Hassle with a silver (marble) lining

India can really get to you. The vacation started out rather stressful.

Between the overt lying/hustling (we were told by multiple people at the Delhi train station that the reservations office was "closed" and that we needed to take a rickshaw down the street to book train tickets; fortunately, we didn't fall for it), painful waiting-in-line-for-inquiries, followed by fruitless efforts at the tourist counter to buy same-day train tickets, we were majorly fed up at trying to get from Delhi to Agra on Saturday. I have spent many hours in train stations in my lifetime of travel, including places in which no English is spoken, but NEVER have I had this much trouble buying a single one-way ticket for a town 200 km away, and the frustration actually brought me to tears. We finally got tickets for the 1130 train (2 hours after arriving at the station) in the "sleeper" car with locals, for about the equivalent of $3.

We had NO success in Agra getting onward journey tickets, and after our 1-hour busride today to a nearby town, I (who, of the three of us is probably the most willing to "rough it" and go cheaply) have decided riding the Indian bus is out of the question. We are taking a hired car tomorrow to our next destination. Indian railway workers are, by far, the least helpful people I have ever met. We also get triple-charged for most things (but don't fall for it), and were told that we had to pay the AC- rate for a non-AC room at the hotel where we booked an AC room (which we contested, successfully). We are constantly having to tell people on the street that we are not interested in their services/"help"/goods, etc., which gets downright exhausting.

I was fearful for what the next 2 weeks of vacation would bring given the tone that was set on our arrival to the north over the weekend; however, we did have a wonderful day yesterday visiting what is (not even arguably) the world's most beautiful building and other local sites. A nice young gentleman, Manish, who met us at the train station the day before (and, unlike most of the other people we have met, seemed non-aggressive, nonthreatening, and actually polite and helpful) escorted us around at a very reasonable price for a full day tour of Agra. We started with an early morning trip to the 17th-century Taj Mahal, a mausoleum built by Shah Jahan for his second wife, which took 20,000 workers 22 years to build. The light was perfect and, despite the already numerous tourists in the morning, we got some great photos (which, unfortunately with the speed of this internet connection, will have to be posted at a later time. I so wish I could get them up to show you the beauty of it and the fun we had!). I had visited the Taj once before, about 15 years ago with my family, but it was still spectacular!

We also got to visit a few other monuments, including the formidable Agra Fort, the Itimad-ud-Daulah, or 'baby Taj,' a similarly spectacular and beautiful mini-monument, and Mehtab Bagh, pretty gardens with a view of the back of the Taj. We learned about marble making, and got to eat yummy "non-veg" fresh food at an outside garden restaurant.

Today, we visited a large mosque and palace complex in Fathepur Sikri, 40 km outside of Agra and finished up at the bazaar.
Kimie leaves us tomorrow for Korea (:() and we head onwards (with hope--transportation willing) to get to a Tiger Reserve!

Citylife!

Medicine is not as exciting as sightseeing, and I already blogged about Indian OB; I spent some more time in Peds (Paediatrics) at MIMS and learned all about the high incidence of Indian children needing phototherapy, common childhood diseases, immunization schedules (only BCG and POLIO at birth; others at 6 weeks and beyond), and NICU care in India. I doubt you want to know more.

For the fun: we were able to escape from our medical island for the weekend and visit some city sites!

Hyderabad (or Cyberabad; located in central India in Andhra Pradesh, 35 km south of Ghanpur Village) is known for both its pearls and high-tech-ness. I have never in my life seen so many jewellry stores-- they really were one after the other, after the other... We were able to explore the Chowmahalla (nizam's) palace, which was rather grandiose, as well as the Ramoji Film City (which, even without the rain, would have been way overrated [Lonely Planet led us astray!-- no chance Universal Studios will go out of business!]. However, perhaps the highlight of the city escape was our food selection, as well as purchasing more toilet paper (for sure, a rarity in India, and apparently unobtainable in Ghanpur Village -- good thing we had come prepared!).

Now, don't get me wrong. I love curry, and I LOVE Indian food; however, I cannot eat the below for three meals a day for four weeks:

Call us obsessed with food (who writes a blog mainly about escaping from lentil curry?!); however, when most of our daily conversations started to sound like, "Gosh, a bacon cheeseburger would be really good right now," or, "what I would do for a PBJ sandwich," we knew we had had enough dal (lentil, or "veg") curry (Due to the large Hindu population, most of Indian food, or advertised food, is veg, or vegetarian). In Hyderabad, the highlight of our Saturday was a meal at a sit-down, "multicuisine" restaurant where we had glorious "nonveg" food including naan, noodles, spring rolls, soda, tandoori chicken and authentic chicken tikka masala, which was amazing. Although I sometimes think I can subsist without meat, I have changed my mind.

Here is Kimie eyeing Kay's food, which arrived first... we were all starving!

We also got to see the sights of Mumbai (formerly Bombay), which is the "New York City" of India. While it's still hard to get away from the constant begging (I kind of hate being a foreigner in India), dust, and heat, it's been fun to be in the metropolis with more to entertain us. We have:

- wandered the Fort area and seen the historic buildings, including the Victoria Station (busiest train station in Asia!)

- explored the Oval Maidens (downtown parks) and photographed the picturesque University of Mumbai

- wandered the Colaba markets and seen the gorgeous and colorful Diwali decorations (the Festival of Lights starts this weekend)

- taken the ferry to and visited Elephanta Island, a site of cave temples dedicated to Shiva (luckily done prior to Obama arriving, as apparently they plan to shut down this traffic)

- seen the Mahalaxmi dhobi ghat, the largest human washing machine, where tons of Mumbai laundry (I was squinting for my shirts!) gets done daily


- SHOPPED (Kimie and Kelvin drive a HARD bargain) at the many streetside bazaars- I have come away with steals for wedding bangles and sparkly wedding shoes!

- popped in to see the "Taj" Hotel, the grandest in town, with a famous staircase


(we all seemed a bit underdressed)

- visited the house Gandhi stayed from 1917-1930 while coordinating the Independence efforts

- had perhaps the best seafood I have ever tasted at LP-recommended Trishna restaurant (masala squid, garlic prawns, tikka butterfish... is your mouth watering yet?!) and eaten various street snacks..

Here, Kelvin smiling as his favorite sugar-cane juice is in sight!

Kulfi (ice-cream...), which is wonderful in this heat!

For some more glimpses of India:

Street wildlife: it is common to see goats, sheep, cows, dogs, and other animals roaming the streets (and chilling on benches!)

"Dumpster-diving cows" abound

I love Indian communication and signs

(this was a bus about 5 feet in front of our cab)!


I saw a shop sign of a place specializing in (I kid you not): "Mutton, chicken, and marriage licenses, all at wholesale rates"!

... I rest for now. The Indian adventure continues...

The Indian Way

Indian Time

There is such a thing as Indian Time. While I always thought that all Asians were punctual, I have since learned that it is typical for Vietnamese weddings to not really "start" until an hour after the posted time (with guests arriving an hour or more late-- please come on time to ours!), and Indian event start times are, similarly, "suggestions." Yesterday, when we were asked to join the hospital chief of staff at the SHARE India office "immediately," the meeting didn't start for over an hour and 15 minutes later! The college-week-finale ceremony last night started, not as scheduled at 5 pm yesterday, but at more like 630. And the music, I think, went on all night!

The head bobble

If you spend 5 minutes in India, you will become accustomed to the "head bobble," which generally means "ok," but I think can mean anywhere from "yes" to "no." We have been well educated, per Lonely Planet, to ask NOT yes-or-no questions for fear you will be led astray by the ubiquitous head-bobble, but rather ask open-ended questions so that your interviewee has to commit to an answer.

+/- Electricity

Our power goes out at least once, usually 2-3 times per day. It is not a huge issue (it usually comes back on within 5-10 minutes) unless you (like Kim was once) are in the shower needing the hot water heater and convenience of lights. The internet is also kind of unreliable-- it was down all day yesterday, but back up today. The absence of convenience can be accepted; however, it is the unpredictability which can become frustrating.

Curry forever
I love Indian food. I love curry. But I am not sure I can eat it three meals per day for a month; currently, this is what we get at the hospital canteen. One day, Kim and I were fantasizing about pancakes and we did indeed get some sourdough-type of pancake for breakfast. Our prayers for eggs and bacon, however, did not amount to anything. We miss IHOP :)

Foreign Medicine

We are a few days in to our global health elective in India.

We are "posted" at the Mediciti Institute of Medical Sciences (MIMS) in Ghanpur Village, which is about 35 km from the major city of Hyderabad.

The rotation hasn't really been what we expected. I think we all expected, like in the Philippines and my past experiences in Peru, to be more involved in direct patient care. Here, they have a small, but rather well-functioning rural hospital, with departments of surgery, medicine, pediatrics ("paediatrics"), obgyn, etc., that handle a small-to-moderate volume. While everyone is great about introducing us to their way of practice, we are mostly shadowing and not feeling particularly useful. Although we are not honing our exam skills to any great degree, we are learning about the practice of medicine in an international, low-resource setting, which has been a good cultural educational experience.

In India, students generally enroll in medical school after high school and complete a M.B.B.S degree (Bachelors of Medicine/Bachelors of Surgery), after which you can opt to complete additional specialty training. There are students (although they are currently on break) as well as "housestaff" (our intern/resident equivalents) which do the bulk of the work. The attendings are all "associate professors."

I have mainly passed time in the OBGYN department, seeing outpatients, as well as joining the doctors in the "OT" (Operating Theatre) for cesarean sections and "tubectomies" (tubal ligations). It has been interesting to learn of the differences in care. During prenatal care, not everyone (gasp) gets a glucose challenge. A random blood sugar is typical, and, if high risk, you get the joy of a 50-g glucola. No group B strep is tested for; however, everyone with ruptured membranes is treated with oral ampicillin. Many patients are anemic and, if you have a rare blood type (i.e. Rh negative), you are responsible for finding your own blood donors should you be anticipating surgery.

The c-section rate is (like in the U.S.), alarmingly high at around 40%. It struck me as quite odd to have rates this high, as obesity is virtually nonexistent here and most babies are small, on the order of 2.4- 3 kg; however, cephalopelvic disproportion still exists, meconium and fetal distress still exists, and, due to unknown uterine scars, the docs are quick to do repeat c-sections rather than offer vbacs. The surgeries are surprisingly near bloodless! I am not sure if it is the nutritional/anemic state of the patients, but I have seen c-sections with EBLs of about 200 cc, which is quite unheard at least where I have been operating! I believe, in the day prior to my leaving UCD OB, our average EBL for the c- sections that day was somewhere around 1500 ml. And the most impressive part of this all is: there is no cautery available.

Suture is rationed and instrument ties used most often to conserve suture. While the anesthesiologists do do spinals for c-sections, no one else gets an epidural (leading to them begging for c-sections). There are no vacuums to be used for deliveries. Forceps are used quite liberally, including on routine elective repeat c-sections. Patients stay until about post op day 6 or 7 due to their rather complicated travel situations and that wounds can be monitored and sutures (not staples) removed prior to discharge. Preeclampsia rates are also alarmingly high. There is a small NICU and there is no expectant management of PPROM due to infection.

Kay, Kim, and I are staying in the "girls' hostel" for about $8/day, while Kelvin is on the guys' side of campus. The accomodations are perfectly adequate, with the added company of some creepy-crawly critters in our room included for free. The food is largely vegetarian, with various types of curry for breakfast, lunch, and dinner, for about 20 rupees (50 cents) per meal. Yesterday, everyone was thrilled for Wednesday special of chicken! We obviously have internet access both in our hostel and in the library, and have quite a bit of free time. It's been nice to sleep (although my late afternoon napping has interfered with my fully getting over jetlag -- time difference is about 12.5 hours), relax, and do some reading in the evening hours.

We are hoping to get to venture into Hyderabad (the big city!) this weekend to do some sightseeing as we are a bit isolated here. We miss you!

Change of Scenery

From:

to:

I've spent the past four weeks on labor and delivery as OB Chief! It was definitely challenging and very busy at times, with code c-sections, ruptured ectopics, overflowing triage, an 11-lb continuity delivery, and several very pretermers, but it also was very entertaining. From amusing floor consults (one for vaginal bleeding which was quite certainly "menses") to caring for some very interesting antepartum characters, I felt like I bonded with my team-members and hope that I wasn't a mean chief, which was my greatest fear :)

I am thankful to be done, though, at least for this block. I am back on OB in December, but get to now head overseas to India to do some medical work in Hyderabad and then have some much-needed vacation which, due to recent time constraints and severe sleep deprivation, is at this point very loosely planned. It will be another adventure :)

Wedding preview

To have to plan a wedding still feels like a very odd situation to be in. While on busy rotations (currently on OB as chief [!]), I have very little time for blogging, much less wedding-planning.

In any case, I am getting asked often by many people, "do you have a date yet?" which, while well-meaning, is sort of adding to my stress at this point.

We are getting closer, though. Here are some photos of the last few weeks:

Engagement party hosted by Wai Kiu and Hanh a few weeks ago:

We prepared a yummy spring roll buffet to give people a taste of Vietnamese culture :)

Thank you to Roxanna and Michael for a lovely cake-- and to Jeremy and Wai Kiu for being the main picture-takers.

Celebrating with Char and Thad

Char and Thad had a private Belize wedding in June, but we were fortunate to be able to celebrate with them at Rocky and John's at a lovely reception 2 weeks ago. Congratulations!

This past weekend, we went down to Orange County to celebrate the wedding of Man, one of K's friends from HS, and Huong. It was really interesting to be involved in a full traditional Vietnamese wedding, and equally interesting to attend a wedding with thoughts of your own wedding in mind.

The morning entailed us attending the "tea ceremony" which involves the groom and groom's representatives traveling in entourage to the bride's home, bearing gifts (enclosed in lacquer boxes, covered in red cloth) including a roasted pig, and asking for permission of marriage. This is followed by a short tea- and candle-lighting ceremony which honors the families; jewelry is also exchanged. This is followed by a trip back to the groom's house for a reception and, if Catholic, mass at the church.

For this morning ceremony, the women generally wear traditional dress, or Áo dài ("long dress"). I was able to join the tradition, having one made back in March when we were in Vietnam. Thanks again to Katherine, who was in charge of my hair and make-up :)

After the luncheon, we broke for the afternoon, and then re-convened for the evening reception, which is usually held at an Asian restaurant (with the whole place rented out). The meal was a 10-course Vietnamese meal, served family style, with appetizers, soup, a seafood basket, lobster with sauce, peking duck, crispy fish, fried rice, and dessert (I think I am missing a few courses but you get the idea!). The bride and groom go around from table to table, greeting guests which is termed "chao ban," or "table shopping".... as, at Asian weddings, apparently the guests give, not gifts, but money in envelopes which is very welcomed by the couple. The bride had three different outfits during the reception-- from a beautiful white wedding gown, to a bright pink ornate Áo dài, to a different white "princess" gown for the cake-cutting.

There was a Vietnamese band, and karaoke encouraged, but the reception was much like most wedding receptions I have been to, with introductions of the bridal party, toasts, slideshows, cake-cutting (although, apparently, the wedding cake is actually fed to the guests, which I have been told is not always the case at "white" weddings), and dancing. It was a great time!

Lovely wedding cake

Us with the happy couple- Man and Huong


While down in OC, we were able to check out several southern CA wedding sites, including the elegant Richard Nixon Presidential Library, Strawberry Farms, and Villa del Sol (the original Hotel California). The previous weekend, we had checked out two wineries (Scribner Bend, Wilson) just south of Sacramento which are in the running for our site. I think we will try to do more research this week and next weekend and, with hope, have a date and venue set for our own wedding in the next two weeks! Stay tuned :)

Incompatible are ....

the following....

• The groom thinking about wearing a brown suit at our wedding, to which I responded "Absolutely not." "Why?" "Because that would be incredibly ugly. And because I am the bride."
• As a second choice, him planning to wear a brown tie with a black suit (Similarly vetoed. It does not match, although he will try to convince you it does, and he really does usually have much better fashion sense than I do)
• Brown with grey. Again, not compatible in my opinion.
• Planning a wedding in So Cal while living in Nor Cal (as a result, the wedding might become a Nor Cal wedding and, at this rate, might be in 2015)
• Planning a wedding while working resident hours
• Planning vacation in India for November 2010 while thinking about planning a wedding and being a resident
• Planning vacation in a month while searching for a job for next year (had an interview Friday up on the northern CA coast) while planning a wedding and being a resident
• Preparing to give OB grand rounds this week while planning this international vacation, searching for a job, planning a wedding, and being a resident

Oof da, as they would say in MN. I feel like I am juggling 10 very heavy balls.