Surgery Camp

As previously mentioned, I decided to forgo the trip to Nagpur last Saturday, July 17th. Because I stuck around campus I was able to observe the first day of the surgery camp that would be lasting for three days. Witnessing the surgeries in the clinic was a very big bonus on top of the work that I am doing at SEARCH, and in many ways unrelated. It is entirely clinical, not for research purposes, and the spinal surgery that was occurring is in no way related to my research focus. However, I found the experience to be extremely fulfilling.

Each year SEARCH organizes and holds several surgery camps. Since the hospital itself primarily deals with medical care and medical interventions, and Ama is a gynecologist/obstetrician by training, there are limited opportunities and resources for surgical interventions. Therefore, several times each year SEARCH brings in highly-trained surgeons, who bring along supplemental equipment, and villagers on a waiting list come and have surgeries. The structure of a surgery camp (often occurring in places of natural disaster, like Haiti, or refugee camps or parts of the developing world) is efficient because a team of surgeons will come in and perform the same surgery over and over. Supplies and equipment that are often not available will become concentrated in the location for the duration of the camp. Earlier in the summer SEARCH held a surgery camp for hysterectomies where over 100 patients were seen in one week!

The surgery camp that took place this past Saturday to Monday was for spinal surgery. The number one surgeon for spinal surgery in India, the premier surgeon in India for this type of surgery, Dr. Shekhar Bhojraj would be in attendance. For Jessica this was a very big deal. She is hoping to go into surgery and work in third world countries. This summer she is starting a research project to assess unmet surgical need.

During breakfast on Saturday I asked Jessica if she thought it was too late to see if I could observe the camp and she said not at all! I went over to the hospital with her in the morning to review the records of the camp's patients alongside Vaibhav, one of the Ayurvedic doctors. Later in the afternoon the team of surgeons arrived from Mumbai, headed up by Dr. Bhojraj. His wife is an anesthesiologist who would also be working on all the surgeries. There were at least four or five other orthopedic surgeons that came to SEARCH. This was not Dr. Bhojraj's first visit to SEARCH. He has been coming here several times a year for the last several years. I went around with the surgeons to meet each of the patients. Four women sat in one room and three men in another. There were seven in total, plus a few walk-ins. All the patients were dressed in green hospital outfits and each had a set of x-rays. I tried to stay out of the way because it was a very large group parading around- all the doctors, a team of aides and nurses, Ama, Vaibhav, Jessica, and myself. Not only were the patients waiting with some of their family members in rooms with no privacy, but then in walks over 15 people to assess their situations! I think Dr. Bhojraj had already reviewed the cases before meeting the patients because things moved pretty quickly. One or two of the patients were told that they may not be able to have surgery because of existing complications. I know this is normal procedure, and happens all the time in the U.S. as well, but I felt bad for the patients because to even be at SEARCH for the surgery camp means the patient has exhausted all medical interventions, survived a waiting list, and anticipated the scheduled camp.

After meeting the patients, the doctors broke away for lunch. Around 2pm we reconvened to start the surgeries. At this point I was still unsure if I was going to be allowed to stay or not. Since I had not received prior permission from Ama, I was very sure I would be kicked out of the operating room, or operating theater, as they call it here. The plan was to conduct two surgeries at once in the one OT that SEARCH has available. All the doctors started dressing in scrubs and masks and scrubbing in. Since Jessica was definitely going to be observing the surgeries, and possibly assisting, she asked if she should go back to her room and put on the scrubs she brought with her from Duke. Very generously, since it looked like I was not going to be kicked out, she brought me with her and gave me a pair of scrubs to wear as well.

Pause...I'm having doubts if I should continue my description of the surgical camp because I think I am going to severely disappoint those family members, who will remain nameless, who have always wanted me to go to medical school...but alas, I will continue.

I put on a green pair of scrubs and when Jessica and I returned to the OT we put on the personal protective equipment: masks and surgeon's cap. I didn't get a chance to take a photo of myself in this getup, but believe me, I looked legit. I felt like I was playing dress-up, but for Jessica this was real life, so I tried to take everything seriously. If anyone really really really wants to see me look like a doctor (the MD kind), I can maybe ask Jessica if I can borrow her scrubs again, and go grab a mask and cap from the clinic, and re-stage the event. We chose not to take any photos of the actual surgery, although the scene was amazing, out of respect for the patients (who were completely naked), and obviously the surgeons who were trying to focus.

Anyway, surgery camp began. This is what it was like: We had two operating tables with a table in the middle that was used to anesthetize the patient before they were moved to the operating table. Dr. Bhojraj decided the order in which the patients would be seen. A team of three surgeons worked at each table, and each surgery would take 1-2 hours. In addition to the six surgeons, there was Dr. Bjojraj's wife and a second anesthesiologist, several surgical nurses from SEARCH, Jessica, myself, at times Vaibhav, and even SEARCH's handyman at one point when the bulb blew out on the operating light. We were all crammed into a room that was roughly 15x15 feet. It was insane.

As the surgeries began I asked Jessica what the major differences were between the surgeries we were witnessing and the ones she had witnessed at home. The most obvious difference was the fact that two patients would be operated on in the same room. Next, not all of the equipment and tools that could potentially be used in these surgeries were available. Now, SEARCH itself has pretty modern capabilities, and this isn't one of those hospitals you hear about that reuses needles and uses unsterilized equipment. Because of proper training and funding that allows the purchase of proper equipment, the surgeries used completely sterilized draping sheets and surgical tools. But in many ways there were small differences. For instance, the anesthesiologist had to use a manual ventilator for the entire duration of the surgery which meant squeezing one of those rubber balls, the size of a soccer ball, every five seconds for the 1-2 hours of the surgery. In a completely modern, state-of-the-art hospital this would be done automatically with a machine. Another example is that because this was back surgery, the patients were lying front down, but propped up by cylindrical foam pillows. The patients were put directly onto these pillows and the pillows were reused between surgeries with no cleaning. So maybe not everything was 100% completely sterile. I think there were other ways in which the doctors had to make-do with available resources, but not being formally trained, and not having witnessed surgery before, I am unsure of what these things were.

Beyond these differences, the surgery happened as it would in any other modern institution. The actual anatomy of the surgery was not much of a surprise to me. I was prepared to see someone cut open and to see blood, and because of dissecting cats in physiology, and of course television, I had a rough idea of what the insides of a body were going to look like. The surgeons used blades and electric cauterization to open the layers of the skin, muscle, and fat. I was really surprised by how deep the surgeons had to go to get to the vertebrae and the spinal cord. The first cut into the body was not weird to me, and neither was the initial depth of a couple centimeters, but halfway through the surgery I realized that we were a good inch or two inside the person's body cavity. This was somewhat amazing.

Also to note, I was very very close to the action. For most of the surgery I was probably one to two feet from the surgical table and I could see everything! I could have stood right at the table, but I found out that while blood doesn't bother me, tiny pieces of spine falling and flying everywhere does. I really did not want to be touched by pieces of what used to be the inside of someone's body, despite wearing the scrubs.

When the doctors were deep enough they used surgical techniques that Jessica explained to be during lunch to remove parts of the spine to allow more room for the spinal cord. Most of the patients were suffering from pain and neurological issues related to reduced space in the spinal canal. The type of surgery I watched is called a laminectomy. This is when parts of the spine are removed to relieve pressure on the spinal cord. One of the techniques removes only the spinous process, which is the part of the vertebrae that you feel when you run your hand down you back. A second technique also cuts into the articular facets to create even more room. The parts of the spine were removed with special tools that had the ability to cut through the spine. At some points Dr. Bhojraj also had to use a hammer type tool. Something else that really surprised me was the aggression and force that were used to remove sections of the spine. There were parts of the surgery where I found it very hard to believe that a real person was lying under the sheets.

At the most critical parts of the surgery I was able to see the spinal cord. Again, seeing the spinal cord of a dead animal does not compare to seeing a live spinal cord of a person, who except for anesthesia, is completely alive in front of you. Jessica was really having a good time and thought the whole surgery was "beautiful" and Dr. Bhojraj's techniques were "elegant" and "like watching art." I don't think I appreciated what I was seeing to the extent that she did, but I was still really in awe.

During the surgery I had a couple chances to speak with Dr. Bhojraj's wife, the anesthesiologist about anesthesia. This was the aspect of the surgery that amazed me more than anything. I just could not get over the fact that the surgeons were doing things to a human being, that if they were alert and conscious they would be screaming and perhaps passing out in pain. The initial cut and separation of the skin and tissues alone would be incredibly painful for someone, but we were also cutting away and yanking on vertebrae, and deep tissues, and I'm pretty sure some of the tools were gracing the spinal cord. I still don't get how even the strongest anesthesia can keep someone from feeling this.

I mainly watched the surgery that Dr. Bhojraj conducted (the second patient to start), even though there was another one being conducted at the other table a few feet away. When the other team finished with the first patient, they prepared to start on the third patient. Here is another difference between the surgeries I witnessed and ones that would take place elsewhere. The staff actually had the third patient come into the OT, while the second patient was still being operated on. Let me just paint this picture for you. A middle-aged women walked into the OT, about to undergo anesthesia and invasive surgery, and the first thing she sees is a naked woman lying with her back up in the air with a huge gaping opening. To Dr. Bhojraj's defense, he was not told the next patient was coming into the room, and he expressed that if he did know, he would have at least stopped his actions for a few moments. Since I was closest to the door when the patient came into the room, I tried to shield her eyes from the operation that was underway and guide her over to the anesthesiologist waiting at the second table. Hopefully I was able to block her view, but she still seemed very scared.

I spent some time watching the first woman recover from surgery. When she was done, but still under anesthesia, they moved her out to the recovery room. She woke up at several points, but not enough to really talk or communicate. During these moments though, I realized I was very very interested in the follow-up that would occur in the minutes, hours, days, and weeks after the surgery, probably just as much so as the surgery itself. I peeked over and watched the surgeons as they waited by the bedside for the patient to become conscious. I was very drawn to this part of the process.

When Dr. Bhojraj finished his patient I decided to call it a day and not stay around to watch the third and fourth patients. I felt like I had seen my share of the surgeries, and I still could not believe that I was able to stay for as long and as close as I did. Since I have not been to medical school, I knew the other surgeries would all appear roughly the same, and I felt I had seen enough blood and body parts for one day. Jessica of course would be staying for the rest of the day, especially because Dr. Bhojraj asked her to actually assist in the last surgery. I didn't stick around to see this, but I think this was a wonderful experience for her.

So, that was surgery camp. I'm not sure if I will ever get the chance to witness something like that in the United States, and again, this wasn't really within the realm of my research areas, but it was still a truly inspiring experience. I have yet to get over the fact that humans have been able to reach this level of technology and knowledge.

Taking Count at Day 30

Today marks the half-way point in my Indian adventure. It's been 30 days since I left the United States, and 30 days until my return.

It dawned on me a couple nights ago that there are major differences in the way I have lived for the last month compared to my normal life back home.

The thought that triggered this feeling was the fact that I have literally not seen a tv in 30 days. Yes, I have seen moving images on a screen- the movies I watched on the airplane and the movies on laptops here, and the occasional YouTube or CNN video if I can get it to download. But, I have not seen a television show. I have not lounged around on a couch, flipping a remote to an assortment of channels, or watching one of my favorite television programs. This is perhaps the longest I've gone without tv since I was maybe 3 years old. While TV in general, and the shows I am missing this summer (the Bachelorette, Top Chef, Mad Men, Bravo's Real Housewives series), are not always at the forefront of my mind, I feel kinda disturbed that I haven't participated in something that is part of my daily routine at home for a month now.

Here are some other things I haven't done in 30 days:
-driven a car
-turned on a stove
-used a microwave
-run a dishwasher or laundry machine
-cooked, baked, or prepared any sort of food for myself
-taken a shower that did not involve a bucket
-used a toilet that I could dispose my toilet paper into
-had an alcoholic beverage
-hugged or kissed Ben

My supplies show the signs of my trip's duration. I have now used exactly half of my toilet paper supply (3 of the 6 rolls I brought with me). This means I will definitely have enough for the trip, especially since I used one entire roll as tissues, and not for actual toilet purposes. In total I have also used 3 of my 6 tissue packets. I've used up the entire initial tub of 42 wet wipes, but I have only just started to use the 84-count refill pack. I have gone through one entire bottle of hand sanitizer, but have two more with me.

I have not used nearly the amount of sunscreen I thought I would. I do put it on in the afternoons on the very sunny days, and whenever we go out to town, but since the rains have started it is mostly overcast, and we are indoors all day. I think I brought four or five tubes along, and have only used a small portion of one. Likewise, I have only used about half of one of my four bottles of DEET insect repellent.

I know I could write more profoundly about how I have changed or grown or learned from this experience, but I just wanted to write about the more simple, less-introspective differences I have observed in the time that has gone by. Also, I'm not entirely convinced I have changed that much. Yes, I have seen things that I would never have seen if I did not come to India. Yes, I have met people and made new friends and have shared the joy of doing global health work/research with them. Yes, I have lived in a situation that I initially found very uncomfortable and have since adapted. Yet, I know as soon as I return to Chapel Hill I will be turning on the tv and watching my reality television and taking for granted all the luxuries in my life.

I will have to assess again how I feel after the next 30 Days.

Changing of the Guard

Group photo during the sendoff. From left to right: Rajnish, Amrut (the Bang's younger son, Anand is the older son), Brenna, Aditi, Kate, Marie, Me, Bhagyashree, and Jessica. At the bottom: Amy and Rushina. Miriam had already left early that morning. Once again, Sona is taking the picture.

The last ten days have seen a lot of changes in the foreigners living at SEARCH.

First of all, Rushina arrived on Thursday, July 8th. We are now roommates. This has made my room a lot more colorful and inviting. Especially because two nights ago we decided to put up mosquito nets. Since hers is green and mine is blue they give some height, depth, and color to the room. Sleeping under the mosquito net is fun. You can sleep without a blanket to protect you from bugs, you don't wake up in the morning all itchy and scratchy, and you feel like you are in your own little sleep bubble.

Picture: Rushina and I in our matching outfits today.

Kate, Brenna, and Amy were all scheduled to leave in mid-July. (I erroneously stated in an earlier post that everyone was staying until August, when really I just meant Miriam and Marie, and eventually Rushina, and of course Jessica who is here until November). A few of the interns from India also left this past week including Sagar and soon Pavan.

To celebrate the send-0ff we went out to our favorite restaurant in Gadchiroli on Saturday, July 10th. We had to get special permission for this outing because we were going on a Saturday night, before the official day off. Permission was easily granted and we scheduled some cars to pick us up. I am still getting used to the ways things operate in India. Seems like things always take forever and the lines of communication are always getting crossed. It took almost two hours for the cars to arrive at SEARCH to pick us up!- and I think they were only coming from Gadchiroli!, but who knows. We finally piled into the cars around 9pm. Going to town had an extra bonus because I only had 11 rupees left to my name and I needed to find an ATM. Sagar was very nice and walked with me a few blocks from the restaurant to the bank building. I'm glad he took the time to go with me because it was obviously dark out and there were still many people in the street, and I did not feel that safe.

Dinner was fun because our party was very large. Seems like each time we go to Rasika we have to combine more and more tables together. We always have the same server. I think there were 15 people in attendance and lots and lots of food on the table as always. This time we even splurged and got sodas for everyone! My favorite dish once again was the one that had paneer (cheese) in it.

Wednesday, July 14th was a sad day. Miriam found out her grandmother passed away. I felt very very sad for her. Miriam knew her grandmother had been sick, and she had already moved up her departure from the third week in August to July 31st. Sadly, her grandmother's health declined more rapidly than expected. Everyone was very supportive, and it was good that Marie, her long time friend, was here to comfort her. I had a quiet talk with her on Thursday afternoon to see how she was doing. Miriam had to decide if she would try to make it back for the funeral or stay for the rest of the trip. Her family chose to have the funeral on Sunday, so that she could make it back in time.

Wednesday and Thursday were a blur because in addition to everyone getting ready to leave, I developed a very bad cold on Wednesday. Seems that is my sick day! It started Tuesday evening with that warm swallowing throat feeling and by Wednesday morning it was a full blown cold. It was very runny and I spent half the day grabbing tissues. In fact, I used up an entire roll of toilet paper as tissues and one my tissue packets; it's a good thing I brought extra. I took two Benadryl on Wednesday afternoon and was completely wiped out the rest of the day. I forced myself to get good sleep on both Wednesday and Thursday, taking some naps as well, so that by Friday I no longer felt sick. I still have a residual stuffy nose though, but no more tissues every five seconds.

Miriam ended up deciding that she would go home for her grandmother's funeral and that in order to catch a flight out of Nagpur to Delhi to home, she would be be leaving on Friday at 4am in the morning! We had a special samosas and pepsi party (treats picked up in town) on Thursday evening as a second celebration to say farewell to those leaving. In Miriam's case it was very bittersweet. After our samosas and pepsi party we had one big gathering again in Kate and Brenna's room where we all exchanged photos and music files. Sufina and Bhagyashree were away at a conference and would return between 1 and 2am, so Miriam had made plans to stay up all night. I was hoping to stay up as well, but with my cold, there was just no way I could make it. Around 11pm I said goodbye to Miriam. Hopefully we will have a chance to cross paths again some day! I set my alarm for 3:45am to attempt saying goodbye again. I woke up and used the bathroom and heard sounds from Marie and Miriam's room, and a suitcase being rolled out, but I chose to go back to sleep rather than force a second goodbye.

Picture: Everyone gathered for the samosa and pepsi party

On Friday afternoon Kate, Brenna, and Amy left. They would be heading up to the airport in Nagpur and then heading to Goa (where the beaches are) and then eventually to northern India for some sight-seeing and tourism. Those of us staying at SEARCH took a nice break from work to hang outside in the central area and see them off. The group photo we took at the time is above.

For most of the day I had been working in the research building so I was not part of some conversations that were had between the girls in the library about Rushina and Marie going on an overnight to Nagpur. Rushina was interested in stopping at the airport because she needed to make some changes to her tickets and I think Marie was just itching to get out of Shodhgram. Right before the three who were permanently leaving were to get in the car, Rushina and Marie asked permission to go to Nagpur on a Friday night and miss work on Saturday. They were granted permission. They were going to hang out in Nagpur and stay in the hotel with the other girls and have a sleepover! I also had the choice to go, but I couldn't justify to myself a 3.5 hour car ride, there and back, just to sleep in a hotel. Although it sounded like fun, I was a happy camper here at SEARCH. Besides, Jessica would not be going because a surgery camp for spine surgery was to begin the next morning. I decided it would be nice to hang around SEARCH for a quieter Saturday.

Saturday turned out to be a good day and I actually had a chance to observe the surgery camp (future post). When Marie and Rushina returned they said they had fun, but that they both spent a fortune between the car rides, dinner, and the hotel.

On Sunday Sagar was leaving so we had Maggi in the morning for breakfast. Aditi and Sufina prepared a huge pot for everyone. Maggi is basically the Indian version of ramen. It looks the same and has the same texture. I think the noodles are identical. The only difference is that it is made with Indian spices, more like curry, instead of the chicken, beef, and vegetable flavorings we have at home in the United States. Maggi is a special treat here, and whenever it is made, we invite all the young kids that live at SEARCH. It is sooo cute to see them light up to eat Maggi!

With girls leaving, two new girls have arrived. Swati, a sophomore from a small private college in Michigan has arrived. She will mostly do observation in the clinic. Haley, Marie's friend from Brown, has also arrived to do a quick internship. She came from another organization in India that was not working out. We all leave the same week in August.

Mini Adventures

Although things have mostly settled down, and big adventures only happen on Sundays, we still find ways to appreciate the land around us and seek out mini adventures.

On Tuesday, July 6th, Amy, Miriam, and I went on a nature walk. In the early evenings between work and prayer service, we are allowed to take walks around the Shodhgram campus where SEARCH is located. I had no idea how much there was to see just outside the front gate. It was so beautiful!

First, still on campus, we went to the SEARCH playground:

Then we stopped by the temple of Goddess Danteshwari, located just before the front gate:

After passing through the front gate, we turned left. This early evening walk was very pleasant, relaxing, and serene! Our first stop on the walk was at a hut with additional god statues:

Then we climbed up on a dirt hill. The sun was just starting to go down:

We saw a woman working in the fields:

I made sure to get a photo of myself:

We walked far enough so that we could see one of the neighboring villages. We could hear a lot of noise emanating from the village as people returned from the fields and gathered for dinner:

I don't have photos from the next two mini adventures, but I can describe them.

Everyone here drives scooters and mopeds! On Thursday, July 8th, Sona was gracious enough to let us have a little fun with her moped. Bhagyashree supervised as we took turns learning to drive it. I myself, did not actually take control of the moped, but once Marie felt she knew what she was doing, I hopped on behind her. Woooo! We zipped down the main road of SEARCH, turned left, and drove down the road where I had taken my nature walk with Amy and Miriam earlier in the week. It was a lot of fun and a nice change of pace from sitting in front of a computer all day. Marie made me get off when she turned around because she did not want me to go flying off the side. Then we took a nice ride back to the center of SEARCH. I hope during the next five weeks here that I am able to get on the moped again.

Finally, later that same Thursday evening we took a night time adventure walk! It seems that I have been completely unaware of some special parts of the SEARCH campus. There is a lake, but it only fills up during the rainy season. Earlier in the day some of the girls visited the lake and saw the "SEARCH lake house" on the other side. Since they had seen it in daylight, they knew where we were headed in the dark. I went completely blind. Bhagyashree headed up our mission to the lake house. It was very dark expect for our head lamps. It was so dark that you couldn't see the lake, it just looked like an even darker empty space. I was worried about snakes and the like, but what kept me going is that I was not leading the pack and I was not trailing the pack. I felt safe in the middle. It wasn't that far of a walk to the lake house, really only four or five minutes. Once we got there, we took two flights of exterior stairs up to the roof. We were hoping to see stars, but unfortunately none were out. So instead, we played around on the roof, flashed our head lamps into the distance, displayed silly dances, told jokes, and got attacked by mosquitoes. We were up on the roof long enough that our eyes adjusted to the dark and we could finally see the lake. The walk back to our rooms was not as scary, since I knew what to expect and the distance we had to go. I will try to get photos of the lake and lake house in the future.

I look forward to more mini adventures in the weeks to come.

Monsoon Nightmare

Picture: One of the weird frogs we saw on the first night of heavy rains.

Last week was another typical work week, except for a 24 hour period from Tuesday night to Wednesday evening. We can call this period my first bad day. This was mainly caused by two events. First, Tuesday is what I would label as the official start of the monsoon. Although it had rained several times in the first two weeks that I was here, Tuesday was the beginning of non-stop, four-days-straight rain. Second, Wednesday was my first experience with traveler's diarrhea.

I woke up on Tuesday morning to the sounds of someone getting sick in the bathroom. By Tuesday afternoon four of the girls had fallen ill. Brenna landed in the SEARCH hospital. Only, Miriam, Amy, and I were left standing. Before dinner we made the rounds visiting each of the girls. While eating dinner, the heavy rains began. We sat in our mess hall enjoying the sounds of the rain and playing with some dogs that ran into the mess hall and under the roof of our residence building for shelter. Back in our bedrooms, I took some time learning to write my name in Marathi. I was enjoying myself and having a good time. The power went out several times, something that happens more frequently now that it is raining a lot. Then, Miriam, Amy, and Bhagyashree discovered these weird looking frogs hanging outside in our courtyard. They were very fat frogs and instead of jumping they walked on four legs. We watched the frogs try to escape the pooling waters and climb to higher ground. One after another they tried to climb up the side of our elevated landing outside our bedrooms. They were cute, but their genetic adaptations were kind of creepy. At one point, Miriam made a comment that the frogs, snakes, and scorpions come out during the rains, driven out of their underground hiding places. Amy took tons of pictures of them. My camera's charge had been used up during a nature walk we took earlier in the evening, so I had to wait a bit before it was ready. By the time I went back outside to take my own photos, the other girls were heading into their rooms and we said goodnight. I stood outside for a few extra minutes taking pictures of Mr. Fat Frog. When I stood up to go inside, I saw something jump off the wall about 15 feet away. "What a funny looking gecko," I thought. It was relatively dark, and I couldn't see that well. I moved a bit closer. "Why is that gecko carrying something on its back?" As the "gecko" turned its body so that I was no longer seeing it in profile, I was horrified. This was not a gecko. No it was not. This was a big, live, scorpion.

Time out.

I was petrified. I saw the curve of its venomous tail curled up over its body. This is what I had mistaken for the load the gecko was carrying. I saw its pincher-type claws. It started trying to hop off the elevated platform of our residence building, decided this was too risky, walked over to a wall and attempted to crawl its way down to the ground. "Guys, guys, there's a scorpion out here!" The sound of the fans in the rooms and the pounding rain easily drowned out my voice. Besides, I'm not even sure if I was speaking audibly; I was frozen with fear. For a quick second I thought about snapping some photos, but then my senses came to me, and I ran inside my room and slammed the door.

Let me just say, the image of this scorpion, with its gigantic black grasping claws, strutting across our landing is forever burned into my brain. It is straight out of my nightmares. I was severely disturbed. Although the walls are made of cement and this thing was far too chunky to ever make it under the door, the fact that I had seen something so terrifyingly nasty close to my bedroom convinced me that there was a way it could make it inside my room. On Tuesday night I felt like I was falling asleep in a horror film. In this movie genetically mutated obese frogs roam the planet on their tiny legs. Black scorpions start crawling out of the walls. Water is flooding everywhere you turn. And half of your friends are falling ill with gastrointestinal illnesses.

On Wednesday morning when I woke up, the first thing that happened is I made a trip to the bathroom with an upset stomach (and it was very very upset; I will spare everyone the details though since this is, after all, a public blog). I had braced myself for this upon arrival in India, and then I thought I had lucked out and skipped this step. On Day 17 my immune system caught up with me.

I sat down along the wall outside our bedrooms and talked with Miriam and Bhagyashree who were also up early. I felt very nauseous and was afraid I was going to vomit, like the other girls had the day before. I also had a theory that because I spent the night in such fitful anxiety that I had made myself physically sick. When Miriam and Bhagyashree went to go get tea, I went into the bathroom and got sick again. This was not good, a pattern was emerging. I decided I would not get ready for the day and instead go back to sleep. Further, since our bathrooms are only in the residence building, I did not want to be that far away from them. Around 9am Sona came to check on me. I told her I felt weak, dizzy, and sleepy, but that I thought I could start my day. She told me to rest and that she would check in again around 11am. At 10:45am I made my third trip to the bathroom. When Sona came back she said I was going to the hospital to get medication and treatment because now I was officially the fifth sick girl.

The hospital at SEARCH is a rural hospital that primarily serves the villagers, so while there is medical equipment and medications and organized surgery camps, it looks more like a school infirmary than a U.S. hospital. It is also roughly 50 feet from our residence building. I don't want anyone picturing brightly lit hallways, individual examination rooms with hospital beds, beeping monitors displaying vital signs, and doctors and nurses scuttling everywhere. This just isn't so. Ama (Dr. Rani Bang) oversees the entire hospital with the assistance of two Ayurvedic doctors. I first met with Ama who checked me out for a bit and then told me I would get an IV. She told me that we shouldn't have eaten eggs at the restaurant in Chandrapur because there could have been salmonella, especially during the rainy season. I was confused because I thought the restaurant we had gone to was one of the "safe" ones. Either way, it didn't really matter at that point.

Amita, one of the Ayurvedic doctors that shadows Ama, led me to the room I would rest in. It ended up being the same room that Brenna had spent all of Tuesday in, getting four IVs of rehydration liquid. Amita and another hospital assistant/nurse gave me three pills, two red and one white. I'm not sure what they were, but I trusted that they wouldn't harm me. They told me Marie was going to come and get an IV too. I didn't really think I needed the IV, but I had heard from others that once SEARCH is aware that you were sick, they are very overprotective. They are responsible for us, and I'm sure they do not want anything bad happening to the foreign interns because they would like to continue to have them come in the future. Since I knew that getting an IV of rehydration liquid was not going to harm me, I didn't put up too much of a fuss, although I do think this was my first time getting a real IV. Marie tried to protest, telling them that going to the bathroom several times did not warrant an IV, but in the end she was made to get one too. We hung out in the room for about 45 minutes while our IV's dripped away. There was nothing else to do, but stare at the walls and the ceiling and listen to the sound of the rain. So really, it was very relaxing. After our IV's we were given instructions to eat bananas, so we did that too. Overall, the IV was not too bad. It hurt a lot more when the nurse removed the needle than the pinch I felt when it was inserted, but I got over that as well. It was very unclear if we were supposed to stay in the hospital room or not, but seeing that we both felt fine, we wanted to leave. The only problem was that it was raining cats and dogs again, and neither of us had an umbrella. Eventually Miriam came to our rescue and we all went back to our bedrooms.

I played the rest of the afternoon slow and only had to use the bathroom one additional time. I only ate a small amount of rice and sprouts at dinner. I was in good company with the other sick girls. We all showed up in the dining hall because the cook, Vimal tai, was starting to worry that her food had made us sick and we were boycotting it. We really like Vimal tai and didn't want her to feel upset, so we went to dinner in solidarity and pretended to eat. I got very good rest Wednesday night and felt golden on Thursday morning! I did not even have to use the bathroom on Thursday (or Friday...seemed like I now had the opposite problem). I really lucked out. The other four girls who had been sick were sick for at least two days, and most of them had vomited as well. I was a mild case. I had escaped what could have turned out to be an awful week of gastrointestinal issues.

Further, on Friday, the rain eventually let up and we had two days of sunshine with some drizzle, until Sunday when it started to rain non-stop again. At least I know that it is not going to rain every minute between now and the time I leave, and that there will be moments when we see the sun.

The only nightmare I did not escape from was that of the scorpion which plays over and over in my head. Now, the spot where I saw the scorpion will always be "that place." And every time I walk by it to go to the bathroom I will nervously scan the area looking for scorpions. I will probably have this anxiety until the day I leave. Gone are the carefree days of scorpion-free housing.

Sunday in Sevagram

This past Sunday, July 4th, we had our weekly day off. Like the previous Sunday, instead of just shopping in Gadchiroli, the American research interns used the opportunity to take a field trip to Sevagram. SEARCH was allowing us to take a field trip without an Indian chaperone, other than our driver. To celebrate July 4th we piled into a van and took the four-hour ride to Gandhi's ashram.

I read before coming to SEARCH that Dr. Abhay Bang was raised in Sevagram, where Mahatma Gandhi's used to live, work, and pray. Although Gandhi was already dead by the time Dr. Bang was born, his father had met Gandhi and it changed the course of his life as an economics professor. Sevagram means "village of service." It is also the home of the first rural medical college in India. Drs. Abhay and Rani Bang have modeled SEARCH after Sevagram and have chosen to follow the Gandhian principles of simplicity and living alongside the poor.

Now, I have to admit, I do not know that much about Gandhi. I know he lived in India. I know he led civil disobedience demonstrations and he is known for his approach of non-violence. I know that he also fasted during times of upheaval and protest.

I am sad to admit that I did not know he lived from 1869-1948, that he was married by the age of 13, that he lived in South Africa as an expatriate for nearly two decades, that he played a major role in the struggle for India's independence from Britain, and upon gaining independence he fought to end poverty, end the caste system, and to inspire economic self-reliance, his wife died while he was imprisoned, and that he was assassinated. All of this I learned during our field trip. To truly understand Gandhi I would probably have to read a lot of philosophy and history books, or I can watch the 1982 Academy Award winning movie, Gandhi.

The car ride itself was uneventful and I spent most of it staring out the window and trying to nap. We made one stop at a gas station. The only way that I can describe this rest stop is that it looked like a simple gas station, but then when you went around back there was a whole bazaar of snack stands. The driver let us out and we went crazy picking up cookies, candies, and munchies. We also had the opportunity to use the bathroom. A long time ago I learned my lesson about using the bathroom when you had the opportunity to do so. (Once, as a college freshman, my lacrosse team had to stop on the side of the highway because I drank so much water during our away game, partially because I was sick with a cough at the time, and I had failed to use the bathroom before leaving. I absolutely could not hold it for the two hours that remained in our drive back to Brandeis). On our way to Sevagram, I did not have to go that bad until I started worrying about what would happen if I did need to go. Therefore, I thought it would best if I made myself use the bathroom at the gas station. All I have to say is American gas station bathroom + multiple squat toilets = you try to imagine it. I told myself it would only be 30 seconds. I ran in, went into the closest stall, didn't even close the door all the way, dropped my pants, and was out of there in less than a minute. I doused my hands with water and hand sanitizer afterwards.

After that lovely story, here are some lovely pictures:


On the way to Gandhi's ashram, we actually stopped at a smaller ashram first. These are the grounds of Brahma Vidya Mandir. It is an ashram founded in 1959 by Vinoba Bhave (Vinobaji) for women who want to live a life of deep spirituality, organic farming and other productive manual labor, voluntary poverty, and service.

We arrived during the noon prayer (in the background). We were warmly welcomed after the prayer was over. Most of the members of the ashram spoke English. According to the pamphlets we received, all decisions about the activities and arrangements of the ashram are decided unanimously, which is thought to strengthen the community.

The members of the ashram lined up at the temple. According to the pamphlet, the ashram does not attach itself to any country or any religion. They welcome everyone. Now men live there too. There was one Western-looking young lady living there. This reminded me very much of the book Eat, Pray, Love.

A view of open-air walls of the temple.

Here are the grounds at Sevagram. Gandhi arrived in Sevagram in 1936 at the age of 67. In India, Gandhi is affectionately referred to as Bapu, which means "father."

A photo taken on the back patio of Gandhi's hut. Unfortunately I did not take many pictures of the huts and buildings straight on; I mostly took pictures of the informative boards that were written in both Marathi and English. When this hut was built, Gandhi mandated that it did not cost more than 500 rupees (about $12 in today's world) and that it use local materials that would be available to everyone. He wanted to model living simply and using the resources that one has at their disposal without getting all fancy.

Another view of the peaceful grounds in Sevagram, Gandhi's ashram.

A monument in Sevagram. The translation is roughly "In this village, we hope to see a world that is healthy and without disease."

A beautiful photo of the sunset, taken during our four-hour drive back to Gadchiroli.

A photo of the Indian flags on the dashboard inside the van.

After Sevagram, we went to Chandrapur (the neighboring town to Gadchiroli) to visit another big temple (no photos taken there) and have a late lunch at another hotel restaurant. Back in Gadchiroli, we stopped at the ice cream store to finish off our July 4th celebration. Here is a picture of us with our driver for the day.

Getting Down to Business

It was my perception that everyone started work on their projects slowly and built up the pace over the course of their internship. I had received a schedule on my first day at SEARCH that outlined my progress points and milestones and I thought I had it under control. I knew I would be presenting at one of the research meetings in the first week of July, but when I arrived in June, July seemed soooo far away. Further, I could have sworn it said something like July 6th or July 7th.

Well, on Thursday, a day that I spent mostly doing nothing and watching girls get their noses pierced, I realized at 4:30pm that I was supposed to present at the 8:30am research meeting the next day, July 2nd! Uh oh! At first I was going to make up some excuse like it was only my first full week and I was not prepared, but I did not think this would be appropriate. Besides, many of the other girls had to present in their first week or two here. So, I immediately snapped into work mode. Although I had not done much of the literature review that was supposed to be the first step in my project, I had already begun looking at the data and had put a lot of thought into the analysis and the output that I hoped to get.

I quickly started drafting up my powerpoint presentation. By prayer service I had about half of it done, and I was proud of myself for taking the work seriously. I talked with the other interns to get a good sense of what would be expected. Some said that since it was my first presentation, I should definitely present my literature review. I panicked because I had barely read the literature on my topic (smokeless tobacco consumption in pregnant women) and I was only going with prior knowledge. They advised downloading some articles before the internet cut out, and reviewing them the best I could. Some of the other girls told me not to worry so much about presenting the literature review, and to just focus on what I had done, and to at least present what my plan would be for the work that I had not yet completed. They all said that sometimes Dr. Bang could be very critical of the work presented, but it was all meant to be constructive.

That Thursday evening was probably the first time I felt professionally stressed at SEARCH. I was excited to be here and work on my project, but all of a sudden I felt like it had gotten the best of me. The presentation would be my first real interaction with Dr. Bang and I wanted him to think highly of me. I did not want it to show that I started preparing my presentation the afternoon before I was scheduled to give it. I used my time wisely for the rest of the evening. When the girls gathered for a movie night to watch Kung Fu Panda, I only stayed for part of it. I wanted to go to sleep early because I planned to wake up early and put some final touches on my presentation.

In the end, everything worked out wonderfully. I was proud of the powerpoint slides that I put together and I think I was able to explain them well and clearly. After my 15 minute presentation, Dr. Bang's first words were "Very good." He asked the room if there were any questions and there did not seem to be any major issues. Then Dr. Bang and Anand asked me six or seven questions between them and I was able to come up with a response to each of them. Although I was sorta half-guessing my answers, the point of the research meeting, or the journal club, is for the project to be a discussion. As long as you say something and do not sit there and look dumbfounded, you have done a good job. At one point I glanced across the room and Miriam gave me a thumbs up! At the conclusion of the meeting the other girls told me I had done a good job and that not all the presentations always go that well. This made me feel really good. I credit the intense methods courses at UNC for preparing me so well and helping me to appear as if I am a true epidemiologist.