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

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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 :)