Hello, Mrs. Salisbury's Classes!

I am sorry that I have not gotten around to doing a post dedicated to you before now.  I am leaving Vellore (the town that I have been staying at) tonight to travel to Delhi for a few days before coming home.  I wanted to do a quick post to you while still in India, and I promise to do a better post next week!  I am leaving for the airport soon, but for now I thought that I would mention the weather in India.  (I hear that you have gotten lots of snow days while I have been out of the country!)

It is currently winter in India, just like in Kansas.  However, India's winter is very different!  Just like at home people are complaining about how cold it gets in the winter.  Right now it gets up to 90 degrees during the day, but people are wearing earmuffs in the morning because the temperatures are in the 70s!  I have told them how cold Kansas gets, and they can't believe it!  Most of the people here have never seen snow, and some did not even know what it was when I talked about it.

People here have also told me that in the summer temperatures get up to 120 degrees!  I'm just glad that I came in the winter!

My Room

I keep forgetting to post the (much earlier) promised pictures of my room!

My bed is on the right.

We each have a closet and desk.

Half of the bathroom

Another view of the bathroom

The shower

Notice that the shower curtain hangs a good 8 inches from the ground, and there is a bucket available for bucket showers.  It's also a good idea to keep the bucket full since we sometimes run out of water.       

The water heater has to be turned on 10 minutes before you shower if you want hot water.

CMC towel

These monkeys are on the ramp to our building.

And some more of their friends are playing across the street.

Last Days in the Gymnasium

January 13


I continued to work with the little girls lacking ankle motion after necrotizing fasciitis, and her ROM (range of motion) is AWFUL!!!  She probably only has 10-15 degrees of motion at the ankle (plantar and dorsiflexion combined).  Even so, it seems like it's maybe moving a little bit better than it was when I met her earlier is the week, and she's working really hard to get back to walking normally. The sole of her foot has really become overly sensitive, so we've been working on desensitization along with her exercises.  She's really sensitive, and would pull away any time that I touched her foot at all.  Eventually I was able to get her to sit still, and even though she didn't say anything her face showed that she was in a lot of pain when I was working on the sole of her foot.  While there's no doubt in my mind that her pain is real, there is a huge psychological component to it as well.  When I was doing scar massage on her leg she didn't even notice that my forearm was touching the sole of her foot at the same time!  When I pointed this out to her she just smiled.

The PMR Building where the gymnasium is located

It was Lucky's last night in town, so a group of the students went to a restaurant in town called Surabi.  It ended up being a pretty small group because plans weren't announced until late, but it was still a really pleasant evening.

Clockwise from bottom left: Lucky, me, Yukio, Tim, Andy, and Devaki

January 14


This was my last day in the gymnasium.  I got to work with the same little girl lack ankle motion, and I have to say I'm a little sad that I won't get to work with her anymore and see her progress.  I am glad for a change in scenery though, since most of my time is just spent watching.

Over my lunch break I ran into Carli and Megan, and they took me up to the roof of the Asha Building on campus.  There's a really nice roof garden up on the roof with a small food stand.  There's also a great view of Vellore.

On top of the Asha Building

Another rooftop shot

Vellore

We had a mellow night at the hostel because we were leaving for Pondicherry and 6:00 in the morning the next day!

More Typical Days

January 10


I got another patient who speaks some English!  I'm not really sure how much she truly understands, but some communication is better than none...  She is a 12 year old who had a case of necrotizing fasciitis and had to have the infected tissue surgically removed.  Now she has a huge scar where the graft was placed, almost no ankle range of motion, and Complex Regional Pain Syndrome.  What saddens me is that the exercises she is getting seem to be largely the same standard ones given out to all of the pediatric patients, which will only provide a limited amount of gains for improving ankle motion.

I also worked with a 14 year old girl with scoliosis.  She was really sweet, but understood almost no English.  This made giving her instructions for a home program really difficult!

We had to leave work early because Dr. Mani (who founded my scholarship) is in town, and we were supposed to meet with him.  What I thought would be a casual gathering ended up being a somewhat formal meeting about arrangements and orientation for incoming international students.  The meeting wasn't very exciting, but we got free dinner at the Alumni House!  It was the best meal that I have had so far in India, but when I asked what it was no one could tell me.  The best response I got was "cauliflower in a capsacin gravy?"  I was telling Devi about it later that night, and she thought it might be Gobi Manchurian.  Based on what I have found online, I think she was right.

Picture of Gobi Manchurian that I found online

January 11


I fell behind in my journalling, so when I got to writing about this day I couldn't remember anything that had happened!  Not good!  It was really just another day in the gymnasium with nothing exciting happening that night, but I don't remember any more details that that!




January 12


This was really just another typical work day, but since it was a Wednesday we made the weekly trek to Darling for dinner.  I finally gave in and ordered pizza, but I had to put up quite a fight to finally get my pizza.  Almost everyone had finished eating, and my pizza still hadn't come!  And in true Indian fashion, the only response from our servers was "Yeah, yeah yeah."  This response left us not sure whether they understood that my dinner was missing or if anything was being done about it.  We had to ask several times, but it was so worth the wait.  The pizza isn't as good as anything at home, but it came out hot and covered in vegetables!  (And trust me, it's hard to get dinner with produce that is easily recognizable here!)

Around Vellore

January 9


I got up this morning and went to a service at St. John's Church with Jerry, Salena, and Carli.  The church is located inside the Fort grounds, and there is a bus to take students there from campus.  According to a handout that they give to visitors, the current church was built in 1846 and is the oldest church building in Vellore.  It was nice to go to a service, but it was too traditional for my taste.

View of the Fort from the bus

Another view of the Fort

St. John's Church

St. John's Church

Fountain in front of the church

In the afternoon we hiked up College Hill, which is located across from campus.  The first path that we took led us to a Muslim burial ground.  A man told us that it would be okay for us to come closer, but we didn't want to run the risk of offending anyone so we decided to back track to the other trail that we'd seen.  The other track took us to the top of College Hill, where we could look out over Vellore.  It's actually bigger than I would have guessed based upon what we have seen while driving around.  At first I didn't think that I was going to make it to the top, as we all know that I'm not much of a climber, but eventually I made it.  (It's still safe to say that I'm not much of a climber though!)

Start of the trail
(You can just see the edge of College Hill on the left of the picture.)

At the top of College Hill (Thanks for the photo, Carli!)
Back row: Andy (KU), Devaki (Singapore), Jerry (Singapore), Adedoyin (California), Selena (Singapore)
Front row: Carli (Tasmania), Me, Kunlin (Singapore)

The Golden Temple

January 8


I enjoyed a lazy Saturday morning, complete with sleeping in and lounging most of it away in bed watching (really bad) movies on one of the two English language channels.  In the afternoon Jerry from Singapore came by and invited me to tag along with a few people going to the Golden Temple, one of the two recommended travel sites in Vellore.  Our group ended up being Jerry, Selena, and Kunlin (all of Singapore) and myself and Andy.

To get to the Temple we decided to take a bus instead of an auto rickshaw, and this choice led to one of our "true India experiences."  Getting to the Temple by bus from where we are staying involves taking one bus and later transferring to another.  The second bus ride was so crowded that I really didn't need to use my arms to maintain my balance while standing on the bus and there wouldn't have been room to turn around if I had wanted to!  Then at one of the stops the bus broke down.  In order to get it started again several of the men had to get off and push until the clutch caught like in the movie "Little Miss Sunshine."

When we got to the Temple there were people everywhere.  Cameras are not allowed, so unfortunately I couldn't get any of my own pictures.  (I will include several that I have found online though!)  Shoes are also not allowed, so we checked them and bought tickets for 100 Rupees (a little over $2).  Tickets are not required, but they turned out to be a wise investment as they later let us pass a lot of the crowd.

There is an enclosed walkway into the temple that is in the shape of a star if viewed from above.  Along the path there are many inspirational sayings from many religions and facts about the good deeds that the Temple does for the community.  One sign in particular read something like, "Why do we build a Golden Temple when tins money could be used to build schools or libraries?  The inspiration received here is enough to lead people to build many more schools and libraries."   I suppose their theory is something along the lines of the "pay it forward" idea, but I'm not sure that I really see the logic in their argument.  The temple was really lovely, but it also probably was a waste of A LOT of money...

View when you first arrive at the Golden Temple

Overhead view showing the star shaped pathway with the Temple at the center.

The entry path into the temple is covered, and the covering has a lot of really intricate woodwork.  However, no one seemed to appreciate it or be interested in looking at it.  In fact, many of the people literally ran through this area.  As we got closer to the temple we had to funnel through what felt like closed in cattle shoots.  Thankfully, we had bought the tickets previously mentioned and we got to go through a special line that skipped ahead of much of the crowd.

The Golden Temple is set in the middle of a pool of water.  It's entirely covered in gold with marble floors and crystal chandeliers.  We went at night, so it was all lit up and glittered beautifully.  I couldn't believe all of the intricate gold carvings on every surface of the temple!  There was a small circular path that went around the outside of the pool and then up to the entrance of the temple so that you could see all sides.

The Golden Temple at night

Detail on some of the columns

Another detail shot

For the ride home we opted to take an auto rickshaw.  Our driver took back roads, so it was very bumpy.  We had originally planned on going to Sun Min's (American student doing research in India for 10 months) house for a movie night, but we ended up cancelling because we were all too tired.  

I spent the rest of the night relaxing in my room, although my relaxation was temporarily put on hold by this little guy!  (Sorry it's so blurry!)

These lizards are all over the place, although this was the first one that I found in my room.  He was only about an inch long from tip to tail, and he was crawling on our wall.  While I'm sure that he is harmless, I really couldn't wrap my head around the idea of sleeping with him crawling on the wall over my head.  I had to wait 45 minutes for him to come low enough for me to catch him between a piece of paperboard and an empty Ramen noodles cups, and then I took him outside and set him free!

Typical Day

January 7


This was actually the first day that we made it into the clinic for the start of the work day, since up until this point our mornings were usually started getting various registration issues sorted out.  I can honestly say that the start of the work day a CMC in unlike any other work environment that I have been in.  I'm not sure if I have mentioned this before, but CMC stands for Christian Medical College.  The staff and students are very religious and there are bible verses and other Christian images posted all around the hospital campus.  The typical workday starts with the physiotherapy department staff and students assembling in the hallway outside of the gym to sing a hymn and pray together.  The staff then splits and goes to their respective areas of the hospital where together they do a brief calisthenic warm-up together.

Overall the rest of the day was pretty typical, but unfortunately it was the last day at CMC for the family that I have been working with that speaks English really well.  I was pretty pleased when they asked if they could get my email address so that they can stay in touch and contact me with any future questions.  I can see why having a contact to discuss their son's condition (cerebral palsy) would be important for them.  Unfortunately, I get the impression that the staff at the hospital is so busy that there is not a lot of time spent educating patients and their families about diagnosis or prognosis.

At the end of the work day I said goodbye to a mother and son that I was currently working with.  The son is 5 years old and very stubborn.  When I said goodbye, he refused to say goodbye in return to me.  His mother asked why he would not say bye, and she informed me that he explained that "bye" is a Tamil word.  Since I do not understand Tamil, he refused to tell me bye because I would not understand him.  In general Tamil seems to be mixed with random English words and phrases, especially counting and medical terms.

That night we had a relatively low-key Friday night with an early dinner at the college canteen.  After that a small group just sat around in Jerry and Quinlan's room across the hall from mine.

Bad Blogger

So I've clearly been a bad blogger, and now, to add insult to injury, I'm having technical difficulties!  As of a few days ago my laptop will no longer charge.  I noticed that my battery was getting low so I went to plug it in, and it wouldn't charge.  Because it was already on, I know that the computer itself is theoretically okay.  Hopefully it's just the cord or my outlet adapter!  Anyways, back to the catch up game!

January 6

I woke up in the morning feeling a little stuffy with a sore throat.  I was pretty antsy, and I started taking some Emergen-C just in case.  Thankfully, it ended up just being my allergies stirred up from all of the dust.

In the clinic I was able to watch a therapist named Arivarason do a few assessments, which was at least better than the last few days have been.  Even though he was speaking to the families in Tamil, I was able to learn some from watching and was even able to help a little bit.  At lunch, the family that I was working with that speaks English really well took me out for juice.  I was kind of antsy about it, but they were so sweet about making sure that there was no water or ice in it that I didn't feel like I could turn it down.  Thankfully, I didn't get sick!  And, because I had mentioned being stuffy from my allergies, the mother went and bought me some tissue.  The tissues were actually perfumed, which seems like an awful idea for allergies, but they get the job done!  In the afternoon I was supposed to go to the hemophilia clinic, but no one came to pick me up, so I just ended up staying in the gymnaseum.

The college was having a research symposium on campus, so they brought in performers to put on a "play" for all of the visitors.  It was basically a narrative of the history of classical Indian music with musical interludes.  It was pretty interesting, but between not feeling well and the rhythmical music, it made me really tired.  Unfortunately, I forgot to bring my camera yet again, so no pictures.  (Hopefully someone will post some on facebook that I can steal!)

Hopefully I will have time to get at least one more post in today, but it's Republic Day and there's a carnival on campus that we're heading over to check out.  I am trying to keep a pretty detailed journal for myself as well, so at least I can just pull information from there as I try to get caught up!

Falling Behind

So I know that I've been a bad blogger and fallen behind, but I'm going to fall even more behind this weekend.  We're going to Pondicherry!  Hopefully I will be able to catch back up next week, but I'm not making any promises...  (At this rate I might still be updating posts after I get back to Kansas!)

Catching Up

I'm still trying to get my posts caught up, so here goes....

January 4

This was the day that I finally got internet set up!  Otherwise it was a pretty uneventful day.  I spent the morning in the clinic and was able to meet one family that speaks English really well, unfortunately they are only around for a few more days.  Once again I had families taking pictures of me.  Apparently being a white makes you a big deal!

Raji had me try to do some patient assessments with families that speak English, but I felt guilty doing much more than a subjective assessment since the families will already be there for several hours for the day getting their children's exercises done.  Also, I've yet to figure out if there is any sort of formal documentation system in the gym.  The therapists seem to write some things down during the initial assessment, but I never see daily notes or updates done.


January 5

Most of this morning was spent getting our I.D. badges, paying fees, and then in the gym again.  Fees ended up being less than I thought they would be.  Yay for saving money!

For the afternoon I was scheduled to go to the traumatic brain injury clinic.  I was pretty excited for this because I don't have much experience with TBIs, and I figured that I would get to see some interesting cases.  Unfortunately, the PT that worked the clinic only ended up needing to see one patient the entire time, so I just ended up sitting around for quite awhile.

Once it became clear that we wouldn't be seeing any more patients in the clinic, the therapist that I was with sent me back to the gym.  Raji called me over to where she was working with a 9 month-old girl who had seizure disorder and had lost head control after one of her seizures.  I was excited to see something new (most of the children we see have cerebral palsy), but I was disappointed when we were unable to rouse the child from her sleep for therapy.  Instead I ended up spending an hour watching the child sleep while Raji spoke to the mother in Tamil.

Luckily, the evening was better because it was Wednesday!  Wednesday night in Vellore means that all of the international students head to the Darling Restaurant for dinner.   I have been told that January is a busy month for having international students at CMC, and that was clear at dinner.  In all there were about 40 students at dinner.  We got to meet lots of students who are staying at places other than our hostel.  I had a dish called the fish tikka, and I really enjoyed it.  (Especially since at the canteen our meals are mostly carbs!)  I can't lie though - I'm already eying the pizza that's on the menu for dinner this week!

After dinner some of the students went downstairs for drinks, but it was already 10:00 and I was exhausted.  I caught an auto back to the campus with 2 girls from Australia instead.  Our rickshaw was interesting.  Our driver had installed a REALLY loud sound system and flashing lights.  Our driver would zip in and out of traffic even more than usual, and we think he was just trying to get a reaction out of the tourists!

The Gymnasium

As I mentioned in the previous post, my first two weeks are in the gymnasium.  Just to give you an idea of what this really means I took a few pictures of the gym before patients arrived one morning.  Bear in mind that usually most of the beds that you see are full and each person arrives with at least one (usually 2 or 3) family member.  Things are really crowded and there are people everywhere!

Gymnasium

Another view of the gymnasium



Pediatrics Area

 

Parallel bars in the pediatrics area


In the pediatrics area I have counted up to 8 pediatric and 1 adult patients using the 2 mats, 2 patients at the parallel bars, and 2 walking with walkers or crutches all at one time.  (And remember that they aren't allowed to come to therapy without at least one family member to help them!)

Besides the crowding and the family presence in therapy, one big difference I have noticed working in pediatrics is that the children perform exercises much like adults.  They are told to do a certain number of each exercise and expected to do them.  I have only seen two toys in the entire pediatrics area.  Many of the children are there 4+ hours each day because the parents are given over 20 exercises that their children are to complete.  I can't believe how well the children do each day given how their therapy is approached!

The Real Reason We Are Here

January 3 - First day of work!

Normally we take the student bus across town to the hospital campus, but Mr. Babu from the Physiotherapy Department picked us up today outside of our hostel at 8:00.  He took us to the campus, where we met in his office to confirm our schedules.  He was very accommodating to our interests, and I have been given the following schedule for the next 6 weeks:

• Weeks 1-2: Gymnasium (Pediatrics)
• Week 3: Pediatric Cardiopulm and Hemophilia
• Week 4: Pediatric Neurology and General Wards
• Weeks 5-6: Rehab Institute

I'll try to give a more detailed explanation of each area as I find out.  I am currently in the Gymnasium, which is the outpatient clinic at the hospital.  I am working under a therapist named Raji.  Mr. Babu introduced me to her after a brief tour of the facilities and then left.  Within a minute of meeting Raji, she took me to a family and told me that they "understand English" and walked away.  I had not received any information on the patient - no name, diagnosis, age, etc.  The family stared at me, and I looked back at them.  I quickly excused myself, and I went to ask Raji for further direction.  I have since found out that in this clinic the family learns a child's exercises on the first day and then is largely responsible for performing them each day with their child.  I did not realize that this family already knew what they were doing, so all I had to do was follow them.   The family-oriented therapy approach has been a double-edged sword for me so far.  On the one hand, I really respect that this facility is really training these families to work with their children who usually have life-long conditions.  On the other hand, it means that I spend a lot of time as an observer more than a therapist.  (I also end up feeling like a bit of an attraction, as people stare all day, and a few of the families have taken pictures of me working with their children.)

The language barrier has also been a big issue so far.  The staff all speak English, but very few of the patients and their families do.  This further adds to my feeling of simply being an observer.  I knew that language would be an issue, but I had the impression that we would have more assistance communicating with our patients.  Instead the therapists are typically working with at least 3-4 patients and their families at one time and don't have a lot of spare time to be spent acting as a translator.

On the first Monday of every month there is a welcome dinner for international students at the Alumni Center, so we wandered over there after dinner.  They had coffee/tea and dessert along with several of the long-term international faculty present.  At each of these gatherings they try to present some aspect of Indian culture.  Tonight they had a man play a drum called the tabla while his father sang.

Tablas

I forgot to bring my camera along, so I'm including a photo that I found online.  The drumming was very intricate, and we were informed that the tablas actually have to be tuned for each performance.  They are played on a 12 note scales, instead of the 8 note (octave) scale that we are used to.

Here's a random tabla video that I found on YouTube to give you an idea:

First Full Day in India

January 2

After arriving the day before, I didn't set an alarm for the morning, allowing my body to catch up on sleep.  I woke up around 8:00 but lounged around in bed until around 10:00.  I eventually got up and took a shower and thankfully figured out how to work the water heater!

A little while later I wandered upstairs to find Andy.  (Our rooms are on different floors.)  We wasted a few hours in the common area watching T.V. (there are 2 English language channels) and playing cards.  Eventually a student named Lucky from Australia joined us.  We wandered down to the canteen on campus for lunch and then back to the lounge for some more cards.  Lucky taught us "Donkey" which is pretty much another version of "P & A."

When Lucky left, Andy and I decided to try the ATM again.  At first it appeared that my card still wasn't working, but thankfully there was a man working today who came to help us.  Turns out that the ATM across the street is just incredibly finicky, so good news -- I HAVE MONEY!!!  We ran by the store to get some water and other staples (conditioner!) and then split up for a bit for the afternoon.

That night we were on our way out to the canteen when Yoshua, a German student, invited us to join them for dinner at the Darling restaurant in town for a Punjabi food festival that they were having.  We got to meet several of the other international students, and it was a really pleasant evening off campus.

Are you wondering what you've gotten yourself into?

January 1 - Arrival at Modale Hostel for International Students

I left off after the cab ride from Chennai to Vellore, so let's start with our arrival at Modale.  Our "hostel" is on campus at Christian Medical College, and it is housing strictly for visiting international students.  It holds up to 20 students at a time, and right now there are many more students than the hostel can actually hold.  Here is a few pictures of the hostel from the outside:

When we arrive to Modale we weren't on that days list of expected arrivals, but the list was hand written and this was quickly resolved with a phone call.  While we were waiting for our keys Andy looked at me and said, "Are you wondering what you've gotten yourself into?"  All I could do in response was look at him and say, "Yes."

 Front desk

Lobby 

Upstairs common area 

 "Computer Lab"

(Thank goodness for wireless!) 

We split up and each went to our own rooms for a little bit to get settled it.  Shortly thereafter my roommate Deviti arrived back to the room.  I was exhausted and was having a hard time getting her name, so she told me that I could just call her Devi (pronounced similar to "Davie").  She is originally from Singapore, however is going to university in Tasmania.

The rooms are pretty bare but do have 2 twin beds, closets, and desks.  The climate here is incredibly humid and we don't have A/C, so I'm very thankful that it's winter!  I was pleasantly surprised that we do have our own bathroom in our room.  I don't have any pictures to post of our actual room yet, as there was laundry drying everywhere when I went to take the other pictures here.

Door to my room

Later Andy and I walked around campus for a bit.  The campus is largely set on dirt roads and nothing like you would expect for a college campus in the States.  The is a small store on campus where you can find almost anything, and it has been great for finding snacks when the canteen doesn't sound too good.

View of our road

There is an ATM directly across the street from the campus, so we walked over there to get some money.  The ATM would not recognize my card, so now I felt completely dependent upon Andy for everything at this point.  Andy was nice enough to buy me dinner in the canteen, which cost around $2 for both of us to eat, and then we just went back to our rooms.

Our showers have their own individual water heaters that have to be turned on 10 minutes before showering to let them heat up.  Apparently I did not let the water heat for long enough, so I ended up taking a cold shower.  At this point I was too tired to care though.  I didn't even notice that I had 2 bottles of shampoo, instead of having any conditioner, until my second shower because I was so tired!  I then went to bed around 8:00 and slept for a WONDERFUL 12 hours!