Market and Success

I went to the market yesterday morning at 545am to see what was going on. My observations: a lot! It felt like it was midday as people scurried all over the place, selling fresh fish, meats, fruits and vegetables, spices, and any houseware items you could think of. The highlights for me included river rat (with live killings by smashing the rats on a rock while holding their tail, thus giving them an immediate cerebral hemorrhage and severed spinal cord, followed by skinning, and de-gutting), pigs heads and intestines, snake, frog, turtle and cockroach, and various types of river fish. They also had every type of meat product you could possibly imagine. It’s interesting to me that the people here, and pretty much everywhere but America, are able to consume nearly the entire animal whereas we are not programmed/taught to do that. I understand that some people in the U.S. eat other parts of the animals than just legs, wings, breast, cuts of steak, etc, but, EVERYONE here does it, not a select few. It’s just more efficient and produces less waste.

The cleft lip/palate procedures that we have been carrying out have been going very smoothly without any complications. Each day has been more successful than the previous, and the families have all shown such great gratitude. It’s amazing how much of a difference a 1 hour procedure can make. For these kids who were looked at as outcasts, after a 1 hour procedure, they regained an opportunity at having a childhood again.

So I have been acting as a scrub tech, who is the person that is in charge of giving all of the instruments and sutures to the surgeons. This has been a very valuable experience as I have learned all the names of the instruments and have gained experience loading needles and understanding the perspective of a scrub tech, with whom I will inevitably work with in my career since ob/gyn’s do a significant amount of surgery.

Anyways, I gotta run. It’s time to go eat some Pho for breakfast and get over to the hospital. We’ve got a long day today with 6 procedures on each table!

Peace Signs on the Street

Fruit at the Market

Bike at sunrise



You Pig.

Eggies



Purses in Plastic

Meat Hanging Out

Bowel Anyone?

French Bread

In the hospital

Waiting

Waiting for her child.

Pre-Op

Suture

Instruments

A fluffy friend

On the table

Roosters in the Morning

It doesn't matter if you are in Salvador, Brazil, New Delhi, India, Ubon Raatchatani, Thailand, or Cao Lanh, Vietnam; all large cities and desolate villages have roosters that crow from 4am- 7am. Waking up at 4am to the crow of a rooster brought back plenty of memories from my travels all over the world and made me think long and hard about the rooster crow. After sitting in bed and staring at the ceiling for a few hours this morning, I decided that the morning crow of the rooster is the one single thing that makes all developing countries the exact same. Anyone who has traveled abroad can correct me on this, but, I feel as though I am going to be hard pressed to find someone that is going to tell me the contrary. It's time to use the skills I developed as a father who is also a medical student, and sleep through the rooster crow so that I am fresh tomorrow morning unlike the way I felt this morning when I stumbled down to breakfast.


The first day in the operating room was exciting, and hot! The morning consisted of two cleft lip repairs, one right incomplete cleft lip and one left complete cleft lip. The afternoon consisted of a complete cleft palate and an incomplete cleft palate. All four of the surgeries were technically challenging and the resident and attending I were working with did a phenomenal job with all of the repairs. One of the most exciting parts of the day was the teamwork between the Vietnamese staff and the American team. The one thing that I believe is most important when doing international surgical missions is developing a relationship and collaborating with the local population in which you are working with. It is important not to just "fly in and fly out," but to foster an ongoing relationship and also learn from and also teach those whom you are working with...

On a food consumption note; I am on day #1 of CIPRO. If you don't know, then you best GOOGLE it or ask somebody. Today's menu included French bread, French fries, Vietnamese coffee (basically manually percolating espresso dripping onto condensed milk), random rice paper-like crepe stuffed with rice noodles, vegetables, and shrimp, spring rolls, a soup with octopus, squid, fish pate nuggets, and other things, Beer (333, Tiger, and Heineken), and more bok choy. It was all tasty although i questioned, to say vaguely, some of the food...

Tonight after dinner I went with one of the residents to check out a "night market;" it was at night and was indeed a market. Because the place was so deserted, we decided to check it out in the morning. We will also be checking out a Karaoke bar tomorrow evening....


I would like to discuss and write about so many more issues; infection control, hospital care, infrastructure, etc, but I am just too tired. Maybe in a few days.....

On the road.

Before...

After...

Food.

In the Operating Room

Bathroom.

Passing Lanes

Variety Stew.

Pos-Operative Overnight Ward

Vietnam

It's back to the eyes, ears, and nose for another round of this blog. This time, I find myself in Vietnam on a surgical mission with Changing Children's Lives, a non-profit organization that provides cleft lip and/or palate repairs to children in developing countries.

After making it successfully out of Newark Airport in Snowmageddon, we arrived 5 hours late to our destination, Cao Lanh, Vietnam. Our trip included stops in Anchorage, Alaska where I ate Reindeer Sausage, Taipei, Taiwan where I had access to the China Airways VIP lounge and ate unlimited Dim Sum and drank unlimited beer and espresso, and a quick visit to the Saigon, Vietnam airport. We then took a 3.5 hour busride and arrived in Cao, Lanh. It is a small city in the Mekong Delta of South Vietnam, and has almost exclusively local people living here.

The first day of our trip involved screening about 50 children to find out about their anatomical deformities and their general health conditions. One patient had to be turned away for an unknown musculoskeletal/neurological deformity and a few patients had to be turned away for other reasons. The patient that was turned away for muscuolskeletal reasons was done so because the patient had a history of being on a ventilator when he was younger and the team was concerned that in the event that the patient had difficulty coming out of anesthesia, the hospital we are at might not be equipped to deal with it.

After finishing the screening around 3pm, we made a 1 hour ride through a weaving road, into the rice paddies and tributaries of the Mekong Delta, and arrived at a Nature Preserve where we went a 1 hour boat ride through the Delta and Preserve. It was serene and relaxing, to say the least.

There is a definite language barrier here as nobody speaks any English at all. In addition, Vietnamese is a tonal language, so it is more difficult than, say, Spanish, to learn. It makes all of the interactions difficult, awkward, and funny, all at the same time. I wish I could communicate more with the people that I see, but, smiling and acting goofy has at least helped me to draw smiles from those I interact with.

The food is both exotic, aromatic, and flavorful. They eat the whole chicken here and when you get chicken, you get everything on your plate, including the head, feet, wings, breasts, tail, etc. They think that by eating the whole thing you are not wasting anything, but more importantly, appreciating the entire life/being of the chicken. I haven't decided what I will be eating of the chicken yet. Other things we've eaten have included a version of egg drop soup with strands of an unknown type of meat and boiled quail eggs, garlic beef w/ baby bok choy, fried fish cakes, which is essentially unknown types of fish mushed together and battered and fried, Pho, which is Vietnamese noodle soup, and spring rolls. Because of the French colonialism, they have great French bread at every meal, which turns out to be a big bonus if you are not into the food that is being served....

Here is what I have seen so far....

On the Street.

Traffic.

Riding With Dad.

Looking On



Arrival

Coffee Time.

Mother and Child.

Moms and Children.

Being Screened.

Snack Time

Screening Room

Screening

Holding On

With Mom

Cleaning Up

Examination

Airport Security Flaws

In Milano Italy: I was stopped at a security checkpoint because of a letter opener (given to me as a gift) that was seen in my bag via x-ray. Follwing is the conversation that happened:
Me: I know what you want...........(I took out the letter opener from the bag).
Security Agent: Sir, this is a forbidden item.
Me: I know. I got it as a gift, isn't it nice? I had nowhere else to put it.
Security Agent: Sir, this is a forbidden item. You will need to dispose of it.
Me: Um, OK.
Security Agent: Sir, where are you going?
Me: America.
Security Agent: Where?
Me: JFK
Security Agent: OK, you can keep it and you may go now.
Me: Um, thanks.

This situation really happened and it is ridiculous. What?! How does one explain this? What I had could clearly be used to seriously injure someone, just as much as a knife. Yet, because I was going the the US it was OK? That is insane. Thoughts anyone?

I arrived at customs at JFK Airport in New York at 2:30pm. While Mr. Customs Officer was looking over my declaration and passport I scanned the desk of the customs officer. He had a list of about 30 Muslim names. I love Racial Profiling.

I am thinking of continuing with my blog while back in the US of A. It will be about medical school and my life. Any thoughts? Or...........?

Vodka Monks Drunks Australians Indians

One thing that is worse than overnight bus-rides in India is an RAC (Reservation After Cancellation) ticket on the overnight train. When I reserved a ticket for my trip from Agra to Varanasi, this was the only ticket available, so I took it. The ticket was in an air-conditioned car, which is probably the nicest way to travel, so I wasn’t concerned at all. Upon arrival onto the train, I went to my seat only to find a man already occupying it. I tried to inform him that I had the seat while he tried to inform me that he had the seat. It didn’t look like he planned on getting up from the seat. So, I went to look for someone to help me out. Finally, I found two guys who said they’d help me. We went back to my seat and the three men started mumbling in Hindi. As it turned out, the three men were all friends. For the next five minutes, it appeared that the two guys I found made fun of the guy who was in my seat. Why you ask? Because since the man and I had the same seat number, we had to share a bed; on an overnight train. The bed was half the size of a single bed. We slept head to foot and I slept horribly. The guys feet were poking and prodding me the whole night. Not Cool. I arrived in Varanasi after 13 hours on a train and about 2 hours of sleep.

After arriving to Varanasi I needed to sleep so I took a nap once I arrived at the Ganga Yogi Lodge. After a nap I went downstairs to find out if it was possible to buy some soap and shampoo nearby. The conversation went like this:
“Excuse me, but, do you know where I could buy some shampoo or soap?”
“Yes. Do you want some Hashish or Opium?”
“Um. What?”
“Hashish or Opium.”
“Oh! Uhh, no, it’s ok. I think I just need to get some shampoo and soap.”
“OK”

I was offered Hashish or Opium at least 100 times over the next two days. After an evening of washing and sleeping, I went to eat at a restaurant called Haifa and then checked out some of the Ghats (stairs that people walk down into the Ganga (Ganges)) with a friend whom I met who was from France but who didn’t speak English but did speak Spanish (which I spoke with him). I made it an early night and hit the sack early because I was getting up at 4:45am the next morning to be on the Ganga (on a boat) for sunrise. Both the sights of the Ganga and the stomachache that I began to have while on the boat were breathtaking. The scene at the Ganga is very powerful. There are thousands of devotees chanting, bathing, singing, socializing, cremating, shaving heads, shitting, drinking, eating, ritualizing, and more. There were colors, smells, sounds, and for those who put the Ganga water in their mouths…flavors (and probably stomach aches later in the day because the Ganges is the most polluted river in the world. This scense happens every day. It is the most holy place on earth for Hindus. It’s like being in Mecca or in Jerusalem. It was amazing, just like the pain I was having in my stomach.

For the next 27 hours I experienced intermittent abdominal pain followed by explosive diarrhea. This happened about every 25 minutes. THE PAIN WAS THE WORST PAIN I HAVE EVER EXPERIENCED IN MY ENTIRE LIFE. Imagine someone being able to twist, wiggle, and pull the nerve endings on your intestines and NOTHING could made the pain recede or lessen. That is what it felt like. It hurt to the point where I laid in the fetal position on my bed for hours upon hours, eating nothing except for cipro, acidophilus, and the occasional potato chip. It was horrible. I hope whatever is in my stomach is almost dead! (I am still feeling occasional pains).

After this 27 hour ordeal of pain and diarizz, I made it out to see some of the temples of Varanasi. The varied greatly from a tranquil temple in the middle of a university to a temple that had robotic gods playing music (this one was weird). Some of the temples were amazingly spiritual while others felt very dull. Some had music and lots of pooja happening and others had noting going on except the chirping of birds. That is all I feel like saying about these temples. Sorrie.

Try to imagine the following scene, my last train-ride in India (this trip at least), a 13 hour sleeper train from Varanasi to Delhi: Myself, an Israeli “Pacifist” who refused to ever serve in the Israeli army and who reminded me a LOT of the rabbi who presided at our wedding, two Buddhist monks from Vietnam, three Indian businessmen, an Australian flight attendant who had a child and who was also divorced and who said that most male flight attendants aren’t gay, and a bottle and a half of Vodka.

Sleeping at the Taj Mahal

So, I find myself travelling alone in northern India, yet I don't feel alone at all, as all of the places I am visiting are packed with tourists and Indians. Three crazy things just happened to me:

1. I just rode in an autorickshaw with 10 people. For those who don't know how small an autorickshaw is, it isn't meant for 10 people. It is meant for a maximum of 3 people, maybe 4 if they are kids.
2. I just saw the horse of a horse drawn carriage fall down while running with 7 passengers in the carriage. Maybe "one horse power" isn't enough for seven people?......
3. I just made a urinary movement in a "public bathroom" on the street. It was absolutely gross. There was shit all over the floor, it smelled narsty, and there was a small golf ball sized hole for materials to thrugh which definitely wasn't working.

A few things to note:

1. India has no health regulations, no traffic laws, and no safety regulations at all.
2. Child labor is alive and doing well here.
3. I will be on a train for 35 of the next 72 hours.

I am in Agra right now. The ancient architecture here is truly unbeleiveable. Yesterday I went to the Agra "Red Fort", the "Baby Taj" (as Rickshaw Wallahs call it), and Akbars Mosoleum. Each site was breathtaking, and cannot be put into words. What I can tell you though, is that at one point yesterday at the masoleum, I had two monkeys on me; one on my head and one on my shoulder.

Today I woke up early at 5:42 (Ellyn and I don't like numbers to end in odds, actually Ellyn doesn't and I adopted the ritual) and headed over to the Taj Mahal for sunrise. Again, it was a sight that cannot be put into words. All I can say really is that it is a massive, beautiful, perfectly constructed specimen of architecture. While there I found a place to lay down and sleep. I think I was the only person sleeping at the Taj Mahal because numerous times I opened my eyes to see people poiting, laughing, or taking pictures. Following this I took a boat ride with a friend of a friend named Tony, who happens to be a tourguide for the Taj Mahal, a trainee actually. Anywhoo, we went out on the river that the Taj Mahal sits on and enjoyed the views from the water....spectacular. We got ripped off by the boatman. He told us it would be 100 Rupees. Then, when we got out into the middle, he only gave us a crappy view of the Taj, and then he told us it would be more Rupees for a better view. WTF?

I didn't realize it, but, most of my pictures over the past few days were taken with 800 speed film. Hopefully they turn out well.

I got cut in line 6 times yesterday.

Side note: I am a little nervous about coming home because i don't want to be asked "how was india?" (by people who haven't read the blog). I don't feel like explaining something that cannot really be put into words....so i am trying to think of ways to diffuse the question. For example: "good", "nice", and "fun" are good conersation breakers.

Tonight I get on a 13 hour train ride to Varanasi, where I will spend some time in and on the Ganges River.

There are many monkeys here and besides sights, this place is a little bit dumpy.

Robitussin and Pungal

OK, I just tried uploading some pictures that would help illustrate my day yesterday, but, I was unsuccesful in doing so. So, these descriptions will have to do.

1. Pungal Festival- A few weeks back I wrote about some warm ginger-like concoction given to myself and Stew by a priest in Kerala. Yesterday, when I attended a festival, I learned that this was called Pungal. At this Pungal Festival, women sat around and cooked Pungal on stoves made of bricks, sticks, and pots. Some little girls got their heads shaved, as did some women. In addition, tumeric and powder was rubbed on their now bald heads. Respect was paid to Idiodipan (wrong spelling), the god of the village who if prayed to, will bring good rains during the upcoming monsoon season. There was music (both recorded and live), men on the exterior of the festival "pooneh watching", aka girl watching b/c pooneh=girl in Tamil, and lots of Pungal eating!

2. Cali Fire Festival- I went with my friend Vinoth to a nearby village named Kottakuppam to attend this festival. Here, respects were paid to the god named Cali by about five thousand devotees. Of these five thousand, two hundred and fifty of them were covered in tumeric, powder, and flowers. These two hundred and fifty people ran through an enormous pile of burning coals, which after 25o people dwindled to a path through the coals. There was chaos, people who were posessed by higher beings, food for sale, toys for sale, balloons for sale, incense, fires, rides for kids, and many people making pooja, or prayer.

3. Dinner at Vinoth's house- I had dinner in one of the villages at Vinoth's house. His mom gave me leftover Pungal from the Pungal Festival, a banana, water, water with "syrup from the boy" which tasted more like Robitussin than the "sweet water" it was supposed to be, and a dosa, which is a typical south Indian dish. It was great food!

Other notes:
a) Indian men wear collard shirts no matter what they are doing....all of the time.
b) I saw a man with a tight afro today. I think this shows the ancestral connection between India and Africa.
c) I get cut often when I am in line here. I also get cut on my body, by shells, knives, soccer games, etc. It's cool though, because I have anti-biotic ointment and bandaids.
d) I have a confession to make: I actually drive a 4-geared motorcycle which is 2 stroke, 100cc bike. I didn't want to tell anyone because I didn't want anyone to worry about me. I upgraded to this bike after the moped wasn't doing what I needed it to. 100cc's isn't very much though.......look it up.