August 7th: Start-ups & Smoothies

Today we talked to people outside of healthcare for the first time. We first went to a company called Catalyzer. This company aims to help support startups, and they work out of this high tech very new looking space, with glass walls and colorful paintings all over done by local school children. The co-founders were incredible: he was a former yogi turned start-up entrepreneur, she had done multiple degrees in the US and now educated 25,000 students around the city.

Mural done by local students

We also met with a local doctor who had created a low cost diagnostic and treatment facility for kids with blood disorders to get free transfusions. Then? Oh they got us Dominoes Pizza. It was a bit different than the Dominoes we are used to in the US (more spice, no meat) but still a fun mix up to the normal curry and rice.

Drawings sent from students in the US to their pen pals in India

Then we went to meet with the consul general at the U.S. Embassy. The building was large and pink and looked very colonial. The CG was extremely nice- very supportive of our ideas and he had a lot of helpful insights on the trends in India.

Looking over city from the hospital

We then went to Apollo Hospital, one of the largest private hospital chains in the area. Our time there was a bit disjointed and I promised a neonatologist I would return Saturday morning to give a device demo. Because there is really nothing else I'd prefer to do on Saturday. In the morning. Our new wonderful tour guide, Divya, took us to her local gym. When I say gym, I really mean mini resort. We went to their cafe and ordered a bunch of smoothies.

Carmen and Akrita enjoying desserts at the cafe

After the relaxation time we jumped back in the van to visit a group nearby who focused on tech transfer. They calmly answered all of our silly questions about IP in India and fed us tea and cookies. With all of these meetings, we are averaging maybe 5 cups of tea a day. At least the caffeine serving sizes are much smaller here- their tea cups are the size of our espresso shots.

August 6th: Back to Hyderabad

After breakfast at the hotel we checked out of the hotel (this involved its own level of drama) and piled into the vans, much later than intended, to return to NRI. When we arrived we briefly got to pop into the post-natal ward before being whisked off to present to the medical students and residents. At the end of the presentation we actually met several students originally from the US who had come out to India for medical school.

NRI students

A pediatric resident then took me to the pediatric ward where we were able to talk about my device in depth. A medical student joined us and we discussed features, how to really get through to mothers, and the challenges around cultural practices. For example, there are groups that don't believe in a child wearing any clothing for the first 11 days of live. The resident seemed frustrated by how difficult it was to implement change, but she seemed resilient.

She took me to see the labor ward and then returned me to the auditorium to meet back up with my group. We then went to find members of the prosthetic team who had been promised a Jaipur limb. When we found John and Jason, Jason proudly showed us the new limb that had been given to him. It was clearly his baby. We tried not to judge.

We all climbed back into the cars. We made a couple of quick stops on the way to the train station. The first was to buy fruit (mmmm bananas and pomegranates) and the second was to buy me some more spices (my first batch was mysterious MIA). We got to the train station around 1pm, but our 1:30pm train got continually delayed until around 2:30 or so. We sat on the floor, playing bananagrams as we waited.

Buying fruit

This train adventure was definitely more eventful than the one we took on the way to Guntur. Instead of the AC compartment, we were in the "everymans" section of the train. The windows and doors were both open, and we were able to see the Indian countryside fly by.

Countryside

Fiona looking out through the door

Our train didn't get into Hyderabad until 7:45 or so. We didn't manage to make it back to the hotel until 10 pm. We were exhausted and covered in train and hungry (no lunch or dinner, i.e. a bit crazed). We hurriedly checked back in, ordered food (this took about, oh, 10 or so tries), showered, and went to bed around 11:30 or so.

August 5th: The More Rural Side of India

I woke up at 4:30 but managed to stay in bed until about 5:30 or so. We had to be downstairs and ready by 7am so we got up and threw stuff together. Breakfast wasn't open yet so Lina and I went out to the street and bought a couple of bananas.

The drive to the rural village took about a half an hour. We met with three local handicapped villagers to discuss their experiences with prosthetics. Some of us then went to a local house to speak with a woman with a 2-month old baby about her experiences with childbirth and caring for her baby. Then we moved to a house down the road to speak with a woman, and her family, who was close to delivery about her experiences. What I found fascinating was that both of them had delivered at private hospitals, even though they would get reimbursed at government hospitals. They both seemed to be relatively well off, educated, and supported by their family.

Villager handicapped by polio and his father

Family with two month old girl

We then assembled at the local town hall and met with a local ANM (axillary nurse midwife) and two ASHA workers. The trio showed us materials they gave pregnant and new mothers. We only had a few minutes with them because they were late for a meeting with other ASHA workers. Each worker supports a population of around 1000 villagers, which, relative the the ratio of doctors to villagers, is pretty good.

Listening to ANM & ASHA workers

 We then met with three other mothers, speaking with them about their delivery experiences and getting feedback on the hat (big surprise, they all had different opinions). We spoke until their babies got too fussy and then switched to speaking with some polio victims. It was so hard seeing these men with their bodies so twisted by polio. They would ask what we could do for them and the truth was nothing. In fact, during this stay in India the presence of handicapped people has been much more prevalent than during my previous stay. I've been shocked by how many kids I've seen who have to drag themselves around because their legs have been destroyed by polio.

After we left the village we went to a local Buddhist temple and walked around. We then went to two local museums. At the first one there were bats hanging from the trees! The old stone archeological artifact was cool.... but gosh bats! They were so cool! We weren't allowed to photograph anything in the second museum but we might have been a bit naughty and snuck in a few photos.

Giant Buddha

Group outside the first museum

We then went to a Hindu temple. When we arrived we had to leave our shoes in the car and wash out feet outside the temple (we were pretty convinced this just made them dirtier, but eh not our temple not our rules). They were in the process of filming either a movie or a TV show and we kept kind of getting in the set (which apparently they are okay with because they love recruiting foreigners into their shows). We weren't able to go into the main part of the temple for about 45 minutes or so, but it was worth the wait. We followed the line and got blessed by a couple of priests (?). I was one of the first people to go and simply tried to mimic the Indian people ahead of me.

Film crew

On our way back to Guntur we stopped by a famous spice shop and bought some local spices. Guntur is known as the spiciest part of India and they grow some very famous chilies. Back at the hotel we had some team meetings and enjoyed some room service. Nothing like lassis and a chick flick at the end of a long hot day.

August 4th: Train to Guntur

The alarm went off at 4:30 am. We had gone to bed maybe three hours beforehand, but rolled out of bed anyways and pulled on our clothes. By 5am we were downstairs, throwing our bags into the car and paying for our hotel stay.

We made a quick stop by Akhila's house to drop off our luggage. We only needed enough for the next two or so days. We then picked up Lillian on our way to the train station. We arrived at the station an hour early so Akrita brought us to get some breakfast. Our train left at 7 am and we spent the next couple of hours (5 to be exact) in an air conditioned compartment of the train, watching the Indian countryside go by.

When we arrived in Guntur we drove to the hotel, dropped off our stuff, and left for a private hospital half an hour away. When we arrived we gave brief presentations on our projects to the hospital administrators. Then the neonatal team went off to the PICU and NICU where we were led around by pediatric fellows who answered all of our questions.

Prior to leaving, with Akhila's help, I bought a thermometer from the pharmacy located in the hospital for 44 rupees (less than a dollar!). We then drove back to Gutur.

We made it back to the hotel around 6pm. I promptly fell asleep, telling myself I was taking a small nap. When my alarm went off at 7, I switched it to 8. When it went off at 8, I turned it off and fell asleep, jeans and all, until 2:30 that morning.

August 3rd: “Spa” Day

We arrived outside a house maybe half an hour or so from our hotel. The sign outside boasted that they could treat a plethora of conditions, including but not limited to paralysis, joint pain, and obesity. This is where Akhila had booked our hair oil treatments and massages. When we walked in there was a series of pictures of different services we could choose. It was very similar to ordering food off of a menu based on pictures, except we didn’t know the prices.

They could only take one girl and one boy at a time. Fiona and Yu-Ja went first, both for full body massages. Meanwhile, Lina, Jason, Akrita and I had decided we really wanted some fruit so we wandered around the neighborhood a bit. We ended up getting several coconuts to share. The vender hacked the tops off with a machete then placed in straws for each of us. The coconut water wasn’t extremely sweet, but was still enjoyable. When Fiona and Yu-Ja came out, Jason and I went in. The woman instructed me to remove the top half of my clothing, and then sat me, topless, in a metal chair. I tried to act calm, like hey I’m sure she just loves massaging topless white girls. This isn’t weird or anything. It’s times like this that you repeat to yourself over and over “This is a cultural experience. This is a cultural experience. This is a cultural experience.”

In the metal chair she started massaging oil on my scalp, and it was, I admit, pretty relaxing. She then massaged my shoulders a bit and pushed me forward to brush over my upper back. She then laid out a towel on a metal table and instructed me to lie down. My head was placed in a divot at the end of the table. To my immense relief, she placed a cloth over my top half. She then tied a string under my hair and right over my eyebrows. She placed two pieces of cotton on my eyes and secured them with the string.

I then heard the sound of heating oil. “Holy guacamole” I thought, “she’s going to pour boiling oil on my face”. I tried to remain nonchalant, my eyes covered, wishing I could watch what was going on. This is what I reasoned from the sounds in the room: She filled a hanging pot over my head with oil and rocked it so it moved slowly back and forth across my forehead. The oil, despite my fears, was a very pleasant temperature. The oil would then drain under my head into a metal bucket, which she would heat back up and pour back in the hanging pot. I only figured that there was a device pouring the oil on me because I could hear the woman moving around the room. She would also intermittently massage my hair and head as the oil poured over me.

The treatment in total lasted around 45 minutes, interrupted occasionally by “Barbie Girl” playing from someone’s cell phone. At the end she squeezed the oil from my hair and sat me back down in the metal chair, where she wiped oil off of me and ran her fingers, determinedly, through the knots in my hair. She came away with a pretty good chunk. I felt strangely that I wanted to apologize for my knots, but then tried to rationalize that even Indian women probably had knots in their hair, and think about how much longer their hair was compared to mine. She put my hair into a bun and sent me outside to sit for the next three hours or four hours while we waited for everyone else to complete their treatments.

We sat, covered in oil, in their entry room until 6pm or so. At points some of us would leave, walk around, buy some food. Lina and I both bought samosas at a local bakery. The samosas in Hyderabad, like the food in general, were much spicier than the ones I had eaten in Kolkata and the US. We got back to the hotel around 6:30 or so and had to leave for Akhila’s house by 7:15, so we took turns hoping in the shower to try to wash of the large quantities of oil. After shampooing twice, I still had oil in my hair, and I suspect it will linger for a while.

While getting ready, Lina, Fiona, and I (well Fiona really) decided that we should all wear bright red lipstick. We met up with everyone, donning fiery lips, and drove to Akhila’s, late per usual because it seems like its impossible for us to all be ready on time.

Akhila’s family’s house is stunning. All of the floors, stairs, etc, are made out of marble. They served us all freshly macheted coconuts, and then brought out some guavas sprinkled in salt and chili power. Lillian then gave us all hand painted cards she had bought at the market that day (there is a camel painted on mine, no big deal its totally awesome). They then ushered us to another room where they had a large spread of homemade food. It was probably the best Indian food I’ve ever had. They kept it much more mild for us than they normally ate. Some of the dishes included vegetable biryani, eggplant stuffed with spices, and these rice cakes. For dessert they had several options, including the Indian equivalent of cotton candy.

Sitting around enjoying coconut water

Guava with salt and chili powder

We then were brought upstairs to a sitting room. Akhila’s younger sister painted our eyes and gave us bindis as they served us ice cream. Akhila and her sister then performed a traditional Indian song for us. They then pushed aside all the chairs, and to Fiona’s request, started blasting One Direction. Amu and Akhila then tought us traditional Indian dance moves (very à la Slum Dog Millionaire) and some Bollywood moves. We, of course, looked ridiculous.

We got home around 11 or so, and hurriedly packed so that we could get to bed around 12:30 or so. We would be getting up the next morning at 4:30 and leaving the hotel by 5am.

August 2nd: The First Day of Babies

After managing to stay awake until 8pm, Fiona and I managed to sleep the entire night. The three of us woke around 6am, feeling much more rested. We counted down the minutes until 7:30, when breakfast started, then hurried downstairs.

The internet, to our horror, wasn't working upstairs so we eagerly caught up on emails and the outside world during breakfast. The whole team was assembled by 9am, including Lillian, a student from the school of public health doing research in Hyderabad for six months and Akhila's younger sister.

The neonatal team squeezed into a small car (the driver kindly assured us that seat belts were not necessary) and we were off to our first hospital for the day, a government neonatal and pediatric hospital (picture below).

Our time in this facility was incredible. We ran around between all of the different wards they had. Not only did they have a level three NICU but they also had multiple other lower level NICU rooms, a resuscitation room, a bilirubin room, and a room for very low birth weight/premature infants.

Babies receiving phototherapy treatment in one of the "NICUs"

I spent most of my time taking pictures of fans and air conditioning units and their educational posters on the wall and trying to slyly measure the temperature in each room. The goal was to understand what was the environment that these babies were in.

How dost one rag?

 

We were able to spend time sitting down with a group of pediatricians/neonatologists and medical students and were able to get a lot of feedback on our device. By then it was 12:45 and we were rushed off to the local medical college because we had a meeting with the principle there.

After meeting with the principle and a couple other doctors and eating an assortment of cookies and bananas, we were brought to a large auditorium. The school's medical students filed in and we presented to them for the next couple of hours.

Around 4:30 or so we left the medical college and traversed some pretty busy roads (I might have actually held onto Akhila the entire time). We tried to get some phones, unsuccessfully, and went to the most famous chaat place in town. Chaat (its taken multiple visits to India and Nepal to understand this concept) literally means a small snack, and there are lots of different options. If I understand correctly, which I probably don't, samosas would be considered chaat.

We took our chaat and ate it in the van, literally feeding one another. I had just realized I had lost my water bottle (my favorite Johns Hopkins BME water bottle NBD or anything) and put on a very brave face.

We then drove to Lotus Hospital, a private hospital that caters just to pediatrics. This facility was pretty stunning. First of all, the waiting room was Madagascar themed. Solid choice. We sat in little children chairs and waited. This made some of the Indian families take pictures of us. We then toured their facilities for the next couple of hours. It ended with us giving some presentations and then them serving us a large banquet dinner (very spicy but very delicious). They told us they had decreased the spice level for us. We couldn't tell.

Another important fact about this facility: each of their patient rooms had themes. These themes included Spiderman and Shrek.

We left the facility around 10pm and got back around 10:30. Its almost midnight (whoops) but apparently tomorrow is our day off. Yoga and massages? Don't mind if I do.....

August 1st: Bharat Vikas Vikalanga Parishad & NIMS

After Akhila picked us up from the airport, we drove around Hyderabad for an hour and a half. We finally made it to the Oyster Suites, our hotel during our Hyderabad stay. We had about an hour to get changed and unpacked and eat some breakfast. And then off to the races!

Our first stop was an NGO called Bharat Vikas Vikalanga Parishad. This group works on giving prosthetics to amputees (mostly due to road accidents). This group is able to provides these prosthetics at 1000 ruppees per patient (that's just over 16 USD!) The organization provides all of these services for free and depends upon donations. They showed us the equipment they use for the shaping of the low cost prosthetics. We even met two patients who had just been fit and we were able to photograph the first time a man had walked since getting his leg amputated 8 months ago (he had had a tumor in his leg).

Placing his leg in the prosthetic for the first time

When the prosthetic didn't fit exactly right, they showed us how they could easily cut it down so that it was right for him. The whole process only took 3 hours.

Practicing walking

After we left Bharat, we went right over to a hospital called NIMS. We met with an orthopedic surgeon, and his team, who had done a lost of work on developing ultra-low cost prosthetics for victims of polio. He was very impressed by everything Jason had to show him and was eager to coordinate clinical trials for the knee.

While none of this was directly helpful for my neonatal hypothermia project, it was still useful to ask questions about local manufacturing and advertising strategies. Tomorrow is supposed to be much more geared towards my project, which is exciting.

In the meantime we are all struggling to stay awake. I took advantage of our lovely room service to get some curd (yogurt) and masala tea (which I have been addicted to since last August in Nepal).

Some of us have been able to stay awake more successfully than others.....

Fiona "reading her book"