A humbled visitor–Bombay, Chennai and Indian trauma

Briefly before I start talking about my recent trip to India here are a few signs that I have been living abroad for awhile

-an air conditioned flight is too cold

-when toilet paper is available I take some extra keep it in my purse or pockets just in case it isn’t available later. IMG_2823

-brushing my teeth doesn’t necessarily include using water

-being around a lot of people who speak English is overwhelming–JFK airport

-I have three types of currency in my wallet which barely totals 10 dollars

-I love airport/airplane snacks/food (this isn’t new just amplified these days!)IMG_2986

They served little ice cream bars on AirFrance ! (See excited face above :))

IMG_2978Chicken Tikka Pizza at Indian International Airport-in an effort to try a lot of new food I wasn’t a strict vegetarian in India

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My favorite airport find!

When I arrived in India I had forgotten how much I take for granted in Haiti. For starters, the fact that I speak Creole and live in a very easy to navigate town are huge advantages. During my first few days in India I felt like a lost small child. I had no idea how to get around and couldn’t just stop and ask people for what I needed. (A lot of people in India speak English but it is still very difficult to get a clear answer about transport, where you are, or where something is). Without my host family and Jyoti (my partner for the neurotrauma project) I would have really struggled for those two weeks. Hopefully, this will remind me to be kinder to visiting teams who ask a lot of questions or need a lot of help. Hopefully, I’ll remember how hard it is to come and work in a country where you don’t know the language or customs. I was getting tired of orienting visitor after visitor to our hospital before we left so maybe this attitude will help me get through the last 2 months of visitors.

Fun fact: There are more people living in Bombay then in all of Haiti. That was the biggest shock to me when I first arrived. It took some time to get used to a lot of people everywhere you go. After living in Haiti for 8 months I can handle a lot of and it takes a lot to surprise me in a medical sense. However, the amount of people in India will never cease to amaze me.

My Host Family—WONDERFUL

The Patils were amazing. Their son-in-law works with my mom and I will forever be in debt to them for this trip. When I arrived not only were there Oreos and Pringles waiting for me but I also had my own room, with a hot shower, AC and wifi!!!!

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The next day I slept off some of the jet lag went to the Leela hotel and had some wonderful Indian food. In the evening I went with Jyoti to King Edwards Hospital to see how data was collected for the project I am working on. IMG_2816Over the next two weeks I went shopping for kurtis (what I wore most of my trip), ate at amazing restaurants, saw the Gateway of India and Taj Mahal Palace. Throughout this time the family told me about the history of Bombay, introduced me to some Indian culture and tried to explain some of the nuances of India. However, I don’t think three lifetimes in India would give me enough time to fully understand the country, religions, and culture.

IMG_2840IMG_2902    The Gateway of India (above) and Taj Mahal Palace (below)          IMG_2900

My favorite dessert rasgulla below–cottage cheese steamed in sugar syrup IMG_2896  IMG_2895     IMG_2842       This little lady hated to be pet but would collect cookies given to her throughout the day! Also an excellent guard dog. She would bark whenever I or anyone came in the houseIMG_2814

Transport in Bombay:

I rode every type of public transport in Bombay (except for the infamous moto). IMG_2875However, I did not ride the train during rush hour and don’t know if I could have survived that. Apparently there is little to no room on the trains and you have to move pretty quickly. Here is a photo of the empty morning train I rode after a night shift.IMG_2827IMG_2825 My favorite mode of transport is the rickshaw. They are small enough that they can weave through traffic pretty easily, usually have a meter, and make it so you can’t see if something is going to hit you from the sides so you feel pretty safe during your ride. I even took a little video of one of my rides.IMG_2851IMG_2888

If you look closely in the mirror you can see my face! Below is the public bus. This was not my favorite mechanism of transport. Probably because I got lost and almost made it to Thane (another city).IMG_2894

The Hospitals: I visited three hospitals in India 2 in Bombay and 1 in Chennai. (Not a lot of photos)

KEM: KEM hospital was founded in 1926. There were over 1800 beds and Jyoti and I only visited about 8 wards on our shift. Each patient comes to Casualty (our version of the Emergency Department) and are then filtered to either the medical or surgical casualty wards. From there a resident evaluates the patient and decides if they need to be admitted to the casualty wards. Once admitted the patients families are responsible for the charts and helping them get the imaging/procedures/lab work they need. If a patient is stable enough and a bed is available on another ward they can get transferred there.

In terms of resources every Indian hospital I went to had resources comparable to those in the States (CT, ICU’s, ventilators, pathology, Cultures etc) However, I only visited large, urban tertiary centers. In rural hospitals I’ve been told  resources are less available.

I got to visit the operating theater (not room in India) for a day while at KEM. I didn’t get to scrub in (which is another huge thing I take for granted in Haiti) but it was interesting just to observe how the OT’s work in India and what equipment was available. The OT was a lot smaller than HUM’s OT. Other than size there wasn’t much difference to the observer. I saw a splenectomy for a large hydatid cyst which is a pretty rare case anywhere in the world. What I’m learning is that what happens in the OR/OT is pretty universal no matter what part of the world you are in. Scrub techs/nurses are the people who you don’t want to make angry. An attending is scrubbed in as well as a few residents, and med students stand on their tip toes and move around to get the best view.IMG_2833

Sion: Is one of the youngest hospitals in Bombay being only 50 years old and has it’s own trauma ward. Dr. Harris (an anthropologist from Duke University) was working at Sion studying trauma from an anthropological perspective. He helped show me around. He has spent over 10 years working in India and spoke both Hindi and Maharati.  It was also who didn’t have a medical background and hear his opinion on the medical system in India.

Chennai: Is the capital of the southern Indian state Tamil Nadu. The national Toward Improving Trauma Care Outcomes (TITCO) conference was held in this city. In Tamil Nadu no one really speaks Hindi or English so we were at the mercy of our Chennai TITCO peers. The hospital was fairly similar to KEM and Sion but is associated with Madras University one of the oldest universities in India.IMG_2930

Madras University. The rest of the photos are from around Chennai and at the beach in Chennai.

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TITCO and Trauma in India: When I met the amazing leaders of the TITCO group Dr. Roy in Dubai I asked if I could come to India and work on a subset of this data because I was very interested in trauma. He said yes. So I planned a two week trip to India not quite knowing what to expect. In India, trauma represents a huge cause of disability and mortality. However, unlike in the United States there is no ambulance or emergency response system in place. Patients can be brought in by family, a private car, taxi, or on the shoulders of four people. Ambulances do exist but are used to transfer patient from hospital to hospital. An incredibly bright and motivated group of trauma surgeons in India and Sweden started a database of trauma patients. The data is collected from 5 hospitals throughout India and the group’s main goal is improving the trauma system in India.

Road traffic injuries are a huge cause of trauma in India and worldwide. Throughout all of Bombay you could see signs with rhyming sayings like this advising drivers to slow down.

IMG_2836Since I have some experience in neurosurgical research they gave me the neurotrauma dataset to work with. When I first got to India I didn’t have a research question and had done very little data analysis. By the time I left I had presented on the head injury patients, had enough research questions for three projects and found myself very inspired. The group of individuals working on this project are all unique and are working to really make a change in how trauma is managed in India. I was honored just to be able to be there.

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