Week Eleven from the Field: General Hospital Kochi

This last week was amazing. I was actually disappointed that I wasn’t able to get this post up sooner but that’s the way things go.

I have been so inundated with new opportunities that I’ve found it hard to focus on anything other than research. Now that I am done with my interviews and the collection of some 300 surveys has gone pretty seamlessly I’ve found it easy to catch up on some of the more extraneous parts of this experience. This post however is being focused on an amazing experience that I had last week visiting a Government Hospital in the neighboring state of Kerala.

Where we live in Tamil Nadu is in close proximity to the neighboring state of Kerala by only about a 30 min bus ride to get to the boarder. Last Thursday I got together with Emma to take a short trip over to the capital of Kerala, Kochi. We went to take advantage of an offer that I got to visit one of the Government Hospital. I received this offer from a young and amiable doctor that I met at Ortho One Hospital here in Coimbatore. His name is Dr Cherian and he is an orthopedic surgeon at the hospital. He offered to give Emma and me a private tour when I told him about our research projects. Emma came along to get a separate tour of the maternity ward and the gynecology department. It was an amazing trip.

In one day I got to see so intimately the workings and structure of one of the hardest to enter facilities in India. The fact is that there is a lot to be done. I realized after my visit that a General Hospital is a scary and hard place to go into and not come out a different person. 

I have visited once the main medical college here in Coimbatore and the comparison even between the two was dismal. The general hospital in Kochi is supposed to be the best in India. Thus as far as General Hospital standards go it was excellent but in all reality they know and the government knows that there has to be huge strides made in medical care if they are to provide a place of safe reliable medical care for their citizens.

I was also able to tour the Operation Theatre. In a matter of an hour and a half I saw 5 surgeries. The doctor then had one of the administrators of the hospital lead me around for the rest of the day. After the surgeries we watched in the morning, Emma was taken straight to maternity ward and spent the rest of the day with the gynecologist. I was able to see everything from, the optometrist’s operation theatre to the nuclear medicine department where the best attempts of oncology procedures are taken out. It was quite the afternoon and I really began to see and understand the struggles that each of the department was facing with limited and under qualified staff. I was also able to observe the ever constant need for more and more resources from the Government that weren’t being allocated correctly. I found it insightful to take some time and talk with the patients about their experience in the hospital. Most of the reports were pretty depressing as they explained that they came as a last resort. However for all of the heartbreaks, the silver lining was that the general hospital in Kochi still outperforms many private hospitals all over India. I am hoping to use the interviews with Dr Cherian and the literature that they gave me for my lit review for my final paper. It has also been a huge help to see the workings of all these systems to make a more accurate evaluation of the status of healthcare currently in India.

This will be my second last blog due to the ending of our projects. We leave next week, which will mark our 13th week in the field. Look out for one more post before I return home.

Week Nine From the Field: Mid Semester Retreat - Research Update

Blog # 5

This weekend was great. We got to go see some of the best sites that Southern India has to offer. All five of us went together and we went to Kanyakumari first. We took a sleeper train down there Friday morning, stayed two nights and got to see some really great stuff. I know that the office wants our Mid Semester retreats to be an escape from our projects but since I am interested in alternative forms of medicine I was constantly on the look out for healers and different places where people could receive medical care in the city. Kanyakumari was beautiful in one aspect but as far as Indian cities go, it was also lacking a lot. The city is more of a tourist destination than anything and the infrastructure and systems are sorely outdated. The general hospital is small and outdated. In order to receive any substantial medical care you would need to be transported all the way to Trivandrum in the next state over almost 90 km away to get decent attention.

We also were able to stay in a really nice hotel on the top floor for the equivalent of around 3 us dollars per person. The views were immaculate and the sunsets and sunrises, which are what Kanyakumari is known for, were breathtaking. We left the next night for Rameswaram the next night on another sleeper train that went through the night saving us more money on hotels.

When we arrived at 5 am in Rameswaram the city was already buzzing. There were people everywhere and we went pretty much unnoticed. We ended up next to the section of the Rameswaram bay that is considered holy water and were very entertained by the religious washing practices of the people there. It was interesting to see. The men strip down into either a Lungi or their underwear and women go in wearing a full saree. They go under several times using buckets to dump the holy water on their heads with their hands and or plastic containers that the poor sell on your way to the water.

After that ceremony is done you walk sopping wet to the temple in the middle of the city, which is beautiful and you go through a 22 step process of ceremonial washings to cleanse you of any bad or evil spirits. This belief is derived from a long held cultural belief in the significant events that took place in Hindu and Indian history on the island of Rameswaram.

We spent the rest of the first day on the beach at Dhanushkodi, which is the point of the island closest to Sri Lanka. I was also to contact some medical providers and I had the rickshaw driver tell me stories about medicine during all of the driving we did that day to get down to the beach. I was able to visit and look around some of the medical facilities in Rameswaram and it was an interesting contrast to the city hospitals that I always visit here.

We took another train from Rameswaram the night after we got there and went straight to Madurai. We all had tickets to leave Madurai the next morning but I had to come back early so I went ahead and booked a ticket that took me straight through to Coimbatore. It was pretty expensive because there were no more sleeper car spots so I paid 8 US dollars to get an AC sleeper car that was super nice and worth every penny of it. I made it home yesterday morning and went straight back to the hospital to continue my rounds.

The research is going well and I even made plans yesterday to take a trip to Kochi next weekend to tour the major General Hospital there with one of the head doctors who I ran into at Ortho One here. I will be doing that for two days next week and the gentleman has offered to put me up. I will find out more when he emails me back but he is expecting me next Thursday at the hospital.

Well I am still ling here in my hammock and I couldn’t be hungrier. The group all just got back and I am going to head in to the city to meet up with Steven and the girls for lunch after Steven gets done with shadowing doctors/dentist in the city. Things are going great and we are all nice and relaxed ready to blow this research out of the water in the last couple of weeks that we have here.

Week Seven From the Field: Medicine

My time here has been fascinating, I really have loved to getting to know more and more about the Indian healthcare systems here in India. I have really focused in the last two weeks on defining my parameters in what types of Indian medicine I am including in my research. This is particularly interesting when I consider what type of care I am looking at studying as a part of my research. 

I came across and article earlier this week by a doctor here in India that was a comprehensive outline at the status of the healthcare programs in India. It is fascinating and I have gleaned a lot of important information from it. I want to out line some of the interesting things that I have learned from reading this paper. I will also include several things that I have learned through my own research as well. I am going to share them here to follow.

One of the biggest things that I have come to understand is that in India there are several healthcare types from different cultures that have left significant impressions on the healthcare status here. The Indian Government recognizes several of these alternative types of healthcare as falling under the acronym AYUSH, Ayurveda, Yoga, Unani, Siddha and Homeopathy.

I knew when I got here that I would be focusing on Ayurveda and Homeopathy but due to the nature of my research it has become very important that I utilize the other specialties. I will use the other specialties in my definition of the healthcare systems here in India. I guess I’m lucky that I went ahead and included the other slot on my survey questions. It is true that Ayurvedic is the one main other type of medicine but I have learned so much about the others as well that it would not be appropriate to leave them out at this point.

In other ways this trip is also really starting to shape up as well. I love the culture and people here so much. I constantly am taken aback as to the genuine and sincere attitudes of the people that I have met here in Tamil Nadu. I catch myself thinking just how lucky I was to be here and have this wonderful experience. I have learned so much and the status of my research reflects that.

Things are going well and I love the place more and more the longer I am here. It has an interesting hold on you like that and I am completely ok with it.

Week Five From the Field: Progress

Blog #3

Besides of spending a lot of time shadowing doctors and getting to know the medical systems a little bit better I got my survey completely translated into Tamil and back translated, so now I am ready to go. It was interesting that in the prep course we focused a lot on how hard it was going to be to get the survey translated but in all reality it was actually super easy. The members of the church here have proven to be an invaluable resource. They know people and service for everything that you want to do. I also have several of them helping me gain entry to their social groups and places of education and employment so that I can administer my survey in other places than just the hospitals in which I already have permission and contacts to administer surveys.

My initial thought upon arriving here in India was that it would be somewhat difficult to learn all the systems of how things work and how the culture really works. I have learned that through working with people on the ground here and with our friends who came with us we can accelerate the process of getting to know the culture and how things work in the city.

I feel very blessed to have come with the group that I did. I love being able to get their insight and work with the group to make sure that we are all doing well and staying on top of things in the culture. I couldn’t have asked for a better group here in India. We all have become fast friends.

Really all is going well. The people are great. The food is awesome. I haven’t been sick really since the first week, which is nice. Things are going smoothly and although I feel that there is still an infinite amount of information that I need to know about the culture and the people I am really excited to get moving.

One last thing, in order to show an appropriate amount of reciprocity for the service that the branch and the members have been we are working with the priesthood leaders in the branch to set up a service project for the Chavadi Branch. The branch president is so great and he is so willing to help us with anything that we need. It only seems right to help them in a similar manner to how we have been helped out here. It has to be something thought out and long term so we are working through some ideas and ill follow up in later blogs.

Week Three From the Field: KG Hospital

Blog #2

Well its coming up on the start of our fourth week in India and I could not be more impressed and in love with this place. I had an experience just this past Tuesday that I want to blog about and outline some of the wonderful experiences that I have been having here in India. In order to prep my story I want to first outline some of the things that have kept me so focused and happy as I work to complete my research. Its all about the people. The countless numbers of people that I get to associate with on a daily basis have really shaped my experiences here. 

Matthew and Giva are so kind and understanding to all of our needs and we have fun teaching their kids English. It’s a wonderful relationship where Giva even commented the other day that in her opinion Edwin (her oldest son) trust our group more than any other group that has ever lived in the village. She said the way that him and Pria both have gravitated towards us makes her trusts us and she really wants us to focus on helping him with his English. What an incredible woman who loves her family so much. We also spend time learning from all the family members, whether its how to open a coconut from Isaac (the uncle) or if its talking with the neighbor who is also a member of the church about her soon to be new baby. Talking with her and the girls about here hopes and fears for the baby are possibly the most heartwarming conversations that I’ve had. Then there are the countless people that I have talked to in the streets of Coimbatore. I have adopted the policy that there is no need for maps or other directories of restaurants and places of interest because the people in the city are so kind and considerate. Most of the time they can’t understand a word of what it is that we are saying but they always go out of their way to help in any way possible. For example a man that Josh was having a conversation with the other day offered him a ride home. Josh declined at first but the man insisted. The man drove Josh all the way to the village and dropped him off our front door. Josh had money to pay him but he refused to take it. He just rode off into the night.

I want to now share my story of how this kindness, genuine respect and mutual friendship helped me have the best hospital tour of my life this past Tuesday. Here is the excerpt from my Journal regarding what happened to me as I went to request the opportunity at K.G. Hospital to shadow and observe their doctors and staff.

“After I had my meeting with Ruben I went to another meeting that I had with the Chairman of the K.G. Hospital here in Coimbatore. It was so incredible. I went and I was directed to go and speak directly with the COO of the Hospital and he told me that the Chairman wouldn’t be available for another hour. The chairman was teaching a class to some newly enrolled medical students in the auditorium in the hospital. The COO offered for me to go down and sit out side of the auditorium and to wait for the chairman, I consented and willfully went down to wait on the chairman. Once I got there I was almost immediately rushed in to talk with him up on stage. After he asked who I was and why I came to the hospital I sat down in a chair along the wall. I figured he would continue his lecture but instead he pulled another chair off from the side of the stage and had me sit down with him in front of the crowd of budding medical professionals. Not knowing a thing about me and not having any idea from where I came or why I even wanted to see him, he asked me a series of questions and presented me honorably to his medical students. It was quite possibly one of the most unique and impressive things that anyone has ever done for me in such an impromptu setting.

After my brief introduction of 5 or 10 minuets he took the woman that was a hospital employee and instructed her to give me a complete tour of the hospital and all of the different facilities and laboratories in the entire facility. It was an extremely exhaustive tour. The doctor in the first lab took me around and showed me all of the laboratory equipment and described in detail the science and job of each piece of equipment.

We then went through several operation theatres and various other labs and rooms, I had to scrub up once to enter the clean or room of the cardiothoracic surgery, the doctor who was showing me his operating room let me wear his personal scrubs (an extra pair obviously) and gave me the mask and head covering. It was incredible how much they let me see and participate in.

After my tour I was directed back to the auditorium where I was first introduced to the Chairman. I was once again brought up on stage and given a microphone this time. I then was put on the spot to describe who I was and what I was studying and where. He was very full of adoration and showed me a lot of respect and he spoke very highly of the United States and gave me the full go ahead to and shadow or observe any doctor in the Hospital. All of this is still in front of the class of medical students. He then had me tell everyone in the room how I was financing my education and why I wanted to practice medicine. He was so interesting and nice. He commented on how impressive it was that I took out loans to pay for school and how the students should be more like the American and be creatively engaged in making them selves and extraordinary person that in my opinion was a bit over the top but he made some great points. At the end of the little show he had me describe my impressions and feelings about KG Hospital. I told him that I was blown away with the authenticity and sincere goodness of everyone that I met. The fact that I had the COO the Chairman of the hospital and countless doctors and nurses showing me the entire facility was unimaginable in the United States. I was incredibly grateful for all of their kindness. I then continued to dramatically and emphatically describe how great their hospital was. The Chairman was moved. The amount of rapport built in that moment was incredible. I would have done anything for that hospital and the Chairman and I could tell that he felt the same about me. I was just grateful for the opportunity to meet him and in hearing his description of the medical field was nothing less than impressive.

After the class was dismissed I went with the Chairman to the office and he had me talk to his personal secretary to fill out all the paperwork I would need to start observing doctors in the hospital(this meant that I took blank paper and wrote my schedule and contact information while they photocopied my passport and ID. Then the most interesting thing happened. He had a visitor who came and with me still in his office, the visitor offered financing and a partnership with his larger hospital in Delhi to expand and create a more profitable enterprise for KG Hospital. The Chairman respectfully declined his offer on the grounds that KG Hospitals only goal is to help as many people as possible and he would not partner with anyone who’s business was business. He said if we cant offer our services for free under this agreement to those poor and underprivileged citizens of our community then I wont sign. The man hesitated and made some comment about profit margins. The Chairman then told him very bluntly that he didn’t need any profit margin as long as he could stay in business and that his business was helping people. He restated that he would not jeopardize that aspect of his business for unnecessary new facilities and more profit. The man was with out words and he was respectfully ushered out of the room! I was again speechless. Here was a man that was just offered part in a merger that would not only increase his next worth who knows how much but would also allow him to probably retire instantly (the chairman was in his early 60’s I’m guessing) and he turned him down on the premise that he wanted to give his money and services away not to hoard more. He then explained that they do over 2500 complex surgeries and somewhere in the range of 15,000 and 20,000 routine operations and checkups annually.

After this conversation he brought in his board of directors and several other top employees and said, “Tell them what you told the medical students earlier”. I chuckled inside at the offer and sat and explained my adoration and respect for the entire program and people that I had met. They all showered me with questions and about 15 minutes later they returned to their jobs. I was flabbergasted at this point wanting nothing more than to learn as much about this entity as I could.

I filled out a schedule for the next five weeks to work in the hospital and to see what the operations and administration of the hospital entails. I got it all approved to see several different aspects of the hospital and he wants me to come present again to another class Friday morning at 8. This should be great relationship with KG Hospital.”

These people never cease to impress me and I feel like I have so much to learn as I keep working on my research here. I just hope that in some way I can reciprocate the wonderful things they have shared with me in some unique and personalized way to each of them.

Week One From the Field: May 5 2012

Friday May 5 2012

I left the states 9 days ago. The progression through many of the steps mentioned in the prep course has been rapid and thorough. I can’t believe that my entire trip is 1/10 of the way done but it has been so memorable thus far.  I want in this post discuss my progression through the cycle of culture shock. In order to describe more uniformly my descent and partial recovery from culture shock I will use terminology and quotations from Spradely’s Coping With Culture Shock.

It was almost 6 hours after arriving into Chennai India on April 28 2012 that the first stages of culture shock set in. Really it was probably a combination of several factors that led to my initial frustrations. Up until this point in my journey I had slept a total of maybe 8 or 9 hours sporadically over the last 4 days with some of the worst and most uncomfortable sleep on the plane from LA to Hong Kong. Then I had a man spill his entire cup of coke on my leg and into my shoe on the same flight. Hong Kong was in the middle of a monsoon type down pour that soak all of our bags and clothes when they were being transferred between planes. On top of all of that we had a delayed flight leaving Hong Kong that set us back 5 hours. Thus all of these factors along with the dismal living conditions, smells and unrelenting heat that welcomed us in Chennai I was a bit overwhelmed rapidly upon arrival. This was when I left the honeymoon stage and moved straight into the bottom of the Irritation and Hostility Stage. This lasted pretty intensely for the rest of the first night. Saturday was a hard day for me. I was in a lull for almost 4 hours and it was really hard for me to communicate and even function at sometimes. For most of the time anything I did was with very little enthusiasm or emotion.

I knew from the reading that this was just a temporary stage of anxiety and frustration but I wanted out of it as soon as possible. Thus I decided to do the one thing that was for sure to work. Once I returned to our hotel that night I got straight on my knees in the bathroom and offered one of the most heartfelt prayers of my life. I poured out my heart in hopes that it would alleviate some of the heartache and discomfort that I was going through. It worked! I felt the one constant and contiguous feeling that from my childhood has comforted me in my moments of utter despair and pain. The relationship that I cultivated with the spirit on my mission and through out my teenage years was the only thing that brought me through that first day in the field. I learned that even in foreign and alien lands we must rely on the companionship of the spirit to really help us overcome life’s more difficult situations. It is the only thing that I had to rely on in such a foreign environement.

Wednesday, April 11 2012

With such a hectic Wednesday I just realized that this blog never got posted. But here is what was saved in my drafts.
It's in, my last and final proposal draft to Margaret. It along with all of the scholarships forms and now this last blog post. Its amazing how even with the prepcourse coming to a close how much I had taken for granted the wonder addition that it was to my under standing to what was up coming in the field. I want to outline some of the last thoughts that I have before I blog in the field concerning somethings that need to be resolved before I go. The first thing that I have been stressing out about is the fact that my IRB is not yet turned into the ORCA office. After the miscommunication as to what was expected from some people in the fieldstudy's department I wasnt able to submit my completed IRB proposal on time. It was rather a stressful time but now that the next deadline is coming up and I have gone through so much to correct and refine my current proposal I hope that I will still have a proposal that doesnt go full board.
I recognize the importance of the IRB and I hope that by tomorrow morning I can get submitted all of the documents that they need. One thing that I realized just the other day is the need that ill have to update my consent form on the IRB. It wasnt writen in a language that is probably that understandable in the first place due to the formatting that is on the ORCA website but it is helpful to note that its really just a form that I can re fill out with the few details that have changed in my proposal.
Also the situation of my visa and its approval is getting kinda grim. I know that I have to get the forms in soon and the consulate is being so slow to respond with my forms. I really hope that everything makes it on time.
I can't wait for the field. I know that the things that I experience and learn out there will be of serious help and use to me as I seek to define what it is that I am studying. As I now go to prepare for the final it will be my last real chance to incorporate what I have learned and prepare to use those techniques in the field.