Christian Medical College - Day One

The Christian Medical College of Vellore is a sprawling medical compound that seem to offer some tranquility in what is otherwise a small but chaotic Indian city. I was relieved to find, when i passed through its wide gates this morning, that the typical and ceaseless (and senseless) horn honking seemed to evaporate behind me. A sigh of relief and i'd only had to walk 100 m from my hotel. I approached the information desk and asked in which building i was to report.

As happens frequently in India, i was told that my actual destination was elsewhere: 7km away, on the campus of the undergraduate Medical College itself. I was instructed to find the No. 1 or No. 2 bus outside the gate and to ask them to drop me at the college. Minutes later, what approached as i waited at the unmarked bus stop/light post was not so much a bus as a caravan, with people bulging from its doors and windows. No less than 6 men were hanging out of each of the two doors...hanging on for dear life. You can imagine what the inside of the bus looked like. It's not uncommon for a bus outside the developed world to carry 2-3 times it's intended capacity. That's outside of rush hour. I spent the first 15 minutes of my unanticipated bus journey hanging out the door of a speeding bus, one that despite (or, perhaps, because of) its considerable inertia attempted to pass every bike, rickshaw and car in its way, honking its shrill horn the entire way. The last 30 minutes of the bus ride i spent packed away like a whitefish in a tin of brown sardines. At some point, i asked the conductor, one of four, to indicate when we arrived at CMC. He pointed back in the direction from which we had come. Arghh! I got off at the next stop and found the next bus in the opposite direction. And then I arrived.

The undergraduate campus of CMC is a true oasis. A broad driveway winds its way between colonial stone buildings and beautiful gardens, the trees that line the paths identified by small yellow plaques. They have basketball and volleyball courts, an aviary with beautiful birds, a canteen, and the residences of many of the doctors who teach at the school. I asked my way to the principle's office and found sitting in chairs ahead of me two medical students from Tufts University in Boston. I can't tell you my relief at the opportunity to have a real conversation with someone, something i'd missed for the last several days. After an hour or so, i had my new identification badge and my assignment and i was ready to go. I wondered around the campus for an hour or so, taking photographs to show to everyone back home. After waiting for 15 minutes for a bus back to town, i hailed a rickshaw and enjoyed the solitude and space of a vehicle with only one passenger.

After one month away, my bowels have finally decided to take offense at something i've sent their way. I've eaten with reckless abandon this trip, from street stalls to dirty (but always busy) hole-in-the-wall joints, and i think it was the nice punjabi vegetarian meal i had last night that sealed my fate (and antagonized my intestines). So, my first patient today was me. I had intended to take great care, as well, eating only rice and bananas and the like. Also i had a couple lassis, figuring that i needed to send some good bacteria to help rescue me from the bad. Anyway, before i made it back to the hospital i ordered a plain dosa, those large crisp crepes of rice flour that are a staple of the south indian diet. Unfortunately, maybe, it came with some deliciously spicy sambar, and various vegetable curries and, well, i couldn't resist. We have yet to see what will come of that and i'll be sure NOT to let you know. Too much information, already, i know, but as you all know, these are the things that we talk about when away. I will say that Tamil Nadu has the spiciest Indian food i've had to date. It's absolutely delicious.

I spent the afternoon with two resident physicians in paediatric endocrine clinic, seeing children of all ages with various \nendocrine disorders. The only thing i saw that we basically never see at home is Rickets, a deficiency of Vit. D. These children were not, apparently, remarkable in their physical appearance but nonetheless carried a diagnosis that is rare in the developed world. I'll not bore anybody with the cases, but rather say something about the care that they are getting, which appears quite good. The clinic situation is certainly different. Rather than a patient waiting in a room to be seen, the doctor sits in an exam room and calls the patient in over the PA. Often, and it was this case this afternoon, there are two physicians sharing one exam room, seeing two different patients at the same time. The children were paraded in and sat on a stool in front of the doctor, while the parents stood behind them and answered questions. Something i'd never seen is the degree of formality assumed for a doctors visit. Children were without fail in their Sunday best, showing a respect for the patient-physician interaction that is antiquated in the west. Most of the children were healthy, maintained chronically on one or more medications. Each flashed their brilliant smiles at the site of a (relatively) tall white boy with a stethescope in the midst. The doctors exam was cursory then, for his ability to bill - unlike physicians in the states - isn't determined by his ability to document any and all physical exam findings.

CMC clearly has resources that most Indian hospitals don't, including the ability to view radiology exams and reports on the computer and computerized lab results. This is something most american hospitals have, as well. I was surprised to find it here. Still, printers are dot matrix and patient charts are paper and decaying. It's a mixture of old and new that, no tech and high tech that seems characteristic of contemporary India. Sadhus with cellphones, if you know what i mean. Furthermore, there's a library with 20 or so computers, a wi-fi connection (so i can send photos from my new camera, as promised), and all the latest journals. After a month of travelling, i feel quite ready to do some learning. I'm excited about my stay here.

You'll hear from me soon.

best, justin

ps. words of wisdom from an Indian boy in Varkala, Kerala: "In America you spend all your time looking up, trying to figure out how to get there. In India, we always look down and are grateful for what we have."