Namaste Hyderabad

Today was our last day in Hyderabad. Before we all left to go our separate ways, we had one last meeting scheduled at Care Hospital with Dr. Krishnamohan. We arrived at CARE at 10:00 and went to see Dr. Krishnamohan in the Cath Lab. Apparently, he had been working all night and there had been two temporary pacing procedures at night and another one early in the morning. He decided to walk us around to see the patients so we could observe how the temporary pacemaker was secured, how the patients were doing, and how their ECG signals looked.

Dr. Krishnamohan also brought us into the imaging room to look at the xrays and fluoro images of these patients. While we were in this room he also showed us some of the leads that the hospital is using and even allowed us to play around with one and see how it felt. This was a really education and helpful experience for us and we really appreciated Dr. Krishnamohan's help with us.

Dhananjay, Dr. Krishnamohan, Erin, and Shruthi at CARE Hospital

Before we left CARE for our last time, we made sure to take a picture and thank him over and over again for all the help he provided us on this trip and over the past few months. We are looking forward to continue our collaboration with him and are hoping to have the chance to come visit again with prototypes later in the spring.

After leaving the hospital we headed a few buildings down the street to Karachi bakery to pick up some Karachi biscuits (cookies), which are famous here in India, to take home to our families. We then made our way back to the Taj Banjara and past our favorite lake for the last time so we could pack our bags and head out. Dhananjay was heading to Mumbai and Erin and Shruthi were heading to Jaipur for the next few days. The car took Dhananjay to the airport while Erin and Shruthi went to visit her families place where they enjoyed a nice authentic home cooked, South Indian meal, and got Mehndi (henna done).

Mehndi on the front of Erin's hands

Mehndi comes in three different styles, Arabic, Indian, and Designer. Both Erin and Shruthi decided to get Indian, which was an intricate pattern completely covering both the front and back of their hands. Each person's Mehndi can take anywhere from 45 minuts to two hours depending on the level of detail and how much of the arm is done. Once the Mehndi has been put on, you are supposed to wait anywhere from 4 hours to 24 hours for it to dry before peeling or scraping it off. Apparently the longer the Mehndi sits on your skin, the darker the color gets. Unfortunately, Shruthi and Erin had to leave for the airport at 4:30 so they were not able to remove the Mehndi until they got to the airport. Luckily, at this point everything was dried, so it came off pretty easily and they were able to have two fully functional and extremely intricate hands.

Erin and Shruthi with their Mehndi and trying not to touch anything

Erin and Shruthi will now be sight-seeing tourists for the next few days with David, who will be meeting up with them in Jaipur. Dhananjay is going to be visiting friends in family in his hometown and Mumbai and will be heading back to America at the beginning of January for our Spring semester.

Until our next global health trip, Namaste and thanks for reading!

A Day With the Village People

Yesterday was our last full day of work in Hyderabad. We decided to visit the peripheral city of Mahabubnagar because Dr. Krishnamohan had a cardiologist contact at a hospital in the town.

We left Hyderabad around 10:30 and set off on our 100 kilometer journey to Mahabubnagar. Knowing that we were going to a peripheral city, we were all expecting a treacherous journey similar to our drive to Baharampu. We were all pleasantly suprsised to find a smooth drive, with nicely paved roads, very little traffic, and only an hour and a half drive. In fact, the ride was so smooth, that all three of us were able to fall asleep on the drive, even when crammed into the back of a tiny car.

SVS Medical College Hospital

We arrived to SVS Medical College in Mahabubnagar around 12:00pm and were immediately brought to the Cath lab. While we sat in the Cathlab area waiting for Dr. Sanjeeva Kumar, a cardiologist and one of the founders of the cardiology department at the hospital, we could not help but admire the facilities in this hospital. Everything was extremely well kept, the entire hospital looked clean, and this was in a place where the majority of the population was under the poverty line. SVS is a private hospital, however, because of the Aarogyasri insurance scheme, patients below the poverty line are able to get free medical care at private facilities such as SVS. 

Paitent shoes outside of the Cardiology department

Anyways, while we were waiting for Dr. Kumar to finish with his patients and a procedure, Shruthi decided to go into the Cath Lab with him and watch. The Cath Lab was very similar to Hopkins: extremely nice equipment, very clean, and the doctor started and finished the angiograph in under ten minutes. 

Authentic South Indian lunch we enjoyed with Dr. Kumar at the hospitals cafeteria

When we finally had the chance to talk with Dr. Kumar and Dr. Narayana, another consulting cardiologist at the hospital, we were able to learn alot about the volume of patients they see here, the struggles they face with pacing procedures, their protocols for both temporary and permanent pacing, and the issues and complications they face as a peripheral hospital. 

Deserted hallway at the government hospital

After leaving SVS, we headed 3 kilometers down the road to a District Government hospital. Much to our surprise, this government hospital seemed deserted and was a complete opposite from what we had seen down the road. When we walked inside, there was no security gaurds, or even patients sitting around, something very uncommon here in India, so we took it upon ourselves to walk around and find someone to talk to. We noticed from the signs on the wall that this hospital did not appear to have a full cardiology department, but that there may have been a cardiologist who generally worked there. 

District Hospital of Mahabubnahar

We finally found ourselves on the second floor of the hospital outside of the Hospital Superindendents office. We knocked, introduced ourselves, and she kindly allowed us to come in and talk. Although she was not as familiar with the cardiac department and cardiology capabilities of the hospital, she did her best to explain to us the problems that there hospital faced and what facilities and things they did have access to. After our talk, we said our goodbyes which Shruthi somehow managed to turn into a 30 minute conversation after realizing that the superindenant was also Tamil and had three daughters our age, one of whom looked like Shruthi and was also named Shruthi.

Shilparamam market in Hyderabad

 After a long day, we got in the car to head back to Hyderabad. Erin and Shruthi, who wanted to get some more shopping in, decided to head out to Shilparamam market for an hour or so before it closed. This was a suprisingly large market with lots of colorful clothes, scarves, and hand-made art work. Erin and Shruthi both ended up buying some things and then headed back to the hotel to get some sleep before there last monrning in Hyderabad.

A Little Glimpse Into Indian Hospitality

During our first trip to India I was extremely surprised that when we showed up to our hotel for the first time at 5:00 in the morning, not only was there a person behind the desk ready to check us in, but there was at least eight other staff standing around with smiles on their faces ready to get us whatever we needed and carry our bags up to our room. In America, when you show up to a hotel during off hours you generally consider yourself lucky if you are able to walk into the hotel and not have to press a bell to get a staff member to help you out. That is not to say that hospitality in America is bad, but just that at hotels here in India, they view warm welcomes a little bit differently. 

Also, when I go to a hotel in the US, I consider it to have good hospitality if they offer me free cookies when I check in and greet me with a pleasant good morning when I pass by the counter on my way out in the morning. Although Indian hotels don't generally have fresh cookies waiting for you on your arrival, they do have a fleet of staff there to help you with everything and anything you could need. At first, I thought having this much staff at a hotel was a bit excessive; especially since it seemed like there was always four or five people who seemed to be just standing around. But I guess in a country with 1.2 billion people, having that many staff is not excessive, but simply the hotel businesses way of helping give as many of these people a job as they can.

As mentioned in the last post, before Shruthi left to visit her grandparents, she made sure that the hotel staff new that I was not feeling well and that they should check up on me. I assumed they would give me a call in the evening and if I was feeling fine, that would be the end of it. I was surprised to learn that it was not just one person who had been assigned to check up on me, but at least 5 different people. Even today, after most of them knew I was feeling better, I got two visits to the door, a phone call from the front desk asking if they could bring anything up to me, and a personal chat with the chef who had made me some bland food yesterday asking if he could make me anything specific for breakfast. I'm telling you, the people here are great and really want to make sure your stay is as pleasant as possible.

Later in the day, Shruthi and I went down stairs to the lobby to have a snack and watch as lots of extravagantly dressed people filed into the hotel for a wedding. While we sat in the crowded lobby, the chef came up to us again and asked how I was feeling and if he could get us anything. We both had eaten dinner earlier, so we told him no thank you and decided to just enjoy some of the free snacks they put out on the table. Not even ten minutes later, the chef was back at our table holding a delicious looking plate of sundried tomato and parmesean stuffed chicken with pesto. He put it down on the table and mentioned something about Christmas and holiday spirit, and left us to enjoy this delicious snack (on the house). 

Although I had no idea what people meant when they talked about Indian hospitality before I came here, I have really enjoyed interacting with all the staff and having at least five people wish me a good morning [or afternoon or night] and offer to help me with anything I need anytime I walk through the lobby.

A Mild Case of India

A trip to India is not complete unless someone gets sick. And, seeing as this time the team consists of two people native to India, and one who is not, Erin was the lucky one to get sick.

This morning the team had planned to go to Osmania Medical College to speak with a cardiologist and MBBS students who do temporary pacemakers. They had planned to meet the car around 9:30 so they could get to the hospital by 10:30. Erin had made it downstairs, but had not been feeling the greatest all night and was still not feeling too great this morning, so she decided it would be best if she stayed back for the day. Since Shruthi was leaving later in the day for Chennai to visit her grandparents, she decided to stay back with Erin and make sure she was okay. Also, since she was going to be leaving in the afternoon, she made sure all the staff at the hotel knew that Erin was not feeling well and that they should keep checking up on her throughout the day. And this they did.

Since neither Erin or Shruthi were able to go to Osmania, Dhananjay was on his own with Naresh for the morning. He met with Dr. Imamuddin at Osmania and learned about how they do temporary pacing and the difficulties they have. He also presented some of our potential ideas and was able to gauge his interest and potential willingness to adapt. Because Dr. Imamudin was a little busy, Dhananjay was only able to sit and talk with him for about 30 minutes; however when they finished, he was able to speak with two patients who had received temporary pacing and learn a little bit more about their procedure, their limitations, and how they came to the hospital.

Sunset view from the hotel window this evening

After Osmania, Dhananjay returned to the hotel and checked up on Erin who had been resting and sleeping all morning. Dhananjay was also tired and, since there were no other meetings for the day, went to his room to take a nap. The rest of the day was spent catching up on sleep and relaxing so that hopefully they both felt well enough to go do some site seeing on their day off tomorrow.

Keeping Appointments in India

Friday was set to be another busy day for the team. After waking up and eating an an early breakfast, we walked across the street to CARE hospital for our first meeting of the day.

When we got to CARE, we learned that the cardiac thoracic surgeon we were supposed to be meeting with had ended up having to come in to the hospital overnight to deal with an emergency and thus, had needed to rearrange his schedule and was running a bit behind. We sat outside in the waiting room while he saw the last couple patients he needed to and then made our way into his office.

Dr. Nemanth was a contact that Dr. Krishnamohan had set us up with. He was another very down to earth doctor and gave some really valuable insight into cardiac surgery and temporary pacing. He also was a very innovative thinker and walked us through some potential avenues for devices and procedures that he was familiar with and that we might find helpful. Unfortunately because Dr. Nemanth had needed to switch around his schedule, he had a procedure directly following our meeting and we were only able to talk to him for an hour. However, before we left he told us we were welcome to come watch a procedure and he would help answer more questions (something we are hoping to do early next week).

After our meeting at CARE we were supposed to head over to Osmania government hospital to meet with another cardiologist. Before we left, Naresh gave the doctor a call and learned that he was going to be unable to meet us today. Instead, Naresh suggested we try to go to another hospital, NIMS, and try our luck there. He was unable to get a hold of a doctor right away, but since we didnt have another meeting scheduled until 1, he told us he would keep trying.

Since the team had some time, they decided to go by a nearby street market bazaar, Ghandi Bazaar, to do a little street side shopping. While at the market, Naresh called again to let us know that the two meetings we had at another facility, CARE Nompally, had been cancelled again because the doctors were busy. We decided to go grab lunch and then head back to the hotel to wait for our afternoon meeting which was still on.

At 3:15, we headed to the CARE outpatient center (OPD). The CARE OPD center is separate from the main inpatient center, but is just about a 5 minute drive from the hotel. At the OPD, we met with Dr. Sridevi, another cardiologist on our graduate committe. Dr. Sridevi was excited to see us and talk in person and was again very helpful with filtering through some of our ideas. She had some hesitations with some of the new ideas we found, because of the difference between Kolkata and Hyderabad, but was very open to sharing some new ideas and how they could and would be adopted. Before we left, Dr. Sridevi mentioned she would be coming to the US in May, 2015 and was hoping to have a chance to visit us at Johns Hopkins, which we were obviously excited to hear about.

We left the meeting feeling good about the direction of our project and decided to take some time in the evening to do some brainstorming and readjusting to our plans to maximize the rest of the trip. Naresh had mentioned that one of the meetings from earlier was going to be rescheduled for the later evening, but this too ended up being cancelled. Nevertheless, we got some really good work done and are prepared to get the most of our last few days in Hyderabad.

During our time here in India it has seemed like a lot of our appointments have been moved around or cancelled. Part of this may be because we are in India were timing and punctuality are not always the most important, but I also think it has a lot to do with these doctors being extremely busy. I imagine that if we were to try and schedule back to back meetings with doctors in America for a week straight, a good number of them would also get cancelled or switched around too do to the uncertainty of scheduling in the medical world. We are doing our best to make use of all the time we have and filling in these missed meetings with additional research, brainstorming, and planning to keep the team on track.

Since we had all had a pretty big lunch earlier in the day, we just stayed in the hotel and ordered a few snacks for dinner before heading out to explore a little more of the city later that night.

Hyderabad Revisited

Although this trip is only about halway over, there are a few key differences I have noticed between this trip and the last one.

First, I have felt a lot more comfortable being in India on this trip. This may have to do with the fact we have been going to a lot of the same places and talking to a lot of the same people as last time, but India does not quite seem as intimidating. 

Second, the hot humid weather we had in August made us a lot more tired and exhausted during our hospital visits and inteviews. This time the weather has been awesome, temperatures between 60 and 80, very little humidity, and very little sweating. 

Third, my impression of Hyderabad has changed significantly. Last time we started in Hyderabad and then went to Kolkata. This time, we did the opposite. I think that my cultural shock from just being in India during our first trip did not allow me to fully recognize the stark differences between these two cities. Since this trip began in Kolkata, which I now realize is much more crowded, much dirtier, and much poorer, I have been able to clearly see why people told us to watch out in Kolkata. Hyderabad is still not the cleanest or most well off place in the world, but I am starting to see more similarities between it and cities in the US.

Now, for what we did on our first full day in Hyderabad. 

We woke up this morning and ate our breakfast at the delicious Taj Banjara buffet. We then braved our way across the street (see our post "Driving in India" from our last trip to understand what crossing the street here involves) to CARE Hospital for our meeting with Dr. Krishnamohan. Dr. Krishnamohan is a senior cardiologist who we met with during our previous visit in Hyderabad and who we have been consulting with as part of our teams graduate committe for the past few months. Him, along with Naresh, a biomedical engineer who helps coordinate CBID groups in Hyderabad, are helping to set up all our meetings and provide us with contacts here in India.

CARE Hospital, our homebase hospital in Hyderabad

During our meeting this morning, the team went over all of what we saw in Kolkata with Dr. Krishnamohan and we expressed what we are hoping to get out of the rest of our visit. It was interesting to hear his take on the things we had heard and seen in Kolkata, because Hyderabad seems to be doing things a lot differently than Kolkata. Dr. Krishnamohan also made some phone calls during our meeting to answer some other questions we had and get meetings set up for the rest of the week. Around 11:30, Dr. Krishnamohan had to go to a procedure, but had told us to go downstairs to the emergency room to talk to a few contacts there about temporary pacing. The emergency staff seemed to be pretty busy, but we were able to talk to a few people and get some insight into how the emergency department at CARE works with the cardiologists and cardiology department at the hospital. When we finished speaking with the emergency medical staff, Dhananjay, Erin, and Shruthi, headed back to the hotel. Dr. Krishnamohan and Naresh had agreed to have lunch with us when the procedure was finished and since we did not have any meetings planned in between, we decided to get some work done while we waited.

When the procedure was almost over, Naresh told us to head over to the restaurant, which happens to be next to the hospital, to meet him and Dr. Krishnamohan. Naresh and Dr. Krishnamohan were a little late because the procedure ran later than expected. Dr. Krishnamohan explained that the procedure, which was scheduled to begin at 12, was not able to actually start til 1 because the Cath Lab was backed up. Because he practiced in England for a long time, he told us that he understands how punctuality does not really exist in India, but that he wanted to do his best for us since he figured we would be.

Authentic Rajistani Thali that we ate for dinner

After lunch Naresh contacted a cardiac anesthesiologist who had agreed to meet with us. The anesthesiologist said that it would be best if we came after 5pm, so we once again headed back to the hotel until Naresh heard back and we were ready to go. Unfortunately, the doctor was unable to clear his schedule for the afternoon, so we instead scheduled the meeting for tomorrow. We all spent the rest of the evening relaxing and then enjoying an authentic Rajistani meal at a restaurant down the street.

New Places and Familiar Faces

Wednesday was our last day in Kolkata. After a quick breakfast, we all packed our suitcases and said goodbye to Rupa and the guest house.

Sign outside the executive suite guest house

Our first meeting of the day was at Shree Jain hospital located in Howrah (near the strain station from the other day). We arrived at the hospital to find out the doctor we were supposed to meet with had forgotten we were coming. Luckily, he was able to put us in contact with another doctor who was at the hospital when we got there.

Interesting sign outside a room at the Shree Jain hospital

We went to the reception counter at the hospital and the receptionest led us to the hospitals ICU where Dr. Saikat Manna was waiting for us. Our talk with Dr. Saikat was extremely helpful and he gave some real perspective for what the patients at this private hospital could afford and what the patients at government hospitals, like NRS Medical college where he had trained, could afford. Dr. Saikat also gave us a good understanding of the use of drugs over device therapy for complete heart block and provided some valuable insight into the costs and perspective of these patients.

After thanking Dr. Saikat, we headed back to the car to go grab lunch. We had a nice quick lunch at a nearby mall and then headed to the airport for our flight. We arrived at the airport around 3 and had an hour and a half to relax before our flight.

Suprisingly, our flight from Kolkata to Hyderabad was the most on-time and efficient flight I have ever been on. I say suprising because we are always talking about doctors not being on time and the overall inefficiency of work here, so the fact that our flight boardered on time in the most efficient way possible, started moving from the gate before 5:00, our scheduled departure time, and arrived in Hyderabad at 7:00 on the dot, was a pleasant suprise.

After getting our bags, we struggled to find a taxi willing to take the three of us with our huge suitcases and eventually had to get a prepaid taxi that was larger to take us to our hotel. We arrived to the Taj Banjara hotel around 8:30pm and we were greeted by many familiar faces that had been here during our last visit in August. We checked in and then headed to our rooms for the night. Although we enjoyed the executive suite in Kolkata, the Taj Banjara was a nice change with the warm water, awesome shower pressure, and fast internet. Also, since we now have fast internet, we were able to add pictures back to all our other blog posts (for anyone interested).

Anyways, we need to go get ready as today we are off to meet with some of the doctors we met last time here in Hyderabad.