Day 22 (Saturday, May 24): Cashews

Woke up spontaneously around 3:30am and again at 7:15am to the alarm. I walked to the bathroom to brush my teeth and spied a colony of white and black ants climbing on the wall surrounding the sink. I used my bug spray on them, so now they’re all dead on the wall. Admittedly gross, but better than hundreds of them crawling around. I was imagining the movie, Bugs Life and wondered if the ants could communicate with one another (i.e. letting fellow ants know about my attempt at using bug spray to decimate them).

IMG_5669Outfit of the Day. Haha.

Left for breakfast around 8:35am. Ran into Anna and walked down with her. Breakfast was good, but didn’t have enough time to finish my plate: potato pancakes, omelet, peas and bean curry. Sesen said she refuses to believe that I’ve worked at Hollister and heard not many people like to work there. People were surprised when I said I actually loved it. They asked what I did there. I said operate the cash register, greet people at the front, and fold clothes. The real reason why I probably liked it is because I love folding clothes. Everyone looked at me quizzically and said they hate folding clothes. Only Lindsey admitted she likes folding too.

Dr. Kamath, Dr. Raj, and most of the group waited outside the library. Dr. Kamath wanted to formally present a mini PowerPoint about occupational diseases among cashew factory workers in South India in our regular classroom on the fourth floor. The information was really interesting. Topics included: where cashews are heavily exported and imported (Brazil, India, West Africa, and Vietnam were producing countries), diverse uses of cashews, steps to produce an edible cashew,

1. Clean, Dry
2. Steam, Cool – dangerous3. Separate shell from kernel manually and mechanically – dangerous
4. Peel
5. Grade
6. Pack

IMG_5642the acidity of the shell, demographics of the workers (mostly women, no skills or education required), and common diseases contracted (contact dermatitis- dark brown dead skin from anacardic acid).

  • Tried to introduce glove usage, but it’s inefficient for grip and speed, so most workers choose not to use because they are paid on efficiency and output. Creams (e.g. paraffin, polyethylene, glycol castor oil) are used as a treatment option. Mechanization isn’t a 100% solution. Machines cause unemployment. Eventually the skin renews, but long-term implication = cancer.
  • Other health problems: back, knee, and shoulder pain.
  • Older people cut and separate, while younger people peel and grade (lower pay).
  • 50-100 rupees to ESI health insurance. Injuries covered.

It surprises me that I’ve never really thought about the field of occupational health before – health issues associated with work, so this was a topic I really enjoyed learning more about in India.

Boarded yellow Manipal bus and sat with Taniqua. I initiated a conversation with Dr. Kamath, who sat across from me. I questioned, “do you work at Manipal’s hospital?” K- “Yes.” Me- “What do you do?” K- “Public health (…)” Me- “You’re a doctor too?” K- “Yes. Do you doubt me?” Me- “Noo! It’s just I don’t think you’ve talked much about yourself.” He went to Manipal University for his education. The accent barrier made the conversation more awkward than I would have liked because I found myself leaning in further to put my ear closer to his mouth, so that I could hear better. I told him my plans of attending medical school next year and possibly getting an MPH too, which is what he did. He said he really likes the combination and it helps to explain many maladies. He shared some examples of how he understands more about a person’s problems by looking at the public health side (i.e. occupational). I said I really liked that aspect. He asked me about my background (education). I said I am majoring in Neuroscience and planning to attend medical school. He also asked about my heritage and I said I’m born in Columbus, but my mom is from Vietnam and my dad is from Malaysia. He mentioned Vietnam as a leading producer of cashews and I told him I remember that from his lecture in the morning. He shared he went to Malaysia last week and I said “really?? For work?” He said yes and that it’s a really beautiful country. He asked if I’ve ever visited. No to Vietnam and yes to Malaysia, but the trip was when I was a year old, so I don’t remember anything. He listed all the countries he’s been to – 12 countries mostly for work/conferences. He asked what my parents do. I said my mom is a waitress at a Chinese restaurant and that I am a first-generation college student. He said a lot of Indians here are too.

10544759_10152428759674620_8988784618373036974_oVisited a Rotary Hospital. Talked to Dr. Shetty.

IMG_5645I asked him what Rotary means. He said I made a nice observation. Essentially, it’s a teaching hospital for medical students (MDBS). Typically, students work for one year on an internship.

  • The hospital sees about 100-200 patients/day and performs 2-3 deliveries/day. Send the mothers back on day 4. Perform 25 operations in a month.
  • Other services: cataracts, vaccinations for 8 diseases, cancer screening, OBGYN.
  • Serve rural population.
  • Setup: common wards and private rooms.
  • Affiliated with public health department and focus on community health and preventative medicine.
  • Rotary International founded and built the hospital. The land was donated to Manipal University.
  • 3-H grants to provide accessible care to poor people.
  • Biggest challenge: shortage of medical staff because of rural environment.
  • Netherlands sends interns here for 1 or 2 weeks.

Visited the ophthalmologist in the hospital.

IMG_1326Most common ailments he treats are cataracts and glaucoma. Used to be free with grant, but it’s decreasing. Common beliefs- watching too much television or going outside (sun damage). Myopia is extremely common in school-aged children.

IMG_1328Arrived at the cashew factory and received a tour. Afterwards, we hung out in the owner’s office, while waiting to purchase cashews. Our whole group played word riddles to pass the time. At one point, the phone rang and Dr. Kamath picked it up. It was funny because the owner had previously picked up the phone last time it rang, but since the office was overcrowded with all of us, Dr. Kamath picked this one up. Then, another man ran around the exterior of the office, told Dr. Kamath to open the window, and took the phone outside. Hahah.

IMG_5646I bought two ½ kg bags of cashew. I am planning to give one to my mom and the other to Arif. In line, Adam told me he had a dream with me in it talking about free medicine. Coincidentally, he was in the background of my dream last night too! Taniqua told me I was knocked out asleep on the way back to campus.

We ate lunch in the cafeteria. They had these hush puppy-like balls in curry that was so good. Went with Lauren to the hospital to get her swollen bug bites checked out. Kelsey R and Adam came also. Lauren got some medication to relieve the swelling and itching.

IMG_5649Went back to the hostel afterwards. After tea time, went with Lindsey and Adam to the library to see if the Wi-Fi guy was there, but he wasn’t. I read case studies until dinner at 7:30pm. Taniqua mentioned how it’s crazy we have one week left and a lot of people are longing to head back home, but I shared my wisdom about appreciating every single day no matter how bad it gets because it’s inevitable that we’ll be leaving. The day will come whether we ask for it or not, so why not enjoy every moment you can? I went back to the room after dinner, washed clothes, showered, and tried to finish the case studies that Dr. Raj sent out. But I gravitated over to my bed around 11pm and fell asleep before a Skype date with mom. Oops.

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Day 20 (Thursday, May 22): Airport Security at the Movies

Woke up an hour ahead of my alarm. I’ve learned to leave the AC off and put the fan on a little higher to make the conditions more comfortable to sleep in. Fell back asleep and woke up again at 7:15am (real alarm). Feeling very refreshed and energized – even had time to read a case study on leprosy. I think I might choose to do my final project on this. The disease is a mix of microbiology and neuroscience, which I find very fascinating. And it’s exciting that we have the opportunity to visit a leprosy hospital today! Breakfast around 8:45am: omelet and two pancakes. Took group photo in front of the library by a professional photographer.

(16)Bus ride was long – a little more than an hour. Saw their College of Nursing and medical college.

IMG_1170IMG_1172Followed guy in a white coat to a lecture room.

IMG_1175Went to the bathroom in someone’s office.

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Refreshments were served: lime juice and a cookie.

IMG_5594The guy in the white coat talked for a little.

IMG_1179We saw a video about the history of the campus and Father Muller (German. Heal and comfort, selfless service, putting patients before self, compassionate care). Dr. Kamath then delivered a powerpoint on leprosy. I knew about half the info because of reading the case study this morning. Hehe.

  • Communicable- spread by droplets, contact.
  • Numbers are coming down into the double digits. On the elimination (1 case per 10,000). WHO is donating meds, which helps the decreasing cases.
  • Myths- curse of God, past sins. Failure to appreciate the social and psychological factors.
  • 750 beds
  • Medical college (2001). Hostel for 1500 students.
    Homeopathic medicine.
  • Occupational rehab. Run a store (sell item as service. Patients receive profit).

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  • Braces (equalize pressure on foot).

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  • Visited some patients.
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  • India has 60% of cases.
  • Signs- White patch. Test: close eyes, cotton feather or pen, no pain sensation. Hypo-pigmented, nodule in ear lobe, acid fast bacilli, nerves sensory loss, weak muscles, foot drop, hand drop, absorption of fingers (no blood supply, no nerve. No need to amputate because not spreading), claw hand (ulnar and median nerve), thickened nerve in elbow.
  • 1st stage: sensation loss (housewife move hot pot and don’t feel). Can reverse. 5th stage: irreversible disability.
  • Everything is free. Vaccine in trial.

Slept on the way home. Ate lunch in cafeteria with Dr. Kamath. Food tasted really good because it was already 3pm when we ate.

Back to room for about an hour. I continued reading case studies. Now, neglected tropical diseases really interest me.

Tea time 5:15pm: pizza roll-like bread and cake.

IMG_5596Ran into Paul at tea time and had a sincere conversation about our future careers, movies, and aspects of this trip. Walked up to the second floor of the cafeteria to find about seven of our classmates sitting waiting for food. I decided to try the aloo patty at Subway for dinner because it was the sub of the day and Sahanna had previously raved about it. I didn’t know what to expect, but it tasted just like hash brown! I like this better than chicken breast. Subway (with an Indian twist) might be one of the best things I’ve had here. Haha.

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Everyone went to the movie theater to watch X-men in 3D. At first, I wasn’t too enthused about the movie choice because I never watched the X-men series and thought I wasn’t intrigued by superhero movies, but boy was I wrong. The ticket cost 180 rupees ($3 USD). They assign seats upon purchasing the movie ticket. I sat with Kelsey and Lauren.

Entering the INOX movie theater, a couple of fast food restaurants line the perimeter. To the right, begins the line through security. The first guy rips the ticket. Then, stop by a counter where the women check inside your bags. I had gum and my camera battery confiscated. The language barrier was a problem, and I didn’t understand what she wanted me to do about it. Thankfully, a girl behind me in line helped me out and said they’ll keep it at the counter and a matching tag will be handed to me, so that I can pick it up after the movie. I walked through the metal detector and then another personnel waved a wand around my body, just like airport security. We couldn’t bring water in. The US should adopt some of these procedures in light of the recent movie theater shootings. After this, we were finally able to walk up the stairs. Kelsey R said I looked traumatized by the experience. Haha. There was a typical concession stand of movie theater food.

IMG_5600Inside, the auditorium felt just like the US. Attendants showed us to our seats and offered a menu for food. Three previews played.

IMG_5598Overall, the movie far exceeded my expectations. I loved the humanitarian aspect – lots of deep quotes. The narration at the beginning and end of the movie was superb. I found myself nodding my head a couple times. I liked the tie to science also – DNA and mutations. Here are some quirky notes about Indian movie theaters:

  • When someone on the screen smokes, a PSA pops up “Smoking is injurious to your health”. I like this a lot.
  • They silenced out a swear word (f#$%).
  • The audience really likes cheering and laughing when the parts aren’t really that funny.
  • Intermission in the middle of the movie. I surprisingly liked this. Affords a bathroom break and builds up anticipation for the second part.

Random: I liked the small amount of Vietnamese spoken in the movie. Haha. I’ve never experienced that before.

In the bathroom, they had square toilets and toilet paper!

IMG_5599Lauren, Kelsey and, I individually took a pic of the bathroom and we shared this factoid after coming out and Lauren was like “we’re soul mates”. Rickshaw back with Lindsey and Taniqua. Washed clothes, showered, skyped mom and got all caught up on the word doc journal!

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.