Destinations

Some of the Many Things I am Thankful For

2008-05-12T05:14:00.000-07:00

Sitting on the flight from Athens to London I began reflecting on my trip and I became overcome with gratitude. There are so many people and so many things for which I feel thankful. This is a list of just a few of the many:

1. The generous donors and the Center of Humanities and Ethics who selected me to have this experience and supported me throughout it.

2. My India travel companions - Claire, Dinesh, Vida, Anne, Cristina, Chris, Swamy, and Kevin - who kept the trip fun and intersting and who I feel a tremendous bond with after our experiences together, especially the crash

3. Everyone coming out of the crash alive and without serious injury - The thanks here really goes to God. I know he must have been watching over us. (I'm actually tearing up just thinking about it)

4. Dr. Jones and Dr. Berggren who both called India to check on us after the accident, Dr. Jones calling and emailing several times to make sure that everyone truly was ok.

5. The doctors and nurses at Christian Medical College - especially in the SICU and CHAD - who made me feel welcomed and comfortable while I obserfed and learned from them and their patients.

6. The villagers who invited me into their homes during visits with CHAD, alsays happy to see us and sometimes offering food or sweets while they have so little for themselves.

7. Dr. Dilip Mathai who monitored my platelets at CMC and met us all in the ER after the accident.

8. Swamy for getting me in contact with Dr. Mathai.

9. Dinesh and his friends in various regions of India (Kerala, Banglore, and Mumbai) who were wonderful hosts and helped us to see India through a local's eyes.

10. Jab We Met - a Hindi film that provided hours of entertainment

11. Claire - the best travel companion I can imagine: enthusiastic, adventuresome, interested and eager to explore/experience, yet laid back, consciencous, and understanding. She really is an all around amazing person, plus she is excellent with directions and loves ice cream and shopping. :)

12. Random decision to spend a few days in Istanbul on the way to Greece - absolutely wonderful and one of the highlights of my trip!

13. Joey, my best friend and roommate who has been keeping my life together back in Texas while I've been gone - She's always taking car of me...a truly wonderful friend!

14. All my great friend that have been there from me over the years - I don't know what I would do or where I would be with out you!

15. Dustin - I love you, you make me incredibly happy, and I can't believe how lucky I am to have you in my life.

16. My family - this is a big one - Mom, Dad, Matt, Greta, Trent, Laura, Grandma Doris, Grandma Jean and Grandpa Morris, and Mary (yes you too): I feel encredibly fortunate to have each and every one of you in my life. I can not possibly thank you enough for the endless love and support you have given me throughout my life. As I reflect now, one week before graduating from medical school, it strikes me that I would not have been able to achieve any of this without all of you. You gave me the tolls and the confidence along with the love and the encouragement I needed to accomplish my goals. (Here I go tearing up again) I really feel that this degree (MD) belongs just as much to you as it does to me. In short, I jsut hope you all know how much I love you, respect you, and appreciate you!

My list could go on and on, and Im sure that there are big things that I have neglected to mention, but I'm running low on time. I will see you all soon back in the US. :)

Headed home

2008-05-12T05:06:00.000-07:00

Yesterday we took a ferry from Mykonos back to Athens, enjoyed our last Greek salad and packed up our bags to come home. This morning we flew from Athens to London and are currently waiting for our flight to Chicago. Hopefully things will go smoothly and we will get in to DFW at 11pm tonight (Monday).

It is kind of funny to think about but we have been going to increasingly more expensive places with each stop: from the Indian Rupee, to the Turkish Lira, then the Euro, and now the darn Pound. Its really expensive here in London! Anyway soon we will be back to the good old dollar. I can't wait!

Our night out in Mykonos

2008-05-11T01:48:00.001-07:00

Claire, Me, and Leandro - our Argentinian friend

Crazy pelican hanging out at one of the restraunts

The waiter holding his beak so we can get a picture

Action shot of Leandro getting bitten :)

Really tall guy from Florida that everyone at the bar was taking pictures with....we didn't want to get left out - unfortunately he was too big for the picture!

Diving in Santorini :)

2008-05-11T01:42:00.000-07:00

Paradise Beach/Paradise Point: the sites of the two dives

Our first morning in Mykonos, after a brief refresher course, I finally used my PADI certification and had mty first experience with ocean diving. It was amazing! At first I was completely freaking out, wonderfing why on earth I was trying to do this - I have forgotten A LOT in the four years since I was certified! But with the help of my

patient instructor/guide, Tasos, I eventually began to feel more comfortable, and I ended up really enjoying the dive. Since it was a shore dive it was not the most impressive scenery, but for someone who had never dove in the ocean, it was incredible! we saw schools of fish, bright orange starfish, various types and colors of coarl, etc. It was beautiful. After we finished the dive I relaxed on the beach and enjoyed a saganaki shrimp appetizer for lunch before preparing for another dive, this time from a boat.

For the afternoon dive I was with Nadia, a German tourist who had obtained an intermediate SCUBA certification earlier in the week, and two instructors, Tasos and Matt. We loaded our gear into the boat and drove to Paradise Point - about 5 minutes from the dive center. There I did my first "boat entry" - basically just falling backwards off the boat with full SCUBA gear on. I doubt it was graceful, but it was fun! We descended along the anchor line then started off along the reef. It was utterly amazing and utterly terrifying at the same time. A few minutes into the dive I became anxious, suddently aware that I was in a foreign country with 3 strangers and I had twelve meters of ocean above me. Needless to say I felt a little trapped. evedntually I was able to calm the hyperventilation and get myself to relax and enjoy the scenery. - I think Matt could tell that both Nadia and I were a little nervous because he stopped us in a sandy area and signaled for us to breath slowly, kick our fins slowly, and enjoy the scenery ( which was fantastic!) - that really helped to calm me down.

Coasting through the reef I felt like I was in a 3D National Geographic move, only it was way better! The water was several incredible shades of blue (different at each depth), the coral was abundant, the rocks created interesting formations with cliffs, coves, and fissures, and schools of fish of various types were all around. As the water warms more and more fish come out. I was fortunate because the guides said that was the most fish they had seen out this season. It was a phenominal experience! I wish I had an underwater camera so I could share it with you all!!!!

Mykonos

2008-05-10T08:58:00.002-07:00

Yesterday we took a ferry from Santorini to Mykonos. after settling into our hotel we walked to Ornosbeach, lay down our towels, and enjoyed a nap in the lat afternoon sun. then we went back to the roomto change before walking to Mykonos village- which was a little farther than we anticipated. Once in the villagewe wound our way through the narrow walkways until we arrived atthe shore, in an areacalled "little venice." We found a seafood restraunt and enjoyed dinner while watchingthe sun set. While we were finishing our dinner we were suprised to see the familiar face of an Argentinian chemical engineer that had been staying at our hosel in Santorini. We invited him to join us, then the three of us wandered the streets of Mykonos village.

Yummy red snapper!

Beautiful sunset

Background info and pictures from Santorini

2008-05-10T08:58:00.001-07:00

-The central mound of volcanic ash

Around 1600-1500 BC the volcano erupted causing the center of the island to collapse into the , splitting the land into three separate islands, and creating a central mound of volcanic ash in the middle of the ring of islands. This eruption caused a tsunami that wiped out the Minoan civilization on Crete. The most recent eruption was in the 1950's, and the volcano is still considered active.

- Akrotiri is an archaelogical wonder that can be found here on Santorini. However, due to a collapse in the roof i 2005 the site is currently closed and we were unable to visit is. The town was destroyed by a volcano eruption, but was miraculously preserved under layers of lava.

- Ancient Thira is the ruins of a city that trived during Greek, Roman, and Byzantine times. It is situated atop a high promontory, overlooking a black lava beach. this is located on the same end of the island as akrotiri and requires a bus ride from Fira ( where we were staying). We had inten ded to hike up to Ancient THira on the morning of our full day in Santorini but rainy/cool weather kept us from venturing out. when the weather cleared we had already started out walk to Skaros from which we continued on to Oia.

- Skaros is a point where the administrative palace for the island was located until an earthquake in the 19th century caused the destuction of the palace.

Me with one of the many churches on the island - supposedly you can build a bigger house if you build a church on your land....the result is LOTS of churches!

A summary of our walk....from the white atop the mountain to where I stand.

White washed houses.

Look Grandma, I'm riding a donkey! :)

2008-05-08T13:14:00.003-07:00

This morning we met up with the group of UTHSCSA students that are also currently traveling in Greece. They all had different plans for the day, so Claire, Megan, and I decided to take a walk from Fira (where we are staying) to Oia (a city at the end of the island...about 6 miles away). It was a gorgeous walk!!! Near the ocean, up and down hills...it was really nice. On the way we stopped at a place called Skaro where there had been a castle prior to an earthquake way back. --- Santorini has a volcano just off shore that has been active since before 1500BC. An eruption around that time caused the island to break into 3 islands. All curve around the central caldera. It really is beautiful.

When we got to Oia we had a late lunch and enjoyed the views before catching a bus back to Fira. Then we took a trek down to the "old port" (Skalao) where we boarded donkeys to bring us back up to the calderra rim. It was awesome!!! Grandma, you would have been proud!

After our donkey ride we met up with the other 15 UTHSCSA students for dinner. It was fun to see some familiar faces and catch up!!!!

Hiking on Santorini

2008-05-08T13:14:00.001-07:00

Me with the center of the volcano

Hiking :)

Megan and Claire

All of us with Fira far off in the distance (the white on top of the cliffs)

Finally at Oia!

Ferry to Santorini

2008-05-07T12:52:00.000-07:00

Ruins on one of the islands we passed by on the way to Santorini

Today we took a ferry from Athens to Santorini....a brief 8 hour journey. It was a cool experience and we saw some beautiful scenery. Once we arrived we basically settled in to our room, familiarized ourself with Fira (the town we are staying in), and found an internet cafe. :) Exciting day!

Coming in to Santorini it looks like little toy houses sitting on top of the cliffs. It is really beautiful! In one of the photos it really looks like snow instead of the white-washed buildings. So far Santorini is not as relaxing as Hydra, but it definitely has its own charm. So stay tuned for more adventures. :)

Lots of Photos!!!

2008-05-07T12:48:00.000-07:00

Hey guys! I posted a bunch of pictures so be sure to go all the way back to Istanbul! :)

Hydra - I love the Greek islands!!! (or at least the one that I have been to)

2008-05-07T12:33:00.001-07:00

Our first island stop was Hydra...Amazing! Hydra is a quaint peaceful island that does not allow motorized vehicles so transportation is either by foot, by boat, or by donkey. :) Its great! The village of Hydra is filled with 18th and 19th century stone archontika (mansions) -many of which have been restored and converted into hotels- that line the waterfront and climb the steep hills surrounding a horseshoe port. Phenomenal! It is easy to see why the Greek Government and the Council of Europe have declared the island of Hydra a national treasure (thats why there are no cars). :)

We arrived by boat in the morning and luckily were able to check in to our hotel. Then we set off exploring the cobble stone streets of Hydra village. We had lunch at a cafe on the port and then took a walk down to a "beach." Hydra does not have great beaches, but there are many places where you can swim off the rocks. The water is bright blue and gorgeous. This place is so peaceful and relazing, it really is like heaven on Earth. Fabulous!
In the afternoon we sat and wrote in our journals and read, enjoying the sun from our private terrace -we booked the room on hostelworld.com...who could have thought it would be so wonderful!

After spending the afternoon on the terrace we headed out forsome more exploration. THis time we ventured down the coast on the opposite side fo the city. When we returned to the village we stopped at ta few shops before finding a seafood restraunt overlooking the water to watch the sunset.

On our second day in Hydra we slept in, enjoyed breakfast at our hotel, and relaxed on the terrace until checkout. Then we packed up our things and wandered down to the rocky ocean access we had found the day before. There we read and enjoyed the sun and fabulous view while we waited for the ferry to take us back to Athens. We also had a fun little picknic with delicious mystery cheese from the supermarket, bread and crossants that we "barrowed" from the breakfast buffet, off

brand nutella (hazelnut chocolate spread - closest thing to peanutbutter available), and cherries we had purchased at the market...all while enjoying the water and the view. What could be better?

For anyone who is looking for a vacation spot where there is nothing to do but relax, this is perfect! Seriously, there is something magical about this little village that takes away all your stresses the second you step foot off the boat. Its wonderful! And it is exactly what we needed after 4 1/2 weeks fo traveling and going non-stop in Istanbul and Athens. I really love Hydra!

Athens: Its all Greek to me...no really I can't read the street signs and I have no idea what anyone is saying!

2008-05-04T13:49:00.001-07:00

At the Acropolis!

The Parthanon

On May 2nd Claire and I flew from Istanbul to Athens and made it to our hostel by 2 pm. We were headed to the Acropolis by 4. It was quite an adventure navigating the streets as you might guess by the title of this post. The good thing is that we did eventually make it to the Acropolis. Our initial reaction was "wow, this is it...this doesn't look anything like the pictures. " Then we walked a little farther. There it was in all of its glory....the Parthanon. Unbelievable! The pillars, the carvings, the amazing views of Athens - absolutely breathtaking! We sat for a long time taking it all in and hoping to see the sunset - unfortunately they close an hour before sunset so we were forced to move along. Still, it was an incredible experience!

After leaving the Acropolis we wandered the streets and got lost a few more times before we stopped for dinner at a great little traditional Greek restruant with the most amazing feta cheese I've ever tasted (I know you are jealous Dustin!). Then it was off to bed to rest up for a long day of sight seeing in Athens - unfortunately the loud pipes and noisy street made that a little difficult, but it is all part of the experience.

The view from the top...looking down on Athens and the ruins of the Temlpe of Zeus

Athens day 2: Archeological Museum

2008-05-04T13:48:00.007-07:00

The next morning we started off our day at the National Archeological Museum - home of the most important collection of ancient Greek art in the world. Once again...Amazing! Such imaculate works! To think that this is what was left over after centuries of looting and destruction. Incredible! If only I could see everything the way it was originally. I bet nothing of the modern world could even begin to compare.

This interesting statue is of a naked Aphrodite fending off the sexual advances of Pan...with her sandal (once again, sorry it is sideways)

Athens day 2 continued

2008-05-04T13:48:00.005-07:00

The Ancient Agora

After the Archeological museum we got on a city operated hop on/hop off sightseeing bus that brought us past several interesting sights. The first we decided to explore was the Ancient Agora - the ruins of the marketplace and city center. From there we hiked up to the top of a hill that provided fabulous views of the Agora, the Acropolis, and the city. I think the time we spent sitting on the hill was my favorite part of the day...so relaxing and beautiful! :)

Our next adventure was going to the port to pick up our ferry tickets and see where we need to be Monday morning. As you may guess we got lost, but we were eventually successful in our mission and we got back on the subway to meet back up withy the sightseeing tour. THinking we were smart, we took the subway to the next stop after Agora - market where we bought fresh strawberries - Yummy! The bus stup was a challenge to find, but we had a wonderful adventure unsuccessfully trying to navigate the narrow walkways of the market. Eventually we saw one of the buses and flagged it dow - luckily they were kind enough to stop for us!

Our next stop was Panathenaian Stadium and the National Garden - easily a hop off and take a picture stop. Then we continued on to the Olympic Zeus Temple and the Andrian Gate. Unfortunately the temple was closed since it was just past five by the time we arrived - but we had seen amazing views form the Acropolis and the view from the fence was quite wonderful.

After that we got ourselves thouroughly lost before a kind stranger stopped and pointed us in the right direction. ON the way back to the hostel we stopped at a grocery store and a bakery and bought dinner, breakfast, and snacks. I never realized this before, but Greeks, like other Europeans, love their pastries...and they are delicious!

View of Acropolis from the Agora

At the top of the hill we hiked up...with Acropolis in the background

Looking down on Ancient Agora

Day Trip to Delphi

2008-05-04T13:48:00.003-07:00

The Temple of Apollo

Today Claire and I took a day trip to Delphi. At 8:30 am we boarded our tour bus and headed out on the nearly 3 hour journey to Mount Parnassus. It was a gorgeous drive! About half of the Greek population lives in Athens, so once you get outside the city there is a lot of beautiful green - mountains and agriculture. The drive was also nice because our tourguide provided wonderful commentary on the history of the region.

Once we arrived at the ruins we went first to the museum and saw many of the amazing relics that had been dug up around the Temple of Apollo. Supposedly when the Byzantine Empire converted to Christianity the temple was destroyed and forgotten. Eventually the village of Delphi was built on top of th ruins. The masterpiece remained hidden until a French archeologist was able to orchestrate the moving of the village 500 meters up the road, somewhere around 1930's. Countless treasures and priceless historical records were found in the rubble.

After the museum we continued on to the ruins. We wandered up the "sacred way" past ruins of treasuries ( built by rich Greek city-states to house their offereings to Apollo), bases where statues had stood, the polygonal wall etched with historical recore, etc. It was fabulous!

This site is famous not only because it is a Temple for Apollo, it was also thought to be the navel (center) of the earth and it had an oracle! An oracle was a place peoploe would go to have their questions answered, not the person. At the site a young beautiful Delphian virgin would sit on a tripod over a whole in the ground from which the fumes of the spirit of Apollo poured. She chewed bay leafs and was "elated" - because the fumes were actually petroleum. :) She would respond to questions in undecipherable ways and the preists would relay the message to the pilgrims. Pretty interesting!

Above the temple is a theater and further up the hill a stadium. The Greeks believed that music, theater, and athletics were ment to honor the gods. Thus these facilities were built high on the mountain to bring them closer to the gods. It was all fabulous to see, and the views were amazing!

After exploring the rui9ns we got back on the bus and headed into the village of Delphi for lunch. Then we headed back to Athens.

In Athens we spent the evening exploring the market area we got lost in yesterday before grabbing dinner and heading back to the hostel to pack up for our trip to Hydra.

Gorgeous view!

Looking down at the theater and temple (on the left)

The stadium

At the ruins

Disclaimer

2008-05-03T11:13:00.000-07:00

Sorry that there still are no pictures! The computer is not recognizing my card. I seperated the experiences into little chunks so that I will able to put photos with the descriptions....they are coming eventually I promise! And Athens info is coming too. :)

Some of the Many Things I Love About Istanbul

2008-05-03T11:07:00.000-07:00

- cobblestone streets
- clean air
- normal toilets with toilet paper
- super friendly people
- rich history
- amazing sights
- not sweating 24/7
- cars don't honk
- the US Dollar is stronger than the Lira
- not being recognized as an American
- Apple tea
- Rugs!!!
- Easy to navigate
- Spice market samples
- Kesme and Baklava

What I didn't like:
- everyone smokes!

Amazing Istanbul

2008-05-03T10:25:00.000-07:00

Immediately upon ariving in Istanbul we Claire and I were struck by the cleanliness of the air, the presence of normal toinlets ( with toilet paper!), seatbelts in vehicles, and we were not sweating. Wonderful! That night we settled into our hostel - 6 beds with bathroom ensuite - and met our roomates - one lade from Australia and 2 girls from the US studying in Egypt ( the second night there were 2 more girls from the US studying in Athens. AFter a delicious dinner - bread dipped in yogurt, yellow cheese pide, and chichen sish (kabob) - we headed to bed to rest up for an eventful day of sightseeing.

Thanks to our wonderful guidebook we already had our day planned out, hitting most of the major sights. So after enjoying some apple tea and breakfast on the roof of our hostel - gorgeous view - we started out to see the sights. First we stopped at an old Turkish bath that is now a carpet showroom. Then is was on to Hagia Sofia - Wow!

Hagia Sofia

2008-05-03T10:24:00.007-07:00

This is an amazing structure built by emporor Justinian when the city was Constantinople. Throughout the gorgeous church there are numerous mosaics depicting Christ, the Archangle Gabriel, etc Which were plastered over when Hagia Sofia was converted into a mosque - this actually served to preserve many of the works. The apse itself took my breath away - beautiful marble walls and pillars supporting an enormous marble dome creating an open space large enough, as our guidebook puts it, for the statue of liberty to do jumping jacks. Looking at the walls one can see a phenominal interplay between the Christian and Islamic influences. - The Christian aspect had been covered up but has now been restored. Absolutely amazing! The Hagia Sofia rivals and threatens to surpass the Taj Mahal in grandeau and appeal (especially since Agra is a dump and Istanbul is a fabulous city.) If I had to rank them I would give Taj #1 in outside appearance, but Hagia Sofia takes the cake from the inside!
1. The Dome of Hagia Sofia
2. Claire and I in front of the alter that marks the direction of Mecca.
3. Christian depictions of Mary holding Jesus in the center and the archangle Gabriel on the side with Ilamic additions adjacent.
4. Mosaic of Mary holding Jesus with Constantine on the left offering up Constantinople and Justinian on the right offering up the Hagia Sofia
5. An example of the magnificent mosaics - this is Jesus

Underground Cistern

2008-05-03T10:24:00.005-07:00

After picking up our jaws as we left Hagia Sofia we walked down the street to the entrance of the Underground (Major) Cistern - once a storage facility for precious water, now a tourist attraction and concert hall (they say the acoustics are wonderful!). This was another amazing sight! THe pillars used to support the cistern had been taken from ruins around the empire and brought to Constantinople to be burried underground and never seen again. In one of the corners there are two Medussa heads that were used to prop up shorter pillars. One story states that this was meant as a slap in the face to the Romans after a history of Christian persecution, but others believe the stones just happened to be the right size to make the pillars fit. Either way it is pretty cool to see.

Hippodrome and Blue Mosque

2008-05-03T10:24:00.003-07:00

View of Hagia Sofia from the Blue Mosque

Claire and I in front of the Blue Mosque

Once back above ground we wandered through a beautiful garden toward the Blue Mosque - built as a true Islamic response to the Hagia Sofia centuries later. Unfortunately the mosque was closed for prayers so we continued on to the Hippodrome. WHile non of the original race track is left this is where chariot races used to take place. Now it is a park housing a fountain (given by Germany just before World War 1) and three oblesks: an Egyptian (stolen from a tomb), one given as a gift from Greece, and one dedicated to Constantine. Across the Hippodrome from the Blue Mosque is the Turkish and Islamic Museum of Art, home to a nice collection of artifacts and tons of gorgeous Turkish rugs. By the time we completed the museaum prayer was over and we were able to visit the BLue Mosque - which although brilliant from the outside, pales in complarison to Hagia Sofia.

Egyptian Oblesk - sorry it takes too long to rotate the photos :)

Blue Mosque with all six minarettes visible (from the the museum), Egyptian Oblesk in foreground

Claire and I inside the Blue Mosque

Topkapi Palace

2008-05-03T10:24:00.001-07:00

More blue mosque...inside and us outside

After the Blue Mosque we enjoyed a very late lunch - delicious Turkish meatballs - and walked to the other side of Hagia Sofia to Topkapi Palace - a huge garden fulled complex that housed the Sultan as well as many governmental agencies. By the time we completed this tour we were starting to feel a bit fatigued so we left Sultanahmet (the old/historic district) and headed to the new district, Istiklal Street (like Michigan Avenue) to do some shopping and see a more modern side of Istanbul. Even this part of town has cobblestone streets. Amazing! So much character! It was here that we were introduced to Moda Cafe and their Baklava and Kesme (Turkish ice cream) - Yummy! - Claire loves ice cream and shopping just as much as I do so w make excellent travel buddies! :)

Topkapi Palace - very beautiful and intricate design.

Istanbul Day 2: Grand Bazaar and Spice Market

2008-05-03T10:23:00.003-07:00

The next day we slept in and enjoyed another breakfast on the roof of our hostel. Then we headed to the Grand Bazaar - the model for our present day malls, merchants would gather to sell their goods in the same covered facility that stands today. While much of the bazaar has been over run by souvenir shops and vendors selling knock off purses/clothes and it is all pretty overwhelming......if you are able to wade through the junk there are some true Turkish jewels! Our guidebook brought us to a small cove down one of the halls lined by pawn shops and frequented by locals. It is here that we spent most of our day admiring handmade jewelry ( we visited the workshop just above the stor - very cool!) and gorgeous traditional hand made wedding dowry Turkish rugs (wool on wool with natural dyes) while we sipped apple tea. What a fabulous way to spend the day!

After prying ourselves from the beautiful merchandise we had another late lunch - doner (shaved meat) with a delicious sauce and yogurt - and headed off to the spice market. What an experience! Shops filled with bins of spices, apricots and other dried fruits, teas, nuts, and Turkish delights ( a gummy sweet covered in powdered sugar). Taste testing was encouraged

so we enjoyed A LOT of goodies and left with full tummys!

Istanbul Day 2

2008-05-03T10:23:00.001-07:00

That evening we took a walk across the Golden Horn on the Gala Bridge and watched the sun set over Istanbul. What an amazing trip! I would really recommend Istanbul to anyone interested in traveling - tons of history, extremely nice people, awesome city, easy to navigae (especially with Rick Steve's Istanbul), and the dollar is stronger than the Turkish Lira (good value)! What a perfect combination!!!
-Marge I know you would LOVE this place!!!

Fishermen lined up on the Gala brigde

Restraunts lining the lower level of the bridge - Mosque in background

Fish sandwich! - cool experience, but not as good as we were hoping for

Sunset over Istanbul/Golden Horn

Istanbul Rocks My World!

2008-04-30T23:32:00.001-07:00

To be honest, I really wasnt sure what to expect from Istanbul. Claıre and I had a few extra days to travel and we decıded, what the heck lets check ıt out. I was just thınkıng ıt was a great lıttle fıller, but ıt ıs absolutely amazıng!!!! We are stayıng at a great lıttle hostel ın the Sultanahmet dıstrıct (Old Town - the hıstorıcal part) so all the major sıtes are wıthın a few blocks. It ıs such a cute and wonderful area - cobblestone streets, lots of restraunts, and tons of other hotels and hostels. Yesterday we dıd all the major sıtes - Hagıa Sofıa (unbelıevable church and later mosque when the ottomans took over control, that can fıt the statue of lıberty under ıts dome - so much amazıng hıstory and ınterestıng ınterplaybetween the chrıstıan and ıslamıc ınfluences), the underground cıstern (an ıncredıble archıtectural feat - the cıstern was buılt wıth pıllars from ruıns around the empıre to collect water ın case of a shortage), the blue mosque, turkısh and ıslamıc art museum, topkapı palace...all of thıs wıthın a few blocks of eachother and where we are stayıng! After the day of sıghts we went to the newer dıstrıct and went shoppıng on theır versıon of mıchıgan avenue. Too fun!!!! :) The food has been awesome the sıghts have been awesome. I really am ın love wıth Istanbul!!! And no one thınks we are amerıcans they all say German, Australıan, or French...kınd of cool not to be recognızed!

Ill try to get some photos up soon, but Im out of tıme for now....today we are goıng to the Grand Bazzar, Spıce Market, and checkıng out the Golden Horn - we have a great lıttle guıdebook wıth walkıng tours of all the great sıghts.

Indıa After Vellore....

2008-04-30T22:37:00.000-07:00

After leaving Vellore Vida, Claire, Dinesh, and I headed to Banglore where we met up with another of Dinesh’s friends before we parted ways with Vida – she flew to Thailand and the rest of us continued on our Indian adventure in Goa.

Photo of me ın a beautıful Banglore garden

After a busy month, Goa was exactly what we needed...some wonderful R&R on the beach - perfectıon! The day we arrıved we went walkıng down the beach near our hotel. It was nıce but we quıckly decıded that that was not where we wanted to be layıng on the beach and swımmıng...kınd of dırty, lots of locals swımmıng and/or playıng crıcket ın theır underwear, and lots of shıps just off shore (the one ın the photo ran ashore about 15 years ago and the cost of movıng ıt ıs so great that the government and the owner are at battle and the shıp just sıts there - ınterestıng!).

The next mornıng we hıred a cab to take us to a more remote beach about a half hour away. On the way he ınformed us that the beach we had mentıoned has "too many Indıans" and he suggested that we go to another even more succluded. I dont know what our orıgınal beach was lıke...but the one he brought us to was absolute perfectıon! We rented a few chaırs (about a dollar each for the entıre day) and camped out under a shade ın between walks down the beach and dıps ın the ocean. Except for a few herds of cows, a few other tourısts, and the beach shack operators we had the entıre beach to ourselves! It was heaven on earth! To top ıt all off the beach shack we rented our chaırs from came around wıth fresh seafood for us to pıck from for lunch....I had the best prawns I have ever eaten ın my lıfe!

Our fınal day we flew out ın the evenıng so we were able to enjoy the day by the pool. Claıre and I also splurged and got pedıcures - our feet were needıng some attentıon after weeks of walkıng around ındıa ın flıp flops. Yet another wonderful day! That nıght we flew to Mumbaı (new name for Bombay) where Dınesh has yet another frıend who was kınd enough to put us up ın one of her frıends apartments that was between renters. Thıs place was phenomınal! Accordıng to Lıla, Dıneshs frıend, one of the Bollywood acresses actually lıves ın thıs buıldıng...quıte a nıce pıece of property! The crazy thıng ıs that when we would look down from our balcony we saw a shanty town. It really made me sıck to thınk of those poor unfortunate people who have nothıng just tryıng to survıve and they have to lıve next to thıs extravagant buıldıng full of the rıch. There ıs an unbelıevable dıfference between the haves and the have nots ın Indıa...especıally ın Mumbaı (whıch ıs a lot lıke New York Cıty)!

The next day Lıla took us around Mumbaı, took us shoppıng, and showed us some of the sıghts. She also took us out to lunch at a wonderful seafood restraunt - supposedly Bıll Clınton eats there when he vısıts Mumbaı. It was darn good food!!!! After a busy day of explorıng the cıty Claıre and I packed our bags to leave Indıa ın the mornıng and head to Istanbul.

It ıs hard to leave and I wıll defınıtely mıss Indıa, but my adventures and experıences wıll remaın ın my memory forever. I feel extremely fortunate to have had so many different experiences and to have seen so much of India. India has so many different sides and they are all absolutely wonderful….ok maybe open sewers and grown men crapping on the side of the road aren’t all that wonderful, but they aren’t something you get to see everyday, so it is interesting!

Givıng Thanks

2008-04-30T22:29:00.000-07:00

Lookıng back on my month ın Indıa I am overwhelmed by gratitude. What an unbelıevable experıence! I am so thankful for the generosıty of donors who provıded me wıth thıs awesome scholarshıp. These experıences will remaın ın my memory forever and they wıll color the way that I approach patients, culture, and life in general for years to come. This really has been my most amazing experience of medical school and it has provided me with priceless education that can really only be obtained through traveling and living in another culture. I feel truly blessed to have had thıs opportunıty!

Goodbye to Indıa

2008-04-29T01:53:00.002-07:00

I have now wrapped up my experıence at CMC ın Vellore and once I complete my Malarıa post I wıll have completed my requırements for my perıod 9 electıve. However, sınce there are stıll a few weeks to go before graduatıon, Claire and I wıll be contınuıng our travels. We have already vısıted Banglore, Goa, and Mumbaı (used to be called Bombay) - posts to come, sorry Im a lıttle behınd - and now we contınue our jouney on to Istanbul, Turkey and Greece. I wıll do my best to keep up to date on my posts so you all can remaın ın the loop. Thanks to everyone for keepıng tabs on me durıng my travels. It really means a lot to have such great support!

Malaria

2008-04-29T01:53:00.001-07:00

Malaria is a disease caused by protozoan parasites of the gnus Plasmodium that is transmitted by the female Anopheles mosquito and has been present throughout most of human history. It was once nearly eradicated but is now re-emerging as a leading infectious killer. There are four different types that can affect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Of these P. falciparum is the most common and most serious causing 80% of cases of malaria and 90% of the deaths. Let us now examine the epidemiology, pathogenesis, symptoms and management.

The major distribution of malaria is around the equator in tropical and subtropical regions of the Americas, Asia, and Africa. The disease targets mainly the poor in rural areas. About 40% of the world’s population is affected by this disease with 2.5 million people at risk and 500 million severely ill yearly. In Africa a child averages 1.6 to 5.4 episodes per year, and malaria is responsible for 1 in 5 childhood deaths. One child dies from the disease every 30 seconds.

Approximately 500 million people are diagnosed with malaria yearly. One to three million of these cases result in death. Uganda and Tanzania lead the world in reported cases of malaria with 12.4 million and 10.7 millions cases respectively. India comes in at number twelve with 1.5 million cases. However, due to the large population of India, only 1.67 cases occur per 1000 people while in Uganda and Tanzania there are 478 and 290 cases per 1000. Out of 1.3 million deaths from malaria in 2002 16,498 were from Congo and 14,498 were from Tanzania.

Malaria is more prevalent in poor countries that do not have the financial capabilities to prevent disease. However, the disease also hinders economic development and has a huge economic impact from healthcare costs, lost working days, missed school, decreased productivity due to brain damage from cerebral complications, and decreased tourism.

As mentioned before the Plasmodium parasite is transmitted by the female Anopheles mosquito. Males do not transmit the disease because they do not feed on blood. The cycle begins with ingestion of the parasite from feeding on an infected human. Then the gametocytes form gametes and fuse in the mosquito gut producing an ookinete. The ookinete penetrates the gut lining and forms an oocyst in the mosquito gut wall. The oocyst eventually ruptures, releasing sporozoites that migrate to the mosquito salivary glands. There they await the next blood meal when they will be injected (along with the saliva) into a new human host.

Within humans there are two stages: hepatic (exoerythrocytic) and erythrocytic. During the hepatic stage sporozoites migrate to the liver where they infect hepatocytes within 30 minutes and then multiply asexually and asymptomatically for 6 to 15 days. As they multiply they also begin to differentiate into merozoites. Eventually the host cells rupture and the merozoites are released to infect red blood cells (RBCs). In cases of P. vivax and P. oval hypnozoites form in the hepatocytes which may remain dormant for months before activating and infecting RBCs.

Within the RBCs they continue to multiply asexually. Malarial pigment is produced as intracellular proteins are degraded leading to lysis of the cells. The infection is amplified with rupture and infection of new cells which eventually synchronizes. Cytokines are released with each rupture, causing the classic cyclical waves of fever and chills seen in malaria.

The plasmodium parasite avoids the immune system by hiding within liver and red blood cells. However, since the infected RBCs are more spherical and less deformable, circulating cells risk destruction in the spleen. To avoid this P. falciparum produces adhesive proteins that stick to the walls of small vessels, preventing the cells from circulating. This feature is responsible for the hemorrhagic complications of malaria which can include breach of the blood brain barrier leading to coma.

Malaria is a great imitator and can have practically any presentation. It usually begins as a vague febrile illness. Eventually as the cycles of cell rupture synchronize the classical relapsing symptoms of shaking chills, high grade fever, and profuse sweating may emerge. In the text book presentation the cycles occur every 48-72 hours with the cold stage lasting approximately 15 minutes to an hour. Then the hot stage sets in, lasting two to six hours. The final stage in the cycle is the sweating stage which lasts two to four hours as the fever gradually subsides. The fever is often accompanied by headache, vomiting, delirium, anxiety, and restlessness. Due to the destruction of RBCs the symptoms of anemia can also be seen. These include light headedness, shortness of breath, and tachycardia. When anemia is present during a child’s brain development significant damage can be done, leading to developmental impairment.

Atypical symptoms are more common with P. falciparum, early or recurrent infection, and patients who are pregnant, extreme ages, immune compromised, or on prophylactic medications. There is a broad range of atypical symptoms that can be seen and many of the symptoms can also be side effects of prophylactic medications. Some of these include: body aches, dizziness, vertigo, behavioral or mood changes, hallucinations, and generalized seizures. P. falciparum may present with tingling skin. Other atypical presentations are couth and congestion, acute retrosternal and precordial pain, abdominal guarding and rigidity and jaundice. Hepatosplenomegally is considered a cardinal sign of malaria, but in reality it is rarely seen.

After a primary attack relapses are possible. These may be short term relapses caused by persisting blood forms occurring after a period of about 8 to 10 days. There may also be a long term relapse. This is caused by latent P. vivax or P. ovale parasites in the liver which may take months or years to present.

The diagnosis of malaria can be achieved by several different methods. Parasitemia can be identified by the presence of ring stages within RBCs. In areas where laboratory tests are not possible history of subjective fever along with clinical predictors of rectal temperature, nail bed pallor, and splenomegaly may be used. However, microscopic examination of blood films is a far more preferred method due to reliability, cost effectiveness, and ability to identify species of Plasmodium. There are two types of films that are used. This films allow the species to be differentiated. Thick films however are 11 times more sensitive and are able to detect much lower levels of infection.

Malaria can also be diagnosed via antigen detection tests that use finger-stick or venous blood to test for P. falciparum lactate dehydrogenase (PLDH). This is one of the most abundant enzymes expressed by P. falciparum and it clears about the same time as the parasites following successful treatment. The OptiMAL-IT assay utilizes differences in PLDH isoenzymes to differentiate between falciparum and non-falciparum malaria down to 0.01% parasitemia. Nucleic acids of the parasites may also be detected by polymerase chain reaction. However, because it is expensive and requires a specialized laboratory it is not a very feasible option in many developing countries.

Once malaria has been diagnosed appropriate treatment is required. If P. falciparum is identified, it is considered a medical emergency7 due to the disruption of blood flow to vital organs, thus hospitalization is required. The other three forms may be treated as an outpatient. There are two major types of anti-malarial medications: quinine based (the first to be developed) and artemisin-based. Chloroquine, one of the quinine-based drugs, is the first line drug due to low cost and high effectivity. However resistance to chloroquine has become common in many areas where malaria is prevalent. The artemisinin-based drugs are the drug of choice in these areas. Their efficacy is greater than 90%. However, they are very expensive and the supply has been unable to keep up with the demand. Investigations are underway to identify other options. One possibility is Propanolol which is thought to block entrance of the parasite into RBCs.

Prophylaxis may be provided using lower doses of anti-malarial drugs. This is a great option for travelers to endemic areas who can begin the treatment one to two weeks before going and continue it for four weeks after returning home, but this is not a plausible option for inhabitants of these areas. A vaccine would be valuable, but as of yet no effective vaccines have been developed.

Currently vector control is the most effective method of controlling the disease. This can be achieved with indoor residual spraying (application of insecticide to the interior walls of living spaces, where mosquitoes land) and with the use of insecticidal nets over beds. The latter option is very cost effective and provides 70% protection since the female Anopheles prefers to feed at night. However, only one in twenty people in Africa own a mosquito net and when they are distributed, they are often used as fishing nets instead of bed covers.

After examining the epidemiology, pathogenesis, diagnosis, and management of malaria it is easy to see that this is an important disease that has a tremendous effect on individuals as well as countries where it is endemic. Throughout history the evolutionary pressures placed by malaria have caused traits of sickle cell disease, thalassaemias, and G6PD deficiency to become advantageous and thus increased in prevalence due to increased survival of the disease. Hopefully medical advances will continue to improve the treatment/management options and eventually lead to eradication of the disease putting an end to its path of destruction forever.

References:

www.wikepedia.com
www.globalhealthfacts.org
www.who.com
www.malariasite.com
www.cdc.com

1st chad encounter

2008-04-29T01:34:00.000-07:00

Here is what I wrote in my journal immediately after my first CHAD experience...

This is what its all about! What an amazing experience! The CHAD program works with CMC hospital in order to provied healthcare to the villages surrounding Vellore. WHile CHAD has many arms, the most interesting to me is the "clinics" that bring the healthcare workers to the villages. There are two types of these clinics: Doctor's rounds and nurse rounds. For doctor's rounds there is a van with medical supplies and a few physicians that travel from village to village seeing the patients that come out to see them. Nurses rounds, however, involve a landover with driver, a nurse, and a health aid worker who go from home to home within each village to personally check in on patients. My first experience with CHAD was nurses' rounds. This was a fabulous opportunity to look into true Indian culture, be invited into villager's homes, and be offered food that they cooked. Awesome!

We started out our day at a primary school and adjacent preschool where we parked and played with the children before heading out on our home visits. Our first stop was a prenatal visit for a woman 2 weeks from her due date. We watched as the nurse performed her exam in a private room off the entry. From where we sat we could also see the other family members sitting on the cement floor of the hallway rolling cigarettes. The nurse told us that is how they make their living and they get paid by the number of cigarettes they role and turn into the complany for packaging. There was also a child in the hallway that was enamered by the white girls sitting in his entryway (I rode out with two other blonde girls from Holland). We had fun playing peek-a-boo with him behind the door.

As we condtinued through the town we spoketo many people and stopped at several homes. Some of the patients were not there to be seen, but the time was filled by others who heard the nurse was in town and came to seek her out.

Once we had comleted our visits in that village we returned to the car and were greeted once again by the children and their teachers. Then we jumped into the Landrover and headed to the next village making a few stops along the way - including one stop for tea and a couple more home visits. At one of the homes a woman offered us bananas and sweets - she wanted to celebrate because her son had been married the day before. Initially I only took the banana, not wanting to pay the price for eatine home-made sweets. However, after insulting the woman by not taking the sweet in the first place and after some prodding, I gladly accepted and enjoyed the sweet.

At the second village we saw a few more prenatal visits as well as checking in on a man with hypertension and a man with external fixation after breaking his leg (both have photos posted). At the home of one of the pregnant patients a woman was preparing okra for lunch. The Dutch students and I were very interested in the process so she offered us a bowl of the finished product - Delicious!!! I ate this with full anticipation that I would get GI payback, but somehow I made it through drinking the tea, eating the sweet, and eating the okra. Amazing! A true miracle!

When we completed the second village we drove to the next and stopped to eat our lunch in the shade. During lunch we were entertained by monkeys playing and local villagers stopping by to visit. After lunch it was back to work. Our first stop was a home where several patients live, but only one was home. The mother had married her maternal uncle so several of the children have problems. The one child that was at home is nearly a year old and has met virtually no developmental milestones. he just lay there in a hammock next to his grandmother who sat weaving flowers into garlin - the only source of family income. When we were leaving we saw a man with two club feet walking through the yard. We inquired about his situation, but the nurse and health aid worker were unsure. It was very interesting from my p9oint of view and I tried not to stare, but it was the first time I had seen an adult with club feet - and to see him walking practically normal was shocking.

After thıs vısıt we encountered several patients on the path. Then ıt was off to the fourth and final vıllage of the day. Here we vısıted an elderly woman who fell and broke her hıp two months ago. Unfortunately her famıly ıs unable to take her to the hospıtal and accordıng to the nurse it is virtually impossible to take her to the hospital and care for her there wiıthout the support of her famiılyç So she lies in bed in pain, unable to move around and depends on the kındness of frıends, neıghbors, and famıly to get her the thiıngs she needs and care for her. Very sad.

The next visit was to an excentric woman who regularly fights wıth the nurse because she does not want to have to pay for her medıcatıons. The last vısıt was to a wealthıer famıly ın town- judgıng by a more ornate house and the fact that theır hay was stored ın the covered entryway rather than outsıde ın the open. They were very excıted to see us and I was handed a half naked baby upon walkıng ın the door. Thıs turned ınto a relatıvely long vısıt because the man was only takıng hıs blood pressure medıcatıons when he felt bad - he had taken one pıll ın the past month.

On the way back to the landrover we stopped at another preschool where we were ınvıted ınsıde to see the chıldren and hear a few songs as well as countıng - up to 100 ın englısh = very ımpressıve! It was obvıous that the teacher was very proud of the work she had been doıng wıth these chıldren. These preschools are part of a program that also provıdes nutrıtıonal supplements ın order to fıght malnutrıtıon ın chıldren.

After the preschool we headed back to Vellore. It was an exhaustıng but thrıllıng day. And although I donit thınk I have ever sweated so much ın my lıfe ıt was an experıence that I would love to have agaın and agaın. What a gıft ıt ıs to have the opportunıty to go to these vıllages and see how lıfe really ıs for the people. Thıs ıs what I came to Indıa to see and experıence - true lıfe. Prıceless!

CHAD - Experience in the Villages

2008-04-25T11:44:00.000-07:00

This has been my most amazing experience of medical school. CHAD stands for Community Health and Development and it is a program in that provides healthcare, as well as other services, to villagers who otherwise would not receive care. In addition to clinical facilities in Vellore, they provide rural healthcare through doctor’s rounds and nurses’ rounds “clinics.” I participated in the nurses’ rounds and it was a truly unforgettable experience. It is such an amazing opportunity to step into true Indian culture and be invited into the homes of villagers. Words really cannot describe how much of an impact this had on me. I am extremely grateful for this wonderful opportunity!

While the language barrier makes it difficult to identify exactly what is going on, both of the nurses that I worked with on my trips, as well as the health aid workers that accompanied us, were very good about explaining what was going on at each house and answering any questions that we had. I have written down in detail my impressions from my first trip out, however, I do not have my journal with me right now, so hopefully I will get a chance to enter that later.

What is interesting to me is that each trip/”clinic” is completely different and each village that we visit has its own feel. For some reason I had thought it might be a bit monotonous, but that was not so at all. There are just so many cultural and social aspects of life that are different from what we are accustomed to in the united states that that alone is enough to keep the interest stimulated. And the children, oh my goodness, the children are amazing!

We went on prenatal visits, postnatal visits, pediatric visits, hospital follow-ups, clinic follow-ups, etc. Each village was a new adventure. We would park the car, grab our umbrellas and set out on foot, sometimes walking through fields to get to the patients’ homes. The second time I went out we went into the mountains which required a little more creativity in getting to the homes than the villages in the plains….wow, that was some incredible scenery!!! Although the days are exhausting beyond belief and I sweated more than I have every sweated before in my life, this has hands down been the best experience of this trip. I hope that students in future classes are able to experience this as well. As I said before, words can not explain how wonderful it was and I am so thankful for this gift!

CHAD

2008-04-25T10:25:00.001-07:00

My first ride-out with a nurse (blue), health aid worker (pink), and two girls from Holland :)

Holding a naked bottomed baby in one of the homes

Adorable kid!

Walking to a home

A crowd of villagers getting medications refilled.

CHAD Pictures

2008-04-25T10:12:00.000-07:00

You gotta love the children!

Cooking Okra for lunch...I tasted some and it was delicious!!!

Blood pressure check

Women carrying cement on their heads to build a road. Wow!

External fixation - waiting to get the hardware out.

Taj Photos

2008-04-23T04:42:00.000-07:00

With our friend from Southwestern in our booties (so we didn't have to take off our shoes)
Taj
Baby Taj

Kerala Pics

2008-04-23T04:16:00.000-07:00

Actually from the houseboat...biggest "shrimp" I have every seen!!!

This is a picture of the second ashram I have been to in India. Each ashram, religious community, has an Amma, founder and central figure within the community. the Amma provides the teachings and focuses the charitable works. The Amma for this ashram, Sri Mata Amritanan damayi Devi, has international recognition with Amma service groups throughout the world, including the US. She is best known for her tradition of hugging each person she meets. this was a very friendly community and I was struck by how many white people there were living and working at the ashram. I will admit that i was somewhat uncomfortable visiting the ashram, but this one appears much more humble and legitimate than the one we visited outside Vellore - The Golden Temple.
Vida and I at the beach
Swamy and Vida admiring Mona Lisa

Houseboat Pictures

2008-04-23T03:56:00.000-07:00

Our Houseboat!

Anne, Vida, and I enjoying the relaxation

Vida and I with Kevin and Swamy

How much hay can you fit on one little canoe???

Dinesh and his gracious friend Manish

For our second weekend trip all seven of us from UTHSCSA as well as our friends from Oklahoma - Kevin and Swamy - drove down to the state of Kerala, on the Southwestern tip of INdia to meet up with one of Dinesh's friends from high school. After a longer than necessary car ride - everything is an adventure in India - we arrived at the docks where we met Manish, Dinesh's friend, and boarded a houseboat to float the backwaters of Kerala. It was magnificent! So Serene, so peaceful, so totally India!

As we floated along it was like watching a documentary on the daily lives of villagers. We saw them bathing, washing clothes, cooking, cutting hay, loading hay onto boats and trasporting it down the river, playing drums in celebration, etc. Wonderful!!! We stopped a few times to buy snacks, walk around on the shore, and purchase the largest shrimp I have ever seen in my life to cook for dinner. Delicious! IN the evening we brought out the Indian music and had a dance party with the houseboat crew - trying out the new moves we had picked up from MTV India and Bollywood films. It was so much fun!

The next morning we woke and were nce again able to enjoy the peaceful backwaters. After a delicious breakfast we returned to the dock, sat that our time on the houseboat was done, but excited to see what other adventures awaited us in Kerala.

We drove from the dock through Alleppey to Haripad, where Manish's family has a home. At his house we were warmly greeted and fed a delicious lunch before departing once again for an afternoon of sight seeing including a palace, an ashram (residential religious community) and a beach. It was a fun an interesting afternoon and an absolutley amazing weekend!!!

Fatepur Sikri

2008-04-22T03:36:00.001-07:00

More Jaipur

2008-04-22T03:18:00.001-07:00

Amber Fort Palace
Water Palace
The bazaar of Jaipur

The Crash

2008-04-22T02:57:00.000-07:00

We had planned to take a train from Vellore to Kerala for the weekend, but we found out the day before we were scheduled to leave that the “emergency quota” train seats that were supposed to be released – and that we had been assured we could get – would not be available. Since all of our weekend plans had already been set up we began searching for alternative transportation. Our travel agent found us a 14 seat tour bus that would be able to transport all 9 of us – the 7 of us from UTHSCSA and our 2 friends from Oklahoma. While we were all a little nervous about the idea of driving, we were also very excited to visit Kerala, so we agreed and set off on our way.
Although the journey took us several hours longer than expected and the driving was less than ideal, we made it to Kerala safely and had a wonderful weekend - more to come in future post. In fact, everything went well up until a point about 80 km from Vellore. We were all fast asleep, so no one is certain of the details, but here is the event from my point of view.
I woke up flying forward into the seat in front of me hearing the crushing of our vehicle and the screams of my friends. I am not sure if I was screaming myself. The next thing I remember I was standing in broken glass looking at the back corner of a truck which was now inside our vehicle about a foot from Cristina’s head and in the seat that I had been sitting in for the drive to Kerala. I was stunned!

Luckily Dinesh was coherent enough to spring into action and take charge of the scene - I for one could do what I was told but could not think very clearly for myself. Somehow Kevin was able to get the back doors open so Vida and he as well as Claire who got out the driver's door were able to work on getting an ambulance - not as easy as one would think. By the time they got out a crowd of villagers had assembled, but none of them did anything. they just stood and stared and talked among themselves. Luckily one passerby stopped to ask if he could help and Vida asked him to call the ambulance.

Cristina had been sitting in the first "bus seat" directly behind the passenger seat which was now occupied by the corner of the truck. We think that the seat came back and hit her in the chest preventing her from flying forward. When she woke up she lifter her eye cover to see the back of the truck close enough to reach out and touch. She had quite a bit of chest pain and was having some difficulty breating but she got herself out of the bus.

Chris was on the floor unconscious immediately after the crash, but he came around within a few minutes. Swamy was initially ok, but began to have loss of vision and extreme leg pain after the crash - in retrospect likely vasovagal response but it scared us a lot at the time. Since we were concerned about c-spine and/or head trauma for both of them we kept them talking and stabilized their necks while we waited forty-five minutes for the ambulance. When the ambulance arrived there were no c-collars, so we wrapped towels around their necks and did our best to support them as they moved.

Once everyone was out of the bus all nine of us, along with our luggage, piled into the ambulance - we were not about to be seperated at this point! Luckily we were able to convince them to take us to CMC Vellore - during the wait for the ambulance Kevin had called Swamy's family friends to warn them that we were coming.

When we arrived at CMC 2 hours after our accident, they were not waiting to take us back to the trauma bay. In fact we had to track down stretchers and wheelchairs on our own. Thankfully Dr. Mathai, the head of Internal Medicine and Swamy's family friend that is monitoring my platelets, arrived shortly after we did. He talked to all of us and decided who needed to be checked out and made sure we got the papers necessary to get charts made for each of those that needed to be treated.

This was definitely an education in the workings of the Indian healthcare system. Perhapse the biggest difference between the healthcare systems in the US and India is that in India everything is pay as you go. When the ambulance dropped us off the expected to be paid, before people could be treated we had to pay to have the charts made, I had to pay before my platelets could be checked, and whenever any madication or intervention was given or any test performed we would he handed a bill to pay.

While the facilities and infrastructure are not what I would call "up to par" with the US, I feel the actual care that Cristina, Chris, and Swamy received was excellent. But then, I was not one of the patients myself and I was off taking care of other things much of the time - getting charts made, paying bills, and getting my own platelets checked ( 103,000 so stable from last week).

Thankfully we all walked away from the crash ok and most of us only ended up with minor bumps, bruises, and abraisions - a true miracle!

Jaipur

2008-04-19T22:19:00.001-07:00

Amber Fort
Elephant Ride!!!!

Looking down on Jaipur from Amber Fort Palace

SICU Pictures

2008-04-19T22:09:00.000-07:00

Rounding :)

Open abdomen after repair of perforated diaphragm...EEK!

Vellore Fort

2008-04-19T21:55:00.000-07:00

Vida and I visiting Vellore Fort with our new friends from Oklahoma - Swamy and Kevin

Around Vellore

2008-04-19T21:39:00.000-07:00

Cows at the travel agent!

The famous auto rickshaws

Children walking home from school

Donkeys!!!!

2008-04-16T05:50:00.000-07:00

Vida and I at the Temple at Vellore Fort
Vida, me, Claire, and Dinesh at Amber Fort

2008-04-16T05:33:00.000-07:00

Me at the Taj Mahal - Amazing!

Labor ward

2008-04-16T05:00:00.000-07:00

Obstetrics and gynecology has been an interesting experience. Just as in the SICU, many aspects are similar but a lot is different. From my point of view one of the most striking differences is the lack of anesthesia! Here the women deal with their pain and do not complain. There is local anesthetic given for episiotomies and opioids are used if analgesia is needed, but for the most part it is all natural. American women would not last long here! Another thing that shocked Vida and I is the use of lateral episiotomies. It looks so barbaric, so painful, and so damaging to musculature! However, we have been equally impressed with the residents' ability to quickly and effectively repair the laceration.

As in the US the Labor ward is a happy place. It is refreshing to see the happy new mothers, glowing with pride. Unfortunately, there really is not much modesty here. The ladies are lined up on either wall in a room maybe 25 feet in width, about 20 patients in one room. There are sheets pulled to provide "privacy" but it is pretty easy to see through the gaps between the sheets. (The sign outside the door of this unit reads "Low cost effective care unit.") During labor the women lay on plastic (that is washed off and re-used) and the doctors wear plastic aprons, all of the linens are washed and re-used as well. We really are spoiled in the US!

Becoming a Patient at CMC

2008-04-16T04:38:00.000-07:00

Since my platelet level was 62,000 one week before leaving for India (I have ITP) my hematologist sent a script with me to have my blood drawn once per week while in Vellore. Sounds easy enough since I'm working at a hospital, right? Wrong! I mentioned my situation to several people I met last week, but the best suggestion I could get was to "find someone in the medicine department." Very helpful. Luckily our friend Swami (one of the guys from Oklahoma) has a few connections here since his mother went to medical school at CMC. Once I told him about my issue we started to get things done. Swami called his mom's friend who sent me to her husbands clinic. Interestingly her husband happens to be the head of the internal medicine department. However, even having this connection the process was not simple.

Upon arriving to his office we (Vida was kind enough to come with me) were sent down the street to another office where we were able to speak with him. He informed us that I would have to have a chart made and then come see him in clinic in an hour and a half, after he finished lecturing. We set off to have the chart made, but had no idea where we needed to go for registration. It was then that we met Joseph - a wonderful man who has worked the front desk at the CMC Annex, where the residents live, for 25 years. We stopped only to ask directions, but he went out of his way to help us. He pulled out the paper work that I would need to fill out, then had one of the other workers go around to make sure that everything was taken care of because as he said "they will give you too much problems." When problems where encountered Joseph walked over himself to talk to the registrar. An hour and a half and 75 rupees later I had a chart! I was so thankful that I could not believe it! I would have been willing to pay any price for the service, but Joseph refused to take any payment. He said he just wanted to help. What a wonderful man! This is why I love Vellore!

After obtaining a chart number we headed back to the clinic to get the lab slip and then were sent back down to registration to pay. At least by this point we had figured out how the whole system worked so we were able to maneuver with minimal difficulty. Once the payment was complete it was off to the lab with plans of returning for the results later in the afternoon.

Overall this was a very interesting, albeit time consuming process and it really isn't all that different than the way things are done in the US. It really is the cultural and language differences that make the process unique. I am very thankful that Vida came with me on this adventure because I would not have wanted to do it alone.

PS My platelet count came out to be 102,000 this time so as of now everything is ok. I will check them again next week.

Weekend Trip to the Golden Triangle

2008-04-15T23:37:00.000-07:00

We arrived in Jaipur around 7pm Friday evening so we were only given a quick glimpse of the city during our drive to Shahar Palace guest house, but this was enough to give us a taste of Jaipur's flavor -camels pulling carts down the street- and leave us anxious for more. After checking in and having a nice conversation with Col. Singh and his wife, the owners, Vida and I ventured off to dinner at Spice Court, a nearby open air restaurant set in a garden featuring traditional folk dancers - wonderful ambiance! It was a really cool experience. At dinner we met a group of Americans working in Kuwait. After dinner it was off to bed to rest up for a full day of esploring in the "pink city." - Maharaja (king) Ram Ringh had the city painted pink in 1876 to welcome the Prince of Wales and this is where the name Jaipur comes from.

We started off our morning with a brief car tour pointing out some governmental buildings of Rajasthan (the state that Jaipur is in). Then we continued on to Amber fort - 11 km North of Jaipur, once the ancient capital of Jaipur state. Here our tourist extravaganza began as we were met by a snake charmer upon stepping out of the car and were soon surrounded by many street vendors. After making it through the crowd we made our way to the elephant stand where we boarded an elephant for the trip up the hill to the fort/palace. So cool...we rode an elephant! Once at the top of the hill we got off our elephant :( and headed inside to hear what stories Raj, our guide for the day, had to share. Since this was our first true tourist experience in India and our first of many palaces, we were pretty excited. This is evident by the sheer volume of photos we took here.

After Amber fort we returned to Jaipur for lunch where we met a fellow traveler who happens to be an incoming first year medical student at Southwestern - small world! The afternoon was reserved for City Palace, the Mausoleum, and shopping at the bazaars - lots of history, beautiful sights, and numerous shops. It was a fun but exhausting day!

That evening we drove out to Chokhi Dhani - a resort that puts on a nightly Indian Renaissance festival-like fair. Here we were able to have dinner as well as enjoy traditional dancers and musicians. In addition to these activities we got mendi drawn on our hands and rode a camel -- so cool! As Vida and I were about to have our camel ride, it started to rain and the power went out, but we were not about to let that get in the way of our opportunity to ride a camel so we sweet talked the camel handler and took a pitch black, rainy camel ride. It was absolutely amazing and so much fun - we laughed the entire time!

The next morning we left Jaipur en route to Agra - home of Taj Mahal and the second city in our "golden triangle" weekend tour. It was interesting to see the countryside in this area since farming seems to be a much larger part of the life here than it is in the south near Chennai and Vellore. One thing that really struck me was the use of camels, and sometimes even elephants, as domestic work animals pulling carts and hauling loads. It just seems so odd, but then here they are not considered exotic animals so I guess it makes sense.

On the road to Agra we stopped at Fatehpur Sikri - "City of Victory" or "perfect city" depending on who you ask. This city was built by Akbar a great Mughal emperor who expanded the empire to cover most of Northern India. Akbar was known for "religious tolerance" taking 3 main wives: 1 Muslim, 1 Hindu, and 1 Christian. He believed in a common truth in all religions - Din-i-llahi = Faith of God.However, Akbar war troubled by an inability to have a son until he visited a Sufi mystic at the site of Fatehpur Sikri. The city was built in honor of the mystic as a physical expression of Din-i-llahi. The problem was that there was no river nearby, so the city was abandoned shortly after Akbar's death - leaving the magnificent ruins that stand today. (In case you were wondering Akbar's liberal ideas about religion were also abandoned.)

Between Gatehpur Sikri and Agra the sun set and we were able to experience the joys of night driving in India. Very scary! There were multiple times that we thought there might be an accident: cars driving without lights then flashing their brights several times to notify us of their presence, bicyclists and pedestrians sharing the road with cars in a state of chaos equal to that in the day, but without the benefit of light. It truly is a disaster waiting to happen!

Somehow, by the grace of God, we arrived safely in Agra and made our way through the crowded, dirty streets headed toward the Taj Mahal. That is until our driver stopped and said he could not take us any farther. There is a 1.5 km perimeter around the Taj Mahal that is supposed to reduce the amount of pollution damage. I'm not sure how much good that will do, but hey I guess it is worth a try. Anyway, at that point we piled out of the car and squished all four of us (Dinesh, Claire, Vida, and I), with our luggage, onto one auto rickshaw to finish our journey at the Shanti Lodge - a budget hotel with a rooftop view of Taj Mahal in the Taj Ganj area (where the artisans lived that worked on the Taj).

After settling into our rooms we met for dinner on the roof. The food was far below average, but it did provide a beautiful moonlight view of the Taj and interesting company. We met a guy from Boston who had spent the last several months doing human rights work in Palestine and an Australian traveler who had been traveling in Nepal but was "strongly advised" to leave before the elections.

The next morning we woke early with hopes of seeing the Taj at sunrise (I guess it happens sometime before 5:45 even though we were told 6:30). Regardless, when Vida and I ran up to the roof for our first view, it took our breath away. There really are no words to describe the amazing presence of this phenomenal structure! After a short walk from our hotel we were at the gate waiting to pay our 750 Rupees, around $18 - 3 times what each person had paid to stay at Shanti Lodge (Rs-500 per room). Once inside the gate we hurried through the courtyard and there it was, a true wonder of the world! It really is more amazing than imaginable. I was awe-struck by the perfect beauty! I hope that my photographs are able to capture even a fraction of the magnificence of this tribute to love.

History of the Taj: Emporer Shah Jahan (Akbar's grandson) built the Taj Mahal as a memorial for his second wife, Mumtaz Mahal, who died giving birth to their 14th child. Construction was completed in 1653 - 5 years later Aurangzeh (Shah Jahan's son) seized power and locked his father in Agra fort where he could only gaze out the window at his marvelous creation. When he died his son laid him next to Mumtaz Mahal, disrupting the perfect symmetry of the monument.

While admiring the beauty of the Taj we coincidentally met up with Lauren, the soon to be MS1 from Southwestern, so we decided to meet her for breakfast at her hotel...much nicer than the Shanti Lodge and with much better food. After breakfast we continued on to Itmad-ud-Daula, aka "Baby Taj." This amazing structure is much smaller than Taj Mahal but it is interestingly more ornate. The Baby Taj was built during the reign of Jehangir, Akbar's son/Shah Jahan's father, and is the tomb of Jehangir's cheif minister - whose daughter happened to marry Jehangir. This was yet another truly amazing sight!

Unfortunately, our schedule did not leave us time for any of the other monuments in Agra so after Baby Taj it was off to Delhi to complete the golden triangle and catch our flight back to Chennai. Oh the drive it was interesting to see the wheat fields being harvested. People would go through cutting the stocks by hand and placing the wheat in small piles. Later they would carry the small piles on their head to a large pile in the center of the field. After that I am not sure what they do. I did see several combines driving down the road, but I never saw them in a field. Also, in town I had seen bundles of wheat sold on the stalk, so who knows what the normal process is.

Our time in Delhi was limited to the drive to the airport, but from the road it seemed like a nice city - fairly clean and working to modernize. Although I very much enjoyed visiting the "golden triangle" I was glad to get back to Vellore where the people are friendlier and it is a more calm and peaceful way of life.

On the side....

2008-04-10T08:28:00.001-07:00

After work yesterday we were finally able to do some shopping and get some Indian tops - very fun and cheap! :) After shoping Vida and I met up with a couple of students from Oklahoma - one of which Vida happens to know from Baylor (SMALL WORLD!). The four of us went to Vellore Fort. It was wonderful - beautiful architecture, amazing views, and great people-watching! Inside the fort is Sri Jalakanterswarar Temple Fort...a beautiful Hindu temple. We removed our shoes before entering (hopefully no hookworm!) and then walked into an amazing and surreal world. I don't know if it was the right time of day or if it was a special holiday, but the temple was very busy and there were many ceremonies going on throughout the temple. It really took my breath away. Unfortunately, we were not allowed to take pictures inside the temple, but it is an experience that I will never forget.

There are many students here from all over the world...London, Detroit, Singapore, etc and it has been fun to get to know them little by little. I have met a lot of people at dinner since there are only so many hotels in town for people to get dinner at. Since I brought up the food...oh my goodness!!! I love it! To be honest, I was not a huge fan of Indian food before I came, and I was a little worried about that. However, the food here is absolutely amazing!!! I must say that came to a very very pleasant suprise.

First Impressions

2008-04-10T02:03:00.000-07:00

Walking out of the airport into the heavy, humid air, I was immediately reminded of stepping off the plane in Tanzania and I was overcome with excitement and fond memories. As we drove from the airport to the hotel I was shocked by the chaos on the road: trucks, cars, autorickshaws, mortorcycles, bicycles, and pedestrians sharing the street with no regard for traffic laws and the phylosophy that honking will solve any traffic problem. This truly was an amazing sight and I must admit that there is a certain adrenaline rush that occurs every time I step inside an autorickshaw...I love it!

I have been very impressed with both Vellore and Christian Medical College (where I am doing my rotation). Vellore is a smaller community with wonderful people and an amazing charm. Despite the "smaller" size of Vellore it is still a very hectic city with crowded streets, buys shops, and frequent sightings of cows, donkeys, or goats walking down the sidewalk and/or blocking traffic. It is truly fabulous!

From what I can tell, CMC seems to be the true heart of Vellore. The medical college and hospital were started in the early 1900's and have grown to become an extremely well respected institution bringing students, residents, and faculty from all over the world and treating patients from India as well as the middle east and Asia. I was very struck by the sheer size of the hospital and how nice the facilities are. Don't get me wrong, things are very different here, but they are more similar to the US than I was expecting...at least in the surgical intensive care unit where Dinesh and I are observing this week.

On our first day Dinesh and I became quite lost while looking for the SICU but we were eventually successful. Upon arivng we were asked to put canvas booties over our shoes and gowns over our clothes - a very good look for both of us...I love the canvas clown shoes! As we entered the unit I was impressed to find a spacious, air conditioned facility with approximately 12 beds, 3 of which are isolation rooms and the rest are open with curtains, all around a central nurses station. Several patients were on ventilators that look very similar to those in the US. From what Claire and Vida describe of their experience on pediatric wards, these luxurious conditions are not uniform throughout the hospital. Nontheless, I was very impressed with what I saw and the day got even better when I discovered that the SICU at CMC is actually run by Anesthesiology - yay! This really is perfect for both Dinesh and I : ortho trauma and anesthesia perspective.

The experience so far has been amazing! The doctors we have been working with have been wonderful and although it is difficult to follow everything that is discussed on rounds, our attending has taken time to explain to us what is going on with the patient be before discussion begins and what has been decided after thier discussion. (Even though the majority of the talking is in english, they tend to speak very softly.) He is really a great teacher and I feel fortunate to be able to observe him. Although the patients currently on serviceare not particularly unique to India pathology wise, it has been extremely interesting to see the approach that is taken to each patient. As a side note: every day there is a break in rounds around 11am for tea and biscuits - amazing! :)

Disclaimer...

2008-04-10T02:00:00.000-07:00

First off, sorry for not posting anything until today!!! Everything has been so crazy -in a good way!!!- that I haven't had a chance to get to my blog. I will try to be better from here on out, but please excuse any misspelled words, grammatical errors, or ramblings. :)

The Journey Begins....

2008-04-06T03:45:00.000-07:00

I began my journey around 8:30 Saturday morning. After a tearful goodbye to Dustin I headed to Austin to pick up Claire, then we drove to Dallas to meet my brother for lunch and drop off my car. The flight from Dallas to London went well except for a delay in landing due to snowy conditions...its crazy to think it is snowing here in London and when I get to India in about 10 hours it will be 100 degrees. :) After a quick bite to eat and some internet access we will be off to Chennai to begin the adventure at Christian Medical College in Vellore. At this point I think I am getting more excited by the minute! I really can not wait to see what adventures are in store for the next several weeks!