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 13 (Thursday, May 15): Mother’s Bounty

Woke up at 7:30am. Packed for the Mysore weekend trip. 8:40am breakfast: pancake, omelet, tomato curry, tea. Looked over public health book. Took the quiz at 9am. It went alright. A lot of people thought it was harder than the first one. Got the 1st quiz back and got 18.5/20 points.

Went back to hostel to get backpack. Waited in the lobby because Dr. Raj was getting the boys from their hostel. Meanwhile, we discovered a small ice cream and snack shop on the ground floor of our hostel. In a single file line, all of us signed out in the security guard’s book – and so the adventure begins.

The vehicle options were a Toyota Sienna minivan or a larger traveling van. Lindsey and I had our eyes on the minivan. Xhonela, Taniqua, Adam, Alvian and our driver Chand were the other occupants in the minivan. Chand played some good throw back jams: Edward Maya, Akcent, Three 6 Mafia (lolli lolli), Rihanna (Umbrella), Wyclef Jean (Sweetest Girl), MIMS (This is Why I’m Hot) and techno dance music. I was enjoying the car ride way too much because of the music haha. Everyone was sleeping at one point, but I didn’t feel tired. I took in all the sights and sounds.

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The driving is so scary. There are numerous signs that forewarn an accident zone with a picture of a skull and “x” – wanted to get a picture of this, but never did 😦 Weaving in and out of traffic was the normality.

We stopped at a restaurant to eat lunch. The waiting time was quite long, but Nikki, Xhonela, Sesen and I passed the time well by talking. We all ordered some really good mango juice called Mazza; it’s healthy and not artificial too.

IMG_0722For food, I ordered the chicken biriyani. I asked the waiter how big the half-size and full-size meals are, and the waiter sized me up and said the half-size is appropriate for me. Haha. The biriyani was okay because it was a little spicy. At lunch, Dr. Raj told me he found my blog through OSU’s public health twitter. He said I wrote too much about him. Haha.

Got back in the car for more driving. Mysore is about 6 hours away from Manipal.

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The ride was crazy as usual. This time, I actually cringed and held on to Adam multiple times. I couldn’t help but think of head-on collisions as we were regularly faced with oncoming traffic.

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Our driver is extremely skilled though. The music was still bumpin: Flo Rida (Low), Akon (Beautiful, Dangerous), Avril Lavigne (Complicated, Girlfriend). Adam mentioned how it’s crazy that we still remember the lyrics of songs that we haven’t heard in awhile. Who else has thought about this? I wish studying worked that way… Driving on the mountain was breathtaking, but nerve-wracking at the same time. A lot of sharp turns and winding roads.

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We lodged in a place called “Mother’s Bounty” on top of a mountain in Madikeri.

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Our minivan arrived late because we took a couple wrong turns. The girl’s living arrangements were: a 2-person room, a 4-person room or an 8-person room with four beds. I stayed in the larger room.

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Before dinner, we took a trip to see the sunset on the mountains. Sesen joined us this time in the minivan because she felt her seat in the traveling fan was precariously uncomfortable. She said she had no one in front of her and no seatbelt, so she has to brace every time the driver brakes. The view was breathtakingly beautiful. There was an official overhang with silver railings ideal for a group picture, but our large group never got a chance to occupy that space because of other visitors so we took a group picture overlooking the mountains at another spot instead.

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Lauren, Kelsey and I decided to hike over to a cliff overhang that looked like it was just floating in the abyss.

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We watched the sunset there, which was absolutely stunning. As a collective group, we took lots of O-H-I-O, jumping, yoga, individual and group pictures.

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This is the most scenic part of the trip so far. We walked back and took a group pic with Dr. Raj in it. Upon arriving, he showed Alvian his Buckeye hat he brought in his backpack, so I asked him where it was before taking this group picture and he put it on. Haha.

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We had to wait about 1.5 hours until dinner so some people played cards or showered. I watched Pitch Perfect with Taniqua. Dinner was served downstairs in a dimly lit dining hall. When I came down, everyone was freaking about a tarantula-sized spider. I tried to take a picture, but it didn’t come out very well – maybe for the better because I don’t want to remember that large creature.

IMG_5492Dinner was okay:rice, rice noodles, stir-fry noodles and an assortment of curry. A lot of the dishes were spicy, so it didn’t sit well with my taste palate.

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The noodles in sweet milk dessert, however, was delicious. It tasted like frosted flakes to me. Made me miss eating cereal every morning for breakfast.

After dinner, they had a bonfire for us. I didn’t feel like going because it was out in the woods at night, where bugs are rampant (I am an attraction for mosquitos), but it ended up to be a good bonding time. At first, we were all mingling, but then someone suggested we play telephone. Sesen came up with the phrase “epidemiological studies depend on monkey species” or something along those lines. At the end, the phrase changed a little bit, but the topic was still correct. Then, someone suggested playing two truths, one lie. Kelsey, Lauren and I simultaneously expressed our dislike for the game, but reluctantly participated. It wasn’t as bad as I thought and I actually enjoyed playing this time. Dr. Raj opted out, but agreed to come up with his own the following day once he has thought more about it. Here was mine: 1) I’ve never donated my hair. 2) I jump rope on a regular basis. 3) I didn’t know English entering Kindergarten. Some people guessed #2, but consensus was #1. Taniqua asked when, and I said last year some time, but it was actually two years ago. Time flies! The bonfire didn’t last too long.

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Experienced a bucket shower because the facility didn’t have a shower faucet. Woohoo adding that to the India Bucket List that I will post on this blog. Haha did you notice the play on words? To my surprise, the bucket shower felt refreshing. Nikki asked how tall I am and I told her the story of how I always thought I was 5 feet tall, but went to the doctors one day and they broke the news to me that I was only 4 feet 11 inches and three quarters – but hey we can round up right? Lindsey found a couple bugs on our bed that had projection-like legs that moved itself. She killed them, but it was freaky. Surprisingly, I wasn’t too phased about it when I was sleeping. There was no AC, just a fan. I was the last one to finish showering and head to bed. Everyone wrapped themselves in their sheets like a cocoon, but I was too hot, so I was just a taco. Hahah what nice analogies. I wore long sleeves and long pants to protect myself from potential bugs. Slept well I guess (except for the nose congestion that a lot of other people felt too) because I didn’t wake up until the morning – must have been the road trip exhaustion.

Day 2 (Sunday, May 4): End Point and Let’s Go to the Beach Beach, Let’s Get Away.

ImageWho got the song reference there??

Woke up at 7:30am. Ate breakfast which consisted of a fried naan-like pancake, curry, toast and jam (Sorry for not giving the full name of each dish). Chai milk tea is also served and I am in love with it. Dr. Raj took us on a morning walk to End Point at 9am. Dr. Raj pointed out a Malaysian medical school to me. The previous night he had told me that there is a huge population of Malaysians here. I asked why a school is so specific to race. I believe he said the locals need Malaysians to serve as teachers in the medical field (not quite sure what that exactly means). I am half Malaysian which is why he thought this topic was of particular interest to me.

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I am astounded at how international Manipal U is. A lot of countries are represented in their students and in study abroad students.

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The walk was about 20 minutes. We were on the outskirts of the college where no one really went so it was very serene. A nice contrast to the hustle and bustle of town. Had a nice conversation with a fellow classmate about med school shenanigans that are happening now and in the next few months. It’s so great to connect with someone going through the same things you are. You’re never alone in the world. Many opportunities to take pictures on the cliff and at the garden were available. I also gathered all the Wolfe scholars for an O-H-I-O picture. I would Instagram but my phone does not get wifi.

IMG_0261(Left to right: Taniqua, Ellen, Kelsey, Nikki. Wolfe recipients)

Lunch was served at 12:30pm. The choices were chicken, regular rice, barley rice and curry. A group of us played card games afterwards. We played BS and mafia… learned those types of games are not my cup of tea. I hate lying (and am bad at it) even though it’s just a game. Spoons was more fun. Beach time at 4pm. We met in front of Manipal U and rode a Manipal bus to Malpe Beach. Had a nice conversation with a fellow classmate about his public health profession plans. Lots of activity and people at the beach. First, we saw a Gandhi statue.

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Then we rode camels. I’m all about checking items off the bucketlist! A group of Indian people were really excited to see our OSU group there and said hi. Another group of people wanted to take a picture with Drew. They told him to wrap his hands around him. A member of our group said that some people really like having a foreigner friend and want to show off. Dr. Raj later told us that some people use that to pickpocket you. Girls in particular should be cautious. Then some people went to touch the water. It was very warm. I wanted to take a picture with the sea in the background but ended up getting my shoes all wet. Worth it though. Haha. We then took a walk down the beach. Dr. Raj used a stick to write out the date and OSU PH in the sand. So cute.

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Walked back. Began getting very tired. Rode Manipal bus to a restaurant in Udupi. Dr. Raj let us pick one snack and one dessert on the house. He’s so nice. Wish he was my grandpa haha. I got vegetable biryani with a mango ice cream slab. A lot of people got masala dosa and milkshakes. We then had to take a citi bus back to Manipal but ended up walking a few blocks to find a bus. Shoes started to hurt and was painstakingly tired. Finally got back around 8:30pm and had time to shower and do some writing but I kept falling asleep in my bed and finally succumbed to sleep around 11pm. Before bed, I noticed gnats were chillin around the light above my bed. I immediately sat up & turned off the light. I even found a few on the bed and pillow. I sprayed bug spray all around. Bugs of any kind scare me especially in one’s living quarters, but instead of thinking how life is so miserable… I thought about how many people in the world have to sleep outside or are exposed to the environment. They deal with worse things than beds in an air-conditioned room. This put things into more of a perspective for me. I am really thankful and blessed to have had the opportunity to live the bare minimum in Panama and to experience this in India. This has truly made me a more understanding citizen of the world and to stop taking things for granted back in the US.