Two part post. A little bit of this, a little bit of that.

This entry is a little bit different from my previous posts. It serves two purposes, to give an update of my first week in Pune, and also reflect on the first half of my journey through India.

So its a bit longer... but I hope you read it until the end :)

The next 5 weeks of rotations all focus on allopathic medicine. While I enjoyed alternative medicine so greatly, I am happy to learn more about the western medicine and health care system in India.

Part one:

Pune: my home for the next five weeks.

I would like to share some of the interesting facts about the city (and my opinions, of course) that were shared with me upon my arrival in Pune.

Pune is the seventh largest city in India, it has a population of 4 million.

Larger than Dehradun by 3 million, and smaller than Delhi by over 10 million. I like this ratio. This works just about perfectly--- I have a longer duration of stay with a comparably bigger city to explore; more ground, and more time to cover it… wonderful.

The mother tongue, or official language for this area is Marathi.

Just as I was getting used to Hindi, and the common simple phrases, I am uprooted and taken to a different state with a totally different language. Not necessarily the most ideal situation, but if all else fails I am getting really good at the universal language of the Indian head bobble.

Pune has 35 engineering colleges, which is the highest in the world in any given city. Pune University has 57 Engineering colleges affiliated to it, which is the highest in the world. Pune is the only city in India to have seven universities.

Surrounded by smart people, an intellectuals dream. India is perhaps the most unrecognized powerhouse in the world. As it applies to me, it is a plus that I am living in the midst of a college town—although you wont find a University of Oregon style Friday night here. It is refreshing however to not be looked at as incredibly peculiar when pulling out my laptop at a coffeehouse. This is the Indian version of Starbucks… so far it has been found throughout all of my travels. Across the street from a university and a short 10-minute walk from my guesthouse… wonderful.

Pune has the highest number of pubs in Asia.

Like I said, this is no Friday or Saturday night ‘get-down’ like it is in the states. It is unfortunate that in the perfect city for a pub-crawl, but it is not practiced… or maybe it is, and I just haven’t met the right people. Unacceptable for woman to drink-- I understand.

Pune is the only city in the world to have commercial and defense Airport operating from the same strip.

I did notice, and thought it was bazaar to touch down on the air strip next to a F-16 fighter jet. Maybe this contributed to the high amount of security, but I am pretty sure the AK-47s intimidation tactic is practiced nationwide.

           

Pune police has the reputation of being second best in India after Bombay.

I have yet to see any police in Pune, but then again, I haven’t seen more than 1 in all of India. Will keep you updated if this changes.

Pune has the highest density of traffic in India.

I didn’t know it could get anymore dense. I was informed that if I can cross the street in Pune, I could cross the street anywhere in the world. I believe that, each day I consider crossing the street a large triumph. Who knew walking and dodging near-death situations could be such a confidence booster. 

What did Shelane say when she crossed the road….. Booyah!

I just couldn’t resist that pun, it was much too easy.

Pune has the highest number of 2-wheelers in all of Asia.

I believe that. You all will be shocked to know I ride a two-wheeler to work everyday, clearly I am not the driver, but for all formalities it is a large personal accomplishment. I am now fearless, even if I still occasionally have to close my eyes. It is comforting my driver, Dada knows how to drive on the wrong side of the road, dodge death, and honk his horn with the best of them. Also, I regret to inform you that they unfortunately do not drive Harleys here.

Pune is considered the fashion capital of the east comparable to Paris.

One word: Shopping

Okay… two words: Fabulous

Pune has produced the maximum number of scientists considered for many high profile prize nominations.

Surrounded by smart people, an intellectuals dream. I am lucky enough to have already worked with some of the most driven, and intelligent people in India already, and it makes me giddy knowing that it will only continue.

Pune has produced the highest number of professionals in the USA. Almost 60% of the Indian population abroad is from Pune

            That would explain where all of the Indian doctors come from. In all areas of medicine I can, without a doubt say that in every American medical facility there is at least one, if not several Indian doctors.

I hope you enjoyed the fun facts as much as I did!

Pune also has lots of flowers to buy on the street. Everyone knows I love having flowers around, even if that means I buy them for myself! Cheapest handmade flower basket! 120 rupees ~ $2.50

Moving on…

The next 5 weeks of rotations all focus on allopathic medicine. While I enjoyed alternative medicine so greatly, I am happy to learn more about the western medicine and healthcare system in India.

This past week I have become wonderful friends with an Indian lady named Apurva. She is 21, and 18 months away from getting her MBA. Yes, you read that correctly-- 21, and in a masters program. She is my “foot in the door” so to speak into Indian culture and tradition. Thus far she has lectured me on the University system and the Caste system. I am still learning about the Caste system (social class designation) so expect this in a future entry. As for the University systems, I will do my best to break it down, and portray it correctly:

Primary school, 1-5 grade and Secondary school, 6-10 grade, although it is not called ‘grade’, but ‘standard’ High school ends at 10^th grade. This is the customary school system. If you don’t go to college, this is where your education ends; otherwise it’s off to higher education. After 10^th standard you choose 1 of 3 cores:

Science, which includes, medicine, engineering and Architecture

Commerce, which includes finance, accounting, economics and

Arts, specializations is psychology, politics, economics and hotel management

After finishing your core it is immediately off to obtain your bachelors+ masters+ Medical doctor+ engineering, or any combination of the first two you see fit within your core.

Also, school is in session six days a week, Monday through Saturday.

Hypothetically at 11^th standard you choose your career, afterwards there is some room for swopping focuses, but for the majority the decision remains. Since you chose your core earlier, you get your degree earlier.

Architecture is still 5 years, Engineering 4 years, Medicine is still 5 years, and obtaining your MBA is 5 years. The catch is you start working towards that degree at 18 and not 22, 23, 24, 25…. Like in the US.

Imagine my frustration when I started working at hospitals with medical residents, or junior doctors who were 23, the same age as me. They all get licensed to practice medicine by 24 or 25 as they begin their one to two year residences at 22 or 23. I must admit, I was (and still am) a little jealous.

Along with learning about India, I have been teaching about America = [tough job]

I have recognized how difficult it is to portray my home/USA to someone who has never been there. How do you break down into detail American lifestyle that is just comes as second nature to me. I have never really had to think about the small details. Sometimes I lack the answer of why? Why is it that way? —because it just is. Apurva and I both kept coming back to the problem of explaining in specifics, but still keeping it all in a positive light. Growing up surrounded by it all (it being everything culture specific which I realize is a broad reference, but just work with me) For example, the credit system came up, I am not sure how that came up, but it dis. It one random question she asked, which happens to have several debatable answers… why does someone who has the cash to buy something, take out a loan, get financed or put it on a credit card when they could just as easily write a check for it. I realize an intricate reasoning exists, but as I am not an economic or finance major, the simple answer I provided was just because that is what the majority of people do--- you could say that it is just how things are usually done.

We both recognized that many answers to the questions we asked each other was just because that is the way it is. Why does everyone honk their horn, what does it mean— I don’t know she said, it just means everything… you just do.  Do you see the difficulty that can arise in seemingly remedial questions?

I am enjoying my temporary family so much, but one of the difficult things is, I don’t remember what hungry feels like. Manisha, Dada’s wife and my temporary mother is a wonderful cook, and she loves to feed me, almost too much. Actually, everyone likes to feed you in India, being full I have found is one of the largest compliments you can give someone. It is a very good thing most all of the food I eat is healthy, otherwise me, and my jeans would be in for trouble.

My assignments for the week:

Siddih Hopsital with OB/GYN Dr. Prakash Kothavale. I worked primarily with him, but I also had the pleasure of meeting his wife, Anesthesiologist Dr. Rashmi Kothavale.

I get the opportunity to see gynecological problems such as infections, cysts, pain, mystery irregular menstruation and a long list of other ailments every day but most exciting, I also I get to observe and give my opinion on obstetrics AKA care for woman reproductive parts and children through conception pregnancy and birth. Every day I get to see ultrasounds of pregnancies that monitor growing babies. Every day I get to sit 5 feet away from a husband and wife that has just been told they are pregnant. Positive UPT urine pregnancy test! 

The language barrier may be tough, but an excited, joyful, and truly heartfelt smile is universal for happiness and greatfulness anywhere in the world.

November 6-11, 2011

In no particular order, here is a collection the events and my thoughts from my week.

I have shadowed and sat in on several surgeries in the states, but I must have forgotten the roughness that comes along with it. Ripping, tearing, pulling, pushing, yanking is medically necessary, I just happened to forget that little detail. When I was growing up I often had strep throat, which eventually led me to getting my tonsils removed, or have a tonsillectomy. This week I watched a tonsillectomy and since I had the pleasure of having one of them myself, it hit close to home. Brutal, but strangely enticing.

Operations I sat in on, my week in review:

1 tonsillectomy

Removal of fluid from the left testicle Hydrocele

Breast tumor removal

Bone graft

3 laparoscopic surgeries (1 tubal ligation + 1 urectomy + 1 appendectomy)

Cervical cauterization

6 abortions: 4 by choice + 2 forced termination due to miscarriages

and my personal favorite…

6 births: 5 cesarean sections + 1 vaginal birth

Is it ironic that abortions and births are proportionate? It is a beautiful thing, and I didn’t realize this point until I sat down to do the tally.

Friday, November 11

11/11/2011

4 cesarean sections and 3 other surgeries scheduled.

Busy day.

How can you not have an absolutely WONDERFUL day when you witness the birth of 4 perfect babies? Even with a difficult language barrier Like I said, smiling is a universal communication everywhere in the world.

The day began with a woman who came in that had just miscarried, since she was so far along, the miscarriage was incomplete and an abortion was necessary. It was sad to see the sorrow in her eyes, but even though it was a terrible day for her, for four other women it was a day they will blissfully remember for the rest of their lives.

The termination of the pregnancy took less than 10 minutes; after Dr. Kothavale was finished he washed his hands, scrubbed up again, and went to the next operation theatre. It was the first cesarean of the day. What a beautiful series of events. Not more than ten minutes after a woman lost her baby, another baby was born. It gives me chills with only the thought. I had to hold back tears as the operation continued, death and life happened in front of my eyes. With every death, other lives continue and new lives begin.

I can’t help but have the thoughts that all humanity starts and begins the same-- with birth, and with death. The mechanisms for both may be different, but in all actuality, regardless it is alike. I truly believe culture and tradition is really what scares people about other human beings. Evolution is responsible for the slight deviations in outer appearance, but anatomically and physiologically we are the same.

The day continued with 3 other births, four in total. Even with the fourth baby being in breech, delivered feet first, the day gave way to four complication-free babies. Two boys, and two girls.

Side note, but excitine… since I observed 4 cesareans back to back, the doctor said that next time, I would assist him, and replace the other doctor…. YAY!!! I will keep you updated!

Continuing on…

As I mentioned before food is one of the biggest compliments you can give someone. Since there were four births on 11/11/11 I was required to eat 4 meals/large snacks. I don’t remember the last time I was almost sick from being full. By the fourth birth my stomach ached, but when the proud, fourth father came into the office offering little sweets I quickly got the eye from the doctor meaning take it, eat it, and like it when I tried to say no.

Besides the births being so beautiful, one rewarding thing about the operating room, is that everyone’s face is primarily covered with a mask and cap. The only thing truly uncovered is the eyes. You can tell a lot about a persons thoughts and persona just by their eyes. I have seen educated eyes, fixated in thought eyes, doting eyes (usually from the fathers), fearful to the unknown eyes (usually new residents), and one I would have never thought to be so obvious—kind eyes. You can see more than you would think through someone’s eyes.

I made a comment in an earlier post about abortions being illegal in India. That is False. Working with an OB/GYN I learned abortion is legal very quickly. Termination of pregnancy is legal for any reason through the first trimester, and only allowed with good reason (good meaning harm to the mother or fetus) through the second trimester. Abortion rate is substantially higher than I would have ever imagined. It is probably equally as high in the United States, but sitting on the physician’s side of the desk I was astonished at the large portion of all clients coming in for termination.

However…

What is illegal is sex determination before birth. Meaning that no woman in India knows the sex of their baby until their 40 weeks is up, and the little one is delivered. I am sure you can guess why it is illegal. As per tradition that some Indians still follow: males are preferred.

The baby born at 11:11 AM on 11/11/2011 was male and everyone cooed in excitement. It wouldn’t necessarily have been bad luck if he were a girl, but superstitiously any baby born on a day of celebration like Diwali or the good fortune of 11:11 should be a boy.Signs are posted throughout all of the hospitals indicating the legality.

The act of 1994 was instated because now females are outnumbered; 826 females/1000 males.

One resident has been extremely wonderful to me. Junior Doctor Vrushali. She speaks broken English, but tries so hard that. Crazy thing: She is 23. This just goes to show you how the University system works.  Young doctors, but brilliant doctors.

One more fun fact:

It is in my educated opinion, based on many observations that Indians seem to prefer blue ink, as opposed to black. It is a good thing I brought my own pens, as I prefer black

Weekend number 1 I am deciding to stay in Pune. I figure if I learn the city well enough, after clinic the next four weeks I can explore mono-y-mono.

(mono-y-mono for all of my Indian and other readers is Spanish for  single and single, by myself, or alone and alone… or something like that)

Part 2:

Reflection on the first 5 weeks of my adventure though India.

My journey is officially half over, and I am still shocked at how many things, how many places and how many people I have met over the past 5 weeks. Reflecting back is almost difficult, as I have learned so much. A spiral notebook that takes me several terms and months to fill up at school is nearly jam-packed with information from all over India. I have studied alternative medicine with masters; gurus and professional healers who have a track record of saving patients that otherwise had death sentences by all allopathic standards.

When I was accepted into this internship my next task was to choose two separate rotations of the 5 CFHI offered. My options: public health, Child and maternal health, HIV/AIDS clinic, alternative medicine, or communicable disease control. My choices noticeably: Alternative medicine and Child and maternal health. I chose alternative medicine with the notion that it was completely foreign to me, and if I was going to commit to learning about it, it might as well be done in the country where it all began.  I grew up in the allopathic world, and wanted a taste of holistic medicine, and I couldn’t have gotten more from my experience.

At five weeks end I find myself realizing that I learned more than just alternative medicine, I learned about the art of traveling and exploring, culture and tradition, but probably most importantly I learned about myself, my ambitions and my future career.

I cant help but look back on the many times growing up that I told people exactly how and when my life was going to pan out.  Like every other 7, 8, 10 ,12 or 15 year old, I had it all figured it out. I would tell you with 100% certainty, … “I am going to be a tap dancer and doctor, married by the time I am 22, and have babies by 25--- a girl and a boy to be exact…. oh, and I will also live in a white house with purple trimming with a purple mailbox. Hmm…

After a decade or so, I realized that, that is not the way life works, but in perspective when you are 10, 23 sounds SO OLD! As the years passed, the purple trimming and the undesirable timeline dissolved with reality, but even still I had a plan.

To be a doctor I had to go to college, to get married I have to find prince charming, and when it comes to kids, I am not ready to grow up myself…

Anyway to my main point, since many of you probably have no idea where this is going…. Two things:

1. I always knew what I wanted to do professionally, I was performing cardiovascular surgery on my Hot Pockets, and finger-painting myself in a white lab coat before I was 10. All I had to do is get through several years of college, and with so much time without internet in India I realized I am half way there. I never needed the confirmation that I was choosing the right career path, but even if I did, India gave me that.  If somehow cadaver dissection, and a truehearted fascination for operations, trauma, needles, blood and gore wasn’t enough affirmation--- I know professionally, I am on the exact path I should be on. I may not have needed to go 8,000 miles away for this, but regardless I am glad I did.

2. There was one other detail that I left out when referring to my life plan I had set out in my youth. I always said that after I graduate college, before I started my career, before I got married before I ‘grew up’, so to speak, I wanted to travel the world.  Even as a ‘high schooler’, I knew it was a good idea to set aside ‘me time’ and do something adventurous solely by myself. Going to Europe in high school was a taste of the world, and I knew I wanted more. When I applied for this internship I had forgot about this objective, I had seemingly filed it away with the many other things I was going to do when I had to become an adult. It wasn’t until nearly week three in India that ‘traveling the world’ before I started the next chapter in my life… was actually happening. I was doing what I always said I would, traveling the world---I was officially a world traveler at 23. And for that, I did have travel 8,000 miles away. 

That concludes my entry for week six of India. I will keep you updated as soon as I can.

Thanks again for all of your positive feedback towards my blog. It makes me even happier to keep writing.

Xoxo,

India and Shelane

In the spirit of things,

11:11 make a wish.

To be all of the happiness and healthiness in the world to myself, my family, my friends and of course—to all of my readers

Also: happy 95^th birthday to the best grandma in the world! I love you!

11-11-1916

Don't worry about me being by myself, I am keeping it calm as a Hindu cow!