Day 15 (Saturday, May 17): Adventures in Mysore + Life Musing

Woke up around 6:45am. Walked down to breakfast around 7:10am. Adam, Drew and Paul were the only ones there when Lindsey and I arrived. I hugged Adam because it’s his birthday! The dining area was immaculate and mostly white in color. Breakfast was buffet style and featured American food! There were an assortment of around 15 dishes, bread, an omelet station, pastries, fruit juice, cereal, milk, coffee and tea. I was craving cereal from yesterday’s noodle dessert that tasted like Frosted Flakes, so I had that along with potatoes, pancake, turkey sausage and a cup of tea.

IMG_0899First stop: Traveled to the top of a mountain to visit the Sri Chamundeshwari Hindu temple.

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Our driver asked if we were all Christian. He told us he’s Muslim. I greeted him with “assalamualaikum” (May peace be upon you) and he responded “Wa ‘Alaikum Assalaam” (May peace be upon you too).

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When we approached the golden temple, little brown blobs were moving around and they turned out to be dozens of monkeys.

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Second stop: Christian church. We explored the congregation area and the basement.

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IMG_1316Third stop: Silk scarf store. I believe the scarves were around 1000 rupees. I didn’t buy any, but quite a few people did.

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While driving, saw an area where a plethora of white sheets were hanging. I don’t remember who told us this, but this is their method to wash and dry hospital sheets.

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Fourth stop: Women’s Health Research Institute.

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After a brief introduction by three ladies, we received a tour of the facility. Most of us quickly realized that mostly women worked here, so someone asked if any men do. They said “yes”. The three guys work as the driver and food coordinators.

We met an intern from the US that’s studying TB at the institute. There is a $500 administration fee to ensure the interns are serious and not just here for vacation. We toured the kitchen for the interns. Before leaving, a group of us talked to the US intern. He’s from California and took a year off after graduating from UC Berkeley with a public health major. He will be attending Yale Medical School in the Fall. He was here for 6 months. Fun fact: he learned to drive a vespa here.

Interns in lab study various topics such as:
– Malaria and helminthes infections in pregnant women
– Joint Indo-US study of lactobacillus and its phages in bacterial vaginosis
– UTI
– Vit D deficiency in women with BV
– Dengue virus IgG ELISA

Research:

Lab
– Molecular epidemiology of bacterial vaginosis. Amsel’s criteria for diagnosing bacterial vaginosis (must meet 3 of 4):

1. Thin homogenous vaginal discharge.
2. Vaginal pH higher than 4.5.
3. Postive whiff test for amine with KOH prep.
4. Clue cells on saline wet prep

Lactobacillus research funded by NHI. Lactobacillus in vagina and urine testing. Post-test counseling and post-natal care (PNC).

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– Evaluation of rapid diagnostic tests
– Antibiotic resistance
– Community acquired resistant UTI
– STI

Community
– Maternal child health projects
– Women’s reproductive health
– Cancer prevention
– Immunization and children health camp

Clinic
– Longitudinal cohort studies on bacterial vaginosis, reproductive tract infections, cervical cancer screening, STI/HIV prevention.
– Obtain HIV blood from mother. Identify positive or negative. Counseling available.

How they build more awareness about their services to the community:
Collect list of pregnant woman from Anganwadi teacher. Go door-to-door (service at their doorstep). This makes it easier to motivate people to come to the mobile clinic in the subsequent days.

2nd day- Education for general public. Awareness program for blood pressure, diabetes, cancer, HIV. Pregnant women. Immunizations. Birth. Flip chart pictures and power points. Family planning.

3rd– Medical camp. Self-help group. Bring women to clinic. HIV stigma very high. ASHA linked to village. Mobile clinic. Given a place to set up like a school. General check-up. Consent. Antenatal exam. Blood draw, serum separation, blood grouping.

– They do not provide treatment, but focus on education, research, detection and counseling.

– The institute is linked to the government.

– Post-natal care follow-ups last up to one year.

– Serve rural areas. Have capacity to serve 144 villages, but currently it’s 82 villages.

– HIV in pregnant woman is decreasing.

– Highest cancer rate in India is cervical.

PAP smear requires a lot of trained workers and is typically administered by private doctors. The rural population needs sustainable tests -> VIA (Mysore is pioneering this) – visual inspection. Treated by cryotherapy and LEEP.

I asked the question “for young girls, is it common to provide preventative vaccinations for cervical cancer like Gardasil?” They talked about how expensive it is – $6000-7000, which is a challenge. Currently, it is not on the required immunization chart. Targets ages 9-30 years old. Research is currently working on a cost-effective approach to preventing cervical cancer. This is also a public policy issue. They need large interest groups to support the vaccinations.

Parliamentary is mostly men. Advocating for women is a constant struggle.

Saving Children Improving Lives (SCIL) is a successful strategy for increasing uptake of HIV/PMTCT services among rural pregnant women. Provision of conditional cash transfers to women’s microeconomic self-help group members to refer pregnant women for antenatal care and HIV testing.

Prerana women’s health initiative. Objectives: provide sexual and reproductive healthcare; physical, mental and family health; conduct research to provide evidence-based care and treatment.

Project Chaitanya: increase awareness and education around the prevention of cervical cancer.

Primary prevention: 1) Creating a peer educator model in rural villages by giving training and awareness about HPV, cervical cancer and vaccination.
2) HPV- Vaccine acceptability study by parents

Secondary prevention: collaboration with prevention international: No cervical cancer (PINCC) from the US –increase screening capacity of developing countries to screen women for precancerous lesions using simple methods

Train health providers in performing simple procedure like cryotherapy and LEEP on detection of precancerous condition.

Current cervical cancer screening program is on Friday (special clinic day only for VIA screening). IMG_0970The ladies were so hospitable in that they provided us delicious snacks during their presentation: samosa, chex-mix like dish, pretzel-shaped dessert and mango juice (I apologize for not knowing some of the technical names for the food).

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Fifth stop: Mysore palace tour. A headphone-guided version was available, but we just did a walk-through. We followed masses of people in the maze-like tour through rooms filled with replicas, paintings, photographs, memorabilia, trinkets and statues. Cameras were not allowed inside. Not sure how exactly long it took, but I would guess around 30 minutes.

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Sixth stop: Café Aramane for lunch. Our group opted to sit in the air-conditioned room because the restaurant environment was smoky and humid. I sat with Nikki and Xhonela, and we shared two platters (one North Indian and the other South Indian).

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Seventh stop: A quaint art gallery with a lot of ancient paintings. Dr. Raj informed us that a lot of the paintings correlate with stories in the Hindu religion. A couple of us observed that exposed breasts were a theme in many of the artworks, and I think Taniqua bravely asked Dr. Raj what that was all about. He informed us that sari’s back then did not include a blouse because blouses are a western invention.

Eighth stop: Pantaloon store at the mall. The department store was so large that we didn’t have time to peruse the other stores in the mall. I was looking for some Indian-styled shirts/blouses, but didn’t come across any that was a good fit. I found a light blue and white patterned scarf for 249 rupees though!

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Headed back to hotel for an hour. Lindsey and I decided to chill in the lobby and asked for the hotel’s wifi password. My phone was extremely slow, so I eventually gave up on accessing the internet.

Ninth stop: Returned to the Mysore Palace to watch the light show. There was a story line behind the light show, but we could only guess what was happening because we didn’t know the local language, Kannada. A few minutes before the show ended, it started raining. Fortunately, as we were walking back to the entrance, we had the opportunity to see the palace all lit up in golden lights. Such a majestic sight.

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We walked about 10 minutes back to the hotel, which was quite an adventure. Imagine a group of 20 students crossing a wide and busy Indian-style intersection at night. Not to worry – we all survived! Haha. I got an adrenaline rush from the experience.

We had some time to kill before dinner, so several of us played “Would you Rather?” in the lobby using a question bank from the internet. The one question that struck a cord with me was “would you rather have a bell ring every time you are aroused? or feel a sharp pain in your side whenever someone says your name?” I was surprised that everyone agreed on the sharp pain, but I would choose otherwise (I didn’t get to voice my thoughts at the time). I’m going on a tangent/a little TMI, but life’s too short to live dishonestly with oneself or to be afraid to tell someone how you feel. I read this relevant quote a couple weeks ago:

IMG_5926I think this message can go beyond a romantic context (I know. I know. The question above used the word “aroused” but forget about that for a second). You can let your family and friends know that you love and care about them. We often take for granted the people we see frequently, so it’s never foolish to remind them of their value in your life. In the case of romantic relationships, if the love isn’t reciprocated, at least you tried and won’t have any regrets. Living with honesty and openness and welcoming candid conversations is extremely liberating. This is what it feels like to be human. I am working on this myself. #gettingoffthesoapbox

Multi-cuisine dinner buffet. We all sang for Adam’s birthday.

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For dessert, I was tempted to try some fruit because I was missing it in my diet, so I ate five small pieces of the assorted pineapple, watermelon and papaya. Ice cream is my weakness, so of course I had some for dessert also. The flavors were vanilla, mango and chocolate. I even went up for seconds.

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The concierge encouraged us to go to the discotech club right outside the hotel.

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As a collective group, we decided to check it out. We only had to walk one minute to see a couple men dressed in black shirts stamping people’s hands with the words “the room” in purple ink. We walked down the stairs to approach a coconut door.

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On the other side of the door was a neon green lit up path that led to the dance floor equipped with a disco ball and everything.

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There were “no smoking” signs plastered on the walls, which was nice. Techno music permeated the room. We stood relishing the sights and sounds for about ten minutes. We went back to our rooms in the hotel. Coincidentally, our room was one of the closest to the club, so Lindsey and I could hear the pulsating beats of the music well into the night, but it didn’t bother me. I showered, packed and went to bed. Stomach wasn’t feeling too well during the night. Suspected it was the fruit. I’m not sure if I mentioned why we shouldn’t eat raw vegetables and fruits here, but it’s because of the water and the different bacteria in it that our stomach might not be used to if we didn’t grow up in the country.

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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

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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.