Surgical times

Hello
This week I have been placed in Surgery 1, which is one of the general surgery units at the hospital, but also specialises in Head and Neck surgery. In the rest of the world H&N cancers make up 10% of the total number of cancers, but in the Indian subcontinent it is up to 40% of the total. This is mainly due to the prominence of chewing tobacco and Betel Nut, often mixed with slake lime, a fairly potent carcinogenic mixture. This leads to some pretty horrific tongue and buccal carcinomas, all at a fairly advanced stage. This means that many of the operations carried out are fairly radical, involving large scale dissections of the neck as well as removing the primary tumour, with fairly large skin flaps from various parts of the body used. Also many of the people had travelled from West Bengal (up near Bangladesh in the north) to come to CMC, but I am not entirely sure why they have travelled so far, obviously it has a good reputation. Aside from head and neck stuff, there was a very nasty case of necrotising fasciitis on the ward, a benign parotid swelling, which we saw carefully removed to avoid damaging the facial nerve and lots of other hemi-colectomies and general surgery type things, which was quite interesting. Also attended some teaching with the Indian medical students, they get a whole week for head and neck conditions whereas we maybe had it mentioned once or twice in the ENT block but more related to pharyngeal cancers. I have enjoyed the week, although I haven't felt hugely well the whole time, quite a lot of standing in the heat and it has been a good opportunity to augment my knowledge illustrated with striking clinical examples.


The other main highlight of the week was our trip to see the Tamil Move Anniyan. Tamil is the main language of this region, Tamil Nadu and most of these films are made in Chennai (Madras), known locally as Kollywood films (cf Bollywood from Mumbai/Bombay). It was quite different from my expectations.
A few observations:

• It was quite violent, having quite a number of fighting scenes and fairly brutal murders, although mostly off screen. I was expecting some kind of lovey-dovey romance with lots of songs and dancing.
  
• There weren't as many songs I was expecting, I counted just 4, but the dancing was quite interesting and there were lots of scene and costume changes (This kind of thing would appall me in an English-language film but was somehow quite interesting in the Tamil film)
  
• It was actually fairly modern, employed now oft-used Matrix-esque time-slicing techniques for the fighting scenes.
  
• I was surprisd with how easy it was to follow the film, except in the long passages of dialogue.
  
• Good representation of Indian transport systems, showing the autorickshaws and the train; a good sense of the 'I've done that' tourist feeling.
  

I'm sure there was more to say but my brain is getting to that seizeing up point in the day.
I'm off on a 3 day taxi excursion round the temple cities of southern Tamil Nadu this weekend, which should be very interesting and provide some good photos.

Hope you have a good one.
All the best.

Good Day Sunshine

So anyway, to start on a good point, I passed my exams! No more written exams for the whole of medical school. It was an ugly pass but as said in ER, "what do you call the guy who graduates last in his class at medical school?....Doctor!"

The weekend trip was to Bangalore:
Left on Friday evening around 6pm (was meant to be a good half an hour earlier) and found my confirmed seat on the train. It was a bench seat which I shared with 2 other commuters whilst my new room mate Christian and 2 English girls Clare and Ali sat on the seat over the aisle; the rest of our group were in the same carriage but further down. It soon became duller and the train lurched into the night. Apart from the less than smooth running of the train we were also fairly constantly interrupted by all manner of people carrying different items for sale or begging for money. Some of the beggars could be very persistent, tapping me or the others on the leg or hand for up to 5 minutes. It was difficult for me. Perhaps in larger cities like London or Glasgow these kinds of thing are more common but in Dundee it is fairly rare to see someone on a street corner and I can count the number of times on one hand that I've been approached to be asked for money. It is difficult to refuse to give money to the polio crippled man who crawls down the train with a rag to clean the floor in return for a few rupees or the child who looks like he hasn't eaten a proper meal in a good few days.

Anyway arriving in Bangalore without somewhere to stay was, in hindsight, a bad idea. We tried phoning ahead once we had got into the train station but most places were already booked up. Having a large group of people (13 or something) was difficult and we were willing to split up but we eventually found a place not to far from the main commercial centre of Bangalore, MG Road. This "hotel" was called the New Central Lodge Hotel. I thought my room in the Annexe here at CMC was spartan, but at least it is fairly respectibly spartan. This hotel, even at 11.30 at night, looked grimy. I had a more comfortable bed on the floor of the train last weekend; fortunately I was exhausted and slept pretty well despite the chill that was in the air.

Saturday
Got up relatively early, in glad expectation of the warm shower I was promised. Bangalore wasn't particularly warm (probably still 23 or something), especially at 8 o'clock in the morning and having slept on a rather rigid bed my bruised shoulders could have done with a nice bit of massaging heat, but as you have guessed the shower was lukewarm at best. At least it wasn't freezing as it was on Sunday. The unhelpful taps didn't make my life any easier either, as I attempted every combination to make the thing heat up. I also have to blame the 10 girls with whom we were sharing the hotel and managed to get up earlier and probably use up all the hot water. Anyway headed off to Mathma Ghandi (MG) Road, the main road in Bangalore for breakfast at a local Barista place...think I had cake or something for breakfast as they didn't offer anything more savoury than this. Mmm, cake for breakfast. MG road was unlike anything I had experienced in India before - it could almost have been in London or Glasgow with its tall buildings and impressive shop fronts (and paved footpaths). Spent quite a while in the very western shops and ended up having pasta for lunch at a Lonely Planet recommended restaurant (average at best, pretty bland. Reminder: stick to Indian food).

After lunch the other side of Bangalore when we headed to the City Market. This was a pretty dingy place at first sight, worsened by the heavy rain (pseudo-monsoon), but the colours and smells of the market were very impressive, especially in the covered part of the market. There were many stalls selling strong-smelling flowers and many others selling strong-smelling brightly coloured spices. Definitely "An Exerience". After this we were a bit more touristy and headed to the Palace of Tipu Sultan, which was interesting building of tall columns and dark coloured wood, with a good guided tour by a friendly local.

Back to the hotel before dinner at an atmospheric restaurant before rounding off the evening with a few drinks at a packed 70s style pub, Pecos.

Sunday
After the frenetic activity of Saturday I had a much more leisurely Sunday, despite the coldness of the shower. Good coffee and chocolate cake for breakfast (at least it wasn't spicy) before we headed off to the Botannical gardens in the city. It was relatively busy (cost me the princely sum of 5 rupees (about 7p) to get in) but still quite quiet and away from the traffic. The gardens themselves weren't particularly beautiful with some low scrubby bushes dominating the flora, but there was some interesting Gneiss formations for all you Geology fans out there. Apparently they were some of the oldest rocks in the world but I don't trust signs.


The train back was at 2.30 so steadily we made our way towards the train station getting good views of the grand City Court and Parliament buildings on the journey as well as helpful advice from the autorickshaw driver regarding possible sleep-inducing drugs being hidden inside sweets offered by fellow passengers; urban legend if you ask me. The train journey itself was much less interrupted and managed to get a good bit of Sufjan-listening sleep. So I arrived back without major illness or even the minor illness that plagued the return journey from Ooty.

Overall it was a good trip, interesting to see the progressive, modern India coupled with areas of the worst poverty I've seen in India. Bangalore has about 5 million people and about 8% of these live in slums. Although this is less than some other places I've been (Kibera in Nairobi being a prime example), the contrast between the flashy banking and IT sectors and these slums is so sharp here, but still there weren't huge numbers of orphaned children or beggars as in Kenya; perhaps the relatively heavy police presence kept them out of sight.

Post-script
Heard about this when I got back, but didn't see any sign of it whilst we were there:
India’s IT capital wakes up to terror threat

Until next time.

The calm before the storm

Today was a very pleasantly relaxing day. It was pretty warm all day here in Vellore and there has not been the evening rain that cools the place down to make it possible to sleep so I predict a fairly restless night ahead, despite my tiredness. Was in the department all morning, nothing particularly exciting, seemed pretty quiet - the cue for a reasonably long lunch break - before a short afternoon stint during which time no new patients were registered. After we could take no more the 2 German students and I decided that we would be much better spending our time beside the pool. It was my first trip and it was very pleasant, the water warm and sun not too scorching, all it needed was someone to serve cold drinks at regular intervals. Last day in Accident and Emergency tomorrow, hope to get an interesting case to write up for this half of the block. Head to Surgery for a week next week, think it's general surgery with some head and neck stuff thrown in for variety; apparently the doctors are quite good at teaching, but otherwise I have not really any idea why I chose to see this!
Anyway the weekend trip starts at 5.30 tomorrow when I head to Bangalore by train. Looking forward to seeing what a modern Indian city looks like - hope it doesn't cost too much.
Off for a nice hot chocolate before bed.
All the best.

Katpadi is the train station closest to Vellore (about 7km from CMC). Click on the map for a more detailed view. Ooty (where I went last weekend) is in the most westerly part of Tamil Nadu. This weekend I will be heading to Bangalore on the train (west of here) and weekend 3 will potentially be a trip down to Madurai (about where the 78E and 10N lines intersect) and Trichy.
So there you go. Click clunk.

The longest weekend (finally)

Hello!
Apologies for the very slight break in communication (I'm not dead Mum and Dad!) but I was away from Friday until Sunday and then feeling a bit dodgy the last couple of days; thanks to the marvels of over-the-counter purchasing of usually prescription-only drugs I am starting to feel better again (antibiotics not morphine or something...although I'm sure that it would be pretty easy to find).

So since I last posted:
Friday
Friday was another interesting day, not quite as hot as the others. Quite a few road traffic accidents came into the department including one who had pretty nasty looking 'road rash' - skin abrasions caused by coming off his two-wheeler after a bus hit him...and I thought motorbikes were dangerous in the UK, here it's only a matter of time before you have an accident and when you do most people have little or no protection and the outcome is usually a lot worse than it would be for a similar accident in the UK; That is, not mentioning other factors like the state of the roads or the cavalier attitude of the drivers towards sides of the road.

So after work we went out for dinner then met up at around 10pm to head down to the train. At this point I still didn't know if I was going to get onto the train, the board at the train station displayed whether I had moved up far enough on the waiting list to get a confirmed bunk in the sleeper carriage.. Alas despite my starting position of 30+ on the list changing some 20 places I didn't manage to be confirmed. Unperturbed by this I got on the train (some 20 minutes late - apparently this isn't a bad delay, at least the train turned up) with my colleagues; after a little wrangling with the train conductor 20 minutes after departure he said I could lie on the floor for the journey. Not ideal, but at least I was on my way.

Saturday
Arriving into Mettupalayam (the bottom of the hill) at about 6am we attempted to board the train that heads up the hill to Ooty...again I had the same problem, except I was now WL43. Ended up standing for 3.5/5 hour train journey (along with 3 others of the group), in a carriage where most of the locals made it fairly clear that the didn't want us to be there. Thankfully the scenery was fairly stunning with views out over the valley, with vegetation (somewhat reminiscent of parts of New Zealand) lining the track for most of the journey and fairly frequent breaks as the steam engine took on water and fuel (at one about 30 monkeys came converged on the train from all directions). Here's a picture of the train (not mine unfortunately but one I got off the net)

Upon reaching Ooty I felt a certain sense of elation, which was seemingly echoed by the train station announcer's words of "you are very priviledged to have taken this train today" - wasn't quite getting the same vibe but nevertheless pleased to stretch my legs again. The furore continued upon detraining with newspaper reporters and television cameras milling about on the platform - a couple of our group were interviewed and pictures taken. Apparently it turns out that the train had only that day been provisionally awarded special heritage status by UNESCO (see Chennai Online News) and that we were the first ones to arrive after this.)

After this excitement a couple of set off to find somewhere to stay and ended up with a chalet-type thing for about £3 for the night. It was pretty basic but clean and had hot water, so I could have my first hot shower since getting here - back in Vellore I was happy enough to have cool showers!

Lunch came and went (but could this have been the start of all the trouble?) and we stepped out into the street to the sight of Monsoon! everywhere. At that point I had never become so wet in such a short period of period time (the rain on Sunday was even worse) but in typical tropical fashion we expected it to be over within an hour or two and so took a leisurely trip out to the boathouse by the lake. Now at this point, being fairly wet I was getting pretty cold so I bought a fleecy hat (dual purpose, keep head warm and keep more rain from soaking head). I never once expected to be buying a winter hat in India, but such is life. When thoughts of taking a pedal boat were dashed after a good hour's wait for the rain to subside (it didn't) and with stubborness that only tourists can possess we went on a motorboat (with canopy around the lake). I'd like to say that this made the whole waiting around thing worthwhile and to a certain extent it was good but y'know, being in a boat in monsoon rain with the wind blowing water off the canopy and onto the only clean/dry clothes you have with you whilst you reminisce about the coat you left in your bag back at the hotel, sound good? Climbed out of the boat after these 20 minutes and sprinted through the rain, shivered whilst aboard the autorickshaw and sprinted through the rain again to the chalet before an alternately roasting/freezing shower. Spent the rest of the evening shivering through dinner, but slept ok afterwards.

Strangely although this day sounds like a nightmare, it was quite fun and I ate some pretty good chocolate (or was this the source of all the trouble?) along the way.

Sunday
Cold. But dry and warm in the sun, pleasant nap over breakfast! Today most of the group had arranged to hike up in the hills around the main town. Well when I say 'hike' it was more of a dander, through the tea plantations and fields. This was the best part of the weekend for me, not only was it not raining or too cold but it made it seem worthwhile making the difficult journey to the town. The sights were pretty fantastic (pity I forgot my camera...stupid stupid) and the silence was amazing, as the guide said 'this is not India'. Apparently the area to which we went was in a lot of the Bollywood films and Tamil films so there were big gatherings of India tourists in the distance. Also we were told that we weren't allowed to take pictures of one of the shepherds working in the fields or the sheep that she tended as she worked for the Government (apparently this rule extends beyond the military and police in India), before "enjoying" a bumpy journey downhill on a crowded bus at breakneck speed.

Back to Ooty, pick up bags, heavens open again, streets fill with water almost instantly, recently dry clothes saturate, shivering starts. Go for lunch, strangely not hungry. Visit toilet. Realise that niggly stomach pains were pointing to something rather more sinister. Worry about long train journey ahead. Take Immodium.

Left for the station immediately after lunch, find my *allocated* seat! Don't know what I would have done without one on the way back so that's good. Settle in for ride, doze off and on, look out through the windows, enjoying some of the views I had missed out on on the way up. Talked to a few of the people around me as well; seems like everyone in this area has heard of CMC, which is a good sign. Unfortunately despite my obvious annoyance at the fact, the father of the small child behind me wants to bow to said child's wishes and open the window fully. Now as I said it was not hugely warm and I wasn't feeling exactly well. A compromise of half open existed for about 20 minutes before somewhat rudely the father reaches over and opens the window fully again without even bothering to ask me (it probably isn't considered rude in India to do this, but I wasn't in the best of form). Cosequently I reached the bottom shivering like a leaf and despite pacing up and down the platform I remained this way pretty much until we got to Vellore. I tried to sleep on the longer train (I had a confirmed bunk this time) but was beginning to get more stomach pains and at one point had to rush to the toilet.

Monday
Arrived back at the Annexe at 3.30am. Didn't sleep too well for the rest of the night and wasn't well enough to go into the hospital on Monday at all. Drank some lovely oral rehydration solution and nibbled on some Milk Bikis, dry and plain. Thankfully I didn't really have any nausea as that would have been much worse. Felt a bit better by evening and able to go out for tea but didn't eat much then spent another fairly restless night.

Tuesday
Starting to feel a bit better, so I head into the department in the morning, but have to retire injured after the first couple of hours before making a triumphant return in the late afternoon. In between I made a dashing mid day expedition to retrieve money and purchase pharamaceutical items including much needed antibiotics, analgesia and some more sugary salty mix (definitely needed after the sun). Out for dinner again before a less restless but interrupted sleep (once to take dose 2 of cipro and secondly at 6.30 when Ravi my laundry man brought back the clothes I gave him on Monday).

And at last the write up is done. Sorry about that epic, hope it's not too much of a slog. Feel free to leave any comments and stuff if you're having a look, as the 2nd Immortal Phrase says, "Ask Any Questions and Take Ye Any Photographs You Like" (the 1st Immortal Phrase refers to different forms of cream).

Brain drain

Hello

Another hot sunny morning here in Vellore, but the clouds have come over and it looks as though it could rain again today. Yesterday's downpour was well received (by me) as it cooled the temperature significantly and managed to have a good night's sleep for once. Still finding the sights and sounds and roads of India quite daunting, but beginning to come to terms with things. Lots of interesting stuff happening in Casualty this week, quite a lot of RTAs, a good few of which Dead on Arrival (somewhat less "interesting"), some overdoses (apparently the area around here is the suicide capital of the world...see BBC News), a couple of cases of malaria and a good few ordinary medical problems too such as food poisoning, heart attacks, strokes and the like. Fortunately none of these things have happened to me yet, although I've felt close to death at many times when I've been in an 'autorickshaw'. Story of the day was a guy who was a driver of one of these autos and was driving along when his vehicle hit a bump and he hit his head off the roof and was knocked unconscious and stopped breathing; he was pronounced dead when he arrived. I'll have to make sure I hold on tightly. It's quite a different medical system to the one I'm used to in the UK, I had never quite appreciated the difference having a national health service made, even more so here when the people have little or no savings and every investigation, every needle, every drug and every bag of fluids has to be paid for. In fact the way it works is that the doctor writes the prescription and the family has to go out and queue up at the pharmacy where they are given the syringes, fluids, venflons etc. and pay in advance for any bloods or imaging that is going to be carried out. It is not until they bring these items or the receipts in that treatment is started. Also referral for further treatment, e.g. ICU, is often based on who can pay rather than who needs the treatment. I have heard the argument that because CMC is a Mission Hospital they should pay for the treatment (and they do for the most needy of patients - discerning these patients is the difficulty, especially in an acute situation) but it would cost an awful lot of money and wouldn't be sustainable for very long. Otherwise I am very impressed with the standard of care, they have CTs and MRI scanners and all the results are available almost as soon as the scan is taken (depending on payment of course), there is good teaching from the senior staff and the junior staff all seem to have a good level of knowledge. It is also interesting to see the interactions between the doctor and the patient/relatives - as I don't understand the local language here I am judging mainly on body language, but it seems more up front than the "touchy feely" approach we are taught in Dundee. Anyhow, rambling aside.

Also managed to bump into the self-titled "laundry man" today to whom I am paying the equivalent of £4 and he'll do all my washing for me for the 4 weeks I'm here. Sounds pretty good to me.

I'm sure I had more to say but half an hour in the sweltering computer room and my brain is mush. No sign of that rain yet.

May be off to Ooty this weekend as long as I get a ticket - I'm currently on the waiting list, so hope that works out or I may be staying here looking round Vellore Fort in the centre of town, which would be ok.

Anyhow. All the best.
Dave.

For the benefit of Mr Kite

Hello
I am in India! Hurray! Wish I had the energy to tell you of the marvellously exciting:

1. Taxi journey from Chennai airport to Vellore in the wee small hours of the morning.
2. Cheap and tasty food that I have been eating
3. Good books (How to be a bad birdwatcher, The Princess Bride and Generation X)
4. Hospital and emergency department here in Vellore (Snake bites et al)
5. Heat...well that's not marvellously exciting but continuously penetrating and interrupting of sleep as well as dehydrating...but I'll get over it!
6. Noise! Yes and at all hours of the day.
7. Other elective students from various parts of the globe.

But maybe some other time, eh? Now I've got my internet working at the hospital, should be easy enough.

Right off to have a cold shower to cool down and then out for some tea methinks. All the best.

0.6p per second

Heathrow 5.20am and there is an increasingly huge queue, which I am about to join, forming for departures. Need to blag my way into the Lufthansa Lounge as well using my Dad's "Diamond Club" card.
This is the first step on my long and increasingly unknown journey into Asia. So far this first night has been pretty good. Dinner at the hotel ok, good power shower, which is always a bonus, expensive taxi to airport, fast check-in using self-service machine; I'm sure these things will become the norm in the coming years, speeds up things muchly and you can choose your own seats, which is good. Anyhoo. Hopefully this won't be my only entry for the next month. Hope you all keep well in the intervening time.
Best be off. 4p left...

Gasp (and sigh).

No more exams!
All done...phew....pretty tricky stuff in the end, got the wrong end of the stick on a few questions, but hey, that's par for the course. But no more on that madness.
Getting ready to head off to India tomorrow, scary stuff.
Room is now quite empty as moving all my stuff (well Helen and my parents are) to my future marital home/flat.
Out for tea this evening, should be good
Attempting to move blog. You shall see if this is successful.
Looking out for updates from fellow world travelling bloggers.

Apologies for non-verbosity of above. Maybe more later.

Time is but a memory

Just a quick message
Shoulder deep in 'revision' at the moment; thankfully handed in all the peripheral paperwork that is required these days for a medical degree and have oooh...about 4 whole days to revise for the actual exam. For the first exam since I came to medical school I feel like I am actually revising rather than learning stuff for the first time, which is good, but although I know a lot more I imagine that everyone else knows a lot lot more. Ah well, just have to try my best as me 'ol mum always says. Scarily only 8 weeks on Thursday till I get married too and in the intervening time I head off to India, for which I am not at all mentally prepared. The massive mental block of 'the exams' has cast a dark shadow over any events following it. I don't feel too stressed but my body is attempting to tell me otherwise with my previously seen lack of hunger in the morning, fatigue and other less than desirable effects.

Points:

• Must write about the time "everyone" came to Dundee to visit as it was very momentous, but too tired right now


• New link to Pete's blog about his elective to Boliva, sure to be interesting if he can get to a compy(-386) out there


• I may be changing the URL of this blog at the end of the week as I am moving flat and this internet account will be deactivated at some point during July, but will redirect it.

Hope you are all well.