As stated previously this last Friday completed my time with the Internal Medicine II team. Although there was a lot of time spent standing or sitting around waiting for things that never seemed to take place, a common event it seems here in India, there were a few brief moments of extreme education here and there. I got to see things I'd never seen -- and I'd gamble many physicians in the US have never seen -- in quick one hour spurts during rounds with the individual medicine subteams. I cannot go into great detail unfortunately as much of the time I was not privy to such detail not being fluent in Hindi or Tamil, but I can give you all a taste of what I saw.
For starters, I saw lots of diabetes. This obviously is not terribly different from San Antonio, but I mention it because of how unexpected it was. Much like diabetes type 2 was relatively uncommon a few decades ago in the US, the progressive Westernization and, more importantly, increased processing and access of foods in India has lead to a significant increase in their own incidence of the disease. Many have speculated that, like many subgroups in the Hispanic population, having adapted to a relatively meager diet for centuries the Indian people are particularly prone to developing insulin resistance in response to a surge of refined sugars in their diets. Thus India has been introduced to the world of diabetes. It almost made me feel at home again.
With diabetes of course comes heart attacks and strokes. Not surprisingly Indian heart attacks and strokes are much like American strokes.
Now we get to the good stuff.
DRESS. Never heard of it -- initially doubtful it really existed -- but DRESS (or Drug Rash with Eosinophilia and Systemic Symptoms) is, as its name would suggest, a violent reaction in response to the administration of certain drugs. In our patient's case it was some antibiotic he got from who knows where, and he responded with airway narrowing, significant angioedema, hepatic enzyme elevation, and, of course, a rash. I am still not terribly sure how it differs greatly from a generic anaphylactic reaction, but DRESS does sound much more dreadful. Acronyms are scary.
Scrub Typhus. Ooh, exotic. A rickettsial illness that, like apparently all rickettsial illnesses, cleans up quite nice with doxycycline, and is associated with relapsing fevers and chigger bites. According to the doctors at CMC it is also associated with an eschar (funky looking scab) that 95 - 99% of the time tells you it is scrub typhus. Now that I look at how to spell Rickettsia I have learned that the bug has been renamed Orientia tsutsugamushi. You know, just so there's no confusion.
Typhoid. Typhus would not be complete without its close sounding but completely unrelated friend typhoid and so my patients obliged. We had to go to the isolation ward to see this guy. He was infected with Salmonella typhi, and, well, there really isn't much else to say about it. The problem with not getting much in the way of a patient history on rapid rounds with the doctors is that all the patients have nice name tags attached to their illnesses, but when you look at them they just look like sick people. Being transmitted through the fecal-oral route there were no cool eschars to see so, aside from looking unhappy, this guy did not appear too out of the ordinary. Nevertheless I was thankful for my oral typhoid vaccine.
Last interesting case that I can remember and care to share: organophosphate poisoning. For those not in the know -- and a pity you are not -- organophosphates are major components of many industrial pesticides. Combine this and ready access in developing nations with the compounds' cholinergic affects and you have a great way to attempt suicide. Or so many people seem to feel. Such was the case with this young man. As usual I was not able to get much in the way of a history from this guy as I saw him only briefly during Grand Rounds, but he had apparently ingested a large amount of it and properly gone comatose. We gave him a healthy dose of atropine (an anti-cholinergic) and by the end of the day he was awake and fairly normal again. It is an interesting side note that suicide in India, like many other developing nations, has only increased significantly with its recent industrialization. Make of that what you will.
I also saw some malaria, some tuberculosis, some connective tissue disease and rheumatoid arthritis, but, honestly, I do not care to comment about them. I either did not get enough information to say much or I do not think they make for the best stories.
But this week comes CHAD (Community Health And Development!) I'll go more into this amazing project later -- and like much of the rest of CMC I do believe it is worthy of the adjective "amazing" -- but for now I'll simply wrap up with a short summary of our weekend.
Saturday we went to see the 16th Century fort, if I remember correctly, that came to be occupied over time by a wide variety of Indian kingdoms, empires, and, finally, the British. Eventually like most forts it became obsolete and so has become instead a store house for a wide variety of government programs and buildings including a number of museums -- if I may be so generous with the term -- a university, and a police academy of sorts. The highlight of the museums? The giant, green T-Rex statue out front. They were otherwise like the Dubai Museum but without the mannequins. A few artifacts here and there, but little in the way of descriptions, history, or impressive appearance. There was also a Hindu temple on the grounds, the Jalagandeeswarar Temple, which we were unfortunately unable to take pictures of, but I will hopefully be able to describe in detail in my next post. For now let me just say it was... uhh... interesting? Back to the fort, though. It was big and impressive, but being stripped of most its features there is not much to write about.
Sunday we took a quick hike up a nearby granite cliff. Being around 12 noon it was a bit hot and a bit hazy, but it was about a 25 minute hike at leisurely speeds, and so was not very taxing. It was fun to be outside, though, and the view of the city and surrounding tropical green areas was nevertheless very nice. It looked a great deal like Enchanted Rock outside Fredericksburg in Texas I felt, and I longed for my climbing shoes. Amazing how geography and geology can be so similar thousands of miles away.
The last of the weekend was spent doing the American thing. After the girls moved into the Johnson House (completing their move out of the roach friendly new building) we discovered a television and proceeded to make use of it. There were a surprisingly large amount of English channels, and, as it was late at night and we had nothing else to do, we watched When A Stranger Calls on Indian HBO. For those of you not familiar with the movie it's about an hour and a half of phone calls followed by a 5 minute chase to close the movie out. Even for those removed of a TV for a week it made for a pretty crummy movie night, but it was relaxing, though, and nice to be free temporarily from the constant churning of Indian life.
Monday, January 14, 2008
Saturday, January 12, 2008
What in the Heck?
As expected India has much of the unexpected. The most surprising of which occurred this last night during a concert at the Winter Symposium (a series of cardiology lectures given by various distinguished physicians and PhDs). The singer whose name I can no longer remember was billed as having "the voice of an angel," and he chose to share this heavenly gift by covering a variety of American songs including Green Day, The Police, Bob Marley, and, best of all, Billy Ray Cyrus. All this was done while he hopped and kicked his away across the stage. The audience reviews were mixed and even now I myself am not quite sure what to make of it all, but I will surely not get "Achy Breaky Heart" out of my head anytime soon.
American songs sung with Hindi accents aside, what has also been interesting is the curious head shake many Indians use to communicate. It is basically an abbreviated "no" with less rotation at the neck and more side to side lateral movement of the head. It seems to communicate everything from, "I hear you" to "yes, ok" to "I'm shaking my head though I've clearly not understood a word you just spoke to me." I did not actually notice it myself at first, but after it was pointed out by other students on the trip it became readily obvious as just about everyone seems to do it.
An unfortunate thing that I was not expecting has been the general distaste for making change and the even greater distaste for giving coins in change which is particularly problematic as many of the ATMs give only large impractical to use bills. My ticket may be 41 rupees but they will only grudgingly accept a 50. "Nope. 41 rupees," they'll say. "Give me 1 more rupee." "But I can't, you guys never give me change." "Ok, then give me 45 rupees." "I don't have any 5's either!" Today I believe I said my first words in anger for the trip as, running down to only 500 and 1000 rupee bills, the local minimart clerk refused to cash a 500. I do not understand what the source of this financial problem is, but it does agitate me sometimes. And sometimes a lot.
An at times annoying thing that I was unaware of until arriving has been the fact that the concept of a line does not exist here. Only pushing mobs. It does not matter if you are standing immediately behind someone placing an order for food and the two of you are the only ones in the area. As soon as that person is done ordering another person will come around the corner, immediately thrust themselves forward, stick out some cash, and proceed to place their own order. Unlike the change issue this does not bother me as much as it does others on our trip, but I often wonder what the source of the problem is. Do they not realize we were waiting to order? Do they not care? Is it such a nonissue here that they do not even think to care?
So some other things...
It seems the vast majority of the population does in fact use their left hand to wipe themselves after the restroom. I guess it saves trees. And spreads enteric fever....
It also seems the vast majority of the population uses their hands to eat (though predominately the right for the above reason.) Seeing as much of their diet consists of rice it is a curious sight seeing a man and woman sitting with grains of rice sticking up their forearms. As silverware is often difficult to come by at some restaurants I too have taken to eating with my hands -- which I honestly get a secret joy out of -- but as I am left handed I frequently use it primarily without thinking. I can only wonder what the Indians think of that.
And then there's the trash. The world is India's trash can it seems. Even on the relatively clean and Westernized medical school campus where a few trash cans do exist, people will step outside their place and gingerly throw a plastic cup down onto a heap of debris immediately adjacent to their porch steps. I have given it a fair amount of thought and am yet still at a loss as to why they do this. Is it cultural and just what they have always done? Is it personal and they each just individually do not care? Does trash in huge sums not bother them? Is it because the government does not provide waste disposal? Is it because the Indian people as a nation have other things to worry about? Truthfully I cannot conceive what an India without trash would look like. Even more beautiful I imagine.
Trash and change and hygiene aside, beyond some occasional irking the cultural differences have not troubled me too much. Really such things are surprising only in that I am finally seeing them in practice. The trip by and large continues to be an enjoyable and unique experience. Work yesterday was cancelled for the previously mentioned Winter Symposium thus completing my week of Internal Medicine II. I attended a few of the lectures, but they always seem to be too narrow in scope to be of practical use. Or so it seems to my simple medical student mind. They had a traditional Indian dance presentation on Thursday too, and that was nice. Hopefully I can load a video of that when I return.
American songs sung with Hindi accents aside, what has also been interesting is the curious head shake many Indians use to communicate. It is basically an abbreviated "no" with less rotation at the neck and more side to side lateral movement of the head. It seems to communicate everything from, "I hear you" to "yes, ok" to "I'm shaking my head though I've clearly not understood a word you just spoke to me." I did not actually notice it myself at first, but after it was pointed out by other students on the trip it became readily obvious as just about everyone seems to do it.
An unfortunate thing that I was not expecting has been the general distaste for making change and the even greater distaste for giving coins in change which is particularly problematic as many of the ATMs give only large impractical to use bills. My ticket may be 41 rupees but they will only grudgingly accept a 50. "Nope. 41 rupees," they'll say. "Give me 1 more rupee." "But I can't, you guys never give me change." "Ok, then give me 45 rupees." "I don't have any 5's either!" Today I believe I said my first words in anger for the trip as, running down to only 500 and 1000 rupee bills, the local minimart clerk refused to cash a 500. I do not understand what the source of this financial problem is, but it does agitate me sometimes. And sometimes a lot.
An at times annoying thing that I was unaware of until arriving has been the fact that the concept of a line does not exist here. Only pushing mobs. It does not matter if you are standing immediately behind someone placing an order for food and the two of you are the only ones in the area. As soon as that person is done ordering another person will come around the corner, immediately thrust themselves forward, stick out some cash, and proceed to place their own order. Unlike the change issue this does not bother me as much as it does others on our trip, but I often wonder what the source of the problem is. Do they not realize we were waiting to order? Do they not care? Is it such a nonissue here that they do not even think to care?
So some other things...
It seems the vast majority of the population does in fact use their left hand to wipe themselves after the restroom. I guess it saves trees. And spreads enteric fever....
It also seems the vast majority of the population uses their hands to eat (though predominately the right for the above reason.) Seeing as much of their diet consists of rice it is a curious sight seeing a man and woman sitting with grains of rice sticking up their forearms. As silverware is often difficult to come by at some restaurants I too have taken to eating with my hands -- which I honestly get a secret joy out of -- but as I am left handed I frequently use it primarily without thinking. I can only wonder what the Indians think of that.
And then there's the trash. The world is India's trash can it seems. Even on the relatively clean and Westernized medical school campus where a few trash cans do exist, people will step outside their place and gingerly throw a plastic cup down onto a heap of debris immediately adjacent to their porch steps. I have given it a fair amount of thought and am yet still at a loss as to why they do this. Is it cultural and just what they have always done? Is it personal and they each just individually do not care? Does trash in huge sums not bother them? Is it because the government does not provide waste disposal? Is it because the Indian people as a nation have other things to worry about? Truthfully I cannot conceive what an India without trash would look like. Even more beautiful I imagine.
Trash and change and hygiene aside, beyond some occasional irking the cultural differences have not troubled me too much. Really such things are surprising only in that I am finally seeing them in practice. The trip by and large continues to be an enjoyable and unique experience. Work yesterday was cancelled for the previously mentioned Winter Symposium thus completing my week of Internal Medicine II. I attended a few of the lectures, but they always seem to be too narrow in scope to be of practical use. Or so it seems to my simple medical student mind. They had a traditional Indian dance presentation on Thursday too, and that was nice. Hopefully I can load a video of that when I return.
Wednesday, January 9, 2008
Monkeys Among Us
Much as many cities of the United States are riddled with chipmunks and squirrels, the cities of India are swarming with monkeys. Although informed of their presence upon our arrival, we did not actually see any until yesterday morning when about a dozen of them commenced to migrate from one group of trees to another to do whatever it is monkeys do. We were also told not to try and befriend them as as charming as monkeys may seem, to some people at least, these are actually thieving monkeys. And they bite too. Or so the rumors go. Who knows what they're actually capable of, but I will keep my distance unless one of the little guys forces my hand. Until then, live and let live.
Speaking of monkeys, though, I myself am about to start throwing poo at some people after two days of my Internal Medicine II service. We created our schedules Monday, but it seems that is about as deep as the organization goes in this elective as I have been only given a sheet of paper with times and locations and nothing else. While that may seem sufficient, and I myself would normally be inclined to think so, I must also add that many of the activities are missing, many of the activities I am in fact not intended to go to, and when I do show up I have no idea what, if anything, I am supposed to do. That last statement goes double for the residents as whenever I ask them where I should go or what I should do I can just about guarantee I will get two different answers from two different people. Confusion was mildly frustrating but acceptable on my own in Dubai when I wasn't supposed to be doing anything in particular. Now that I am it is getting rather annoying. I would not care to only attend rounds a few hours a day, and they are quite nice rounds, but at least say that that is all that is expected. Asking too much? Quite possibly so.
Since I briefly mentioned that I am the Internal Medicine II service I will go ahead and post the rest of my clinical schedule for the next three weeks.
This week (07 Jan - 12 Jan): Internal Medicine II
Plain old internal medicine and rheumatic disease (like arthritis and lupus and stuff.)
Next week (14 Jan - 19 Jan): CHAD [Community Health something or other]
A community outreach program that takes the clinic to the surrounding areas.
Last week (21 Jan - 26 Jan): Internal Medicine I
Plain old internal medicine and infectious disease (hurray!)
Back to rounds, though, they are generally the only real education packed parts of my day, and they are generally over with in an hour. They occur just like rounds in the states but typically with much worse pathology. We go from bed to bed with the residents and the attending (or registrar as they seem to be called here) and briefly discuss each patient and the plan. Although I frequently do not hear much of what is said during Grand Rounds (all the teams together), as they speak rather softly, and I frequently do not understand much of what is said during normal rounds, as I just cannot seem to deal with the India accent sometimes, they are interesting. Where else would I see bacterial endocarditis, malaria, scrub typhus, typhoid, and organophosphate poisoning? And only in two days at that. They almost make up for the fact that I usually then spend the following two or three hours sitting around the hospital reading or staring until the next random activity.
As I am on the topic of medicine I will also just pause to say that the CMC Hospital is amazing. It's like an entire medical compound. Imagine a dusty, 1950s looking version of the Houston medical center. There are a few really nice, modern facilities, but most are fairly old and jam packed with desks, beds, and people. On the ward I am currently on there is about 3 feet between each iron frame bed and easily 12+ patients along each side of the wall separated only by what appears to be a shower curtain. There are a few more private rooms and obviously some isolation rooms, but by and large the amount of space allotted to a patient and his visitors is about the size of many small apartment kitchens. It seems they expect and are used to such conditions, however, as I am not aware of any complaints, but it is definitely medicine as I envisioned it being practiced about 50 years ago at least in regards to the facilities. The quality of the care, on the other hand, is, as far as I can tell, amazingly high in light of the undoubtedly few resources available. India for all its growth is still a poor country and the needs are ever many so the fact that they can provide top of the line medicine, CT scans, chemotherapy, and the like in such a setting is something I feel worthy of envy. CMC is an amazing place and I cannot wait to share some photos when I am able to load them back in the good ol' USofA.
And while I am on the topic of amazing things I will add the CMC campus itself. Amazing may perhaps be too strong a term, but it is quite lovely. Very green and pleasant. I know I discussed it briefly earlier as a camp setting, and it is, but it is kind of a early 1900s British colonial India camp setting. Lots of old stone buildings with thick panes of glass separated by slightly overgrown gardens. In as much as the legacies of empire can be a good thing, this is a nice place.
Meanwhile life goes on. Rachel and Rebecca moved from their roach infested squatter's roost to a much larger and nicer place similar to mine and Paul's. Luggagewise, Paul and Rachel have both finally received theirs and Rebecca is expecting hers tomorrow. There's a 50/50 chance her toiletries will be missing. No signs of traveler's diarrhea or typhoid as of yet. No histrionic longings for home. No trips to Indian jail.
Speaking of monkeys, though, I myself am about to start throwing poo at some people after two days of my Internal Medicine II service. We created our schedules Monday, but it seems that is about as deep as the organization goes in this elective as I have been only given a sheet of paper with times and locations and nothing else. While that may seem sufficient, and I myself would normally be inclined to think so, I must also add that many of the activities are missing, many of the activities I am in fact not intended to go to, and when I do show up I have no idea what, if anything, I am supposed to do. That last statement goes double for the residents as whenever I ask them where I should go or what I should do I can just about guarantee I will get two different answers from two different people. Confusion was mildly frustrating but acceptable on my own in Dubai when I wasn't supposed to be doing anything in particular. Now that I am it is getting rather annoying. I would not care to only attend rounds a few hours a day, and they are quite nice rounds, but at least say that that is all that is expected. Asking too much? Quite possibly so.
Since I briefly mentioned that I am the Internal Medicine II service I will go ahead and post the rest of my clinical schedule for the next three weeks.
This week (07 Jan - 12 Jan): Internal Medicine II
Plain old internal medicine and rheumatic disease (like arthritis and lupus and stuff.)
Next week (14 Jan - 19 Jan): CHAD [Community Health something or other]
A community outreach program that takes the clinic to the surrounding areas.
Last week (21 Jan - 26 Jan): Internal Medicine I
Plain old internal medicine and infectious disease (hurray!)
Back to rounds, though, they are generally the only real education packed parts of my day, and they are generally over with in an hour. They occur just like rounds in the states but typically with much worse pathology. We go from bed to bed with the residents and the attending (or registrar as they seem to be called here) and briefly discuss each patient and the plan. Although I frequently do not hear much of what is said during Grand Rounds (all the teams together), as they speak rather softly, and I frequently do not understand much of what is said during normal rounds, as I just cannot seem to deal with the India accent sometimes, they are interesting. Where else would I see bacterial endocarditis, malaria, scrub typhus, typhoid, and organophosphate poisoning? And only in two days at that. They almost make up for the fact that I usually then spend the following two or three hours sitting around the hospital reading or staring until the next random activity.
As I am on the topic of medicine I will also just pause to say that the CMC Hospital is amazing. It's like an entire medical compound. Imagine a dusty, 1950s looking version of the Houston medical center. There are a few really nice, modern facilities, but most are fairly old and jam packed with desks, beds, and people. On the ward I am currently on there is about 3 feet between each iron frame bed and easily 12+ patients along each side of the wall separated only by what appears to be a shower curtain. There are a few more private rooms and obviously some isolation rooms, but by and large the amount of space allotted to a patient and his visitors is about the size of many small apartment kitchens. It seems they expect and are used to such conditions, however, as I am not aware of any complaints, but it is definitely medicine as I envisioned it being practiced about 50 years ago at least in regards to the facilities. The quality of the care, on the other hand, is, as far as I can tell, amazingly high in light of the undoubtedly few resources available. India for all its growth is still a poor country and the needs are ever many so the fact that they can provide top of the line medicine, CT scans, chemotherapy, and the like in such a setting is something I feel worthy of envy. CMC is an amazing place and I cannot wait to share some photos when I am able to load them back in the good ol' USofA.
And while I am on the topic of amazing things I will add the CMC campus itself. Amazing may perhaps be too strong a term, but it is quite lovely. Very green and pleasant. I know I discussed it briefly earlier as a camp setting, and it is, but it is kind of a early 1900s British colonial India camp setting. Lots of old stone buildings with thick panes of glass separated by slightly overgrown gardens. In as much as the legacies of empire can be a good thing, this is a nice place.
Meanwhile life goes on. Rachel and Rebecca moved from their roach infested squatter's roost to a much larger and nicer place similar to mine and Paul's. Luggagewise, Paul and Rachel have both finally received theirs and Rebecca is expecting hers tomorrow. There's a 50/50 chance her toiletries will be missing. No signs of traveler's diarrhea or typhoid as of yet. No histrionic longings for home. No trips to Indian jail.
Monday, January 7, 2008
Foreign is Foreign is Foreign
It's been a few days.
Here's what has happened.
I sat at an airport for a while.
I sat some more.
I watched some cricket on TV.
We traveled to Vellore.
That was basically Sunday. Today, Monday, has been devoted not to sitting around idly at airports, but to sitting around idly at the CMC campus. Seeing as none of us are really into planning ahead no real planning ahead took place and, with a few exceptions here and there, we were generally unprepared for our first official day in Vellore. Had to talk to Sally, but in reality we had to talk to Samantha, or maybe Sandra or Susan, and then sign this, sign that, what was that?, repeat that?, and so on and so forth. It took only about 2 hours to, in able to avoid autorickshawing back into town, to make some sketchy photocopies of our drivers licenses so as to provide the school with small, passport size photos for our CMC IDs. Mine definitely looks like it was made in someone's garage. Oh wells, at least I am official now. Huzzah!
Speaking of autorickshawing, though, that's fun. Kind of like being chauffeured around in a go cart. Also crazy cheap. About $1.50 for three of us on a 10 minute ride. For those of you who don't know what an autorickshaw is, fun cultural fact #2, it's essentially a three wheeler with a small bench strapped to the back and a carriage cover placed over it all to make it look a little safer. They seem to essentially have replaced taxis in Vellore, which is fine with me because you cannot reach out and snatch thinks from passing bikers in a taxi. Not that I have done that. Yet.
Our accommodations are rather rustic; I feel like I am at camp. Complete with the separation of sexes lest any unchristian hanky panky take place. Paul and I lucked out I think with the Big Bungalow Annex. Though everything seems to be made out of cement and stone, we have a nice big bedroom, bathroom with separated shower to prevent the entire area from being flooded with water (apparently quite rare here), a kitchen without any appliances, and a screened in patio: my pride and joy. There's no AC but it's not needed now, and the toilet has some flushing issues, but all in all not a bad place to live. Being on the heavily vegetated college campus and with about 2 or 3 guards per a square foot it's actually pretty nice. The girls, however, seem to not have lucked out as much living essentially in a third world apartment block. The especially unlucky ones, Rachel and Rebecca, have/had a roach problem, but some aggressive counterinsurgency tactics by Katheryn and her insecticide fogger may have hopefully remedied that.
Amongst all this, what has really surprised me is not the people, poverty, or place we currently reside at, which I have not discussed in any great detail, but how generic the whole experience has been so far. Although it was a long, long time ago back when I was a sophomore in high school, I feel that my experience then to Honduras was much like this experience now. Though many of the details were different as clearly no one would confuse Honduras for India, the thoughts and feelings that I have so far felt have been essentially the same. Likewise with my experiences in Dubai and some cities in Europe. Looking back I suppose there is not necessarily any good reason why my thoughts and feelings would be any different as, despite the details, I am a first world traveler in a third world country in both instances, but regardless I have so far been unmoved and unstirred. Not that I feel I do not appreciate the reality of life as it is in India, in as much as I can as a first world traveler in a third world country, just that I feel it's the same story with different characters. I am sure I will get a great deal out of this trip, but, as of now, I do not think it will be because this is experience is anything new.
Here's what has happened.
I sat at an airport for a while.
I sat some more.
I watched some cricket on TV.
We traveled to Vellore.
That was basically Sunday. Today, Monday, has been devoted not to sitting around idly at airports, but to sitting around idly at the CMC campus. Seeing as none of us are really into planning ahead no real planning ahead took place and, with a few exceptions here and there, we were generally unprepared for our first official day in Vellore. Had to talk to Sally, but in reality we had to talk to Samantha, or maybe Sandra or Susan, and then sign this, sign that, what was that?, repeat that?, and so on and so forth. It took only about 2 hours to, in able to avoid autorickshawing back into town, to make some sketchy photocopies of our drivers licenses so as to provide the school with small, passport size photos for our CMC IDs. Mine definitely looks like it was made in someone's garage. Oh wells, at least I am official now. Huzzah!
Speaking of autorickshawing, though, that's fun. Kind of like being chauffeured around in a go cart. Also crazy cheap. About $1.50 for three of us on a 10 minute ride. For those of you who don't know what an autorickshaw is, fun cultural fact #2, it's essentially a three wheeler with a small bench strapped to the back and a carriage cover placed over it all to make it look a little safer. They seem to essentially have replaced taxis in Vellore, which is fine with me because you cannot reach out and snatch thinks from passing bikers in a taxi. Not that I have done that. Yet.
Our accommodations are rather rustic; I feel like I am at camp. Complete with the separation of sexes lest any unchristian hanky panky take place. Paul and I lucked out I think with the Big Bungalow Annex. Though everything seems to be made out of cement and stone, we have a nice big bedroom, bathroom with separated shower to prevent the entire area from being flooded with water (apparently quite rare here), a kitchen without any appliances, and a screened in patio: my pride and joy. There's no AC but it's not needed now, and the toilet has some flushing issues, but all in all not a bad place to live. Being on the heavily vegetated college campus and with about 2 or 3 guards per a square foot it's actually pretty nice. The girls, however, seem to not have lucked out as much living essentially in a third world apartment block. The especially unlucky ones, Rachel and Rebecca, have/had a roach problem, but some aggressive counterinsurgency tactics by Katheryn and her insecticide fogger may have hopefully remedied that.
Amongst all this, what has really surprised me is not the people, poverty, or place we currently reside at, which I have not discussed in any great detail, but how generic the whole experience has been so far. Although it was a long, long time ago back when I was a sophomore in high school, I feel that my experience then to Honduras was much like this experience now. Though many of the details were different as clearly no one would confuse Honduras for India, the thoughts and feelings that I have so far felt have been essentially the same. Likewise with my experiences in Dubai and some cities in Europe. Looking back I suppose there is not necessarily any good reason why my thoughts and feelings would be any different as, despite the details, I am a first world traveler in a third world country in both instances, but regardless I have so far been unmoved and unstirred. Not that I feel I do not appreciate the reality of life as it is in India, in as much as I can as a first world traveler in a third world country, just that I feel it's the same story with different characters. I am sure I will get a great deal out of this trip, but, as of now, I do not think it will be because this is experience is anything new.
Saturday, January 5, 2008
Do You Understand the Words That Are Coming Out of My Mouth?
Being a fairly cosmopolitan town Dubai has two primary languages: Arabic and English. The English, however, is not a form I have ever heard of. Much of the time I have felt wild gesticulations communicated more than any English being spoken to me. Oh wells, I will be in India soon enough. I hear they speak proper Queen's English there. Oh I say!
Anyways, the problem with goal directed wandering is that it is still wandering, and the problem with doing this towards your hotel at night and from a different direction than which you originally started from is that it quickly regresses into just plain old wandering. After walking for more than three hours back from the mosque, interrupted a bit for some dinner at a Lebanese restaurant, I then spent another 30 - 45 minutes circling the neighborhood my hotel was located in but never quite finding it. All I wanted to do was get back to my hotel to have a sip of water and a good sit, but instead I traversed street after street which, though looking familiar enough, were generally not too close to my actual hotel. I finally did find Eureka Hotel and after washing up I promptly fell asleep watching the Orange Bowl. Good times.
The only major highlights for today have been finally finding the Dubai Museum and finally figuring out the water taxi system. The Museum was not much to write about. Just imagine mannequins in Arabic garb with a few captions strewn about. For about a $1 admittance, however, I could not complain. The water taxis on the other hand were even cheaper, and even more enjoyable. If there's anything I enjoy as much as in-flight meals it is boats. Well there are plenty of things I enjoy as much or more than in-flight meals actually, but nevertheless crossing Dubai Creek (about 130 yards across) on what seemed to be almost a glorified motorized canoe with about twenty other people was quite nice. Perhaps it was just because I was off my feet; though, I think I need some arch support.
It probably comes as no surprise that the Westerners are where the money is, but it seems in Dubai that this is also where the Arabs are. Despite being at the Eastern terminus of the Arabian Peninsula the city grew so fast and the indigenous population was initially so small that the Arab population in the city is clearly a minority and is, in general, almost as wealthy as the tourists and businessmen coming to visit. The significant majority of the less affluent population, on the other hand, would appear to be from either SE Asia or the Indian subcontinent. It almost appears to be a colony of the latter at times. Curious.
Well, off to India tonight. Dubai's alright, but I'll be happy to move on and to me up with the other UTHSCSA folk. Just need to get past sitting at the airport for 5 or 6 hours tomorrow morning. Oh bugger!
Anyways, the problem with goal directed wandering is that it is still wandering, and the problem with doing this towards your hotel at night and from a different direction than which you originally started from is that it quickly regresses into just plain old wandering. After walking for more than three hours back from the mosque, interrupted a bit for some dinner at a Lebanese restaurant, I then spent another 30 - 45 minutes circling the neighborhood my hotel was located in but never quite finding it. All I wanted to do was get back to my hotel to have a sip of water and a good sit, but instead I traversed street after street which, though looking familiar enough, were generally not too close to my actual hotel. I finally did find Eureka Hotel and after washing up I promptly fell asleep watching the Orange Bowl. Good times.
The only major highlights for today have been finally finding the Dubai Museum and finally figuring out the water taxi system. The Museum was not much to write about. Just imagine mannequins in Arabic garb with a few captions strewn about. For about a $1 admittance, however, I could not complain. The water taxis on the other hand were even cheaper, and even more enjoyable. If there's anything I enjoy as much as in-flight meals it is boats. Well there are plenty of things I enjoy as much or more than in-flight meals actually, but nevertheless crossing Dubai Creek (about 130 yards across) on what seemed to be almost a glorified motorized canoe with about twenty other people was quite nice. Perhaps it was just because I was off my feet; though, I think I need some arch support.
It probably comes as no surprise that the Westerners are where the money is, but it seems in Dubai that this is also where the Arabs are. Despite being at the Eastern terminus of the Arabian Peninsula the city grew so fast and the indigenous population was initially so small that the Arab population in the city is clearly a minority and is, in general, almost as wealthy as the tourists and businessmen coming to visit. The significant majority of the less affluent population, on the other hand, would appear to be from either SE Asia or the Indian subcontinent. It almost appears to be a colony of the latter at times. Curious.
Well, off to India tonight. Dubai's alright, but I'll be happy to move on and to me up with the other UTHSCSA folk. Just need to get past sitting at the airport for 5 or 6 hours tomorrow morning. Oh bugger!
Friday, January 4, 2008
The Marigolds are Abloom in Dubai
Part of the reason I have essentially never traveled by myself abroad is simply because I have never desired to do so. Truthfully, I do not even desire to do so now. I would prefer the company of friends and loved ones, but, in light of the fact that these same people often do not have the same interests or opportunities that I do, I will have to make do. The reason for this feeling, I believe, is because of how profoundly isolating foreign travel is. A different language, a different culture, a different people, and a different location thousands of miles from home force the idea of separation on you. In small quantities this feeling is not bad, and can even be enjoyable in a way, but I have generally felt it to be a downside when it comes to international travel. Not that it'd prevent me from doing it, but I certainly don't like traveling far far away *because* it makes me feel different than other people.
To drag this thought on a bit longer, I think this sense of "aloneness" is only exacerbated by the fact that foreign travel is usually accompanied by a feeling, at least for myself, of adventurism -- a form of romanticism. It is exciting, new, and adventurous -- even if in a relatively controlled and unadventurous sort of way -- and it generally serves to both increase your basal adrenalin secretions and awaken your senses ever so slightly. How could you not want to share this experience with someone then? Certainly words will never suffice and pictures, though lovely, are only pictures. It is because of this romantic adventuristic spirit that I feel the sense of isolation has been only all the more prominent for me. Not that I feel lonely -- that is certainly not the case -- and not that I am unhappy with my experiences so far -- by and large these first few days are going great -- it is just that I acutely feel the desire to be sharing in my travels with others. I've noticed that marigolds seem to be the flower du jure in Dubai as they are planted in great beautiful numbers all along the city's main thoroughfares, but no matter how much detail I may go into explaining this fact and no matter how great my photos of these long, stretching lanes of flowers may be, the image I create and the image I am experiencing will never match. A shame.
All that ho hum aside, life in Dubai is good. The trip did not start off entirely well as my first flight from San Antonio to Houston was almost subverted by my own silliness as I tried to check in at the Southwestern kiosks for a Continental flight, but after some gentle correction I was on my way. The Emirates flight was packed and the 777 we flew on was huge. I found my way to my economy class seat, dutifuly put up my luggage, and then did not move for 13 hours. For all the restrictions in movement, though, the individual television screens just about made up for it. I watched some Simpsons, some Scrubs, some Transformers and Balls of Fury (both fairly terrible movies), and played a variety of video games so that, despite not really sleeping at all, the flight went by relatively quickly. This was even with the extra hour added on to defrost the pooper which had apparently somehow frozen over (in Houston of all places.) The highlight of the trip, however, was the food. Perhaps because it is generally never served on domestic flights anymore, or perhaps I just get excited about stupid things, but in-flight meals have always made me happy. It is almost kind of like eating around a campfire. The food is not usually anything great, but the experience is.
My night in Dubai was uneventful as it was late, I had already eaten, and so simply checked into my room and went to bed, but the following day, today, has been busy. After giving myself a brief pep talk to get myself out of the hotel room and into the world, I left the hotel and immediately went to the small neighborhood market across the street. Breakfast today would be a box of fig newtons -- or the Arab equivalent at least -- some water and a granola bar. Not terribly satisfying to say the least, but not knowing what was safe to eat of the local fare I was generally terrified of the local restaurants. Not terrified so much as generally completely unwilling to eat there. I will have to ease into that.
My travel strategy, when it comes to places I am unfamiliar with, is generally a goal directed wandering. I pick some places I want to go, figure out a basic route, and head in that direction. As I frequently am unable to figure out road signs very well -- in foreign places or at home -- I am usually content with simply heading in the right direction. As such I wandered completely past my first destination, the Dubai Museum, and instead into one of the local souks which, for today's culture fact #1, are Arabic open air markets specializing in one particular class of goods. Dubai is known primarily for its gold and spice souks, but I stumbled upon its silk and cloth souk. Being as Friday is a weekend day and apparently the weekend day of prominence (kind of like Sunday in the US) most the market was closed. Oh wells, it just so turns out I have all the silk and cloth I needed anyway. Myeh.
After traversing the silk souk for a brief while, I continued along the shoreline of the Dubai Creek passing what was possibly a hundred different empty tourist dhows which I had heard are a fairly popular means of getting across the creek, but as they were all universally empty I decided to defer a leisurely river cruise till a later date. Now particularly hungry and not finding many in the way of appealing looking restaurants I ventured into a nearby Carrefour hoping to find a food court. It turned out not to be an Arabic minimall, though, but an Arabic Walmart complete with a thumping electronics department, cheap hair salons, a handy optometrist, and a one hour photo. After briefly watching some foreign gentleman play some sort of race car game on a Playstation 3 for a minute I got myself a sandwich and moved on.
My last destination, really the only intended one I have actually made it to so far, was the Grand Jumeirah Mosque. I made it there right as the imams were calling for prayer, and not knowing how they would react to a foreign gawker with a camera, I decided to wait across the street till it was all over. I'd like to say it was a remarkable experience watching hundreds of men in unison bow to pray while the speakers blared overhead, but it wasn't. Perhaps because I am familiar enough with what they were doing to be indifferent, or maybe because I had seen it on television so many times before, but for whatever reason I sat down and lost myself in thought while they continued to lose themselves in prayer.
Well in the interests of time, both for the reader and my internet cafe bill, I will bring this to a close. I am not entirely sure how interesting or entertaining this entry is as it has mostly been mildly edited stream of conscious, but hopefully with more time in Vellore I can edit things down a bit. Or at the very least learn to write less.
Now for a two hour walk back to the hotel!
To drag this thought on a bit longer, I think this sense of "aloneness" is only exacerbated by the fact that foreign travel is usually accompanied by a feeling, at least for myself, of adventurism -- a form of romanticism. It is exciting, new, and adventurous -- even if in a relatively controlled and unadventurous sort of way -- and it generally serves to both increase your basal adrenalin secretions and awaken your senses ever so slightly. How could you not want to share this experience with someone then? Certainly words will never suffice and pictures, though lovely, are only pictures. It is because of this romantic adventuristic spirit that I feel the sense of isolation has been only all the more prominent for me. Not that I feel lonely -- that is certainly not the case -- and not that I am unhappy with my experiences so far -- by and large these first few days are going great -- it is just that I acutely feel the desire to be sharing in my travels with others. I've noticed that marigolds seem to be the flower du jure in Dubai as they are planted in great beautiful numbers all along the city's main thoroughfares, but no matter how much detail I may go into explaining this fact and no matter how great my photos of these long, stretching lanes of flowers may be, the image I create and the image I am experiencing will never match. A shame.
All that ho hum aside, life in Dubai is good. The trip did not start off entirely well as my first flight from San Antonio to Houston was almost subverted by my own silliness as I tried to check in at the Southwestern kiosks for a Continental flight, but after some gentle correction I was on my way. The Emirates flight was packed and the 777 we flew on was huge. I found my way to my economy class seat, dutifuly put up my luggage, and then did not move for 13 hours. For all the restrictions in movement, though, the individual television screens just about made up for it. I watched some Simpsons, some Scrubs, some Transformers and Balls of Fury (both fairly terrible movies), and played a variety of video games so that, despite not really sleeping at all, the flight went by relatively quickly. This was even with the extra hour added on to defrost the pooper which had apparently somehow frozen over (in Houston of all places.) The highlight of the trip, however, was the food. Perhaps because it is generally never served on domestic flights anymore, or perhaps I just get excited about stupid things, but in-flight meals have always made me happy. It is almost kind of like eating around a campfire. The food is not usually anything great, but the experience is.
My night in Dubai was uneventful as it was late, I had already eaten, and so simply checked into my room and went to bed, but the following day, today, has been busy. After giving myself a brief pep talk to get myself out of the hotel room and into the world, I left the hotel and immediately went to the small neighborhood market across the street. Breakfast today would be a box of fig newtons -- or the Arab equivalent at least -- some water and a granola bar. Not terribly satisfying to say the least, but not knowing what was safe to eat of the local fare I was generally terrified of the local restaurants. Not terrified so much as generally completely unwilling to eat there. I will have to ease into that.
My travel strategy, when it comes to places I am unfamiliar with, is generally a goal directed wandering. I pick some places I want to go, figure out a basic route, and head in that direction. As I frequently am unable to figure out road signs very well -- in foreign places or at home -- I am usually content with simply heading in the right direction. As such I wandered completely past my first destination, the Dubai Museum, and instead into one of the local souks which, for today's culture fact #1, are Arabic open air markets specializing in one particular class of goods. Dubai is known primarily for its gold and spice souks, but I stumbled upon its silk and cloth souk. Being as Friday is a weekend day and apparently the weekend day of prominence (kind of like Sunday in the US) most the market was closed. Oh wells, it just so turns out I have all the silk and cloth I needed anyway. Myeh.
After traversing the silk souk for a brief while, I continued along the shoreline of the Dubai Creek passing what was possibly a hundred different empty tourist dhows which I had heard are a fairly popular means of getting across the creek, but as they were all universally empty I decided to defer a leisurely river cruise till a later date. Now particularly hungry and not finding many in the way of appealing looking restaurants I ventured into a nearby Carrefour hoping to find a food court. It turned out not to be an Arabic minimall, though, but an Arabic Walmart complete with a thumping electronics department, cheap hair salons, a handy optometrist, and a one hour photo. After briefly watching some foreign gentleman play some sort of race car game on a Playstation 3 for a minute I got myself a sandwich and moved on.
My last destination, really the only intended one I have actually made it to so far, was the Grand Jumeirah Mosque. I made it there right as the imams were calling for prayer, and not knowing how they would react to a foreign gawker with a camera, I decided to wait across the street till it was all over. I'd like to say it was a remarkable experience watching hundreds of men in unison bow to pray while the speakers blared overhead, but it wasn't. Perhaps because I am familiar enough with what they were doing to be indifferent, or maybe because I had seen it on television so many times before, but for whatever reason I sat down and lost myself in thought while they continued to lose themselves in prayer.
Well in the interests of time, both for the reader and my internet cafe bill, I will bring this to a close. I am not entirely sure how interesting or entertaining this entry is as it has mostly been mildly edited stream of conscious, but hopefully with more time in Vellore I can edit things down a bit. Or at the very least learn to write less.
Now for a two hour walk back to the hotel!
Wednesday, January 2, 2008
Formal Dress With Sandals
At 2:30 this afternoon I will be in the air on the first stage of a multistaged trip to India. Neat.
Although I am not generally one to show much in the way of emotion aside from an occasional goofy smile, I do feel that I'm getting there. Feeling it. A bit excited. A bit anxious. A lot unsure of what to expect. Even though I will only be by myself for a few days and only in Dubai, I have only been by myself abroad once before for a day in Berlin, and I imagine things are a wee bit different in the UAE. Well, actually, I imagine they're remarkably similar with just a different tongue, dress, and slightly different mannerisms, but the fear of the unknown nevertheless makes me contemplate otherwise. We'll see soon enough I suppose. If this turns out to be my second and only entry feel free to assume I've been abducted and am somewhere in Saudi Arabia or Yemen.
On a more scientific note, we will be conducting a short series of experiments while in India. Specifically, does doxycycline *really* make for good antimalarial chemoprophylaxis? The sample size will only be three, there will be no placebo control, and blinding is impossible, but I think we may be able to get a publication out of this. Our second clinical trial will unfortunately, or perhaps fortunately depending on your view of things, have an n = 1, but I am fairly confident it's a novel research question. We get to see if storing oral vaccines needing to be refrigerated instead briefly at room temperature will affect the quality of host immunity generated. The end point in this study will be whether or not Rachel gets typhoid or not. What fun science is!
And on a final note, amongst all the packing and running about preparing for this trip I was pleased to note that on the CMC site the expected dress is "formal" which consists of, "a short sleeved shirt, a pair of trousers, and sandals/shoes." Truly India is an enlightened nation to have finally cast off the oppressive rule of closed-toe footwear. I think I may like this place.
Although I am not generally one to show much in the way of emotion aside from an occasional goofy smile, I do feel that I'm getting there. Feeling it. A bit excited. A bit anxious. A lot unsure of what to expect. Even though I will only be by myself for a few days and only in Dubai, I have only been by myself abroad once before for a day in Berlin, and I imagine things are a wee bit different in the UAE. Well, actually, I imagine they're remarkably similar with just a different tongue, dress, and slightly different mannerisms, but the fear of the unknown nevertheless makes me contemplate otherwise. We'll see soon enough I suppose. If this turns out to be my second and only entry feel free to assume I've been abducted and am somewhere in Saudi Arabia or Yemen.
On a more scientific note, we will be conducting a short series of experiments while in India. Specifically, does doxycycline *really* make for good antimalarial chemoprophylaxis? The sample size will only be three, there will be no placebo control, and blinding is impossible, but I think we may be able to get a publication out of this. Our second clinical trial will unfortunately, or perhaps fortunately depending on your view of things, have an n = 1, but I am fairly confident it's a novel research question. We get to see if storing oral vaccines needing to be refrigerated instead briefly at room temperature will affect the quality of host immunity generated. The end point in this study will be whether or not Rachel gets typhoid or not. What fun science is!
And on a final note, amongst all the packing and running about preparing for this trip I was pleased to note that on the CMC site the expected dress is "formal" which consists of, "a short sleeved shirt, a pair of trousers, and sandals/shoes." Truly India is an enlightened nation to have finally cast off the oppressive rule of closed-toe footwear. I think I may like this place.
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