Yes, we all can fit in one (1) auto-rickshaw.

It’s been really interesting seeing how medicine is done at the MGMC & RI, and we are especially grateful to Dr. Hanifah teaching us so much during rounds in the ICUs. Here’s a group picture of all of us on our last day, the man on the left is the PG, or resident, on service. Ladies, please note the mustache.

Today we saw another case of organophosphate poisoning, this time given via injection! It turns out they can get syringes very easily at the pharmacies without a prescription, which I guess shouldn’t be surprising to us since they can get all the azithromycin they want too, maybe sometimes they want to get it IV? Anyway, his arm didn’t look too good, we didn’t linger in the RICU today as it was stifling-hot in there, but I hope he was on some abx, because I don’t think he used medical injection-grade organophosphates. Per the admitting doctor it was another case of “love gone wrong.” It’s sad how many suicide attempts we’ve seen in our few days here.

As Brian mentioned we ran into two Americans, Matt and Chris from Dalit Solidarity, who seem to be doing a lot of the stuff we were talking about the other night. I don’t want to belabor the point, but I really am just so happy that we found someone doing what we all agreed was the most important, which is improving the basics, including providing PCP-like care! You know I love my ID peeps, but before we can have good efficacious HIV treatment we need these people to have the basics that allow them to take that medication and avoid other infections, and prevention! They even taught us a little Tamil, which is too bad we’re leaving soon!

And since you wanted to see some pictures of the ‘stashes, here is a cute group photo. Alas, the facial hair is still sparse in this picture, but I am confident in a few days they will really be very nice. In the background is the Auroville dome which you can’t really see on account of glare. Also maybe Brian’s camera had too many options for the man whose meditation we interrupted to have him take this photo. Perhaps when Dr. Yadavalli rejoins the group tonight or tomorrow we will get another group picture. Oh man, speaking of that… I better work on my presentation…

More musings from Pondi….

As per the usual, Brian did an excellent job in covering what happened on the Pediatrics side of things here in Pondi. One comment from that… I am not entirely sure why they chose to put the pt on linezolid when the pt failed Ceftriaxone. When I asked the professor he said it was for resistant Strep Pneumo and not MRSA. If they are using ciprofloxacin on the neonates, wouldn’t moxifloxacin/levofloxacin have been a viable alternative??? 

From what I have heard (many voices in my head), the original musings were a hit! Allow me to add a few more and also update you on some of the previous posts…

– I was told to tell you all that “all” of us did not buy drums, only “most” of us did. If any of you can figure out who is happy that he/she did not buy drums, I have a present for you. Please comment below…

– Mustaches are still on, no one has fallen off that wagon yet (Brian never got on). We will have pics up once we are smart enough to figure out how to do that. Also, we have yet to figure out the penalty for the person that gets rid of the mustache first…. so if you got something please let us know….

– Still no signs of Betsy. I think that Betsy caught wind that Tim likes meat (esp steaks) and has yet to grace us with her presence again

– If you are ever in the neighborhood of Mahatma Gandhi Medical College and Research Institute, I highly recommend going to R.R. Caterers (the “dive” that Brain refers to). They have amazing tandoori chicken. This place will now be known as the Official Tandoori place of CIT2.

– The canteen that we go to for breakfast has started using a cash register today. The good thing about that is that we can now double check what we ordered and not get totally surprised with what appears on our plate (see: communication problems). The bad thing is that the canteen has lost a lot of efficiency which means that it takes a long time to get the right order. I’m not sure which is better…

– We had yet another rousing game of euchre yesterday. I believe that we will next be learning how to play pinochle. After that, apparently it’s on with travel Scrabble!!

– For the record, I’m still not married…

– I miss diet coke. The soft drinks that they have (all regular) really do taste like sugar syrup now. Fortunately, some of the restaurants carry diet coke (with 1 calorie instead of 0) so I have tried my best to get my fill on there.

– On our visit to Auroville, we had a “guide” that was no help. In fact, the most he did was attempt to steal a car that he thought was ours. Fortunately, Gopal saved the day and alerted the guide that the car was not his and that he could not have it. Then he sent him to a timeout…. at a meditation center…

Throwdown: Zyvox vs. Survanta

I’ve taken a break from blogging for a day or so.  So, I have a little to catch up on.   Yesterday I started getting some GI upset, fortunately not the Cipro-taking kind.  I’m thinking my bland American stomach is being thrown into convulsions from an exclusively Indian food diet.Yesteday we rounded in the NICU.  It’s pretty amazing what they are trying to do with limited resources.  I’m still surprised that first line therapy includes amikacin.  What would that be–a dry martini, shaken not stirred?

Second line includes piperacillin and ciprofloxacin.  In a neonate.  They obviously have not read the literature on beagle pups and cartilage.  We’ll call that infant formula–second best to mother’s milk.

Overnight, the NICU sent a baby out to mom, and then got a SGA pre-term twin that weighed 850 grams.  The baby was intubated, but they couldn’t give Survanta.  Why is that?  Survanta costs 13,000 rupees (US$300)…per dose, which is way too expensive for a typical Indian family.

Out on the wards, the young girl with pneumonia was going home today.  Choice of antibiotics Zyvox (linezolid).  Cost?  40 rupees (about US$1).  Compare that to our cost of US$40…per pill.  We’ll call this fortified mother’s milk.  Or maybe a Rum and Coke.

Also on the Peds Wards today, we saw a case of Duchenne’s muscular dystrophy, calf pseudohypertrophy, Gower’s maneuver and all.  This is one of those cases which we never see admitted to inpatient at Rainbow, though I’m sure it exists.  We also saw a probable case of cerebral palsy/developmental delay.  I thought about how much stuff and resources we would send these parents home with in the US, and wondered what kind of support they would get here in India.

Rest assured, we are not just working.   Yesterday we went sightseeing to Auroville, a eutopian, non-denominational settlement outside of Pondicherry.  It was founded on the principles set forth by Mother and Sri Aurobindo.  In the middle of the settlement is a Banyan tree, and right next to it is a huge, Disney-esque meditation chamber.   Think Epcot center except with gold discs.  It is supposed to be reminiscent of the divine consciousness.  It’s surrounded by brick “petals”, and to get into it you go down a ramp, then up a set of stairs.  Of course they make you remove your shoes and socks, but they also make you put on a pair of white socks which they provide.

You then start your ascent by a ramp that slowly spirals along the outside of the ball to reach the meditation chamber.  The inside of the meditation chamber is all white, with 12 white pillars, white carpet, and a huge crystal ball on a golden stand.  A ray of sunlight shines down from the ceiling.  Even when it’s full of people, when everyone’s quiet, it’s a very cool, experience.