After meeting up with Brian at the
hotel, we signed up online for something called the 'city walk' with these guys
who work for a company that helps slum children. The guides themselves
are kids that used to live in the slums. During the tour we learned that
most street children spend any money they get on things like video games. Because they sleep on the street, they can’t
afford to have any money on them because it will just get stolen overnight. One of our guides Iqbal
told us that his parents used to beat him and put pepper in his eyes, and one
day his father just left him at a market. A couple found him there and told
him they were his aunt and uncle. They
took him home and used him for slave labor, and they used to beat him
too. So one night when he was six he ran away and took a train to
Delhi. He actually doesn’t even remember where he’s from, because he was
so young when he left. He used to work
as a pickpocket on the streets of Delhi, and then he was part of a gang for
safety. When a woman from the Salam
Balaak Trust asked him if he wanted to go to school and live somewhere
nicer. Initially he didn't trust her,
given his previous experience with strangers offering him things. Now he works for this company and they
provide money for schooling, and they have places for children to stay and
everything. It's pretty great. It's called Salaam Baalak Trust, which
means salute the children. They’re also
able to get documents for the children so that eventually they can open bank
accounts and become a productive part of society.
Later in the day we went to the Red Fort
later today and the Jama Masjid.
TAJ
MAHAL- Mathura, Fatehpur Sikri
The next day, we had hired a car to pick us up early in
front of the hotel. The train tickets
were sold out, and confusing to figure out.
So we decided to pay a bit of extra money to hire our own driver with an
air conditioned car. This way, we could
also stop in Matheran, and in Fethepur Sikri during our Taj Mahal trip. In Matheran, there was a beautiful temple
where Krishna is said to have been born.
The security at this place was very tight. We weren’t allowed to bring anything but
money into the place. Being a temple, we
had to remove our shoes. This sometimes
posed a challenge because the ground is so hot.
In a lot of places they had rugs down for people to walk on so they
wouldn’t burn their feet.
Within the temple compound, there were a few buildings. In one of them, there was a group of men
singing and playing drums while some people danced, and some people sat. The women were on one side, and the men were
on the other. One of the other buildings
had more of an artistic feel, with a lot of painted pictures of various gods
hung on the wall. An Indian woman and
her family took us around and told us which god was which, although she didn’t
speak any English.
When we got to the Taj Mahal, we hired a guide to take us
around and tell us the history. The Taj
was built under the Mughal emperor Shah Jahan.
He built it for his 3rd wife Mumtaz, who died giving birth
the their 14th child. She was
his only love marriage, and his favorite wife.
So he built the Taj Mahal as her Mausoleum and buried her beneath
it. It took 12 years to complete, so she
was actually buried somewhere else first and then dug up and put under the
Taj. There is also a Mosque in the
grounds, so the Taj Mahal is closed on Friday except to those who go there for
prayers. There are three different
entrances to the Taj Mahal, depending on what standing you had. Most of the Taj Mahal is made of White Marble
which was somehow shipped in from Rajasthan.
There is also some red sandstone which comes from Fatehpur Sikri. One of the most impressive things about the
Taj Mahal is the marble inlay work.
There are countless numbers of precious stones inlayed into the marble
in various shapes of flowers and vines.
The stones used are Jade, Crystal, Turquoise, Jasper, Lapis Lazulie,
Sapphire and Carenelian. In a lot of
places where they haven’t walled it off, you can see how deeply inlayed these
are because people have popped them out to sell. There is also a lot of lattice work that was
pretty intricate, and incredible because large chunks of lattice are carved out
of one piece of marble. There is a myth
that after the Taj Mahal was built, Shah Jahan had the workers’ hands and
tongues cut off so they could never tell or build another one like it. The guide book said there was no evidence
supporting that. After Mumtaz was buried
in the Taj, Shah Jahan’s son ended up taking over the empire and imprisoning
his father. When Shah Jahan died,
however, he buried him next to Mumtaz under the Taj Mahal.
After the Taj Mahal we went to Fatehpur Sikri. This place had 3 palaces and a holy area that
were built by another Mughal emperor named Akbar. He had 3 wives, one Christian, one Muslim,
and one Hindu. He built each of them a
palace, and then at the holy place he integrated all religions into the
construction. It was pretty cool to see
all the different architecture mixed together.
Our guide told us that Akbar believed there was only really one
religion, since most religions ultimately believe in one god.
After this very long day, we drove back to Delhi and brought
our stuff to the hotel down the street where we met up with the Himalayan
Health Exchange program to begin our journey into the Himalayas.
HHE
The first day with HHE we woke up at 4AM to go to the
airport. We flew from New Delhi to
Chandigarh, and then found our cars and drivers waiting for us at the
Chandigarh airport. They packed our bags
up on top of the cars and we got in and began our first 5 hour drive to
Bilaspur. We had a quick meeting on the
first night in Bilaspur, and got all of our air conditionings working before
eating dinner and going to bed. We met
the other ~25 medical students, and attendings, residents, and a few family
members. There was a group of people
from various places in Canada, a couple of girls from the UK, a group traveling
together from Ohio, a group from Texas, and a sprinkling of other people, with
a good amount from the New England area.
The next morning we woke up and had a nice breakfast before
heading out for another 5 hour drive to Manali.
They had us driving only short distances each day so that we could
acclimatize to the altitude. The 5 hour
drives were not covering as much distance as one would expect in the U.S. because
the roads are so much worse. From Manali
we traveled for a very long day over the Rohtang pass to Udaipur in Himachal
Pradesh India. Google maps estimates
that this drive will take 2.5 hours.
However, with the stand-still traffic, and tiny road only big enough for
one-way traffic at a time, the drive took us 14 hours in total. In my car was the two girls from the UK,
Clair and Shruti, as well as one of the girls from Ohio, Linda, and Nick from
Oregon. Our driver’s name was Prem,
which we learned means ‘love’ in Hindi.
He became my favorite driver. We
were spending some time trying to learn Hindi that would be helpful for the
clinic and we made up a Hindi version of “head, shoulders, knees and toes”
(sar, kandha, ghunte, panw, onk and kaan, and muh and nonk). We even got Prem singing along. We got to know each other very well that day,
and the girls went on many outings to find rocks large enough to pee
behind. We also hadn’t been prepared for
these circumstances and didn’t really have enough food. Shruti and I split a chick-pea salad/burger
thing and also some sweet corn that they had grilled with lemon and salt. It was all really tasty, although a bit scary
(travelers diarrhea, worms…). We arrived
at our first campsite around 8:30pm, ate some dinner and went to bed. The crew had already arrived there before us
and set up all the sleeping tents, dining tents, bathroom tents, shower tents
etc.
In the morning they had Chai ready for us at 6am, and
breakfast ready at 8am. They continually
had hot water for those who wanted to shower in the morning (and in the evening
after clinic). Breakfast was often
pancakes, eggs, toast, and things like that.
After breakfast, they had a dish cleaning set up where we could wash our
own dishes. We then packed up our day
bags with our gloves, stethoscopes, TB masks, hand sanitizer etc. and headed
off to the first clinic. Some of the
crew drove the pharmacy boxes, and some drove us.
Before clinic, we arrived and there were a bunch of children
playing a game that looks a bit like duck-duck-goose, only they are all in a
line and it has something to do with which direction you’re looking. They were also playing volleyball in the flat
area next to the clinic. There was also
a pretty famous temple in Triloknath where they had a white marble idol of Lord
Shiva. However, because it is so far
north in India, there is also a huge Tibetan influence. At this temple there were prayer wheels,
prayer flags, and a lot of other Tibetan Buddhist contributions in and around
the temple. We entered the temple and rang the bell (a Hindu ritual), passed
through the ‘sin columns’ and were given a white fabric tie around our wrists.
At the clinic, they had assigned each student to a
tent. After the patient saw the intake
for weights and ‘chief concern’, they came to our triage tent where 2 students
would take blood pressures and heart rate of each patient coming through. They would also monitor the flow of patients
and point them in the direction of whichever tent they ought to go. Beyond triage, there were two adult medicine
tents (with adult or family doctors), two pediatric tents (with pediatric or
family doctors), and one Gynecological/OB tent with a family doctor or our
OB/family doctor. After a patient was
seen and diagnosed, they were given the sheet with the notes and doctors
signatures to take to the pharmacy. They
were given whatever medications they needed, and then they took the sheet with
them. Frequently patients are seen by
many different doctors, so it is good for them to hold onto their own records
so they can bring it with them to whichever practitioner.
Around 1 o’clock, the clinic would break for the lunch our
cooks made for us fresh at the site. We
then would start up again in the afternoon until everyone had been seen that
day.
The first day, Shruti and I were assigned to triaje. It was kind of interesting because we were
able to see every patient who went through that day. Even if not in detail, it was a good overview
before beginning the patient interviews at the next clinics. One of the most interesting patients was the
first patient we saw that day. He was a
9 year old boy with an ‘eye issue’. His
eyelid looked deformed on one side, and he was unable to close his eye all the
way. We learned after he had gone to the
pediatrics tent that it was the result of a post-natal chlamydia infection. In the developed world we typically screen
expectant mothers for chlamydia and gonnorhea, and may or may not also
prophylactically treat a baby’s eyes with antibiotic to prevent this (depending
on the country/hospital etc.) This boy
fortunately did not have any loss of sight, but was at increased risk for
trauma and damage due to drying. He
didn’t have any sign of current infection though, so they just tried to explain
to him the importance of keeping his eyes moist and clean.
Another memorable patient was a little girl who was 8 years
old. She came in because her mother said
she wasn’t growing (she looked like she was about 4 years old), and because
there was something visibly wrong with her chest. Although I didn’t get to hear it, they found
an incredibly loud murmur indicative of a Ventricular Septal Defect (the heart
has four chambers that are meant to be separate, and with this defect the two
largest and strongest chambers are connected, which really messes up the
oxygenation and pumping of the body’s blood).
They referred her for surgery, so hopefully she will be able to get that
soon. Without it she will die.
A few other general things we noticed was that almost every
patient had low blood pressure. I think
the average was probably somewhere around 110/70. The highest ones we saw were
140-160/90-110. It must be the diet and
lifestyle that makes this true across the board. There were also a lot of eye problems. It seemed like a lot of people had allergies,
and general sensitivity to the sun. Most
of our patients were farmers, so that makes sense. We didn’t bring nearly enough eye drops or
sunglasses though unfortunately. There
was also one woman who described to us that she had ‘angina pectoris’, which is
the typical squeezing chest pain and shortness of breath that one gets with
cornonary artery disease. However, she
didn’t speak English. So instead she
huffed and puffed and then demonstrated a squeezing motion over her chest. It was quite easy to figure it out. Seems to be a universal sign.
That evening, Shruti and I had been assigned to do a
discussion of Ayurvedic Medicine in India and Traditional Tibetan
medicine. We had talked a bit about them
so we decided to combine our topics, since Tibetan medicine has a huge
Ayurvedic component, and because I had just spent the previous 2 weeks learning
a lot about Ayurvedic medicine. One of
the most interesting things I think was the prevalence of Ayurvedic medicine in
Himachal. In every town we went to,
there was a local Ayurvedic health office. However, the only two hospitals (and therefore
allopathic medicine) were in Kullu or in Udaipur. The other thing about Ayurvedic and Tibetan
medicine is that they both take a very holistic view of the patient. They spend a lot of time listening to the history
and daily habits of a patient to determine exactly what the problem is and what
the best solution for that patient is. I
think the process of these types of medicine could definitely be something we
strive towards in allopathic medicine, but the treatments are pretty
different. In a lot of cases, the
patients trust Ayurveda more than they trusted the allopathic medicine, because
it is what they grew up with. We tried to
use whatever we knew about it to build repore and even to help treat the
patients. For example, a lot of the
first-line treatments in Ayurveda and Tibetan medicine are lifestyle and
dietary changes. These are things that
our patients could get on board with, with an obvious difficulty in some
lifestyle changes due to the physically very difficult nature of their
work.
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