate presentation definitely persuaded me! OSU needs to step up its game. Haha.

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Walked back to the hostel. Thought tea time was at 4pm (instead of 4:30pm), so I ended up walking and exploring by myself near the cafeteria and library.

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At tea time, the snack was fried dough balls. Didn’t eat it, but drank tea.

As we were walking up to the hostel so people can get money for shopping, a woman drove up to us on a motorcycle asking if we’re from Ohio. I recognized her as the doctor who showed up to one of our lectures last week to introduce herself to us. She said she needed someone to accompany Lindsey at the hospital. Sahanna volunteered and jumped on the motorcycle. Lindsey had a gastrointestinal infection and needed IV fluids and two shots because she could not keep any food or liquid in her system. This ended up costing her an equivalent of $20 USD for medical treatment, which is a notable difference compared to the US.

Kelsey F, Rachel, Anna, Dan and I went shopping. Rachel and Anna went to a purse shop while Kelsey, Dan and I searched for the bangle shop. We were directed to a gift house that had two floors, and we walked up the twisty narrow stairs with toys and clocks lined on the side walls. There were a bunch of knick knacks everywhere. I ended up buying orange and yellow sparkly bangles for 80 rupees.

Dinner consisted of rice, veggies, potatoes and curry. A lot of people are telling me that they’re relying on my blog posts to remember details for their own journal. Haha. It feels nice to know these serve some type of purpose.

Intermission

Hello all!

I apologize for falling off the face of the blogging world. The last two weeks of India were spectacular and very busy. We were all working very diligently on our final paper and presentation about a global public health topic of our choosing. Surprisingly, this assignment was one of many highlights for me.

Not to fret! I have not abandoned my plan to continue the 29 Days of India series. I have all the memories saved on a word doc, so the posts will not be any less detailed. However, I have some bad news. I plan on finishing the series in late June and early July. I will set a date here so that I can keep my promise: July 7, 2014 is the latest that I will upload the rest. Sorry to the people I told I would finish in the week after our return to the US :/

So why July 7th? I am stressed out and freaking out (inside). (Fun fact: my favorite number is 7, so that’s why I chose 7/7 😛 )

At first, I was mad at myself for not working on anything med school related in India because the stress immediately hit me when I stepped onto US soils. The jet lag and sickness I contracted from the airplane did not help this matter. But as my mind cleared after a few days of recovery, I wanted to believe there are no regrets.

I remember my professor telling me that I should just enjoy the study abroad trip and not to worry about the MCAT (you’ll have enough time when you get home – he said). And I honestly couldn’t have asked for a better trip. The lesson I learned here is that balance is essential. You may have a lot of unchecked boxes on your to-do list (and if you’re like me, you let this run your life), but you also have to remember to just live life. Enjoy the outdoors, enjoy company, enjoy life.

This is my goal for the next year as I travel further on the journey to medical school.

Wow I still cannot believe the time has come for my peers and I to apply to graduate and professional schools. I remember having this epiphany a few days ago when I was staring at the AMCAS front page. This is probably an extremely stressful and arduous time for all. To stay motivated, I remind myself how grateful I am to have these opportunities in life. To have access to education and pursue one’s dreams, whatever that might be. Someone else in the world wishes they could have the same choices that you do. So make the most out of your opportunities. Use the phrase “I get to..” rather than “I have to..”

ImageFond memories of MD Camp in high school. Something that keeps me going.